Schizotypal Personality Disorder Features Research Articles

Linking narrative identity with schizotypal personality disorder features in adolescents.

Adolescents with schizotypal personality disorder (STPD) features such as odd thinking and bizarre fantasies may have difficulty developing effective life narratives. Their autobiographical memories likely will include aberrant, stressful experiences that are difficult to integrate into a cohesive, healthy sense of self. Moreover, these adolescents are likely to face relationship difficulties with both family members and peers who typically play an important role in narrative identity formation. We examined the link between STPD features and narrative identity in adolescence. Dutch community-dwelling adolescents, 125 with high-STPD features and 1,417 with low-STPD features, wrote life narratives about a turning point in their lives. These narratives were coded for a variety of features including the theme of agency, self-event connections, redemption sequences, and Cluster A- and STPD-like symptom descriptions. We found that the turning point narratives of adolescents with high STPD trait levels were significantly less likely to be agentic and redemptive, but more likely to contain Cluster A- and STPD-like symptom descriptions than the narratives of adolescents with low STPD trait levels. However, there were no significant associations of STPD trait levels with self-event connections. All the findings were robust and consistent. The current study demonstrated that early emerging personality disturbances may manifest themselves in aspects of personality other than traits-specifically, in the narratives young people are developing about important experiences in their lives. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Schizotypal personality disorder in clinical obsessive-compulsive disorder samples: a brief overview.

Obsessive-compulsive disorder (OCD) is a chronic and disabling mental disorder characterized by the presence of obsessions and/or compulsions that cause major distress and impair important areas of functioning. About 9 out of 10 patients with OCD have comorbid psychiatric diagnoses. A high proportion of clinically diagnosed OCD patients fulfill diagnostic criteria of a schizophrenia spectrum disorder, to the point that significant evidence in the literature supports the existence and the clinical relevance of a schizo-obsessive spectrum of disorders, including schizotypal personality disorder (SPD) with OCD (schizotypal OCD). In this paper, we provide a brief but comprehensive analysis of the literature on the clinical coexistence between OCD and SPD. The clinical validity of the so-called schizotypal OCD is analyzed through a comprehensive investigation of the relationship between SPD features and obsessive-compulsive phenomena in clinical OCD samples. This review describes the potential connections between OCD and SPD on the epidemiological, sociodemographic, psychopathological, and clinical levels. SPD is commonly observed in OCD patients: about 10% of OCD patients have a full categorical diagnosis of SPD. Early clinical identification of SPD features-and, more generally, of psychotic features and personality disorders-in OCD patients is strongly recommended. In fact, a proper and early diagnosis with early treatment may have benefits for prognosis. However, although schizotypal OCD seems to have clinical and predictive validity, further neurobiological and genetic studies on etiological specificity are warranted.

Supplemental Material for Linking Narrative Identity With Schizotypal Personality Disorder Features in Adolescents

Supplemental Material for Linking Narrative Identity With Schizotypal Personality Disorder Features in Adolescents

Clinical Practice Guidelines for Management of Schizophrenia.

Clinical Practice Guidelines for Management of Schizophrenia.

Devaluation of Rewards for the Future Is Associated With Schizotypal Personality Features

ObjectiveEmpirical evidence has suggested that schizophrenia is associated with dysfunctions in the reward system and working memory. However, little is known about individuals at risk for schizophrenia. In particular, it is not known if those with schizotypal personality features will show similar deficits in these two domains. This study examined whether individuals with schizotypal personality disorder features will subjectively devalue potential rewards in the future and show changes in their decision‐making behaviour, compared with healthy controls, and whether this devaluation is inversely associated with working memory performance.MethodA total of 44 participants with schizotypal personality features and 22 healthy control participants without schizotypal personality features completed the Monetary‐Choice Questionnaire, the Cambridge Gambling Task, and number and letter span tasks, which assessed delay‐discounting rate, decision‐making behaviour, and working memory, respectively.ResultsThe results showed that participants with schizotypal personality features, especially those with negative features, valued delayed rewards in the future to a lesser extent than healthy control participants. However, there was no significant group difference in decision‐making on the Cambridge Gambling Task. Moreover, the delay‐discounting rate of individuals with schizotypal personality features correlated significantly with working memory performance.ConclusionThe findings suggest that people with schizotypal personality features may be impaired in future reward perception and that this impairment is related to their working memory ability, although their capacity to make decisions is not affected.

