Schizotypal personality disorder and suicide: problems and perspectives

Schizotypal personality disorder (SPD) is classified in DSM-V as a cluster A personality disorder. Cluster A personality disorders are described as odd or eccentric conditions. SPD is associated with significant disability and many psychiatric comorbidities. Several studies have shown that SPD and schizotypal traits are associated with suicidal ideation and behavior. Suicide prevention interventions in individuals with SPD are impeded because (1) SPD is frequently not diagnosed; (2) SPD is difficult to treat; and (3) there are no guidelines for suicide screening or suicide prevention interventions in individuals with SPD. Suicide prevention in persons with SPD consist of (1) diagnosing SPD; (2) providing appropriate treatment for SPD; and (3) providing suicide screening and suicide prevention. Interventions aiming at reduction of depressive symptoms, improvement of self-esteem and interpersonal skills may be effective at reducing suicide risk among individuals with SPD. Studies of suicidality in persons with SPD are needed and may be an important area of suicide research. It is to be hoped that future studies of the pathophysiology of suicidality in individuals with SPD will help to develop strategies for suicide screening and suicide prevention interventions in persons with SPD and improve suicide prevention in this challenging patient population.

Treatment of catatonia with asenapine in a patient with schizotypal personality disorder, psychotic depression and septic shock from SARS-CoV-2 - A case report.

Introduction: Catatonia is a psychomotor syndrome that presents with severe symptoms which can lead to dangerous and lethal conditions if not diagnosed and treated properly. SARS-CoV-2 is a positive-sense single-stranded RNA virus that can occur in severe cases with acute pneumonia, ARDS, sepsis and septic shock. In these cases, ICU admission is necessary. Case Summary: A 59-year-old Caucasian man with septic shock and bilateral interstitial pneumonia from SARS-CoV-2 and schizotypal personality disorder presented with catatonic behaviour manifested by soporous state, response to intense painful stimuli with opening of the eyes, execution of simple verbal commands, maintenance of the same position, catalepsy, immobility, rigidity and mutism. At the same time, there were symptoms of septic shock and catatonic symptoms causing greater difficulty in the correct formulation of the diagnosis. During the course of his hospitalization, he was treated with asenapine 20 mg/day. The catatonia responded rapidly and significantly to the asenapine. Discussion: To date, the pathophysiology of catatonia is unclear and few guidelines are available for the treatment of catatonia. In the literature, studies have reported the efficacy of benzodiazepines such as lorazepam and diazepam, GABAA agonists such as zolpidem, NMDA receptor antagonists such as memantine, antidepressant SSRIs such as fluoxetine and paroxetine and antipsychotics such as olanzapine, clozapine and aripiprazole. We demonstrate that the antipsychotic asenapine is also effective in treating catatonic symptoms in psychiatric disorders. Conclusion: Asenapine produced a rapid and significant reduction in catatonic symptoms in our patient with schizotypal personality disorder.

Computerized Adaptive Testing for Schizotypal Personality Disorder: Detecting Individuals at Risk

As schizotypal personality disorder (SPD) increasingly prevails in the general population, a rapid and comprehensive measurement instrument is imperative to screen individuals at risk for SPD. To address this issue, we aimed to develop a computerized adaptive testing for SPD (CAT-SPD) using a non-clinical Chinese sample (N = 999), consisting of a calibration sample (N1 = 497) and a validation sample (N2 = 502). The item pool of SPD was constructed from several widely used SPD scales and statistical analyses based on the item response theory (IRT) via a calibration sample using a graded response model (GRM). Finally, 90 items, which measured at least one symptom of diagnostic criteria of SPD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and had local independence, good item fit, high slope, and no differential item functioning (DIF), composed the final item pool for the CAT-SPD. In addition, a simulated CAT was conducted in an independent validation sample to assess the performance of the CAT-SPD. Results showed that the CAT-SPD not only had acceptable reliability, validity, and predictive utility but also had shorter but efficient assessment of SPD which can save significant time and reduce the test burden of individuals with less information loss.

