Cluster A and C personality disorders — structured clinical viva

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]