Criteria For Schizotypal Personality Disorder Research Articles

T113. CATEGORICAL AND DIMENSIONAL APPROACHES EXAMINING THE JOINT EFFECT OF AUTISM AND SCHIZOTYPAL PERSONALITY DISORDER ON SUSTAINED ATTENTION

BackgroundAccumulating evidence for the co-occurrence Autism spectrum disorder (ASD) and schizotypal personality disorder (SPD) at both the diagnostic and symptom/trait levels raises important questions about the nature of their association and the effect of their co-occurrence on the individual’s phenotype and functional outcome. It has been recommend that informing etiological and phenotypic overlaps between ASD and schizophrenia spectrum disorders (SSD) would require the utilization of a dual-diagnosis cohort compared with two control groups, each singly diagnosed with ASD or SSD, and that the development of a multidimensional model for understanding the relationship between these two spectra would require cohorts to be described not solely by diagnosis, but also by using dimensional measures that cut across diagnostic boundaries. Research comparing adults with ASD and SPD, as well as the impact of their co-occurrence on outcomes is extremely limited. To fill in this gap, we investigated executive functioning in terms of response inhibition and sustained attention, candidate endophenotypes of both conditions, in adults with ASD, SPD, comorbid ASD and SPD, and neurotypical adults using both categorical and dimensional approaches.MethodsA total of 88 adults (Mean Age ± SD = 37.54 ± 10.17): ASD (n = 26; m/f = 20/6); SPD (n = 20; m/f = 14/6); comorbid ASD and SPD (n=9; m/f =6/3) and neurotypicals (n=33; m/f =23/10) completed the Sustained Attention to Response Task (SART) in both its fixed and random forms.Individuals with ASD had a DSM-IV diagnosis of either autism or Asperger Syndrome and met ASD cut-offs on the Autism Diagnostic Observational Schedule-Generic (ADOS-G). All individuals with SPD met DSM-IV criteria for SPD using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Individuals in the comorbid group met criteria for both ASD (determined by DSM-IV and the ADOS) and SPD (determined by the SCID-II). In addition, in both the clinical and healthy participants, positive and autistic symptom severity were assessed with the positive subscale of the Positive and Negative Syndrome Scale (PANSSpos) and the PANSS Autism Severity Score (PAUSS), respectively.ResultsControlling for full scale IQ, working memory and medication dosage, group analyses revealed that the comorbid group committed fewer omission errors than the ASD group on the fixed SART, and fewer omission errors than the ASD and SPD groups on the random SART. The individual difference analyses revealed that the PANSSpos and PAUSS interactively reduced omission errors in both the fixed and random SARTs, as well as increased d’ scores, indicative of improved overall performance.DiscussionConcurrent elevated levels of autistic and positive psychotic symptoms seem to be associated with improved sustained attention abilities. We propose that sustaining and switching attention may represent two poles of irregularities across the autism and schizotypal spectra, which appear to converge in a compensatory manner in the comorbid group. Our findings highlight the importance of investigating the concurrent effect of ASD and SPD at both the symptom and diagnostic levels, and the potential benefit of this research approach to understanding the underlying mechanisms of seemingly overlapping phenotypes.

Schizotypal personality disorder in individuals with the Attenuated Psychosis Syndrome: Frequent co-occurrence without an increased risk for conversion to threshold psychosis

The Attenuated Psychosis Syndrome (APS), proposed as a condition warranting further study in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a controversial diagnostic construct originally developed to identify individuals at clinical high-risk for psychosis. The relationship of APS and Schizotypal Personality Disorder (SPD) remains unclear with respect to their potential co-occurrence and the effect of SPD on risk for conversion to threshold psychosis. We examined the prevalence and effect on conversion of SPD in a cohort of 218 individuals whose symptoms met APS criteria. Results indicated that SPD was highly prevalent (68%), and that SPD did not influence risk for conversion. Rather, total positive symptom burden measured by the Structured Interview for Psychosis-Risk Syndromes (SIPS; OR 1.12, p = 0.02) emerged as the strongest predictor of conversion. These data suggest that when encountering a patient whose presentation meets SPD criteria, the clinician should assess whether APS criteria are also met and, for 1–2 years, carefully monitor positive symptoms for possible conversion to threshold psychosis.

