What is Schizotypal Personality Disorder

Schizotypal disorder until the nineties of the last century was known as “sluggish schizophrenia” or “slow-flowing” (“pre-schizophrenia”, “mild schizophrenia”, “pseudoneurotic schizophrenia”). It is a relatively benign, slowly progressive endogenous process that occurs in one third of all schizophrenic patients . In the current ICD-10 classification of mental disorders, schizotypal disorder is an independent diagnosis, isolated from schizophrenia. It includes a group of functional mental disorders that occupy an intermediate position between schizophrenia and personality pathology.         

In the current ICD-10 classification of mental disorders, schizotypal disorder is an independent diagnosis, isolated from schizophrenia.   

The group of schizotypal disorder includes persons with impaired interpersonal functions, cognition, emotions and behavioral control who show a genetic predisposition to schizophrenia, the so-called “hidden carriers of the disease.” The latter are members of the family of patients with schizophrenia, are distinguished by chronic features of thinking and communication, and low social activity.      

The first signs of schizotypal disorder appear in childhood or adolescence. The provocation that triggers the disease can be psychological stress. Schizotypal disorder is characterized by a gradual, usually imperceptible onset, the absence of pronounced exacerbations and outlined remissions, and has a chronic continuous character.  

With the course of the disease, there is a gradual decrease in working capacity associated with a drop in intellectual activity and initiative, impoverishment of emotions and contacts, and deepening of social self-isolation. At the same time, about 30% of patients with schizotypal disorder continue to work, choose easier, home-based types of work activities that are more acceptable to them; some of the sick become dependents, invalids.      

The main symptoms of schizotypal personality disorder

The clinical signs of schizotypal disorder are varied, but some of them are fundamental for diagnosis:  

strange beliefs, speech;

strange or magical thinking;

unusual sensations and bodily illusions; 

Suspicious or paranoid thoughts (thoughts of stalking) 

inappropriate emotions or lack of emotional response (narrowed affect);

strange, eccentric, or specific behavior or appearance;

lack of close friends or confidants, except for relatives of the first degree of kinship;

excessive social anxiety that does not diminish after dating and is usually associated with paranoid fears.   

These signs can be grouped into three groups: 

  • cognitive-perceptual deficits: strange beliefs, perceptual impairment, paranoia, or suspicion
  • interpersonal deficits: lack of close friends, social anxiety, paranoia, or suspicion
  • disorganization: fuzzy speech or thinking, dull affect, strange behavior

Additional signs

Along with the main signs of schizotypal disorder listed above , other symptoms in both men and women are present in the clinical picture , which are usually found in neurotic diseases, mood, behavior or personality disorders.   

Neurotic manifestations. The most common disorders in schizotypal disorder include anxiety-phobic – fears, panic attacks, obsessive-compulsive symptoms; heightened self-observation, heightened reflection, somatoform phenomena, asthenia. There are frequent cases of painful concern about their somatic or mental health (hypochondria) or “mysterious” symptoms and diseases, unconfirmed by specialists.     

Eating disorders. Eating disorders are quite common – in the form of anorexia or bulimia.   

Mood disorders (affective disorders). Comorbid mood disorders are the rule rather than the exception – long-term mild depression or unreasonable mood swings (euphoria), long-term or short, but without psychotic symptoms.   

Conduct disorders. Aggressive, antisocial behavior, ridiculous actions, impulse disorders in the form of vagrancy, sexual perversion, alcohol abuse, psychoactive substances can be observed .  

Some of the described disorders become permanent or “axial”, others can replace each other or join the existing ones, becoming additional, aggravating the patient’s condition.  

In Depending on the predominance of certain symptoms distinguish several basic options for schizotypal personality disorder:  

  • pseudoneurotic schizophrenia (outward resemblance to neurosis) 
  • pseudopsychopathic schizophrenia (outwardly similar to psychopathy) 
  • poor in symptoms of schizophrenia (characterized by increasing asthenia and a decline in working capacity) 
  • schizotypal personality disorder
  • latent schizophrenia

Differences between schizotypal disorder and schizophrenia in psychiatry 

The diagnosis “schizotypal disorder” excludes gross psychotic disorders characteristic of schizophrenia, among them: delusional, hallucinatory, movement disorders (catatonia), confusion.

In addition, schizotypal disorder never has such severe outcomes as schizophrenia, such as apathic-abulian dementia. 

In addition, schizotypal disorder never has such severe outcomes as schizophrenia, such as apathic-abulian dementia. 

