: Reading time:
What are the characteristics of a diagnosis of “schizotypal disorder”, how does it differ from schizophrenia and how is schizotypal disorder treated – says Irina Valentinovna Shcherbakova, Doctor of Medical Sciences, Professor, Psychiatrist.
Until the nineties of the last century, schizotypal disorder was known as “sluggish schizophrenia” or “slow-onset” (“pre-schizophrenia”, “mild schizophrenia”, “pseudo-neurotic schizophrenia”). It is a relatively benign, slowly progressive endogenous process that occurs in one third of all patients with schizophrenia. 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.
Schizotypal disorder includes individuals with impairments in interpersonal functioning, cognition, emotion, and behavioral control who exhibit a genetic predisposition to schizophrenia, so-called “hidden carriers.” The latter are family members of patients with schizophrenia and are distinguished by chronic peculiarities 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 defined remissions, and is chronic and continuous.
As the disease progresses, there is a gradual decline in working capacity associated with a decline in intellectual activity and initiative, impoverishment of emotions and contacts, and deepening social isolation. At the same time, about 30% of patients with schizotypal disorder continue to work, choosing lighter, home-based types of work activities that are more acceptable to them; Some patients become dependents and disabled.
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
Diagnosis and diagnosis in psychiatry
The variety of clinical manifestations of mental illnesses sometimes creates significant difficulties in determining the nosological affiliation of one or another psychopathological symptomatology...
Methodology and research
In the process of psychiatric diagnosis, the doctor relies on identifying symptoms (signs) of the disease. psychiatric diagnosis begins . At the same time, the relationship of a given symptom to a particular syndrome and to the nosological form of the disease is identified.
So let's start with the concept of symptoms. Symptoms (The definition of signs of a mental disorder in our case corresponds to the international standard for the study of major mental illnesses adopted by the World Health Organization (WHO).), according to the well-known concept of Jackson, are divided into negative and positive. The first include symptoms of loss of certain functions of mental activity (exhaustion of mental activity, psychopathization of the individual, decreased energy potential, dementia). Positive, or productive, symptoms are the result of painful excitation of functional systems (illusions, hallucinations, delusions and obsessions, manic and depressive states, etc.). Negative symptoms (minus symptoms) are nosologically more specific compared to productive symptoms (plus symptoms). At the same time, it is inert, invariant and relatively resistant to therapy. Negative and positive disorders, despite the fact that they differ from each other, are closely interrelated. The clear expression of negative symptoms entails the rudimentary manifestations of positive ones. The slow, chronic course of the disease is accompanied by a predominance of negative symptoms, while the acute development of psychosis is accompanied by pronounced productive impairments. Productive symptoms are especially clearly manifested in psychoses associated with a disorder of consciousness (amentive, delirious, oneiric, etc.), as well as in other conditions accompanied by psychomotor agitation (catatonic, hebephrenic, etc.) and acute hallucinatory-delusional symptoms.
The concepts of “negative” and “positive” disorders, although they are among the cardinal ones in general psychopathology, are not always interpreted unambiguously. In particular, negative disorders are considered to be persistent, irreversible, and positive ones are considered temporary, dynamic, transient expressions of a mental defect. However, clinical studies in recent years have shown that with intensive antipsychotic treatment, reversibility and compensation of negative disorders is possible. Therefore, it should be considered that negative symptoms are associated not so much with a loss of mental functions, but with a temporary cessation of the functioning of individual systems.
Psychopathological symptoms that are similar in external manifestations may have different diagnostic solutions. For example, zoopsia occur in patients with delirium tremens. They usually see animals and insects reduced in size, somewhat elongated, and black in color. This indicates that these disorders belong specifically to alcoholic psychosis. At the same time, the brightness and colorfulness of hallucinatory phenomena with scenes of religious content or violent events indicates the possible presence of epileptic disease in patients. A similar comparison can be made with regard to auditory hallucinations in alcoholic and syphilitic hallucinosis, hallucinatory-paranoid schizophrenia; or disturbances in thinking in the form of its fragmentation (in schizophrenia) or incoherence (in an amentive state).
However, individual symptoms do not provide sufficient information to make a psychiatric diagnosis. Only the analysis of a number of signs of the disease that are similar to each other in clinical picture, that is, the identification of disease syndromes, makes it possible to determine the clinical boundaries of a particular process. Syndromic diagnosis is more accurate than symptomatic diagnosis. The syndrome reflects the activity of an entire functional system and, as a rule, is closely related to other syndromes.
Establishing a diagnosis is the final stage of psychiatric diagnosis , which is carried out on the basis of a comprehensive analysis of psychopathological symptoms, individual personality characteristics, objective and subjective anamnesis, disease dynamics and the results of paraclinical studies. However, for an accurate diagnosis of mental illness, it is not enough to simply state pathological changes. To do this, it is necessary to study the etiology and pathogenesis of the disease.
The variety of clinical manifestations of various mental illnesses often creates exceptional difficulties in determining the nosological affiliation of one or another psychopathological symptomatology. In this case, the doctor uses the most important method for diagnosing mental illness - the method of clinical observation. The doctor must see the patient, listen, examine him.