Examining the continuum of psychosis: Frequency and characteristics of psychotic-like symptoms in relatives and non-relatives of patients with schizophrenia

BackgroundA key finding underlying the continuum of psychosis concept is the presence of psychotic-like experiences (PLEs) in healthy subjects. However, it remains uncertain to what extent these experiences are related to the genetic risk for schizophrenia and how far they actually resemble attenuated forms of psychotic symptoms. MethodsForty-nine adults with no history of mental illness in first-degree relatives and 59 siblings of patients with schizophrenia were rated on the psychosis section of the Computerized Diagnostic Interview Schedule IV (C DIS-IV) and the Rust Inventory of Schizotypal Cognitions (RISC). Those who rated positive on the CDIS-IV were re-interviewed using the lifetime version of the Present State Examination 9th edition (PSE-9) and the Structured interview for Schizotypy (SIS). ResultsSeventeen (34.69%) of the non-relatives and 22 (37.29%) of the relatives responded positively to one or more of the psychosis questions on the DIS. This difference was not significant. RISC scores were also similar between the groups. At follow-up interview with the PSE-9, 13/40 PLEs (32.50%) in the non-relatives were classified as possible or probable psychotic symptoms compared to 11/46 (23.91%) in the relatives. Using liberal symptom thresholds, 5 of those who attended the follow-up interview (2 non-relatives and 3 relatives) met SIS criteria for schizotypal personality disorder. ConclusionsRates of PLEs, however considered, do not differ substantially between relatives and non-relatives of patients with schizophrenia. Only a minority of PLEs picked up by screening interviews resemble attenuated forms of psychotic symptoms.

Decreased fractional anisotropy values in two clusters of white matter in patients with schizotypal personality disorder: A DTI study

ObjectiveTo find a difference in fractional anisotropy (FA) between young adult males with schizotypal personality disorder (SPD) and healthy controls (HCs). MethodsSixteen males with SPD and sixteen HCs were selected from 3500 freshmen across two universities. The 32 participants were evaluated by the Minnesota Multiphasic Personality Inventory (MMPI) (Chinese Version Sc≥70) and the Schizotypal Personality Questionnaire (SPQ). Structured diagnostic interview was carried out and all the subjects in the SPD group met DSM-IV diagnostic criteria for SPD. All participants underwent brain magnetic resonance imaging, and their diffusion tensor imaging (DTI) data was collected. DTI data was analysed using tract-based spatial statistics (TBSS), and the neurofibre connection from the hippocampus to the right entorhinal cortex was traced. Informed consent was obtained from all participants. Results(1) SPD and HCs had a significant difference in SPQ symptoms (P<0.05). (2) There was a significant difference in the fractional anisotropy of two clusters of the brain between the two groups (P<0.05). The first cluster included the right pallidum, right retro-lenticular part of the internal capsule, right inferior longitudinal fasciculus (rILF), right posterior parietal lobe, right temporal lobe and right occipital lobe. The second cluster included the right hippocampus, right fornix, and right temporal lobe. (3) FA volume in the rILF positively correlated with scores related to the “lack of friends” subscale of the SPQ. ConclusionThese results suggest reduced white matter in two brain clusters of young adult males with SPD. These findings are similar to previous reports on patients experiencing their first schizophrenic episode.

The validity of the Schizotypal Personality Questionnaire in a Greek sample: Tests of measurement invariance and latent mean differences

BackgroundThe Schizotypal Personality Questionnaire (SPQ) is a widely used scale for measuring schizotypal characteristics modeled on DSM-III-R criteria for schizotypal personality disorder (SPD). The aim of this study was to examine the factorial structure of the Greek SPQ, its factorial invariance across gender and different age groups and possible gender and age group differences at latent mean level. MethodsEight hundred sixty-five community participants completed the Greek version of the SPQ. ResultsWith regard to the factorial structure of the original first-order model, the results showed that a seven-factor model (sub-scales “no close friends” with “constricted affect” and “ideas of reference” with “unusual perceptual experiences” were combined) was replicated adequately. Furthermore, the second-order “paranoid” model provided also adequate fit. With regard to the factorial invariance of the SPQ across gender and age, the analysis revealed that both, the first- and second-order models showed measurement invariance (configural, metric and structural) across gender and age groups (17–35 vs. 36–70). Latent mean differences across gender and age groups were also found. ConclusionsBased on these findings, we can conclude that the Greek version of the SPQ is a psychometrically sound instrument for measuring schizotypal characteristics and a useful screening tool for SPD across gender and age.

