Schizotypal Personality Disorder

Schizotypal Personality Disorder
Classification: Personality Disorder Cluster A

Basically schizotypal personality disorder is a psychological condition or disorder of an individual who is unable to create or tends to dislike close relationships and bonding with people. Also individuals with schizotypal personality is characterized by disturbances and eccentric behaviors, thoughts and perceptions.1

Also schizotypal personality disorder is common among first degree relatives who have schizophrenia. Patients suffering from schizotypal personality disorder may suffer from major depressive/personality disorders like paranoid personality disorder.

There truthfully are known causes for schizotypal personality disorder other than the fact that it may be hereditary and as mentioned above, often occurs among people who have first degree relatives that suffer from schizophrenia. However, psychologists often state or mentions that one possible main cause of schizotypal personality disorder is early influences from an individual’s environment. Some experts mention incidents like childhood abuse, neglect or stress in the brain that can possibly cause impairment of interpretation or understanding in an early age as a possible cause for schizotypal personality disorder. 3

  • Ideas of Reference- “Delusional belief that media content, e.x. television or radio broadcast, refers to oneself, or that others are talking or thinking about oneself.”
  • odd beliefs or magical thinking that influences behavior and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)
  • unusual perceptual experiences, including bodily illusions
  • odd thinking and speech (e.g., vague, circumstantial, metaphorical, over elaborate, or stereotyped)
  • suspiciousness or paranoid ideation
  • inappropriate or constricted affect
  • behavior or appearance that is odd, eccentric, or peculiar
  • lack of close friends or confidants other than first-degree relatives
  • excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self 1

* However if the above symptoms happen or occur during the course of other medical or psychological conditions like schizophrenia, a mood disorder with psychotic features, physiological effects of a neurological condition.2

Treatments/ Therapies6
  • Medications- There is no specific chosen or set medication for the treatment of schizotypal personality disorder. However, antidepressants and anti-psychotic medications are often prescribed in order to alleviate or help associative conditions like anxiety, depression, etc.
  • Psychotherapy- “An emotionally charged, confiding interaction between a trained therapist and someone who suffers from psychological difficulties.
  • Behavior Therapy- Therapy that applies learning principles to the elimination of unwanted behaviors.
  • Cognitive Therapy- Therapy that teaches people new, more adaptive ways of thinking and acting; based on the assumption that thoughts intervene between events and our emotional reactions.
  • Family Therapy- Therapy that treats the family as a system. Views an individual’s unwanted behaviors as influenced by or directed at other family members; attempts to guide family members forwards positive relationships and improved communication.”12

Case Study

Case report. Mr. A, a 22-year-old engineering student of middle-class socioeconomic status and urban background, presented to our hospital in August 2007 with an insidious onset and continuous course of illness of 5 years’ duration characterized by odd and eccentric behavior, oddities in speech, avoidance of social situations, deteriorating academic performance, idiosyncratic repetitive behaviors, and magical thinking. His family members were concerned about his odd and eccentric behavior, social dysfunction, and academic decline. The above symptoms could not be attributed to any clear-cut psychotic disorders, mood disorders, substance use disorders, or general medical conditions. He had never received treatment for the symptoms. The patient's history and family history were noncontributory.

Structured assessment conducted at baseline using the Structured Clinical Interview for DSM-IV Axis I Disorders11 and Structured Clinical Interview for DSM-IV Axis II Personality Disorders12 revealed that Mr. A had schizotypal personality disorder. The Schizotypal Personality Questionnaire (SPQ)13 revealed social anxiety, odd beliefs, odd behaviors, blunted affect, suspiciousness, lack of close friends, and magical thinking. A baseline score of 4 on the Clinical Global Impressions-Severity of Illness scale (CGI-S)14 was noted. Other baseline psychodiagnostic assessments were also conducted, such as the Object Sorting Test, Thematic Apperception Test, and Rorschach Inkblot Test, which revealed the absence of pathognomonic signs of psychosis. After giving informed consent, Mr. A was started on treatment with aripiprazole 10 mg at night.
At 2-month (week 8) follow-up, the patient reported a 70% decrease in his symptoms, started attending his engineering college regularly, and showed interest in his studies. His family members reported marked improvement in his social and academic functioning. They also reported that his odd ideas, eccentric behaviors, magical thinking, and suspiciousness were reduced to minimal. His interaction with friends and his mood also improved. His CGI-S score was 3 (mildly ill), and his CGI-Improvement score was 2 (showing much improvement).

This patient with SPD had a 5-year duration of untreated illness and was assessed with structured instruments. He responded to treatment with 10 mg of aripiprazole. Currently, thiothixene, haloperidol, risperidone, and olanzapine have been documented to be effective in treatment of SPD. This case report assumes importance in the light of the paucity of aripiprazole studies in SPD. However, the choice of antipsychotic medications is largely based on side effect profile. Available data on aripiprazole reveal that it is an effective medication with a benign adverse effect profile.9,10 Aripiprazole, being a dopamine- serotonin system stabilizer, is hence an ideal drug to target the odd and eccentric behavior, stereotyped thinking, social anxiety symptoms, and obsessive symptoms of SPD. Future double-blind, placebo-controlled studies examining the effectiveness of aripiprazole in the treatment of SPD are needed.7

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