|SCHIZOTYPAL PERSONALITY DISORDER||
Schizotypal Disorder F21 - ICD10 Description, World Health Organization
Schizotypal Personality Disorder - Diagnostic Criteria, American Psychiatric AssociationLike personality disorders, schizotypal disorder is a deeply ingrained and enduring behaviour pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behaviour pattern tends to be stable. It causes subjective distress and problems in social performance.
Core Features:Individuals with schizotypal personality disorder grow up being socially and emotionally withdrawn and odd or eccentric. The core features of this disorder are: (1) detachment (suspiciousness, social withdrawal, intimacy avoidance, inability to feel pleasure, restricted emotional expression), and (2) irrationality (eccentricity, odd beliefs, perceptual distortions). This disorder is only diagnosed if: (1) it begins no later than early adulthood, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning. This disorder should not be diagnosed if its symptoms occur exclusively during the course of a psychotic disorder or autism spectrum disorder.
Lack Of Social Skills And Personality DisordersThere are certain social skills that are essential for healthy social functioning. Individuals with schizoid personality disorder lack the essential social skills of: normal behavior, normal beliefs, and normal perception. They also lack intimacy, sociabililty, and emotional expressiveness (that are also lacking in individuals with schizoid personality disorder); and lack trust (that is also lacking in individuals with paranoid personality disorder).
Social Skills That Are Lacking In Schizotypal Personality Disorder
Paranoid, schizoid, and schizotypal personality disorder are so closely related that they are referred to as the "detached" cluster of personality disorders.
Social Skills That Are Lacking In The "Detached" Cluster Of Personality Disorders
Social Functioning:Individuals with schizotypal personality disorder have acute discomfort with close relationships. Thus these individuals have few close friends and little desire for sexual intimacy.
DetachmentIndividuals with schizotypal personality disorder have little reaction to emotionally arousing situations, and restricted emotional expression. Thus they may appear indifferent or cold. They may have social withdrawal with avoidance of social contacts and activity. Individuals with this disorder may have undue suspiciousness and feelings of persecution. They may have excessive social anxiety with these paranoid fears.
IrrationalityIndividuals with schizotypal personality disorder do not have psychotic symptoms (i.e., delusions, hallucinations, disorganized speech, or grossly disorganized/catatonic behavior). However, they may have ideas of reference and odd beliefs that are almost delusions. Likewise, they may have unusual perceptual experiences, including bodily illusions, that are almost hallucinations. They may have odd speech (e.g., vague, circumstantial, overelaborate, or stereotyped) that is almost grossly disorganized.
Effective TherapiesThere has been only one randomized, placebo-controlled clinical trail for the effectiveness of therapy for the core symptoms of schizotypal personality disorder. This was a 9-week randomized, double-blind, placebo-controlled study of low-dose risperidone (starting dose of 0.25 mg/day, titrated upward to 2 mg/day). Patients receiving active medication had significantly (p <.05) lower scores on the PANSS negative and general symptom scales by week 3 and on the PANSS positive symptom scale by week 7 compared with patients receiving placebo. Side effects were generally well tolerated, and there was no group difference in dropout rate for side effects. Thus low-dose risperidone appears to be effective in reducing symptom severity in schizotypal personality disorder and is generally well tolerated. In another two-year follow-up study that was not placebo-controlled; 25.0% of patients with schizotypal personality disorder that were randomized to receive "integrated treatment" developed psychosis compared to 48.3% for patients randomized to "standard treatment". Note: The fact that schizotypal personality disorder frequently converts into a psychotic disorder, and dramatically responds to antipsychotic medication; all supports the conclusion that this disorder isn't a "personality disorder", but instead is simply an early stage in the development of schizophrenia. Individuals with this disorder seldom voluntarily present for treatment; yet low-dose antipsychotic medication can be very beneficial. Thus a trusting relationship with primary care physician who prescribes this antipsychotic medication is probably the best therapy.
Ineffective TherapiesSix months of cognitive behavioral therapy was shown, on 3-year followup, to not affect transition to psychosis.
Which Behavioral Dimensions Are Involved?The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: courage, helping others (service), justice, moderation, and wisdom. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., negative emotions, detachment, antagonism, disinhibition and irrationality).
PrevalenceSchizotypal personality disorder occurs in 0.6%-4.6% of the general population. This disorder occurs slightly more commonly in males.
CourseSchizotypal personality disorder may first appear in childhood and adolescence with solitariness, poor peer relationships, social anxiety, underachievement in school, hypersensitivity, peculiar thoughts and language, and bizarre fantasies. These children may appear odd or eccentric and attract teasing. With some adolescents, these schizotypal features may be caused by transient emotional turmoil, and these features disappear when the turmoil resolves. For other adolescents, these schizotypal features persist into adulthood, and they become chronic and stable. Only a small proportion of individuals with this disorder go on to develop schizophrenia or another psychotic disorder.
Familial PatternSchizotypal personality disorder is more common among first-degree biological relatives of those with schizophrenia, and visa versa.
ComplicationsIn response to stress, individuals with this disorder may experience very brief psychotic episodes (lasting minutes to hours). If the psychotic episode lasts longer, this disorder may actually develop into brief psychotic disorder, schizophreniform disorder, delusional disorder or schizophrenia.
ComorbidityPersonality disorders are an overlooked and underappreciated source of psychiatric morbidity. Comorbid personality disorders may, in fact, account for much of the morbidity attributed to axis I disorders in research and clinical practice. "High percentages of patients with schizotypal (98.8%), borderline (98.3%), avoidant (96.2%), and obsessive-compulsive (87.6%) personality disorder and major depressive disorder (92.8%) exhibited moderate (or worse) impairment or poor (or worse) functioning in at least one area."
Some other disorders frequently occur with this disorder:
Associated Laboratory FindingsNo laboratory test has been found to be diagnostic of this disorder.
Primate Evolution:There appears to be three different ways in which primates have evolved socially:
Core Behaviors Of The Detached Cluster Of Personality Disorders
Religious HermitHistory is filled with thousands of stories of religious hermits who withdrew to a solitary place for a life of religious seclusion.
The core feature of the paranoid-schizoid-schizotypal cluster of personality disorders is detachment. Individuals with these disorders are socially and emotionally withdrawn; thus prefer a solitary life.
Setting Goals In Therapy
Free Diagnosis Of This Disorder
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