In the currently used tenth edition of the ICD, schizotypal disorder is classified in section F20-F29 along with schizophrenia and delusional disorders. But in the previous, ninth, adapted edition of the ICD, this disorder was defined as low-progressive (sluggish) schizophrenia. Thus, schizotypal disorder includes neurosis-like schizophrenia and psychopathic-like schizophrenia with a poorly progressive course, the absence of extensive psychotic symptoms and a pronounced schizophrenic defect. ICD 10 lists synonymous names: borderline schizophrenia, latent, prepsychotic, prodromal (that is, pre-manifest stages of schizophrenia), pseudoneurotic, pseudopsychopathic. Other descriptive criteria for schizotypal disorder include behavioral traits such as eccentricity and a tendency to withdraw from social contacts. If in the International Classification of Diseases ICD 10 schizotypal disorder is presented as, strictly speaking, a type of schizophrenia with low progression (progression) in the absence of extensive psychotic symptoms, then in the DSM 5 classification used in the USA this mental health pathology is classified as a group of personality disorders (psychopathies), as well as paranoid and schizoid personality disorders.
So, schizotypal disorder is a pathology with disturbances in perception, thinking and, as a result, behavior that are stable, but not so pronounced as to correspond to the diagnostic signs of schizophrenia at any stage of the development of the disease.
Individuals with schizotypal disorder are characterized by unusual, culturally unusual behavior, abnormal thinking and emotional reactions.
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;
suspiciousness or paranoid thoughts (thoughts of persecution);
inappropriate emotions or lack of emotional response (constricted affect);
strange, eccentric or peculiar behavior or appearance;
lack of close friends or confidants other than first-degree relatives;
excessive social anxiety, which does not decrease after dating and is usually associated with paranoid fears.
These signs can be combined into three groups:
- Cognitive-perceptual deficits: strange beliefs, perceptual disturbances, paranoia or suspiciousness
- interpersonal deficits: lack of close friends, social anxiety, paranoia or suspiciousness
- disorganization: unclear speech or thinking, dulled affect, strange behavior
Additional signs
Along with the main above-mentioned signs of schizotypal disorder, the clinical picture also contains other symptoms in both men and women, which are usually found in neurotic diseases, mood, behavioral or personality disorders.
Neurotic manifestations. The most common disorders in schizotypal disorder include anxiety-phobic symptoms - fears, panic attacks, obsessive-compulsive symptoms; heightened introspection, increased reflection, somatoform phenomena, asthenia. There are often cases of painful concern about one’s physical or mental health (hypochondria) or “mysterious” symptoms and diseases that have not been confirmed by specialists.
Eating disorders. Eating disorders, such as anorexia or bulimia, are quite common.
Mood disorders (affective disorders). Concomitant mood disorders are the rule rather than the exception—long-term, shallow depressions or unreasonable mood elevations (euphoria), long-term or short-term, but without psychotic symptoms.
Behavioral disorders. Aggressive, antisocial behavior, absurd actions, and desire disorders in the form of vagrancy, sexual perversions, and alcohol and psychoactive substance abuse may be observed.
Some of the described disorders become permanent or “axial”; others can replace each other or join existing ones, becoming additional, aggravating the patient’s condition.
Depending on the predominance of certain symptoms, there are several main variants of schizotypal personality disorder:
- pseudoneurotic schizophrenia (external resemblance to neurosis)
- pseudopsychopathic schizophrenia (external resemblance to psychopathy)
- schizophrenia, poor in symptoms (characterized by increasing asthenia and decreased ability to work)
- schizotypal personality disorder
- latent schizophrenia
Features of the flow
The question of whether schizotypal disorder can be cured is of high relevance. The positive prognosis depends on the characteristics of the course of the disease. There are three main forms of the disease:
- The latent period is characterized by the appearance of the first symptoms of pathology, which do not have specific features.
- The active form is an acute period in the development of the disease, characterized by the maximum severity of the clinical picture.
- Stabilization - this form of progression is characterized by a gradual decrease in the frequency of hallucinatory attacks and delusional ideas. At this moment, changes in the personality spectrum become more pronounced.
Synonyms of schizotypal disorder - sluggish schizophrenia, latent schizophrenia, low-progressive schizophrenia
Latent form
With a latent course of the disease, signs of a decrease in the level of intelligence and social interaction are usually absent. In addition, many patients demonstrate a pronounced desire for various forms of self-realization. The first signs of the disease appear in the form of symptoms of the schizoid circle. They consist in the paradoxical behavior model, mild autism, as well as difficulties in building communication connections.