Screening schizotypal personality disorder for detection of clinical high risk of psychosis in Chinese mental health services

Schizotypal personality disorder (SPD) is viewed as a marker of prodromal psychosis. However, information regarding genetic risk (e.g. SPD) is often overlooked in the identification process. This study assessed whether SPD screening questionnaire help the prodromal psychosis (also widely applied “clinical high risk” (CHR) for clinical sample) detection in Chinese mental health service. This work also examined whether SPD had higher frequency in genetic risk population and CHR subjects. Two wave studies concerning the SPD identification was used for analysis. Wave 1 survey: 3075 subjects were assessed by Personality Diagnostic Questionnaire for SPD (PDQ-SPD) and Structured Clinical Interview for DSM-IV Axis II (SCID-II). Wave 2 survey: 2113 subjects screened with the prodromal questionnaire -brief version (PQ-B), PDQ-SPD, and interviewed by Structured Interview for Prodromal Symptoms (SIPS). Subjects with family history of mental disorders or with psychosis reported significantly higher scores in SPD. Receiver operating characteristic curves suggested that PDQ-SPD had moderate sensitivity and specificity for identifying CHR subjects. There was significant higher on SPD features in subjects with early stage (Course less than 1 year) of psychosis. Identifying SPD may be useful in early detection of psychosis especially in detecting the genetic risk syndromes and can be integrated with existing prodromal screen tools to improve its efficiency.

Ten-year stability of self-reported schizotypal personality features in patients with psychosis and their healthy siblings

Schizotypal personality disorder (SPD) symptoms or features are common in patients with psychosis and their healthy relatives. However, the long-term stability of these SPD features and therefore their constituting enduring traits underlying vulnerability to psychosis remain to be clarified. Thirty-two patients with psychotic disorders and 29 of their healthy siblings were included from the long-term follow-up study of 89 nuclear families. Participants were clinically assessed by means of a semi-structured diagnostic interview, whereas the Schizotypal Personality Questionnaire-Brief (SPQ-B) was applied for the self-assessment of SPD symptoms. The assessments were carried out upon admission to the study and at follow-up, about 10 years later. The patients had higher scores than their siblings on the SPQ-B both at baseline and follow-up. In addition, self-reported SPD symptoms remained stable over time in total scores and in all the SPQ-B subscores, except for the SPQ-B Disorganization subscale. Self-reported SPD symptoms were stable over the long term among patients with psychotic disorders and their healthy siblings. This finding provides new support for including the SPD construct as a trait measure for studies addressing both vulnerability to psychosis in first-degree relatives of patients with psychosis and long-term persistence of symptoms in patients suffering from psychosis.

Developmental trajectories of schizotypal personality disorder-like behavioural manifestations: a two-year longitudinal prospective study of college students.

BackgroundPrevious evidence has shown that schizotypal personality disorder (SPD) is part of the schizophrenia spectrum. Few studies have examined latent classes in the developmental trajectories of SPD features over time in individuals with SPD features.MethodsWe adopted a longitudinal prospective study design to follow up a cohort of 660 college students during a two-year period. Participants’ SPD-like symptoms and psychosocial function were measured by a comprehensive set of questionnaires that covered SPD features and cognitive, emotional, and psychosocial functions. Latent class growth analysis was used to examine the trajectory classes.ResultsThree trajectory classes were identified: a low, a medium, and a high SPD features group. Participants in the low group reported few SPD features and their symptoms declined over time. The medium group students had more SPD features than the low group and these symptoms stabilized during the follow up period. Participants in the high group reported the most SPD features and their symptoms increased over time. The three groups differed in paranoid thoughts, psychological distress, neurocognition function, and emotional expression over time. Results of multivariate regression analysis suggested that paranoid thoughts, emotional experience and prospective memory were predictors of social functioning in the high SPD feature group.ConclusionsOur findings suggest that individuals with SPD features may be delineated into different developmental subgroups and these subgroups differ significantly in psychosocial function. Delusions, emotion, and prospective memory may be important features to consider in early diagnosis and interventions for individuals predisposed to SPD and schizophrenia.

