Schizotypal Personality Disorder

1. 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 behavior, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
   1. ideas of reference (excluding delusions of reference)
   2. odd beliefs or magical thinking that influences behavior and is
   3. inconsistent with subcultural norms (e.g., superstitiousness, belief in clairvoyance, telepathy, or "sixth sense"; in children and adolescents, bizarre fantasies or preoccupations)
   4. unusual perceptual experiences, including bodily illusions
   5. odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped)
   6. suspiciousness or paranoid ideation
   7. inappropriate or constricted affect
   8. behavior or appearance that is odd, eccentric, or peculiar
   9. lack of close friends or confidants other than first-degree relatives
   10. excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self
2. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder.
3. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Note: If criteria are met prior to the onset of Schizophrenia, add "Premorbid," e.g., "Schizotypal Personality Disorder (Premorbid)."

Treatment Option:

Antipsychotics (typical)	Dose mg/day	Anti- cholineric¹	EPS²	Sedation	Hypotension (orthostatic)
Chlorpromazine (Thorazine)	100-2000	++++	++	+++++	+++++
Thioridazine (Mellaril)	100-600	+++++	+	++++	+++++
Trifluoperazine (Stelazine)	5-60	++	++++	+	++
Thiothixene (Navane)	5-60	++	++++	++	++
Fluphenazine (Prolixin)	5-30	++	+++++	++	++
Haloperidol (Haldol)	2-200	+	+++++	++	+

Antipsychotics (atypical)	Dose mg/day	Anti- cholineric¹	EPS²	Sedation	Hypotension (orthostatic)
Risperidone (Risperdal)	1-6	+	+	+	++
Olanzapine (Zyprexa)	5-20	+	+	++	+
Clozapine³ (Clozaril)	5-60	+++++	+	+++++	+++++

¹ Dry mouth, constipation, blurred vision, urinary retention.
² Extrapyramidal side effects (dystonia, parkinsonism, akathisia, tardive dyskinesia).

³ Requires weekly White Blood Cell (WBC) count because of risk of agranulocytosis.
Adapted from Bernstein JG: Handbook of drug therapy in psychiatry, ed 3, St. Louis, 1995, Mosby.

Special Antipsychotic Adverse Reactions

1. Neuroleptic Malignant Syndrome. May occur at any point during the course of treatment. Includes symptoms of autonomic instability, altered mental status, which may progress to hyperthermia, stupor, and muscle hypertonicity. Death may occur. Cause: Neuroleptics (phenothiazines, etc.)
   Characteristics. Same symptoms as malignant hyperthermia (see below) but generally develops over days instead of minutes. Treatment: As per malignant hyperthermia.
   • Malignant Hyperthermia.
     Cause. 1:20,000 in response to a muscle-relaxing agent (such as succinylcholine) or an inhaled anesthetic (such as halothane). Is hereditary. May also be secondary to physical or emotional stress.
     Characteristics. Hyperthermia, muscle rigidity, tachycardia, acidosis, shock, coma, rhabdomyolysis.
     Treatment includes IV dantrolene 1 to 10 mg/kg IV titrated to effect, management of acidosis and shock, peripheral cooling (see management of heat stroke below).
2. Tardive Dyskinesia. Involuntary movements of the tongue, face, mouth, or jaw associated with long-term administration of antipsychotics. Elderly females at highest risk. May be irreversible.

• Depressed Mood
• Odd/Eccentric/Suspicious Personality

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

• Delusional Disorder;
• Schizophrenia;
• Mood Disorder With Psychotic Features;
• Autistic Disorder;
• Asperger's Disorder;
• Expressive and Mixed Receptive-Expressive Language Disorders;
• Communication Disorders;
• Personality Change Due to a General Medical Condition;
• Symptoms that may develop in association with chronic substance use;
• Paranoid Personality Disorder;
• Schizoid Personality Disorder;
• Avoidant Personality Disorder;
• Narcissistic Personality Disorder;
• Borderline Personality Disorder;
• Schizotypal features during adolescence.