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Clinical Atlas Prestige · Evidence-first

Psych VivasGeneral adult psychiatry — personality disorders

Psych Vivas · General adult psychiatry — personality disorders

Cluster A and C personality disorders — structured clinical viva

Fellowship viva covering schizotypal spectrum adjacency, OCPD vs OCD, dependent PD safeguarding, psychotherapy evidence including schema therapy, and limited pharmacotherapy.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the psychiatry registrar. A GP refers a 26-year-old woman with lifelong odd beliefs about telepathy, eccentric dress, few friends, and social anxiety that feels 'people are watching me,' without clear voices or fixed delusions. Separately, the same clinic day includes a 40-year-old accountant with disabling perfectionism and possible OCD rituals, and a 35-year-old man who will not leave a coercive relationship because he 'cannot cope alone.' Discuss diagnosis, differentials, risk, and management principles across Cluster A and C.

Interpretation

Reveal interpretation

Case A — likely schizotypal PD. Cognitive-perceptual oddness, eccentric style, sparse friendships and paranoid-tinged social anxiety without frank psychosis fit schizotypal PD if enduring and impairing. Discriminate schizophrenia/delusional disorder (frank psychosis, deterioration), ASD (developmental communication profile), and paranoid PD (distrust without broader oddness). Monitor conversion risk; engage slowly; psychosocial strategies first; low-dose antipsychotic only as time-limited trial for severe cognitive-perceptual symptoms with low-certainty evidence and review dates; treat frank psychosis on a psychosis pathway.[1][4]

Case B — OCPD ± OCD. Separate ego-syntonic perfectionism/control from ego-dystonic obsessions/compulsions. Co-occurrence is common. ERP + SSRI algorithms treat OCD; CBT/schema strategies treat OCPD rigidity.[2][3]

Case C — dependent PD with safeguarding. Excessive need for care, fear of being left, and inability to leave a coercive relationship raise adult safeguarding duties, suicide risk after rupture, and therapy goals of graded autonomy without abrupt abandonment. Do not collude with exploitation.[5]

Cross-cutting. ICD-11 severity + traits; psychotherapy first-line (schema therapy RCT evidence for mixed PD including Cluster C); drugs for comorbidity/targets only; no nihilism.[2][5]

Key points

Schizotypal is spectrum-adjacent

Oddness without frank psychosis still needs conversion monitoring and careful medication restraint.[1]

OCPD is not OCD

Ego-syntonic control versus ego-dystonic rituals — both may coexist.[3]

Schema therapy has named RCT support

Bamelis 2014 is a high-yield non-BPD PD psychotherapy citation.[2]

References

  1. [1]Kirchner SK, Roeh A, Nolden J, Hasan A Diagnosis and treatment of schizotypal personality disorder: evidence from a systematic review NPJ Schizophr, 2018.PMID 30282970
  2. [2]Bamelis LL, Evers SM, Spinhoven P, Arntz A Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders Am J Psychiatry, 2014.PMID 24322378
  3. [3]Pozza A, Starcevic V, Ferretti F, et al. Obsessive-Compulsive Personality Disorder Co-occurring in Individuals with Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis Harv Rev Psychiatry, 2021.PMID 33666394
  4. [4]Jakobsen KD, Skyum E, Hashemi N, et al. Antipsychotic treatment of schizotypy and schizotypal personality disorder: a systematic review J Psychopharmacol, 2017.PMID 28347257
  5. [5]Lampe L, Malhi GS Avoidant personality disorder: current insights Psychol Res Behav Manag, 2018.PMID 29563846