Personality Pathology and Increased Use of Medical Resources in Later Adulthood

Personality pathology is associated with many negative health outcomes in young adulthood, including overutilization of healthcare resources. It is unclear, however, what the relation between personality pathology and medical resource utilization is as individuals age and develop new physical health problems. The present study examined whether personality disorder (PD) features were related to greater medical resource utilization in a sample of 1,630 community-dwelling participants, aged 55-64 years. PD features and health status were measured at baseline; medical resource utilization and new physical health problems were measured at four 6-month follow-up assessments. Multilevel modeling analyses tested associations between number of physical health problems and PD features in medical resource use over time. Greater number of physical health problems significantly predicted higher medical resource utilization. The results also showed that many PD features were related to higher reported medical resource utilization independent of health status and sociodemographic variables. Schizoid and schizotypal PD features were associated with less reported medical resource utilization. When all PDs were included in the model together, dependent, antisocial, histrionic, and narcissistic PD features remained predictive of higher medical resource utilization. Personality pathology remains a relevant predictor of greater medical resource utilization into later adulthood and should be considered an important risk factor when trying to determine ways to reduce costly overuse of healthcare resources among older adults.

Alternative DSM-5 Model for Personality Disorders

Alternative DSM-5 Model for Personality Disorders

Semantic processing impairment in individuals with schizotypal personality disorder features: A preliminary event-related potential study

This study aimed to examine semantic processing features in individuals with and without schizotypal personality disorder (SPD) features. An implicit semantic task was used to examine the automatic spreading semantic activation process which is relatively free from the influence of attention. An explicit semantic task was used to examine the controlled semantic processing which requires high involvement of attention. Individuals with stable SPD features (n=17) were those who scored higher than 36 on the schizotypal personality questionnaire (SPQ) at two time points. Individuals with unstable SPD features (n=15) were defined as participants who scored higher than 36 at the baseline time point but lower than 36 at the second time point. Their performances in the two semantic tasks were then compared to 17 individuals without SPD features (scoring below 36 at both time points). Event-related potentials (ERP) were recorded when participants were performing the two tasks. Behavioral data, early ERP components and N400s were analyzed in each experiment. No between-group difference was observed in the implicit semantic task. In the explicit semantic task, the differences involved only the N400 component. When compared to the group without SPD features, participants with stable and unstable SPD features showed enhanced N400 effects (difference wave), while there was no difference between the two groups with SPD features. Moreover, the larger N400 effects were found to be due to less negative N400 amplitudes to related target words. These findings suggest that individuals with SPD features were impaired in processing of context-related stimuli. The inhibition function to contextually unrelated materials in participants with SPD features appeared intact.

Poor Nutrition at Age 3 and Schizotypal Personality at Age 23: The Mediating Role of Age 11 Cognitive Functioning

Poor prenatal nutrition has been associated with schizophrenia spectrum disorders in the Netherlands and China, and it has been suggested that perinatal and postnatal nutritional factors lead to the development of schizophrenia and the exhibition of schizotypal traits later in life. There appears to be no prior research on the existence of possible factors that may mediate the relationship between malnutrition and schizophrenia spectrum disorders or whether this association is a direct one. The authors tested the hypothesis that low IQ mediates the relationship between early childhood malnutrition and adult schizotypal personality. Participants were drawn from a birth cohort of 1,795 boys and girls who were followed prospectively. Objective indicators of malnutrition (anemia and stunting) were assessed at age 3. Verbal and performance intelligence were assessed at age 11, and schizotypal personality was assessed at age 23. Both stunting and anemia at age 3 were associated with low IQ at age 11. Low performance IQ at age 11 was associated with increased interpersonal and disorganized features of schizotypal personality at age 23. Poor performance IQ was found to mediate the relationship between poor nutrition at age 3 and interpersonal and disorganized features of schizotypy at age 23. Findings in female participants were replicated in male participants. Given that poor nutrition is an alterable risk factor, these findings suggest that nutritional enhancements may improve brain functioning and possibly reduce some features of schizotypal personality disorder.