Some suggestions for the DSM-5 schizotypal personality disorder construct

This study relates to the schizotypal personality disorder (SPD) proposal of the upcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by investigating the construct validity of SPD as defined by DSM-IV in a large sample of patients from the Norwegian Network of Personality-Focused Treatment Programs (N = 2619), assessed by structured diagnostic interviews and the Longitudinal, Expert All Data standard. We investigated factor structure and psychometric properties of the SPD criteria, as well as co-occurrence patterns between SPD and other PDs. Thirty-six patients were diagnosed with SPD and 513 patients (21%) endorsed at least 2 schizotypal criteria. We found that 2 factors were specific for SPD, a cognitive-perceptual factor (ideas of reference, magical thinking, and unusual perceptual experiences) and an oddness factor (odd thinking and speech, constricted affect, and odd appearance or behavior). The criteria belonging to these factors had appropriate psychometric properties. The criteria of the cognitive-perceptual factor were more strongly associated with borderline personality disorder (PD) than with the other PDs. We did not find support for a consistent factor that reflected interpersonal problems. The criteria that used to be part of this factor (suspiciousness, lack of friends or confidants, and excessive social anxiety) performed poorly as specific SPD criteria. SPD was more strongly associated with antisocial PD and paranoid PD than with the other PDs. We suggest that ideas of reference should be included explicitly under the schizotypal facet of cognitive dysregulation in DSM-5, with less emphasis on the social phobic aspects of this feature. Furthermore, there should be more emphasis on the cognitive aspects of suspiciousness in SPD, and it should be considered to split up the affectivity criterion into constricted affect and inappropriate affect, with the latter type of affect being the expression of problems with intersubjective regulation. Finally, it is suggested that interpersonal dysfunction is secondary to the 2 primary SPD factors. Therefore, the SPD narrative should start by describing eccentricity and cognitive-perceptual aberrations rather than interpersonal difficulties.

Overlap of autistic and schizotypal traits in adolescents with Autism Spectrum Disorders

This study addresses the unraveling of the relationship between autism spectrum and schizophrenia spectrum traits in a population of adolescents with Autism Spectrum Disorders (ASD). Recent studies comparing isolated symptoms of both spectrum disorders as well as diagnostic criteria for each (DSM-IV-TR) suggest resemblances in the clinical phenotype. A group of 27 adolescents with ASD (11 to 18 years) and 30 typically developing adolescents, matched for age and gender, participated in this study. Within the ASD group 11 adolescents satisfied DSM-IV-TR criteria for schizotypal personality disorders. Autistic and schizotypal traits were identified by means of well validated questionnaires (Autism Questionnaire, AQ and Schizotypal Personality Questionnaire-Revised, SPQ). Significantly more schizotypal traits in adolescents with ASD were found than in typically developing controls. Besides high levels of negative symptoms, adolescents with ASD also displayed high levels of positive and disorganized symptoms. There appeared to be a relationship between the mean level of autistic symptoms and schizotypal traits, as well as specific associations between autistic symptoms and negative, disorganized and positive schizotypal symptoms within individuals. Schizotypal symptomatology in all sub dimensions that are reflected by the SPQ scores, was most prominently associated with attention switching problems of the autism symptoms from the AQ. These findings indicate that patients diagnosed with an ASD show schizophrenia spectrum traits in adolescence. Although other studies have provided empirical support for this overlap in diagnostic criteria between both spectrum disorders, the present findings add to the literature that behavioral overlap is not limited to negative schizotypal symptoms, but extends to disorganized and positive symptoms as well.

Tailoring the definition of the clinical schizophrenia phenotype in linkage studies

The delineation of schizophrenia-related symptomatology is critical to informative clinical phenotyping in linkage studies. A minority of first-degree relatives of schizophrenia and schizoaffective probands (RelSZSA) qualifies for a clinical diagnosis in the schizophrenia spectrum. Schizotypal personality disorder (SPD) is a key component of this spectrum, largely because of its relatively specific familial aggregation in relatives. The criteria for SPD were not developed for the purpose of identifying RelSZSA, however, and SPD is not a homogeneous clinical disorder, potentially introducing false positives and false negatives into affectedness classifications. In this study we used logistic regression (LR) to identify the combination of clinical signs and symptoms that maximized the discrimination between nonpsychotic first-degree RelSZSA ( n = 241) and controls ( n = 161). Three variables contributed significantly to optimizing this distinction: no close friends or confidants other than family members, social isolation and irritability. The combination of deviant LR scores and schizophrenia-spectrum psychotic disorders had greater sensitivity for identifying RelSZSA, 23.7%, than SPD and schizophrenia-spectrum psychotic disorders, 16%. Importantly, the diagnosis of SPD and deviant LR scores were not significantly correlated. Most individuals with deviant LR scores did not meet criteria for a diagnosis of SPD and only a minority of those who were diagnosed with SPD had deviant LR scores. Since misclassification of gene carriers as non-gene carriers in linkage analyses increases the risk of false negatives, it may be advantageous to tailor the definition of the clinical phenotype to those aspects of social–interpersonal dysfunction that optimize the discrimination of RelSZSA from controls.