Causes of schizotypal disorder

Genetic reasons. The external clinical similarity of schizotypal disorder with other mental illnesses may be due to hereditary factors. Scientists have found a number of common genetic abnormalities with schizophrenia, bipolar disorder, and personality disorders (psychopathies). For example, the genetic contribution explains the exceptionally high level of characteristic features of patients: strange appearance and behavior, alienation, and lack of close friends. The genetic commonality of schizotypal disorder and schizophrenia also determines some cognitive abnormalities that relate to attention and memory.         

Environmental factors. The causes of schizotypal disorder are associated not only with heredity, but also with factors unfavorable for the development of the fetus, psychological trauma in early childhood, and chronic stress. In particular, maternal influenza during the sixth month of pregnancy was associated with a higher level of schizotypal symptoms in the adult male population. Serious risk factors for the development of schizotypal disorder in adolescence can be malnutrition of a pregnant mother and child under three years of age, a history of child abuse, emotional abuse (including bullying and post-traumatic disorder), neglect, neglect, especially if the genetic background is appropriate.                 

The combination of various adverse effects leads to disturbances in the neurochemical balance in the brain, hormonal and immune abnormalities that determine the clinical picture and accompany schizotypal personality disorder.    

Diagnosis of schizotypal disorder

The variety and multicomponent symptoms in men and women with schizotypal disorder in psychiatry creates difficulties in diagnosis. Outwardly, patients may exhibit anxiety or “neurotic conflicts” that are defined or aggravated by “hidden” magical ideas, strange beliefs, or overvalued ideas. Therefore, schizotypal patients are initially often diagnosed with attention deficit disorder, social anxiety disorder, autism, dysthymia, neuroses, bipolar disorder, depression, and psychopathy.   

Only a psychiatrist can make a diagnosis of schizotypal disorder and give a prognosis after appropriate clinical studies of the patient, obtaining objective information about his behavior and manifestations of the disease from close relatives.  

Only a psychiatrist can establish a diagnosis of schizotypal disorder after appropriate clinical studies of the patient, obtaining objective information about his behavior and manifestations of the disease from close relatives.  

Additional methods – pathopsychological, neurophysiological examinations, blood tests to identify markers of activity and severity of a mental disorder (for example, Neurotest) – will help to improve the quality and reliability of diagnostics .    

Thanks to the pathopsychological examination (carried out by a psychologist), the peculiarities of cognitive processes, the emotional-volitional sphere, and personal characteristics, which form the psychological portrait of the patient, along with pathological features caused by schizotypal disorder, are revealed. Neurophysiological examination gives an idea of ​​the degree of damage or distortion of cognitive functions, the degree of reserve and compensatory capabilities of the brain.      

The neurotest includes several indicators reflecting the state of the immune system involved in the formation of schizotypal disorder and other disorders of the schizophrenic spectrum. Certain combinations of deviations in the indicators indicate a specific variant of the disease, suggest its prognosis, the severity, severity of the condition and the effectiveness of the therapy.      

Treatment for schizotypal disorder

Treatment for schizotypal disorder should begin as early as possible and be comprehensive. Timely diagnosis and adequately selected therapy not only reduce painful symptoms, but also reduce the risks of complications in the form of disability, social isolation, loneliness, the transition of a slow-paced painful process to more severe forms of schizophrenia, addictions, and suicidal tendencies.       

Complex therapy is an effective combination of psychotropic drugs and psychotherapeutic techniques. Remember! Only a trained psychiatrist knows how schizotypal disorder is treated.    

Drug therapy. Used drugs of various pharmacological groups – neuroleptics, antidepressants, normotimics, tranquilizers. Specific schemes are selected individually, taking into account the clinical picture, the duration of the disease, the state of somatic health. Treatment is long-term: after the relief of actual symptoms, supportive therapy is carried out.   

Psychotherapy. In order to obtain a positive and stable result, the patient’s supervision by a psychotherapist is mandatory. In contrast to schizophrenia, schizotypal disorder when allowed to use virtually all types of known psychotherapeutic methods. In the sessions with a psychotherapist produced the necessary skills of coping with symptoms, maintain social ties, the formation of plants on the activation of volitional and motivational impulses, correction of pathological personality characteristics. Psychotherapeutic sessions have an important psychoprophylactic value, helping to increase the patient’s stress resistance and prevent auto-aggressive behavior.          

In contrast to schizophrenia, schizotypal disorder under treatment involves the use of almost all known psychotherapeutic methods.  

The primary prevention of schizotypal disorder in children is early environmental enrichment. This includes exercise, cognitive stimulation, and improved nutrition between the ages of three and five, which improves brain function and reduces the likelihood of developing illness in adolescence.        

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