人格障碍

症状在短期内发展迅速并且表现出机能改变。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013. 包括躯体症状，例如失眠、体重减轻或躁动。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013. 有人格障碍的患者，心境通常具有反应性，对人际关系事件及内在体验做出反应。

把人格障碍当作一种共病状况来考虑。

临床访谈。

使用DSM-5诊断标准。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.

精神障碍的初级评定(PRIME-MD)[56]Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994 Dec 14;272(22):1749-56.http://www.ncbi.nlm.nih.gov/pubmed/7966923?tool=bestpractice.com 可能提示存在表明心境障碍的症状。

情绪障碍问卷[60]Hirschfeld RM, Williams JB, Spitzer RL, et al. Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire. Am J Psychiatry. 2000 Nov;157(11):1873-5.https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp.157.11.1873http://www.ncbi.nlm.nih.gov/pubmed/11058490?tool=bestpractice.com 可能提示存在表明有情绪高涨状态（轻症躁狂和躁狂）的症状。

患者健康问卷-9 (PHQ-9)[57]Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001 Sep;16(9):606-13.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495268/http://www.ncbi.nlm.nih.gov/pubmed/11556941?tool=bestpractice.comPatient Health Questionnaire PHQ-9 可能提示自伤、自杀观念的存在。

人格障碍不出现持久的妄想和幻觉。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013. 然而，边缘型人格障碍的患者可能有短暂的与应激有关的偏执观念体验；分裂型人格障碍的患者可能有牵连观念（不包括关系妄想），还有古怪信念或奇幻思维。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.

把人格障碍当作一种共病状况来考虑。

临床访谈。

使用DSM-5诊断标准。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.

社交焦虑障碍因有许多症状与回避型人格障碍的重叠，所以难以区分两者，并且关于这两种障碍事实上是否有区别，也存在争议。然而，回避型人格障碍似乎涉及更广泛的多功能损害。

广场恐惧症的回避行为很局限且和惊恐发作的出现有关（而回避型人格障碍的回避行为在涉及人际接触的各种情况下都明显发生）。

存在强迫观念和强迫行为（而强迫型人格障碍，其完美主义特性明显）。

把人格障碍当作一种共病状况来考虑。

临床访谈。

使用DSM-5诊断标准。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.

广泛焦虑障碍-7(GAD-7)或广泛焦虑障碍-2[58]Kroenke K, Spitzer RL, Williams JB, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007 Mar 6;146(5):317-25.http://www.ncbi.nlm.nih.gov/pubmed/17339617?tool=bestpractice.com[59]Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006 May 22;166(10):1092-7.https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/410326http://www.ncbi.nlm.nih.gov/pubmed/16717171?tool=bestpractice.com 可能提示表明焦虑障碍的症状存在。

除了药物相关障碍诊断外，反社会型人格障碍症状必须出现于儿童期（明显早于物质相关障碍的发生）并持续至成年期。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.

把人格障碍当作一种共病状况来考虑。

尿液毒品筛查。

临床访谈。

使用DSM-5诊断标准。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.

精神障碍的初级评定(PRIME-MD)[56]Spitzer RL, Williams JB, Kroenke K, et al. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. 1994 Dec 14;272(22):1749-56.http://www.ncbi.nlm.nih.gov/pubmed/7966923?tool=bestpractice.com[62]Whitlock EP, Polen MR, Green CA, et al. Behavioral counseling interventions in primary care to reduce risky/harmful alcohol use by adults: a summary of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2004 Apr 6;140(7):557-68.http://annals.org/aim/fullarticle/717333/behavioral-counseling-interventions-primary-care-reduce-risky-harmful-alcohol-usehttp://www.ncbi.nlm.nih.gov/pubmed/15068985?tool=bestpractice.com 可能提示存在表明酗酒/酒精依赖症状。

人格症状反映偏离基线水平的变化，通常是由某种直接的生理原因造成的（如，颅脑创伤、内分泌疾病或者其他累及中枢神经系统的疾病）。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.

体格检查或神经系统检查可能提示特定身体状况特征。

如果可能的话对患者和知情者均进行临床访谈。

使用DSM-5诊断标准。[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013.

影像学检查（头颅 CT/MRI）、神经心理学检测或实验室检查（如甲状腺功能检测）可能获得提示性结果。

特性被认为是不精确的、适应性良好的、不稳定的且和损伤无关的。

临床访谈

采用 DSM-5 诊断标准[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed. Arlington, VA: American Psychiatric Association; 2013. 排除人格障碍诊断