Attenuated Resting-State Functional Anticorrelation between Attention and Executive Control Networks in Schizotypal Personality Disorder

Exploring the disruptions to intrinsic resting-state networks (RSNs) in schizophrenia-spectrum disorders yields a better understanding of the disease-specific pathophysiology. However, our knowledge of the neurobiological underpinnings of schizotypal personality disorders mostly relies on research on schizotypy or schizophrenia. This study aimed to investigate the RSN abnormalities of schizotypal personality disorder (SPD) and their clinical implications. Using resting-state data, the intra- and inter-network of the higher-order functional networks (default mode network, DMN; frontoparietal network, FPN; dorsal attention network, DAN; salience network, SN) were explored in 22 medication-free, community-dwelling, non-help seeking individuals diagnosed with SPD and 30 control individuals. Consequently, while there were no group differences in intra-network functional connectivity across DMN, FPN, DAN, and SN, the SPD participants exhibited attenuated anticorrelation between the right frontal eye field region of the DAN and the right posterior parietal cortex region of the FPN. The decreases in anticorrelation were correlated with increased cognitive–perceptual deficits and disorganization factors of the schizotypal personality questionnaire, as well as reduced independence–performance of the social functioning scale for all participants together. This study, which links SPD pathology and social functioning deficits, is the first evidence of impaired large-scale intrinsic brain networks in SPD.

ON THE ISSUE OF SPATIAL PERCEPTION IN ADOLESCENTS WITH SCHIZOTYPAL PERSONALITY DISORDER: NEUROPSYCHOLOGICAL ANALYSIS

Отклонения от нормативного созревания мозга в подростковом возрасте связанные с нейрокогнитивным дизонтогенезом, порождаемым психическими нарушениями, могут приводить к нарушениям формирования пространственного фактора. Выявлены особенности зрительно-пространственного и квази-пространственного восприятия у подростков с шизотипическим расстройством личности (F21). Disorders of the spatial organization of mental activity are observed in neurocognitive dysontogenesis associated with mental disorders. The features of visual-spatial and quasi-spatial perception in adolescents with schizotypal personality disorder (F21) were revealed.

Neural Correlates of Schizotypal Personality Disorder: a Systematic Review of Neuroimaging and EEG Studies

Background: : Schizotypal personality disorder (SPD) is a cluster A personality disorder affecting 1.0% of general population, characterised by disturbances in cognition and reality testing dimensions, affect regulation, and interpersonal function. SPD shares similar but attenuated phenomenological, genetic, and neurobiological abnormalities with schizophrenia (SCZ) and is described as part of schizophrenia spectrum disorders. Objective: Aim of this work was to identify the major neural correlates of SPD. Methods: This is a systematic review conducted according to PRISMA statement. The protocol was prospectively registered in PROSPERO - International prospective register of systematic reviews. The review was performed to summarise the most comprehensive and updated evidence on functional neuroimaging and neurophysiology findings obtained through different techniques (DW-MRI, DTI, PET, SPECT, fMRI, MRS, EEG) in individuals with SPD. Results: Of the 52 studies included in this review, 9 were on DW-MRI and DTI, 11 were on PET and SPECT, 11 were on fMRI and MRS, and 21 were on EEG. It was complex to synthesise all the functional abnormalities found into a single, unified, pathogenetic pathway, but a common theme emerged: the dysfunction of brain circuits including striatal, frontal, temporal, limbic regions (and their networks) together with a dysregulation along the dopaminergic pathways. Conclusion: Brain abnormalities in SPD are similar, but less marked, than those found in SCZ. Furthermore, different patterns of functional abnormalities in SPD and SCZ have been found, confirming the previous literature on the ‘presence’ of possible compensatory factors, protecting individuals with SPD from frank psychosis and providing diagnostic specificity.