Narcissistic personality disorder: Difference between revisions
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==Background== | ==Background== | ||
A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy | *A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy | ||
==Clinical Features== | ==Clinical Features== | ||
| Line 15: | Line 15: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
*Other personality disorders | *Other personality disorders | ||
*Mania or hypomania | *Mania or hypomania | ||
*Substance use disorders | *Substance use disorders | ||
==Evaluation== | ==Evaluation== | ||
A clinical diagnosis; however if entertaining other organic causes may initiate workup below | *A clinical diagnosis; however if entertaining other organic causes may initiate workup below | ||
{{General ED Psychiatric Workup}} | {{General ED Psychiatric Workup}} | ||
==Management== | ==Management== | ||
Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment. | *Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment. | ||
==Disposition== | ==Disposition== | ||
*Discharge | |||
==See Also== | ==See Also== | ||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Revision as of 22:12, 21 October 2017
Background
- A pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy
Clinical Features
- Five (or more) of the following criteria, beginning by early adulthood and present in a variety of contexts:[1]
- Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).
- Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.
- Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).
- Requires excessive admiration.
- Has a sense of entitlement (i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations).
- Is interpersonally exploitative (i.e., takes advantage of others to achieve his or her own ends).
- Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.
- Is often envious of others or believes that others are envious of him or her.
- Shows arrogant, haughty behaviors or attitudes.
Differential Diagnosis
- Other personality disorders
- Mania or hypomania
- Substance use disorders
Evaluation
- A clinical diagnosis; however if entertaining other organic causes may initiate workup below
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
- Referral for outpatient psychiatric treatment, as psychotherapy is the primary treatment.
Disposition
- Discharge
See Also
External Links
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.