Schizotypal personality disorder: Wikis

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Schizotypal disorder
Classification and external resources
ICD-10 F21.
ICD-9 301.22
MeSH D012569

Schizotypal personality disorder, or simply schizotypal disorder, is a personality disorder that is characterized by a need for social isolation, odd behavior and thinking, and often unconventional beliefs.

Contents

History

The specific term schizotype was coined by Sandor Rado in 1956 as an abbreviation of schizophrenic phenotype[1].

Diagnostic criteria (ICD-10) - schizotypal disorder

The World Health Organization's ICD-10 lists schizotypal personality disorder as (F21.) Schizotypal disorder. (Note that in ICD-10, Schizotypal disorder is classified as a mental disorder associated with schizophrenia rather than a personality disorder as with DSM-IV. The DSM-IV designation of schizotypal as a personality disorder is controversial anyway.)[2]

It is characterized as:

A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies have occurred at any stage. There is no dominant or typical disturbance, but any of the following may be present:
  1. inappropriate or constricted affect (the individual appears cold and aloof);
  2. behaviour or appearance that is odd, eccentric, or peculiar;
  3. poor rapport with others and a tendency to social withdrawal;
  4. odd beliefs or magical thinking, influencing behaviour and inconsistent with subcultural norms;
  5. suspiciousness or paranoid ideas;
  6. obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents;
  7. unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization;
  8. vague, circumstantial, metaphorical, overelaborate, or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence;
  9. occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations, and delusion-like ideas, usually occurring without external provocation.
The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves into overt schizophrenia. There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to schizophrenics and is believed to be part of the genetic "spectrum" of schizophrenia.
Diagnostic Guidelines
This diagnostic rubric is not recommended for general use because it is not clearly demarcated either from simple schizophrenia or from schizoid or paranoid personality disorders. If the term is used, three or four of the typical features listed above should have been present, continuously or episodically, for at least 2 years. The individual must never have met criteria for schizophrenia itself. A history of schizophrenia in a first-degree relative gives additional weight to the diagnosis but is not a prerequisite.
Includes:
  • borderline schizophrenia
  • latent schizophrenia
  • latent schizophrenic reaction
  • prepsychotic schizophrenia
  • prodromal schizophrenia
  • pseudoneurotic schizophrenia
  • pseudopsychopathic schizophrenia
  • schizotypal personality disorder
Excludes:

Millon's subtypes

Theodore Millon identified two subtypes of schizotypal [1][3]. Any individual schizotypal may exhibit none or one of the following:

  • insipid schizotypal - a structural exaggeration of the passive-detached pattern. They include schizoid, depressive, dependent features.
  • timorous schizotypal - a structural exaggeration of the active-detached pattern. They include avoidant, negativistic (passive-aggressive) features.

Differential diagnosis: associated and overlapping conditions

There is a high rate of comorbidity with other personality disorders. McGlashan et al. (2000) stated that this may be due to overlapping criteria with other personality disorders, such as avoidant personality disorder, paranoid personality disorder and borderline personality disorder.[4]

There are many similarities between the schizotypal and schizoid personalities. Most notable of the similarities is the inability to initiate or maintain relationships (both friendly and romantic). The difference between the two seems to be that those labeled as schizotypal avoid social interaction because of a deep-seated fear of people. The schizoid individuals simply feel no desire to form relationships, because they quite literally see no point in sharing their time with others.

Prevalence (epidemiology)

Schizotypal personality disorder occurs in 3% of the general population and occurs slightly more commonly in males.[5]

Causes (etiology)

Genetic

Although listed in the DSM-IV-TR on Axis II, schizotypal personality disorder is widely understood to be a "schizophrenia spectrum" disorder. Rates of schizotypal PD are much higher in relatives of individuals with schizophrenia than in the relatives of people with other mental illnesses or in people without mentally ill relatives. Technically speaking, schizotypal PD is an "extended phenotype" that helps geneticists track the familial or genetic transmission of the genes that are implicated in schizophrenia[6] There are dozens of studies showing that individuals with schizotypal PD look similar to individuals with schizophrenia on a very wide range of neuropsychological tests. Cognitive deficits in patients with schizotypal PD are very similar to, but somewhat milder than, those for patients with schizophrenia.[7]

Social / Environmental

People with schizotypal PD, like patients with schizophrenia, may be quite sensitive to interpersonal criticism and hostility, and there is now evidence to suggest that parenting styles, early separation and early childhood neglect can lead to the development of schizotypal traits [8][9]

Treatment

See also

References

  1. ^ a b Millon, Theodore, Personality Disorders in Modern Life, 2004
  2. ^ Schizotypal personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  3. ^ Millon, Theodore - Personality Subtypes
  4. ^ McGlashan, T.H., Grilo, C.M., Skodol, A.E., Gunderson, J.G., Shea, M.T., Morey, L.C., et al. (2000). The collaborative longitudinal personality disorders study: Baseline axis I/II and II/II diagnostic co-occurrence. Acta Psychiatrica Scandinavica, 102, 256-264.
  5. ^ Internet Mental Health - schizotypal personality disorder
  6. ^ Fogelson, D.L., Nuechterlein, K.H., Asarnow, R.F., et al., (2007). Avoidant personality disorder is a separable schizophrenia-spectrum personality disorder even when controlling for the presence of paranoid and schizotypal personality disorders: The UCLA family study. Schizophrenia Research, 91, 192-199.
  7. ^ Matsui, M., Sumiyoshi, T., Kato, K., et al., (2004). Neuropsychological profile in patients with schizotypal personality disorder or schizophrenia. Psychological Reports, 94(2), 387-397.
  8. ^ Deidre M. Anglina, Patricia R. Cohenab, Henian Chena (2008) Duration of early maternal separation and prediction of schizotypal symptoms from early adolescence to midlife, Schizophrenia Research Volume 103, Issue 1, Pages 143-150 (August 2008)
  9. ^ Howard Berenbaum, Ph.D., Eve M. Valera, Ph.D. and John G. Kerns, Ph.D. (2003) Psychological Trauma and Schizotypal Symptoms, Oxford Journals, Medicine, Schizophrenia Bulletin Volume 29, Number 1 Pp. 143-152

External links

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