Lecture 16: SZ spectrum personality disorders

Question 1

SZ spectrum personality disorders are:

Answer 1

• A rigid pattern of thought, emotion and behaviour that affects all aspects of life
• Results in unstable, limited or dysfunctional relationships
• Impacts social, work and other life goals
• Insight is usually poor
• People do not change their behaviour, despite poor outcomes
• Appears in adolescence or young adulthood

Question 2

Schizotypal would be associate with which analogy? And describe its relationship to SZ.

Answer 2

• (believer in crystals and auras)
• Closest to SZ: both positive and negative spectrum symptoms
• Seen in family members of those with SZ
• May be to be a precursor to SZ, especially those at risk

Question 3

Paranoid

Answer 3

• (cult leader)

- More functional than schizotypal

Question 4

Schizoid is associated with which analogy? And is more functional than which SZ PD

Answer 4

• (junk shop owner)

- More functional than schizotypal

Question 5

What is the personality disorder closest to SZ?

Answer 5

Schizotypal

Question 6

What personality disorder may be the May be to be a precursor to SZ?

Answer 6

Schizotypal

** especially those at risk***

Question 7

What personality disorder would be be associated with believing in crystals and auras?

Answer 7

Schizotypal

Question 8

What personality disorder would be associated with a cult leader?

Answer 8

Paranoid

Question 9

What personality disorder would be associated with a junk shop owner?

Answer 9

Schizoid

Question 10

What are the two personality disorders which are more functional than Schizotypal?

Answer 10

Paranoid (cult leader) and Schizoid (junk shop owner)

Question 11

What are the two things which are important to remember about SZ spectrum personality disorders?

Answer 11

• Significant overlap in the diagnoses of these disorders

- May indicate risk for developing SZ

Question 12

What are the diagnostic criteria for paranoid personality disorder

Answer 12

• Pervasive distrust and suspiciousness of others
• Four (or more) of the following:
  1) Groundless suspicions that others are exploiting, harming, or deceiving
  2) Unjustified doubts about the trustworthiness of friends or family
  3) Reluctant to confide in others because of unwarranted fear that the information will be used against them
  4) Reads hidden negative meanings into benign remarks or events
  5) Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
  6) Perceives attacks that are not apparent to others and is quick to react angrily or to counterattack
  7) Has recurrent unjustified suspicions about the fidelity of a spouse or partner

Question 13

What are the Differential diagnosis for paranoid personality disorder?

Answer 13

SZ or other psychotic disorder, drug abuse, PTSD, Bipolar (manic phase), Borderline, dementia

Question 14

What is the prevalence for paranoid personality disorder?

Answer 14

2-4%

Question 15

What is the common co-morbid diagnosis with paranoid personality disorder?

Answer 15

alcohol and substance abuse

Question 16

What are the diagnostic criteria for schizoid personality disorder?

Answer 16

• Restricted relationships and range of emotions
• At least four of the following:
  1) Does not desire or enjoys close relationships, including family (loner)
  2) Almost always chooses solitary activities.
  3) Has little or no interest in sexual experiences with another person
  4) Takes pleasure in few activities
  5) Lacks close friends or confidants other than first-degree relatives
  6) Appears indifferent to the praise or criticism of others
  7) Shows emotional coldness, detachment, or flattened affect

Question 17

What are the differential diagnosis for schizoid personality disorders?

Answer 17

SZ, depression with psychotic features, autism spectrum disorder

Question 18

What is the prevalence of schizoid personality disorder in the population?

Answer 18

3-5% of the population

Question 19

Schizoid personality disorder is occasionally co-morbid with _______

Answer 19

depression

Question 20

What are the diagnostic criteria for Schizotypal personality disorders

Answer 20

• Social and interpersonal deficits; cognitive or perceptual distortions, odd behaviors, beliefs

At least five of the following:

1) Ideas of reference (not true delusions)
2) Odd beliefs or magical thinking that are inconsistent with cultural norms (e.g., belief in ghosts, telepathy, UFOs; bizarre fantasies or preoccupations)
3) Unusual perceptual experiences, including bodily illusions.
4) Odd thinking and speech (e.g., vague, circumstantial, overelaborate, or stereotyped)
5) Suspiciousness or paranoia
6) Inappropriate or constricted affect
7) Behavior or appearance that is odd, eccentric, or peculiar
8) Lack of close friends or confidants other than first-degree relatives
9) Excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self

Question 21

SZ-spectrum Personality Disorders can be a precursor to SZ but also they are ___________

Answer 21

• More common in family members of people with SZ

- Especially schizotypal PD

Question 22

SZ-spectrum PDs may have similar __________

Answer 22

genetic and environmental risk factors

Question 23

Are SZ-spectrum PDs are stable across the lifespan?