The relationship between interview-based schizotypal personality dimension scores and the continuous performance test

The existing research that has examined cognitive performance in samples with subclinical schizotypal personality features has been largely limited to psychometric self-report questionnaires, which may be biased by distorted self-awareness of symptoms. The present study examined the relationship between performance on a degraded-AX continuous performance test (CPT) and continuous dimension scores created from a structured clinical interview for schizotypal personality disorder (SPD), which reflected both the breadth and severity of schizotypal personality symptoms, in 52 undergraduate students. Only one participant met full diagnostic criteria for SPD. The overall dimension score from the SPD clinical interview showed a positive correlation with both omission (rs=.47) and false alarm (rs=.41) errors on the CPT. Interpersonal symptoms were positively correlated with omission errors (rs=.47), while Disorganized symptoms were positively correlated with false alarm errors (rs=.40). Results suggest that higher SPD interview-based dimension scores are associated with lower levels of performance on the CPT, even when examining a relatively subclinical sample of young adults. In contrast, scores from the psychometric Abbreviated Schizotypal Personality Questionnaire in the same sample did not correlate with accuracy measures on the CPT, suggesting that the interview-based measure of schizotypal personality may have a stronger relationship with CPT accuracy. Findings also add to a growing literature suggesting that Interpersonal SPD symptoms are primarily related to omission errors, while Disorganized SPD symptoms are primarily related to false alarm errors.

Predictors of Remission, Schizophrenia, and Bipolar Disorder in Adolescents with Brief Psychotic Disorder or Psychotic Disorder Not Otherwise Specified Considered At Very High Risk for Schizophrenia

The aim of this study was to examine predictors of diagnostic and symptomatic outcome in adolescents with either psychotic disorder not otherwise specified (PsyNOS) or brief psychotic disorder (BrPsy) followed in a schizophrenia prodromal program. As part of a naturalistic study of adolescents considered at clinical high risk for schizophrenia, 26 youths (mean age, 15.9 +/- 2.6 years, 65.4% male) with psychosis not fulfilling criteria for schizophrenia/schizoaffective disorder and diagnosed with PsyNOS or BrPsy were evaluated for predictors of diagnostic and symptomatic outcome after at least 6 (mean, 22.8 +/- 19.4) months follow up. Progression to schizophrenia, schizoaffective disorder, or psychotic bipolar disorder (n = 10, 38.5%) was predicted by fulfilling criteria for schizotypal personality disorder at baseline (p = 0.046). Development of schizophrenia/schizoaffective disorder (n = 7, 27.0%) was associated with worse executive functioning (p = 0.029) and absence of anxiety disorders (p = 0.027). Conversely, progression to bipolar disorder (n = 4, 15.4%), with (n = 3, 11.5%) or without (n = 1, 3.8%) psychosis, was associated with the presence of anxiety disorders (p = 0.014). Remission of all psychotic as well as attenuated positive or negative symptoms (n = 5, 19.4%) was predicted by Hispanic ethnicity (p = 0.0047), an initial diagnosis of BrPsy (p = 0.014), longer duration of antidepressant treatment (p = 0.035), and better attention at baseline (p = 0.042). Results from this preliminary study suggest that patients with PsyNOS, BrPsy, or schizotypal personality disorder features in adolescence should be followed as separate risk groups in prodromal studies of schizophrenia and bipolar disorder. Executive function deficits and absence of anxiety disorders may be risk markers for schizophrenia, while presence of anxiety disorders may be linked to bipolar disorder risk. After achieving full remission, patients with sudden onset of psychosis and brief episodes could once be given the option of careful, supervised treatment discontinuation. The potential salutary effect of antidepressants during the psychotic prodrome and presence of characteristics differentiating patients at risk for schizophrenia or bipolar disorder should be investigated further.