Many patients experience hysterical realities that make their behavior more demonstrative. Pedantry, anxiety and indecisiveness are specific symptoms of the latent period. Quite often, patients become overly suspicious and attach excessive importance to their person.
Affective period
This period is accompanied by hypomanic states in combination with somatization and neurotic depressive disorders. The appearance of these ailments can be characterized as one of the types of reactions to constant tension in the nervous system. Depression manifests itself in the form of a critical attitude towards oneself, irritability, uncertainty, depression and increased tearfulness. Lack of self-worth and a pessimistic attitude can lead to thoughts of suicide.
The hypomanic state can be described as a one-sided productive period combined with excessive optimism and increased physical activity. Along with this, delusional thoughts, groundless fears and insomnia appear. Most patients during this period suffer from increased excitability of the nervous system, which leads to the appearance of signs of somatic disorders. Dysfunction of internal systems and organs, pain syndromes and vegetative pathologies accompany the affective period of the disease.
Active form
Before talking about how to recover, it should be mentioned that the pathology in question can occur either in the form of attacks or continuously. Exacerbations during puberty are characterized by the occurrence of hypochondriacal or adynamic depression, which disrupts the perception of the surrounding world. In addition, the disease is accompanied by symptoms of senestopathy. At a more mature age, attacks of the disease provoke the development of paranoid and affective disorders. Acute schizotypal personality disorder, the symptoms are as follows:
- Delusional ideas - manifest themselves in the form of obsessive desires, contrasting thoughts and suddenly developing phobic disorders. Many patients suffer from thoughts that the disease is gradually driving them crazy. The progression of the disease leads to the fact that obsession loses its affective coloring. Delusional thoughts take on a monotonous form, which has a negative impact on the patient’s condition.
- Depersonalization is characterized as disturbances in the sphere of self-awareness. Patients cease to perceive their own personality. This condition is characterized by a lack of imagination, decreased intelligence, emotional lability and changes in appearance. A person suffering from depersonalization perceives the world around him in the form of a “movie”, the events of which he observes from the outside.
- Hypochondria - manifests itself in the form of vegetative pathologies that disrupt the functioning of internal organs and systems. Cardiac abnormalities, increased sweating, shortness of breath, insomnia, anorexia and bulimia, as well as attacks of nausea are the primary signs of hypochondriacal disorder. This condition is also characterized by conversion symptoms and pain in various parts of the body.
- Hysterical state - characterized by gross psychopathic disorders, which manifest themselves in the form of a passion for adventurism, vagrancy and deceit. The patient's behavior becomes demonstrative. Despite the absence of organic brain lesions, the patient gradually loses his writing skills. Under the influence of stress factors, symptoms such as nausea, heaviness in the head and hysterical attacks appear.
Most often, the disease develops before the age of 20, however, the first signs of mental illness may appear at a later age.
Differences between schizotypal disorder and schizophrenia in psychiatry
The diagnosis of “schizotypal disorder” excludes severe psychotic disorders characteristic of schizophrenia, among them: delusional, hallucinatory, movement disorders (catatonia), clouding of consciousness.
In addition, with schizotypal disorder there are never such severe outcomes as with schizophrenia, for example, apathetic-abulic dementia.
In addition, with schizotypal disorder there are never such severe outcomes as with schizophrenia, for example, apathetic-abulic dementia.
Obsessive-compulsive actions
Separately, it is necessary to note such symptoms of the disease as obsessive fears and actions. They so often accompany the illness that it is sometimes difficult to determine whether it is OCD or schizotypal disorder.
Among the frequently encountered fears are social phobia, agoraphobia, mysophobia, etc. One teenager with SR developed cancerophobia. His grandmother died of cancer. Moreover, at that moment, as he himself notes, he did not feel anything. Some time later, he watched a TV series in which they said that one of the first signs of brain cancer is phantom odors. From that moment on, he began to smell odors that were not really there. He was tormented by a terrible headache. And he was terrified that he had developed brain cancer.
An example of obsessive actions is the situation with a young guy. At school, his classmates made fun of him and bullied him in every possible way. Not knowing how to survive this, he simply repeated to himself the phrase: Lord, help. At first it was limited to 1-2 times. But then he needed to say it 10, 20 times to calm down and pull himself together.
