1. NAME : LOKESH AGRAWAL CCT-ID : 9034 SEMESTER : 9th TOPIC :A CASE STUDY ON SCHIZOTYPAL PERSONALITY DISORDER(SPD) 6/3/2014 1

2. CONTENTS OBJECTIVE : INRODUCTION: WHAT IS SCHIZOTYPICAL DISORDER PATIENT INFORMATION SIGNS AND SYMPTOMS : CAUSES OF DISEASE : PSYCHOSOCIAL REGIONS : TREATMENT : PSYCHOTHERAPY MEDICATIONS(PHARMACOLOGICAL TREATMENT) CONCLUSION : 6/3/2014 2 3. OBJECTIVE 6/3/2014 3 TO STUDY VARIOUS CAUSES , SIGNS , SYMPTOMATOLOGY AND MEDICATIONS IN THE CONDITION OF SCHIZOTYPAL PERSONALITY DISORDER(SPD). 4. Introduction 6/3/2014 4 WHAT IS SCHIZOTYPICAL DISORDER : Schizotypal personality disorder is a personality disorder categorized on the axis-11 in the DSM-4 TR . Characterized by a need for social isolation, anxiety in social situations, odd behaviour and thinking, and often unconventional beliefs. People with this disorder feel extreme discomfort with maintaining close relationships with people, and therefore they often do not. People who have this disorder may display peculiar manners of talking and dressing and often have difficulty in forming relationships. 5. PATIENT INFORMATION : 6/3/2014 5 Name : Tyler Parker Age : 15 year Sex : Male Occupation : School Student Background Information :- Tyler is a 15 year old male who is currently living at home with his mother and younger sister. His mother describes Tyler as always being an odd child who had significant difficulty relating to his peers.As a child he would spend a great deal of time alone involved in role playing. She said that social situations always provoke great anxiety in Tyler and he is extremely socially inept. CurrentlyTyler rarely socializes, and when he is not in school he spends most of his time on his computer.Tyler spends several hours a day on the Internet playing on-line games and interacting with others in chat rooms.Tyler reports having one close real-life friend but it is not clear when he sees this person. However, he did list several online friends, none of whom he has actually met in person. Tyler has a history of doing poorly in mainstream school and currently is attending a vocational school. He reports being very anxious at school because he doesnt fit in. His mother suffers from depression and anxiety, and he has two maternal uncles diagnosed with schizophrenia. 6. Background Information : 6/3/2014 6 Inappropriate or Constricted Affect Tyler was highly animated and often inappropriate with smiling and laughing through much of the interview. He avoided eye contact with the interviewer. OddThinking and Speech Throughout the interviewTyler focused on trivial details, and matters of importance were often vague.Tyler is unable to have an ongoing conversation, and this is particularly apparent when he is interacting with people other than close family. Behaviour or Appearance that is Odd, Eccentric or Peculiar Tyler looked unkempt, he only dresses in black and despite the warm weather he wore a coat into the interview and did not take it off. Lack of Close Friends or Confidants Other than First-Degree Relatives Tyler predominantly socializes only with his mother and sister, even he does not have any single friend whom he met personally. Odd Beliefs or MagicalThinking that Influences Behaviour For example, his mother expressed concern aboutTylers intense fascination with ghosts.Tyler is extremely preoccupied with websites that advertise paranormal research, and he continually asks his mother to purchase ghost hunting equipment from themTyler also reports that he is superstitious. For example cats crossing his path, lack of a breeze and things falling are all bad signs that negative energy is in his area. 7. Background Information : 6/3/2014 7 Unusual Perceptual Experiences Tyler says that since the age of eight he has been hearing a voice that says his name at night. In January of this yearTyler saw his surroundings turn from colour to black and white as if all the colour had drained away.This experience lasted for a couple of minutes and only. Excessive Social Anxiety that Does Not Diminish with Familiarity and Tends to be Associated with Paranoid Fears Rather than Negative Judgments About Self Tyler is noticeably anxious in social situations, especially with those he is not familiar with. Even whenTyler is exposed to the same group of people over time such as his classmates his social anxiety does not lessen. He presents as being suspicious of his peers.Tyler thinks his teachers and classmates have negative thoughts about him. After psychiatric examination based on DSM IV TR, Tyler classified as Schizotypal Personality , It means he suffered from Schizotypal Personality Disorder. The other information related to Schizotypal personality disorder are as follows >>>>>>>>>>>>>>>>>>>>>>> 8. MOVIE CLIP ON SCHIZOTYPAL DISORDER6/3/2014 8 9. Problems associated to schizotypal disorder( co morbidity): 6/3/2014 9 Axis I Schizotypal personality disorder usually co-occurs with major depressive disorder, dysthymia, and