Answer 23

True SZ-spectrum PDs are stable across the lifespan

Question 24

Discuss the outcome of SZ-spectrum PDs

Answer 24

• Less commonly hospitalized, prescribed anti-psychotics

Question 25

SZ spectrum PDs (especially schizotypal) more common in _____________________

Answer 25

the off-spring of people with SZ

Question 26

People with Schizotypal PD more often have _____

Answer 26

children with SZ

Question 27

What types of Sz-personality disorders PD less common in families of SZ?

Answer 27

Paranoid and Schizoid

Question 28

Some of the same genes associated with SZ are associated with ____________

Answer 28

SZ-PD (shizotypical PD)

Question 29

What are shared environmental factors which increases the risk in both Schizotypal and SZ?

Answer 29

prenatal stress (including maternal illness),
birth complications,
trauma,
chronic stress

Question 30

For Schizotypal, many of the same cognitive deficits seen in SZ, what are those deficits?

Answer 30

• frontal lobe
• working memory,
  attention and planning deficits
  (memory & executive function)

Question 31

Similarly to SZ, Schizotypal shows poor performance on which task?

Answer 31

• Wisconsin card sorting,
• verbal fluency,
• continuous performance task
• and theory of mind

Question 32

For Schizotypal, many of the same frontal lobe working memory, attention and planning deficits seen in SZ, This may be linked to ___________

Answer 32

dysregulation of frontal DA systems similar to that seen in SZ

Question 33

Temporal and frontal changes (Hazlett, 2008) study
Methodology:
- Looking at structural brain changes in Schizotypical personality disorder (SZ-PD)
- they look at grey/white matter volumes in frontal lobe and temporal lobe

What were the results?

Answer 33

• SZ-PD patients have reduced grey matter in the temporal, but smaller reductions in the frontal lobes
• Which means that for the temporal lobe the changes were significant but not for the frontal lobe in schizotypical personality disorder.

Question 34

Discuss the association of the temporal lobe volume with psychotic symptoms (results of the Goldstein, 2009 study) in schizotypal PD. [include the comparison to what we previously discussed in SZ in your explanation].

Answer 34

• Smaller grey matter volumes related to greater symptom severity:
• In our discussion of SZ, we know that disruptions the temporal lobe and the dopamine circuits to the temporal lobe are related to positive (psychotic) symptoms in SZ.
• In schizotypal PD, those odds beliefs are related to the volume of the temporal lobe. Higher scores in the severity index are related to the smaller grey matter volumes in the temporal lobes.

Question 35

Discuss the Spatial memory (Goldstein et al, 2011) study.
They were showed an image with squares, they had to find the blue square.
Hint: They looked at the spatial memory and executive deficits in people with SZ-PD and compared it with people with bipolar disorder.

Answer 35

• Compared people with SZ-PD to people with bipolar disorder
• People with bipolar and controls performed relatively similarly.
• There a response selection and inhibition component.
• SZ-PD made relatively more errors
• They looked at the volume of area 44 of the frontal lobe region
• Poor performance (higher # of errors) was related to smaller volumes of 44 frontal lobe region.
• There are exc. func. deficits in people with SZ-PD

Question 36

What are the diagnostic criteria for Paranoid Personality Disorder (DSM-5)

Answer 36

1. A pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
2. Suspects, without sufficient basis, that others are exploiting, harming, or deceiving him or her.
3. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates.
4. Is reluctant to confide in others because of unwarranted fear that the information will be used maliciously against him or her.
5. Reads hidden demeaning or threatening meanings into benign remarks or events.
6. Persistently bears grudges (i.e., is unforgiving of insults, injuries, or slights).
7. Perceives attacks on his or her character or reputation that are not apparent to others and is quick to react angrily or to counterattack.
8. Has recurrent suspicions, without justification, regarding fidelity of spouse or
   sexual partner.
9. Does not occur exclusively during the course of schizophrenia, a bipolar disorder or
   depressive disorder with psychotic features, or another psychotic disorder and is not attributable to the physiological effects of another medical condition.