Unfortunately, in psychiatry, unlike other medical fields, there are fewer opportunities to use instrumental techniques that allow direct study of the organ affected by the pathological process - the brain. Therefore, in psychiatry the main research method is the clinical-psychopathological method. It made it possible to substantiate the nosological specificity of schizophrenia, borderline neuropsychiatric disorders, a group of exogenous and gross-organic psychoses, and also to create a modern classification of mental illnesses.
At the same time, biological research methods are also widely used in psychiatry. They are aimed primarily at establishing the causes and pathogenesis of mental illness. True, without clinical identification of psychopathological conditions it is impossible to correlate the results of biological studies with data concerning the prognosis and outcome of mental illnesses, as well as therapy, prevention and social rehabilitation. Nevertheless, data from modern neurophysiology, biochemistry, genetics, and psychology make it possible to obtain valuable information for the correct diagnosis of mental illness.
When making a clinical diagnosis of a mental illness, the doctor must take into account that it may have changed the patient's personality, and in determining its cause, the subjective history may not correspond to the data of an objective study. The factor that caused the disease may subsequently have no influence on its course, and it will develop according to its own pathogenetic laws.
It should be said that a psychiatrist in his daily practical work constantly has to deal not only with various pathological phenomena of mental activity, but also with deviations in the patient’s somatic functions, as well as with the complex interweaving of his interpersonal relationships.
Patients with a somatoneurological profile usually report more complaints to the doctor than mentally ill patients. The latter often do not complain at all and do not consider themselves sick for a long time. A mentally ill person often lacks the feeling of discomfort inherent in a somatically ill person. Mental illness can be asymptomatic for a long time or manifest itself with only one or two signs, which can lead to a late diagnosis.
Psychiatric diagnosis is aimed at determining not only the nosological affiliation, stage of development and type of course of the disease, but also its prognosis in relation to life, recovery, and ability to work.
However, it should be remembered that the specificity of the clinical manifestations of various mental illnesses, in particular exo- and endogenous psychoses, is very relative. Psychopathological symptoms can undergo a wide variety of changes depending on the premorbid properties of the individual, his constitutional characteristics, and the nature of the impact of traumatic situations. Borderline neuropsychiatric disorders are the most difficult to identify. They can develop not only as a reaction to a difficult situation, but also endogenously, they can be congenital and acquired. Here the most difficult issue of psychiatric diagnosis arises especially acutely - the definition of normality and pathology. Signs of the endogenous course of the pathological process can also be carried by exogenous diseases - organic, reactive, various symptomatic psychoses.
At the same time, the relativity of the specificity of mental disorders does not exclude the possibility of nosological diagnosis of diseases. Studying together all the signs that express the unity of etiology and pathogenesis allows the clinician to determine the nosological independence of a particular disease. In this case, both information about the patient himself and objective data about his relatives and social environment play a significant role. It is very difficult to resolve issues related to systematics in psychiatry. The classifications of mental illnesses that exist both in our country and abroad are to a certain extent arbitrary, since among psychiatrists in different countries there is no consensus in identifying individual psychopathological signs and in understanding the causes and mechanisms of development of many mental disorders.
Currently, a version of the International Classification of Diseases, 10th revision (ICD-10) is being adapted (in the USA, a national classification was introduced, which formed the basis of ICD-10. The taxonomy was first adopted by the American Psychiatric Association in 1952 and since then has been repeatedly supplemented and DSM-III-R has been in effect since 1987, and currently its 4th revision has been developed and is in use.). The classification of mental illnesses in the 10th revision has undergone significant changes compared to previous classifications. First of all, the number of diseases has been reduced according to the nosological principles of division traditional in clinical psychiatry and preference has been given to syndromic categories. The boundaries of schizophrenia were narrowed, the division of diseases into psychoses and neuroses was excluded, some new headings were introduced using original terminology that had not previously been used. For example, throughout the classification, the term “disorder” has been introduced instead of the terms “disease, disease.” According to the authors of the classification, the term “disorder” is more accurate, since it refers to a more specific group of symptoms than is the case when using the concept “disease”.
Source: “New Psychiatry” No. 1, 2010
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.
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.
Treatment of pathology
When treating such mental disorders, it is necessary to use detoxification treatment and neuroleptics in medium and sometimes high dosages. The most optimal combinations are considered to be combinations of haloperidol and aminazine, haloperidol and triftazine, or the simultaneous use of neuroleptics and tranquilizers. Due to the high likelihood of developing recurrent psychosis, the patient is recommended to take maintenance dosages of antipsychotics for some time after therapy.
We reviewed the diagnosis F23 and its explanation.
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.
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.
Causes
Factors that can lead to mental discord can be divided into two groups:
- External (exogenous): exposure to viruses and microbes, consumption of alcohol, drugs, influence of poisons, radiation, traumatic brain injury. This also includes vascular diseases of the brain.
- Immanent (endogenous): gene diseases, disorders at the chromosome level, hereditarily transmitted disorders, disorders of metabolic processes in the body.
However, the causes of many such psychological illnesses are still unknown to psychiatry.