Auditory processing abnormalities in schizotypal personality disorder: An fMRI experiment using tones of deviant pitch and duration

BackgroundOne of the cardinal features of schizotypal personality disorder (SPD) is language abnormalities. The focus of this study was to determine whether or not there are also processing abnormalities of pure tones differing in pitch and duration in SPD. MethodsThirteen neuroleptic-naïve male subjects met full criteria for SPD and were group-matched on age and parental socio-economic status to 13 comparison subjects. Verbal learning was measured with the California Verbal Learning Test. Heschl's gyrus volumes were measured using structural MRI. Whole-brain fMRI activation patterns in an auditory task of listening to tones including pitch and duration deviants were compared between SPD and control subjects. In a second and separate ROI analysis we found that peak activation in superior temporal gyrus (STG), Brodmann Areas 41 and 42, was correlated with verbal learning and clinical measures derived from the SCID-II interview. ResultsIn the region of the STG, SPD subjects demonstrated more activation to pitch deviants bilaterally (p<0.001); and to duration deviants in the left hemisphere (p=0.005) (two-sample t). SPD subjects also showed more bilateral parietal cortex activation to duration deviants. In no region did comparison subjects activate more than SPD subjects in either experiment. Exploratory correlations for SPD subjects suggest a relationship between peak activation on the right for deviant tones in the pitch experiment with odd speech and impaired verbal learning. There was no difference between groups on Heschl's gyrus volume. ConclusionsThese data suggest that SPD subjects have inefficient or hyper-responsive processing of pure tones both in terms of pitch and duration deviance that is not attributable to smaller Heschl's gyrus volumes. Finally, these auditory processing abnormalities may have significance for the odd speech heard in some SPD subjects and downstream language and verbal learning deficits.

The heterogeneous structure of schizotypal personality disorder: Item-level factors of the schizotypal personality questionnaire and their associations with obsessive-compulsive disorder symptoms, dissociative tendencies, and normal personality.

A. Raine et al.'s (1994) 3-factor scheme is currently the most widely accepted model of schizotypal personality disorder (SPD). Factor analytic studies of the Schizotypal Personality Questionnaire (SPQ; A. Raine, 1991) subscales, which represent the 9 Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for SPD, have provided the model's primary support. The use of only 9 modeled variables, however, limits the number of factors that can be extracted. To explicate this structure more fully, the authors conducted item-level factor analyses of the SPQ in a large student sample that completed the instrument twice within a 2-week interval. The authors' analyses failed to support either the 3-factor model of SPD or the 9 existing DSM-based subscales of the SPQ. Instead, 5 replicable dimensions emerged that capture recurrent symptom pairings found in the broader SPD literature: Social Anhedonia, Unusual Beliefs and Experiences, Social Anxiety, Mistrust, and Eccentricity/Oddity. These factors are only weakly correlated with each other and show differential correlational patterns with the Big Five personality traits, dissociative tendencies, and symptoms of obsessive-compulsive disorder. Moreover, they are congruent with dimensional models of personality psychopathology. Implications for SPD in DSM-V are discussed.

Significant correlation in linkage signals from genome-wide scans of schizophrenia and schizotypy

Prior family and adoption studies have suggested a genetic relationship between schizophrenia and schizotypy. However, this has never been verified using linkage methods. We therefore attempted to test for a correlation in linkage signals from genome-wide scans of schizophrenia and schizotypy. The Irish study of high-density schizophrenia families comprises 270 families with at least two members with schizophrenia or poor-outcome schizoaffective disorder (n=637). Non-psychotic relatives were assessed using the structured interview for schizotypy (n=746). A 10-cM multipoint, non-parametric, autosomal genome-wide scan of schizophrenia was performed in Merlin. A scan of a quantitative trait comprising ratings of DSM-III-R criteria for schizotypal personality disorder in non-psychotic relatives was also performed. Schizotypy logarithm of the odds (LOD) scores were regressed onto schizophrenia LOD scores at all loci, with adjustment for spatial autocorrelation. To assess empirical significance, this was also carried out using 1000 null scans of schizotypy. The number of jointly linked loci in the real data was compared to distribution of jointly linked loci in the null scans. No markers were suggestively linked to schizotypy based on strict Lander-Kruglyak criteria. Schizotypy LODs predicted schizophrenia LODs above chance expectation genome wide (empirical P=0.04). Two and four loci yielded nonparametric LOD (NPLs) >1.0 and >0.75, respectively, for both schizophrenia and schizotypy (genome-wide empirical P=0.04 and 0.02, respectively). These results suggest that at least a subset of schizophrenia susceptibility genes also affects schizotypy in non-psychotic relatives. Power may therefore be increased in molecular genetic studies of schizophrenia if they incorporate measures of schizotypy in non-psychotic relatives.