Causes of schizotypal disorder
Genetic reasons. The external clinical similarity of schizotypal disorder with other mental illnesses may be explained by hereditary factors. Scientists have discovered a number of common genetic abnormalities with schizophrenia, bipolar affective disorder and personality disorders (psychopathy). For example, the genetic contribution explains the exceptionally high level of characteristics characteristic of patients: strange appearance and behavior, aloofness, and lack of close friends. The genetic commonality of schizotypal disorder and schizophrenia also causes some cognitive deviations 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 higher levels of schizotypal symptoms in the adult male population. Serious risk factors for the development of schizotypal disorder in youth may include malnutrition of the pregnant mother and child under three years of age, a history of child abuse, emotional abuse (including bullying and post-traumatic disorder), neglect, and neglect, especially with a corresponding genetic background.
The combination of various adverse effects leads to disturbances in the neurochemical balance in the brain, hormonal and immune abnormalities, which determine the clinical picture and accompany schizotypal personality disorder.
Classification and stages of development
Anxious personality disorder
The disorder can develop in different ways. There is the following classification of schizotypal deviations:
- A disorder that occurs as a neurosis;
- An illness resembling psychopathy;
- Sluggish or latent form of schizophrenia;
- Violation of social functions, resulting in partial or complete loss of ability to work.
At the initial stage of the disease, the patient’s behavior practically does not change, only somewhat strange habits, obsessions and rituals may appear. At the stage of development of the disease, there is a significant decrease in performance and productivity at work, associated with the person’s reluctance to fulfill his job responsibilities and social maladjustment. The third stage is a severe form of the disease, developing into schizophrenia. In some cases, the patient may need treatment in a hospital (for example, when attempting suicide under the influence of depression).
Diagnosis of schizotypal disorder
The diversity and multicomponent nature of symptoms in men and women with schizotypal disorder in psychiatry creates difficulties in diagnosis. Outwardly, patients may exhibit anxiety or "neurotic conflicts" that are determined or aggravated by "hidden" magical ideas, strange beliefs, or overvalued ideas. Therefore, schizotypal patients are often initially diagnosed with attention deficit disorder, social anxiety disorder, autism, dysthymia, neuroses, bipolar disorder, depression, and psychopathy.
Only a psychiatrist can establish a diagnosis of “schizotypal disorder” and give a prognosis after appropriate clinical examinations of the patient, obtaining objective information regarding his behavior and manifestations of the disease from close relatives.
Only a psychiatrist can establish a diagnosis of “schizotypal disorder” after appropriate clinical examinations of the patient, obtaining objective information regarding his behavior and manifestations of the disease from close relatives.
Additional methods will improve the quality and reliability of diagnosis - pathopsychological, neurophysiological examinations, blood tests to identify markers of the activity and severity of a mental disorder (for example, Neurotest).
Thanks to a pathopsychological examination (conducted by a psychologist), the characteristics of cognitive processes, the emotional-volitional sphere, and personal characteristics are revealed, which form the psychological portrait of the patient along with pathological traits caused by schizotypal disorder. 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 that reflect the state of the immune system involved in the formation of schizotypal disorder and other schizophrenia spectrum disorders. Certain combinations of deviations in indicators indicate a specific variant of the disease, suggest its prognosis, the degree of severity, severity of the condition and the effectiveness of the therapy.
Notes
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Treatment of schizotypal disorder
Treatment of 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 developing complications in the form of loss of ability to work, social isolation, loneliness, the transition of a slow-moving disease process into more severe forms of schizophrenia, the emergence of addictions, and suicidal tendencies.
Complex therapy is an effective combination of psychotropic drugs and psychotherapeutic techniques. Remember! Only a qualified psychiatrist knows how schizotypal disorder is treated.
Drug therapy. Drugs of various pharmacological groups are used - antipsychotics, antidepressants, mood stabilizers, tranquilizers. Specific regimens are selected individually, taking into account the clinical picture, duration of the disease, and state of physical health. Treatment is long-term: after relief of current symptoms, maintenance therapy is carried out.
Psychotherapy. Supervision of the patient by a psychotherapist is mandatory to obtain a positive and stable result. Unlike schizophrenia, with schizotypal disorder the use of almost all known types of psychotherapeutic techniques is permitted. During sessions with a psychotherapist, the necessary skills are developed to cope with symptoms, maintain social connections, form attitudes to activate volitional and motivational impulses, and correct pathological personal characteristics. Psychotherapeutic sessions have an important psychoprophylactic value, helping to increase the stress resistance of patients and prevent self-aggressive behavior.
Unlike schizophrenia, treatment for schizotypal disorder involves the use of almost all known types of psychotherapeutic techniques.
Primary prevention of schizotypal disorder in children involves early environmental enrichment. This includes exercise, cognitive stimulation and improved nutrition between three and five years of age, which improves brain function and reduces the likelihood of developing the disease in youth.