Event-related potential correlates of suspicious thoughts in individuals with schizotypal personality features

Suspiciousness is a common feature of schizophrenia. However, suspicious thoughts are also commonly experienced by the general population. This study aimed to examine the underlying neural mechanism of suspicious thoughts in individuals with and without schizotypal personality disorder (SPD)-proneness, using an event-related potential (ERP) paradigm. Electroencephalography (EEG) was recorded when the “feeling of being seen through” was evoked in the participants. The findings showed a prominent positive deflection of the difference wave within the time window 250–400 ms after stimuli presentation in both SPD-prone and non-SPD-prone groups. Furthermore, the P3 amplitude was significantly reduced in the SPD-prone group compared to the non-SPD-prone group. The current density analysis also indicated hypoactivity in both frontal and temporal regions in the SPD-prone group, suggesting that the frontotemporal cortical network may play a role in the onset of suspicious thoughts. The P3 of difference wave was inversely correlated with the cognitive-perception factor and the suspiciousness/paranoid ideation trait, which provided preliminary electrophysiological evidence for the association of suspiciousness with SPD features.

P02-189 - Differencial diagnosing of schizotypal personality disorder

Background and aimClinical definitions and differencial diagnosis criteria of «Schizotypal personality disorder» is not enough investigated yet, especially how it differs from schizoid personality disorder and continuous sluggish schizophrenia. It is impossible to consider diagnostic indications (that the symptoms of schizophrenia couldn’t be observed before and during actual examination) sufficient to explain the special place of this mental disorder. Some criteria of diagnosis of schizotypal disorders (for example, suspiciousness and paranoid ideas, episodes of quazi- psychotic disorders) are not applicable.With the aim to define the clinical features of schizotypal personality disorder 58 patients were examined. All patients were characterized by mainly personality disorders.Results-Schizotypal personality disorder is similar to deficit states, observed at schizophrenia, clinically limited to personality sphere, without the signs of flow of endogenous process and psychotic disorders.-Schizotypal personality disorder on the clinical content reminds schizoid, but insignificant ideatory disorders are rather typical. Dymamic of psychopathy - disposition to decompensation - is never observed.-Schizotypal personality disorder can be diagnosed as latent, prodromal schizophrenia, because the clinical picture of these states is very similar. The special value acquires a dynamic aspect, allowing to find the signs of «flow» and dynamics typical of the endogenous process.ConclusionThus, the main differencial diagnosing criteria of schizotypal personality disorder are the dynamic aspects and changing of clinical features.

Exploratory study on the base-rate of paranoid ideation in a non-clinical Chinese sample

Recent findings from several large-scale community surveys suggest that delusions tend to occur in non-clinical samples as a continuous phenotype rather than as an all-or-none phenomenon. However, the majority of studies on the prevalence of delusions and paranoid ideation are limited to Western samples. The present study aims to examine the phenomenon and base-rate of paranoid ideation in a Chinese non-clinical sample. A total of 4951 undergraduates (65.9% male) completed a checklist for paranoid ideation and the Schizotypal Personality Questionnaire (SPQ). Participants were classified into individuals with and without schizotypal personality disorder (SPD) features based on the SPQ. For the frequency subscale, 2.1–18.2% of the participants without SPD features experienced certain types of paranoid ideation at least once a week during the survey. The prevalence rate even elevated to a higher proportion in conviction and distress dimensions. For the conviction subscale, 9.3–53.5% of the participants somewhat believed of the ideations. For the distress subscale, 14.7–31.3% of the participants felt somewhat distressing in the experienced paranoid ideation. Participants with SPD features reported significantly higher prevalence in most items across these three dimensions. Findings indicate a high base-rate of attenuated forms of psychotic-like symptoms in a non-clinical Chinese sample, and provide further evidence for the continuity of psychotic phenomenon in non-clinical samples.