Taxonic structure of schizotypal personality disorder: A multiple-instrument, multi-sample study based on mixture models

This study used a multi-sample, multiple-instrument strategy to evaluate the hypothesis that schizotypal personality disorder (SPD) is taxonic. In Study 1, 721 consecutively admitted inpatients and outpatients were evaluated with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and the Personality Diagnostic Questionnaire-4+ (PDQ-4+). The data from both questionnaire types were submitted to multivariate normal mixture analysis, which was carried out on factor scores obtained from a three-factor model of SPD criteria; these results supported the hypothesis that SPD is taxonic. The same was true of Study 2, which administered the Semi-structured Interview for DSM-III-R Personality Disorders (SIDP-R) to an independent sample of 537 consecutively admitted outpatients. Similar findings were observed in Study 3, in which the SIDP-R was administered to 225 non-clinical subjects. The results show that the typology of DSM III-R and -IV SPD diagnosis is consistent with the latent structure of SPD features.

Cognitive Function and Symptoms in Adolescents with Schizotypal Personality Disorder

Cognitive deficits have been documented in schizophrenia and spectrum disorders. This study examines cognitive functioning and its relation to symptoms in adolescents with schizotypal personality disorder (SPD). Participants are 89 adolescents recruited for a study of youth at risk for Axis I disorders, especially psychosis. At intake, 34 met criteria for SPD, 38 for another Axis II disorder and/or conduct disorder (Other disorder-OD), and 17 did not currently meet criteria for any DSM-IV disorder (normal control-NC). At initial assessment, cognitive functioning was measured using subtests from the Wechsler Intelligence Scales and Wechsler Memory Scales (WMS), and symptoms were measured using the Structured Interview for Prodromal Symptoms (SIPS). At the time of this report, 50 were readministered the SIPS at 1-year follow-up (T2). The SPD group scored significantly below the NC group on the Arithmetic subtest of the Wechsler Intelligence Scales, but there was only limited evidence of group differences on the WMS. Poorer performance on the Wechsler Intelligence Scales was associated with greater severity of negative and disorganized symptoms. Deficits on the WMS were linked with more severe disorganized symptoms. The findings reported here are consistent with previous reports of limited cognitive deficits in adolescents with SPD, with the most marked deficits in mental arithmetic. The associations between symptoms and cognitive scores parallel those observed in adults with schizophrenia and spectrum disorder, and they are consistent with the notion that negative symptoms are more stable and partially reflect premorbid cognitive functions.

Clinical, cognitive, and social characteristics of a sample of neuroleptic-naive persons with schizotypal personality disorder

Introduction Schizotypal personality disorder (SPD) shares with schizophrenia many biological features, yet little is known about the clinical characteristics of persons diagnosed with this disorder. This report describes the clinical, cognitive and socio-occupational characteristics of a community sample of subjects diagnosed with SPD. Method Sixty-four male and 40 female neuroleptic-naive DSM-IV SPD subjects and 59 male and 51 female comparison subjects were recruited from the community for a total sample of 214 subjects. Demographic and cognitive differences between groups and, within the SPD group, the effect of gender on clinical features, such as the SPD criteria, SAPS, SANS, Schizotypal Personality Questionnaire, and co-morbidity, were examined using ANOVA and Chi-square distributions. Results SPD subjects, in contrast to comparison subjects, had significantly lower socio-economic status, poorer social relationships and skills, and lower vocabulary scores. Furthermore, SPD subjects demonstrated more impairment on Vocabulary scores than on Block Design, as measured by the WAIS-R, a pattern not seen in comparison subjects. In the SPD cohort, positive symptoms predominated and nearly half were co-morbid for major depression. With respect to gender, male SPD subjects, compared with female SPD subjects, evinced significantly more negative symptoms, fewer friends, had more odd speech, and were more likely to also suffer from paranoid and narcissistic personality disorders. In contrast to male SPD subjects, female SPD subjects perceived themselves to be more disorganized. Conclusions SPD subjects, similar to schizophrenics, are impaired socially, occupationally, and cognitively, particularly in the area of verbal measures. Moreover, male SPD subjects may be more severely affected than female SPD subjects across multiple domains of functioning.