generalized social phobia. Furthermore, sometimes schizotypal personality disorder can co-occur with obsessive-compulsive disorder, and its presence appears to affect treatment outcome adversely. Some persons with schizotypal personality disorders go on to develop schizophrenia,however most of them do not.Although STPD symptomatology has been studied longitudinally in a number of community samples, the results received do not suggest any significant likelihood of the development of schizophrenia. In case of methamphetamine(N-methyl-alpha-methylphenethylamine) use, persons with schizotypal personality disorders are at great risk of developing permanent psychosis. Axis II In most instances, schizotypal personality disorders co-occurs with the schizoid, paranoid, avoidant, and borderline personality disorders. 10. Signs and Symptoms : 6/3/2014 10 Schizotypal personality disorder is characterized by a pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following Ideas of reference (excluding delusions of reference) Odd beliefs or magical thinking that influences behaviour and is inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or sixth sense; in children and adolescents, bizarre fantasies or preoccupations) Unusual perceptual experiences, including bodily illusions 11. Signs and Symptoms : 6/3/2014 11 Odd thinking and speech (e.g., vague, circumstantial, metaphorical, over elaborate, or stereotyped) Suspiciousness or paranoid ideation Inappropriate or constricted affect Behaviour or appearance that is odd, eccentric, or peculiar Lack of close friends or confidants other than first- degree relatives Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self 12. Most professionals subscribe to a bio-psychosocial model of causation that is, the causes of are likely due to 1. Biological and genetic factors, 2. Social factors (such as how a person interacts in their early development with their family and friends and other children), 3. psychological factors (the individuals personality and temperament shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible rather, it is the complex and likely intertwined nature of all three factors that are important 12 Causes of schizotypal disorder - 13. PSYCHOSOCIAL REGIONS: 6/3/2014 13 Schizotypal personality disorder appears in about 3.9 percent of the general population according to NESARC research. Prevalence of schizotypal PD is about 3 percent and occurs slightly more commonly in men than women. Like most personality disorders, schizotypal personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s. Because personality disorders describe long-standing and enduring patterns of behaviour, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. However, if it is diagnosed in a child or teen, the features must have been present for at least 1 year. 14. DIAGNOSIS :- 6/3/2014 14 Schizotypal personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. A diagnosis for schizotypal personality disorder is made by a mental health professional comparing the symptoms and life history with those listed in the standard manuals suggested by APA and ICA.They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis. DSM-IV-TR Structured assessment conducted at baseline using the Structured Clinical Interview for DSM-IV Axis I Disorders and Structured Clinical Interview for DSM-IV Axis II Personality Disorders. The American Psychiatric Association defined Schizotypal Personality Disorder as a "pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts. 15. DIAGNOSIS :- 6/3/2014 15 International Classification of Diseases (ICD)issued by the World Health Organization (WHO) The ICD-10 does not have a diagnosis of schizotypal personality disorder, but Schizotypal disorder. In ICD-10, Schizotypal disorder is classified as a clinical disorder associated with schizophrenia rather than a personality disorder as with DSM-IV.The DSM-IV designation of schizotypal as a personality disorder is controversial. The ICD definition is: A disorder characterized by eccentric behaviour and anomalies of thinking and affect which resemble those seen in schizophrenia, though no definite and characteristic schizophrenic anomalies have occurred at any stage.There is no dominant or typical disturbance, but any of the following may be present: Inappropriate or constricted affect (the individual appears cold and aloof); 16. Diagnosis :- 6/3/2014 16 There is no dominant or typical disturbance, but any of the following may be present: Inappropriate or constricted affect (the individual appears cold and aloof); Behaviour or appearance that is odd, eccentric or peculiar; Poor rapport with others and a tendency to withdraw socially; Odd beliefs or magical thinking, influencing behaviour and inconsistent with subcultural norms; Suspiciousness or paranoid ideas; Obsessive ruminations without inner resistance, often with dysmorphophobic, sexual or aggressive contents; Unusual perceptual