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.
On this page & tools
Target exams
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
References
- [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]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]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]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]Lampe L, Malhi GS Avoidant personality disorder: current insights Psychol Res Behav Manag, 2018.PMID 29563846