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Schizotypal Personality Disorder

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 Schizotypal Personality Disorder


 Scenario

During an informal gathering, a teacher at a medical school discusses with you a first-year student who has just moved away from his parents to a hostel. The teacher states that he behaves strangely and tries to avoid socialisation. He does not have any friends but passes his time with video games. He sometimes enjoys spiritual activities and shows interest in magic. When a colleague tried to make fun of him, he resented a lot and lodged a written complaint with the principal. The parents state he is like this since his former life and has always been "different" but a "good" child. His academic record varies from average to above average.

  1. What is the most likely diagnosis?
  2. What psychodynamic factors may have contributed?
  3. What are the risk factors for developing this disorder?

Diagnosis 

Schizotypal disorder/schizotypal personality disorder

Risk factors

This is more frequent among biological relatives of individuals with schizophrenia than among adopted relatives or controls (Kendler et al., 1981). 

A review of 17 structural imaging studies of people with this personality disorder found brain abnormalities that were similar in most ways to those in people with schizophrenia (Dickey et al., 2002). 

Similarly, there is sound evidence for a genetic contribution, with heritability scores of 0.35–0.81 in twin studies (Ji et al., 2006; Kendler et al., 2006, 2007). 

These findings suggest that this personality disorder may be a milder form of schizophrenia, or that the 2 are related in some other way.

Diagnostic criteria

To diagnose a schizotypal personality disorder, the patient must exhibit five or more of:

  1. Ideas of reference, which must be non-delusional.
  2. Odd beliefs or magical thinking, for example in clairvoyance, a sixth sense. 
  3. Unusual ideas and perception and bodily illusions. 
  4. Odd thinking and speech.
  5. Suspicion or paranoid ideation.  
  6. Inappropriate or constricted affect- 
  7. Odd, eccentric or peculiar appearance and behaviour.
  8. Lack of friends and confidants other than family.
  9. Social anxiety that doesn't get better with familiarity because of paranoid fears

Mnemonic: ME PECULIAR

  • M: Magical thinking or odd beliefs
  • E: Experiences unusual perceptions
  • P: Paranoid ideation
  • E: Eccentric behaviour or appearance
  • C: Constricted (or inappropriate) affect
  • U: Unusual (odd) thinking and speech
  • L: Lacks close friends
  • I: Ideas of reference
  • A: Anxiety in social situations
  • R: Rule out psychotic disorders and pervasive developmental disorder
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