Question 37

What is the diagnostic criteria for Schizoid Personality Disorder (DSM-5)

Answer 37

1. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
2. Neither desires nor enjoys close relationships, including being part of a family.
3. Almost always chooses solitary activities.
4. Has little, if any, interest in having sexual experiences with another person.
5. Takes pleasure in few, if any, activities.
6. Lacks close friends or confidants other than first-degree relatives.
7. Appears indifferent to the praise or criticism of others.
8. Shows emotional coldness, detachment, or flattened affectivity.
9. 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 and is not attributable to the physiological effects of another medical condition.

Question 38

What are the diagnostic criteria for Schizotypal Personality Disorder?

Answer 38

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:
2. Ideas of reference (excluding delusions of reference).
3. 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).
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.
11. 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.

Question 39

Which of the following presentations is characteristic of schizotypal personal- ity disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
B.Apattern of acute discomfort in close relationships,cognitive or perceptual distortions, and eccentricities of behavior.
C. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.
D. A pattern of instability in interpersonal relationships, self-image, and af- fects, and marked impulsivity.
E. Apatternofgrandiosity,needforadmiration,andlackofempathy.

Answer 39

Correct Answer: B.

A pattern of acute discomfort in close relationships, cog- nitive or perceptual distortions, and eccentricities of behavior.
Explanation: The essential feature of schizotypal personality disorder is a per- vasive 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. This pattern begins by early adulthood and is present in a variety of contexts.

Question 40

Which of the following presentations is characteristic of paranoid personality disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
B. A pattern of distrust and suspiciousness such that others’ motives are inter- preted as malevolent.
C. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.
D. A pattern of instability in interpersonal relationships, self-image, and af- fects, and marked impulsivity.
E. Apatternofgrandiosity,need for admiration, and lack of empathy.

Answer 40

Correct Answer: B. A pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.

Explanation: The essential feature of paranoid personality disorder is a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This pattern begins by early adulthood and is pres- ent in a variety of contexts. Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to sup- port this expectation.

Question 41

18.6 A cardiologist requests a psychiatric consultation for her patient, a 46-year-old man, because even though he is adherent to treatment, she is concerned that he “seems crazy.” On evaluation, the patient makes poor eye contact, tends to ramble, and makes unusual word choices. He is modestly disheveled and wears clothes with mismatched colors. He expresses odd beliefs about super- natural phenomena, but these beliefs do not seem to be of delusional intensity. Collateral information from his sister elicits the observation that “He’s always been like this—weird. He keeps to himself, and likes it that way.”

Which of the following conditions best explains this man’s odd behaviors and beliefs?

A. Schizoid personality disorder.
B. Schizotypal personality disorder. C. Paranoid personality disorder. D. Delusional disorder.
E. Schizophrenia.

Answer 41

Correct Answer: B. Schizotypal personality disorder.

Explanation: Schizotypal personality disorder is characterized by pervasive social and interpersonal deficits, which include odd behaviors, odd beliefs and speech, and social withdrawal. The odd beliefs may include ideas of reference or even paranoid ideation, but true delusions and hallucinations are not pres- ent. Individuals with schizoid personality disorder or paranoid personality disorder may also be loners, and either of these disorders may coexist with schizotypal personality disorder. However, neither of those disorders is char- acterized by marked oddness or eccentricity.

Question 42

18.10 A 43-year-old warehouse security guard comes to your office complaining of vague feelings of depression for the last few months. He denies any particular sense of fear or anxiety. As he gets older, he wonders if he should try harder to form relationships with other people. He feels little desire for this but notes that his coworkers seem happier than he, and they have many relationships. He has never felt comfortable with other people, not even with his own family. He has lived alone since early adulthood and has been self-sufficient. He al- most always works night shifts to avoid interactions with others. He tries to re- main low-key and undistinguished to discourage others from striking up conversations with him, as he does not understand what they want when they talk to him.

Which personality disorder would best fit with this presentation?

