Schizotypal personality disorder: Difference between revisions
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==Background== | ==Background== | ||
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 | *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 | ||
==Clinical Features== | ==Clinical Features== | ||
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**Lack of close friends or confidants other than first-degree relatives. | **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. | **Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self. | ||
*Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder | *Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Psychiatric Disorders with Psychotic Symptoms DDX}} | |||
*Neurodevelopmental disorders | |||
*Personality change due to another medical condition | ===Other=== | ||
*Substance use disorders | *Neurodevelopmental disorders | ||
*Other personality disorders and personality traits | *Personality change due to another medical condition | ||
*Substance use disorders | |||
*Other personality disorders and personality traits | |||
==Evaluation== | ==Evaluation== | ||
A clinical diagnosis; however if entertaining other organic causes may initiate workup below | *A clinical diagnosis; however if entertaining other organic causes may initiate workup below | ||
{{General ED Psychiatric Workup}} | {{General ED Psychiatric Workup}} | ||
==Management== | ==Management== | ||
Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, and | *Ask for clarification of any unclear terminology, be genuinely curious | ||
*Know patient may underreport symptoms due to desire to end social interaction with you | |||
*Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, and antipsychotics medications | |||
==Disposition== | ==Disposition== | ||
*Discharge | |||
==See Also== | ==See Also== | ||
*[[Personality disorders]] | |||
==External Links== | ==External Links== | ||
==References== | ==References== | ||
Latest revision as of 22:30, 20 August 2019
Background
- 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
Clinical Features
- Five (or more) of the following criteria, beginning in early adulthood and present in a variety of contexts:[1]
- Ideas of reference (excluding delusions of reference).
- Odd beliefs or magical thinking that influences behavior 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.
- Odd thinking and speech (e.g., vague, circumstantial, metaphorical, overelaborate, or stereotyped).
- Suspiciousness or paranoid ideation.
- Inappropriate or constricted affect.
- Behavior 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.
- Does not occur exclusively during the course of schizophrenia, a bipolar disorder or depressive disorder with psychotic features, another psychotic disorder, or autism spectrum disorder
Differential Diagnosis
Psychiatric Disorders with Psychotic Symptoms
- Acute psychosis
- Schizophrenia
- Schizoaffective disorder
- Delusional disorder
- Schizotypal personality disorder
- Schizoid personality disorder
- Bipolar disorder with psychotic features
Other
- Neurodevelopmental disorders
- Personality change due to another medical condition
- Substance use disorders
- Other personality disorders and personality traits
Evaluation
- A clinical diagnosis; however if entertaining other organic causes may initiate workup below
General ED Psychiatric Workup
- Point-of-care glucose
- CBC
- Chem 7
- LFTs
- ECG (for toxicology evaluation)
- ASA level
- Tylenol level
- Urine toxicology screen/Blood toxicology screen
- EtOH
- Urine pregnancy/beta-hCG (if female of childbearing age)
- Consider:
- Ammonia (see Hepatic encephalopathy)
- TSH (hypo or hyperthyroidism may mimic mental illness)
- CXR (for Tb screen or rule-out delirium in older patient)
- UA (for rule-out delirium in older patients)
- Head CT (to rule-out ICH in patients with AMS)
- Lumbar puncture (to rule-out meningitis or encephalitis)
Management
- Ask for clarification of any unclear terminology, be genuinely curious
- Know patient may underreport symptoms due to desire to end social interaction with you
- Referral for outpatient psychiatric treatment, which can include psychotherapy, antidepressants, and antipsychotics medications
Disposition
- Discharge
See Also
External Links
References
- ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.