P03-155 Clinical content of schizotypal personality disorder

Background and aim:«Schizotypal personality disorder» occupies a special position in the classification of mental disorders. It is not enough investigated, what kind of disorders they are like, their characteristics are, and how they differ from schizoid personality disorder and continuous sluggish schizophrenia. with the aim to define the clinical features of schizotypal personality disorder 58 patients were examined.Results:•Schizotypal personality disorder is similar to deficit states, observed at schizophrenia, clinically limited to personality sphere, without the signs of flow of endogenous process and psychotic disorders.•Schizotypal personality disorder on the clinical content reminds schizoid, but insignificant ideatory disorders are typical. Dymamic of psychopathy - disposition to decompensation - is never observed.•Schizotypal personality disorder can be diagnosed as latent schizophrenia, because the clinical picture is similar. the special value acquires a dynamic aspect typical of the endogenous process.•High quality remission of schizophrenia limited of specific personality changes, as a variant of «acquired psychopathy» can be considered as clinically identical to «schizotypal personality disorder».Conclusion:A content of Schizotypal personality disorder includes a group of disorders of schizophrenia spectrum, different originally, from shizofreniform personality disorders without the signs of dynamics to the different states of development of schizophrenia - initial (latent schizophrenia), and final (high quality remission of schizophrenia as practical completion of schizophrenia process with the formation of certain features of personality). It can explain the special place of «Schizotypal personality disorder» in the classification of psychic disorders.

Frontal release signs among patients with schizophrenia, their first-degree biological relatives, and non-psychiatric controls

Background Frontal release signs (FRS) are a subset of neurological soft signs that are overrepresented among patients with schizophrenia and their unaffected relatives and may be correlated with neuropsychological functioning and chronicity of illness. This study sought to explore FRS and their associations with verbal memory and symptoms of schizophrenia in an African American sample of patients, and FRS and their associations with verbal memory and schizotypal features among first-degree relatives and non-psychiatric controls. Method FRS, verbal memory, schizophrenia symptoms (in patients), and schizotypal features (in relatives and controls) were assessed in 63 patients with schizophrenia and related disorders, 33 of their unaffected first-degree relatives, and 51 controls. Results Patients and their relatives displayed greater FRS than controls. Among relatives and controls, greater FRS were related to greater self-reported disorganized and interpersonal features of schizotypal personality disorder. FRS were not associated with patients' schizophrenia symptoms in the expected direction. In the entire sample, greater FRS were associated with poorer verbal working memory. Conclusions Because they are easy to assess, may be correlated with neuropsychological functioning, and appear to covary with level of genetic diathesis for schizophrenia, the study of FRS may shed light on the neurodevelopmental processes that underlie schizophrenia.

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.

Childhood and current autistic features in adolescents with schizotypal personality disorder

The diagnostic boundaries between autistic- and schizophrenia-spectrum disorders have varied over the years, and some overlap in diagnostic criteria persists. The present study examined childhood and current signs of autistic disorder (AD) in adolescents with schizotypal personality disorder (SPD) or other personality disorders, as well as healthy controls. A structured interview was administered to rate participants' current symptoms. Participants' guardians were interviewed with the Autism Diagnostic Inventory—Revised (ADI-R), a clinical assessment of childhood and current autistic signs. Compared to both the other personality-disordered and healthy groups, adolescents with SPD were rated as having significantly more impairment on childhood and current social functioning, and having more unusual interests and behaviors. For the entire sample, impaired childhood social functioning and unusual interests and behaviors were associated with higher negative symptom scores. Current impairments in social functioning, unusual interests and behaviors, and communication were also linked with greater negative symptoms. However, neither childhood nor current autistic features significantly predicted later conversion to an Axis I psychotic disorder over the course of three years of follow-up. The findings indicate that past and current autistic signs are more common in adolescents with SPD, but neither current nor childhood autistic features are linked with conversion to psychosis.