A comparative profile analysis of neuropsychological function in men and women with schizotypal personality disorder

The purpose of this study was to compare the cognitive profiles of men and women with clinically defined schizotypal personality disorder (SPD). We examined the neuropsychological profile of SPD in 26 right-handed females and 31 right-handed males who met DSM-IV criteria for SPD, and matched comparison subjects. Cognitive performance was assessed on measures of abstraction, verbal and spatial intelligence, learning and memory, language, attention, and motor skills. Neuropsychological profiles were constructed by standardizing test scores based on the means and standard deviations of comparison groups matched for sex, age, handedness, ethnicity and parental SES. Overall, SPD subjects showed mild, general decrements in performance in most cognitive domains. However, unlike male SPD subjects, female SPDs did not show relative deficits in verbal learning and abstraction. The results suggest a less severe pattern of cognitive deficits in women with SPD compared to men, consistent with hypotheses of gender differences in cognitive function in schizophrenia.

Familial association of schizotypal traits with psychotic and affective disorders

The criteria for schizotypal personality disorder were developed on the basis of traits observed in biologic relatives of schizophrenic and borderline schizophrenic probands from the Danish adoption studies. In this review, the relationship between schizotypal personality disorder and the schizophrenic spectrum, affective disorders, and psychotic disorders is explored. A dimension of psychosis may overlap with the schizophrenia spectrum to yield chronic schizophrenia, with the affective disorders spectrum to yield psychotic affective disorder, or by itself lead to other psychotic disorders. Schizotypal personality disorder in this model is posited to represent schizophrenia spectrum disorder that does not overlap with psychosis, whereas nonpsychotic affective disorders represent the affective disorders that do not overlap with psychosis. Delusional disorder represents another psychotic disorder that is not specifically related to either schizophrenia or the affective disorders. Evidence suggests that the schizotypal personality disorder criteria, particularly those emphasizing the negative symptoms or deficit-like symptoms of this disorder, specifically identify a unique relationship to the schizophrenia spectrum.

Schizotypal personality traits in nonpsychotic relatives are associated with positive symptoms in psychotic probands.

There remains disagreement over whether increased risk of schizotypal personality disorder (SPD) is confined to the relatives of patients with a diagnosis of schizophrenia or whether it is a more general characteristic of the relatives of all psychotic patients. To examine the relationship between schizotypal dimensions in relatives and psychopathological syndromes in patients with functional psychoses, factor analysis was carried out on (1) ratings from Present State Examination (PSE) interviews with 172 consecutively admitted patients with psychosis (52% of them with schizophrenia), and (2) ratings on items from three schizotypal scales concerning 263 of their nonpsychotic first degree relatives. The factors derived from the patients' PSE interviews were correlated with the schizotypal factors and the nine DSM-IV criteria for SPD concerning the relatives and subjected to a canonical correlation analysis. In this study, no differences were observed concerning the distribution of schizotypal factors or DSM-IV schizotypal features in the relatives of patients with different psychotic diagnoses. However, a syndrome characterized by delusions, hallucinations, and thought interference (positive symptoms) in patients was correlated with high scores on the three schizotypy scales and with positive and negative schizotypal features in relatives.

Prediction of personality disorder traits by psychosis proneness scales in a German sample of young adults

Prior research has focused on schizophrenia-spectrum disorder traits in psychosis-prone subjects. The whole range of personality disorders were only explored in patient samples and with the relatives of patients. In light of this situation, the predictive value of Physical Anhedonia (PhA), Perceptual Aberration (PER), and Magical Ideation (MI) for personality disorder traits were examined dimensionally and categorically in a non-patient sample. We selected a non-student sample (n = 404) and focused on two risk groups (PhA: n = 14; combined PER/MI: n = 36), and a control group (n = 19) using the SCID II to assess personality disorders at a time period two years later. MI explained most of the variance in clinically relevant schizotypal personality disorder symptoms, while PER and PhA dimensionally were associated with the number of diagnostic criteria met for other personality disorders. While both risk groups exceeded the control group in clinically relevant borderline traits, only the PER/MI-individuals differed in fulfilling more criteria for schizotypal personality disorder.