experiences including somatosensory (bodily) or other illusions, depersonalization or derealization; Vague, circumstantial, metaphorical, over-elaborate or stereotyped thinking, manifested by odd speech or in other ways, without gross incoherence; Occasional transient quasi-psychotic episodes with intense illusions, auditory or other hallucinations and delusion-like ideas, usually occurring without external provocation. The disorder runs a chronic course with fluctuations of intensity. Occasionally it evolves into overt schizophrenia.There is no definite onset and its evolution and course are usually those of a personality disorder. It is more common in individuals related to people with schizophrenia and is believed to be part of the genetic "spectrum" of schizophrenia. 17. Diagnosis :- 6/3/2014 17 Differential diagnosis :- There is a high rate of co-morbidity with other personality disorders. McGlashan et al. (2000) stated that this may be due to overlapping criteria with other personality disorders. There are many similarities between the schizotypal and schizoid personalities. Most notable of the similarities is the inability to initiate or maintain relationships (both friendly and romantic).The difference between the two seems to be that those labelled as schizotypal avoid social interaction because of a deep-seated fear of people.The schizoid individuals simply feel no desire to form relationships, because they see no point in sharing their time with others. 18. TREATMENT : 6/3/2014 18 Psychotherapy Medications 19. TREATMENT : 6/3/2014 19 Psychotherapy :- While individual therapy is the preferred modality at the onset of therapy, it may be appropriate to consider group therapy as the client progresses. Such a group should be for this specific disorder, though, which may be difficult to form or find in smaller communities. There is no simple solution to this problem. Social skills training and other behavioural approaches which emphasize the learning of the basics of social relationships and social interactions may be beneficial 20. TREATMENT : 6/3/2014 20 Medications Medication can be used for treatment of this disorders more acute phases of psychosis. Psychosis is usually transitory, though, and should effectively resolve with the prescription of an appropriate anti-psychotic. Studies have been conducted on the efficacy of haloperidol, thiothixene, olanzapine, and risperidonein SPD. Schizotypal patients who appear to be almost schizophrenic in their beliefs and behaviours (aberrant perceptions and cognitions) - they are usually treated with low doses of antipsychotic medications, e.g. thiothixene. However, it must be mentioned that long-term efficacy of narcoleptics is doubtful. Schizotypal patients who are more obsessive-compulsive in their beliefs and behaviours - in this case SSRIs, e.g. fluoxetine, appear to be more effective. Aripiprazole is a novel antipsychotic with a unique mechanism of action. It is a partial agonist of D2 and D3 dopamine receptors and 5-HT1A serotonin receptors, which are, respectively, responsible for its efficacy on positive, negative, and cognitive symptoms of schizophrenia and its antidepressant and anti-anxiety actions. Hence, it is called a dopamine-serotonin system stabilizer . 21. Prognosis :- 6/3/2014 21 There are dozens of studies showing that individuals with schizotypal personality disorder score similar to individuals with schizophrenia on a very wide range of neuropsychological tests. Cognitive deficits in patients with schizotypal personality disorder are very similar to, but quantitatively milder than, those for patients with schizophrenia MRI studies shows the schizotypal personality subjects had significantly less gray matter in widespread temporal, frontal, and parietal regions of the brain than did controls. Generally the deficits were the same as those known to exist in patients with schizophrenia, but less sever. 22. CONCLUSION 6/3/2014 22 Schizotypal personality disorder findings - Tyler has a pervasive pattern of social and interpersonal deficiency marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behaviour, beginning by early adulthood and present in a variety of contexts. More Common in men rather then women. This can be distinguished with schizoid and schizophrenics. 23. REFERENCES : 6/3/2014 23 Schacter, Daniel L., DanielT. Gilbert, and Daniel M.Wegner. Psychology.Worth Publishers, 2010. Print. Internet Mental Health - schizotypal personality disorder Millon,Theodore (2004).Personality Disorders in Modern Life. JohnWiley & Sons, Inc., Hoboken, New Jersey. ISBN 0-471- 23734-5. American Psychiatric Association. (2000).Diagnostic and statistical manual of mental disorders (DSM-IV-TR) (4th ed.) page 689Washington,DC:American Psychiatric Press. Haznedar, M. M.; Buchsbaum,M. 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"Schizotypal personality disorder". Mayo Clinic. Retrieved 21 February 2012. 24. 6/3/2014 24 Thank You