![]() In the forthcoming ICD-11, it will remain in the block of schizophrenia spectrum disorders. 14 This review focuses on the diagnosis of and therapeutic approaches in patients with a disease severity that fulfills the criteria of STPD not only as a premorbid condition or risk state but also as a separate diagnostic entity.įor years, the International Classification of Diseases (ICD) from the World Health Organization (WHO) and other classification instruments, e.g., the DSM from the American Psychiatric Association (APA), have differed in their classification of STPD (referred to as schizotypal disorder in the ICD): In ICD-9 and -10, it is listed under schizophrenia spectrum disorders, whereas in DSM-III to -5 it is classified as a personality disorder. ![]() The differentiation between schizotypal traits and STPD is clinically important and reflects the degree of impairment in occupational and interpersonal functioning and the severity of symptom presentation. The original STPD item set was derived from the criteria of borderline schizophrenia seen in the relatives of schizophrenia patients. Since the introduction of the diagnosis of STPD in Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) in 1980, the diagnosis and treatment of STPD have remained difficult because of the lack of evidence-based algorithms. Several authors argue for a dimensional approach and a continuum between schizotypal traits and schizophrenia spectrum disorder 1, 11, 12 support for their argument is provided by genetic and linkage studies showing a considerable overlap between genetic association profiles in schizotypy and schizophrenia. 1 Consequently, research has been performed in both clinical patients and healthy schizotypal individuals. ![]() The term schizotypy refers to both people with schizotypal personality disorder (STPD) and healthy individuals in the general population with certain personality traits and a latent liability for psychosis. 5Īccording to the theoretical models of Meehl, 6, 7 Lenzenweger, 8 Chapman, 9 and Kwapil, 10 schizotypy is a premorbid condition. 5 Mason described 16 different schizotypy scales that were based on clinical concepts or definitions and six scales for psychometric/personality measures of schizotypy. 3 The assessments for schizotypal traits are mainly used to define a high-risk group and its proneness to psychosis. Schizotypy, as a broader collection of both clinical and nonclinical traits, is assessed by psychometric inventories such as the Wisconsin Scales of Schizotypy. 2– 4 Raine 1 described two types of schizotypy: (1) neurodevelopmental schizotypy with relatively stable traits and significant brain and neurocognitive impairments that predispose to schizophrenia, and (2) pseudoschizotypy, a pronounced psychosocial entity with more symptom fluctuation that is unrelated to schizophrenia. Schizotypy is a heterogenous syndrome that is expressed across multiple dimensions, including cognitive-perceptual, disorganized, and interpersonal symptoms 1 or according to the symptomology of schizophrenia, positive, negative, and disorganized factors. Larger interventional trials are needed to provide the data for evidence-based recommendations. We conclude that there is currently only limited evidence on which to base treatment decisions in this disorder. This is a systematic evaluation of diagnostic instruments and treatment studies in schizotypal personality disorder. Because of the heterogeneity of the studies and the small sample sizes, it is not yet possible to make evidence-based recommendations for treatment. Studies on the longitudinal course described a moderate remission rate and possible conversion rates to other schizophrenia spectrum disorders. Second-generation antipsychotics (mainly risperidone) were the most often studied drug class and were described as beneficial. We identified several suitable and reliable questionnaires for screening (PDQ-4+ and SPQ) and diagnosing (SIDP, SIDP-R, and SCID-II) schizotypal personality disorder. A total of 54 studies were eligible for inclusion: 18 were on diagnostic instruments 22, on pharmacological treatment 3, on psychotherapy and 13, on the longitudinal course of the disease. ![]() Two independent reviewers extracted and assessed the quality of the data. A systematic search in the PubMed/MEDLINE databases was conducted. The main objective of this review was to evaluate studies on the diagnosis, treatment, and course of schizotypal personality disorder and to provide a clinical guidance on the basis of that evaluation.
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