What is this condition
Schizotypal disorder is intermediate between personality traits and schizophrenia. Unlike schizophrenia, there are no long periods of delusions and hallucinations, behavior in general remains organized, and the person most often works and takes care of himself. The state differs from ordinary isolation in the stability and unusualness of thinking: the world is perceived through the prism of signs, coincidences and special meanings. Manifestations are usually noticeable from youth and persist for years, sometimes intensifying due to stress, sometimes weakening. In some classifications, the disorder is classified as personality disorder, which reflects its persistent nature.
- Belongs to the schizophrenia spectrum
- There are no full-blown psychoses
- Appears in adolescence or adolescence
- The course is long and undulating
- Partial criticism of one’s condition remains
Causes and risk factors
There is no single reason. The greatest contribution is made by hereditary predisposition: the disorder is more common in relatives of people with schizophrenia. This is influenced by peculiarities of brain development, complications of pregnancy and childbirth, as well as difficult childhood experiences - emotional neglect, abuse, bullying, long-term isolation. A separate risk factor for adolescents and young adults is the use of cannabis and other psychoactive substances, which can trigger the first episodes of unusual experiences. Chronic stress and lack of sleep increase symptoms, but do not themselves cause the disorder.
- Hereditary history of schizophrenia
- Features of the development of the nervous system
- Complications of pregnancy and childbirth
- Psychological trauma and neglect in childhood
- Bullying and long-term social isolation
- Use of cannabis and other psychoactive substances
- Chronic stress and sleep disorders
Signs and symptoms
Manifestations concern thinking, emotions and communication. The person seems strange to others: he dresses unusually, speaks floridly, is interested in esotericism, believes in telepathy or his own ability to influence events. Fleeting illusions, a feeling of someone else's presence, and depersonalization often arise. Emotions seem muted or inappropriate to the situation, there are few close contacts, and anxiety grows in the company, which does not decrease with familiarity. In this case, delusions and constant hallucinations are absent, and behavior does not destroy life as much as in schizophrenia.
- Magical thinking, belief in special abilities and signs
- Suspicion and ideas of attitude
- Strange, pretentious, or overly detailed speech
- Emotional coldness or inappropriate emotions
- Eccentric appearance and behavior
- Severe social anxiety and lack of close friends
- Brief unusual experiences without persistent delusions
Diagnostics and what they confuse with
There is no special analysis or image: the diagnosis is clinical. The psychiatrist questions the patient in detail and, with his consent, his relatives, assesses the dynamics over several years - according to the international classification, the signs must persist for a long time, at least two years. A clinical psychologist conducts a pathopsychological study of thinking and emotions. Conditions that give a similar picture must be excluded: intoxication with psychoactive substances, thyroid diseases, temporal lobe epilepsy, consequences of traumatic brain injury. If necessary, blood tests and a brain examination are prescribed.
- Clinical conversation with a psychiatrist
- Estimated duration of symptoms, at least two years
- Pathopsychological examination
- Information from loved ones with the patient’s consent
- Elimination of the effects of psychoactive substances
- Blood tests, thyroid hormones
- Brain examination according to indications
Treatment and support
The main tool is regular psychotherapy. The cognitive-behavioral approach helps to gently test unusual beliefs, reduce anxiety and suspicion, and social skills training helps to learn conversation, teamwork, and maintaining relationships. Medication is prescribed only by a psychiatrist: usually short courses of low-dose antipsychotics for increased suspicion and unusual experiences, as well as drugs to treat co-occurring anxiety and depression. Sleep patterns, avoidance of cannabis and alcohol, feasible employment and family support are of great importance. Hospitalization is rarely required if there is a risk to yourself or others.
- Regular psychotherapy, primarily cognitive behavioral
- Social and communication skills training
- Medications in small doses and short courses as prescribed by a psychiatrist
- Treatment of co-occurring anxiety and depression
- Complete abstinence from cannabis and alcohol
- Stable sleep schedule and feasible employment
- Working with families and informing loved ones
- Hospitalization only if there is a risk to life