A. Paranoid. 
B. Schizoid.
C. Schizotypal. 
D. Avoidant. 
E. Dependent.

Answer 42

Correct Answer: B. Schizoid.

Explanation: His avoidance of others is not based on fears of being exploited, deceived, or harmed, as in paranoid personality disorder, nor is it based on a fear of being found inadequate, as might be seen in avoidant personality dis- order. There is no mention of odd or eccentric behavior, and he even makes a deliberate effort not to appear unusual in any way. Individuals with dependent personality disorder often feel uncomfortable or helpless when alone, and con- stantly seek out nurturance and support from others.

Question 43

18.11 Which of the following behaviors or states would be highly unusual in an in- dividual with schizoid personality disorder?

A. An angry outburst at a colleague who criticizes his work.
B. Turning down an invitation to a party.
C. Lacking desire for sexual experiences.
D. Drifting with regard to life goals.
E.Difficulty working in a collaborative work environment.

Answer 43

Correct Answer: A. An angry outburst at a colleague who criticizes his work.

Explanation: One of the hallmarks of schizoid personality disorder is the re- duced expression of emotion in interpersonal settings, often making them ap- pear indifferent to criticism from others. It is also typical of individuals with schizoid personality disorder to choose solitary experiences and avoid social events. They may have difficulty in collaborative work environments because of their lack of social skills, but can thrive in jobs with considerable social iso- lation, like a nighttime warehouse security guard.

Question 44

Which of the following is one of the general criteria for a personality disorder in DSM-5?

A. An enduring pattern of inner experience that deviates markedly from the expectations of the individual’s culture.
B. The pattern is flexible and confined to a single personal or social situation.
C. The pattern is fluctuating and of short duration.
D. The pattern leads to occasional mild distress.
E. The pattern’s onset can be traced to a specific traumatic event in the indi-
vidual’s recent history.

Answer 44

Correct Answer: A. An enduring pattern of inner experience that deviates markedly from the expectations of the individual’s culture.

Explanation: A personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adult- hood, is stable over time, and leads to distress or impairment.

Question 45

18.19 Which of the following presentations is characteristic of schizotypal personality disorder?
A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
B. A pattern of acute discomfort in close relationships, cognitive or perceptual distortions, and eccentricities of behavior.
C. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.
D. A pattern of instability in interpersonal relationships, self-image, and af- fects, and marked impulsivity.
E. A pattern of grandiosity, need for admiration, and lack of empathy.

Answer 45

Correct Answer: B. A pattern of acute discomfort in close relationships, cog- nitive or perceptual distortions, and eccentricities of behavior.

Explanation: The essential feature of schizotypal personality disorder is a per- vasive 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. This pattern begins by early adulthood and is present in a variety of contexts.

Question 46

18.20 Which of the following presentations is characteristic of paranoid personality disorder?

A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
B. A pattern of distrust and suspiciousness such that others’motives are inter- preted as malevolent.
C. A pattern of submissive and clinging behavior related to an excessive need to be taken care of.
D. A pattern of instability in interpersonal relationships, self-image, and af- fects, and marked impulsivity.
E. A pattern of grandiosity, need for admiration, and lack of empathy.

Answer 46

Correct Answer: B. A pattern of distrust and suspiciousness such that others’ motives are interpreted as malevolent.

Explanation: The essential feature of paranoid personality disorder is a pattern of pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent. This pattern begins by early adulthood and is pres- ent in a variety of contexts. Individuals with this disorder assume that other people will exploit, harm, or deceive them, even if no evidence exists to sup- port this expectation.

Question 47

18.22 Which of the following presentations is characteristic of schizoid personality disorder?
A. A pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation.
B. A pattern of acute discomfort in close relationships,cognitive or perceptual distortions, and eccentricities of behavior.
C. A pattern of detachment from social relationships and a restricted range of emotional expression.
D. A pattern of instability in interpersonal relationships, self-image, and af- fects, and marked impulsivity.
E. A pattern of grandiosity, need for admiration, and lack of empathy.

Answer 47

Correct Answer: C. A pattern of detachment from social relationships and a restricted range of emotional expression.

Explanation: The essential feature of schizoid personality disorder is a perva- sive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. This pattern begins by early adulthood and is present in a variety of contexts. Individuals with schizoid personality disorder appear to lack a desire for intimacy, seem indifferent to opportunities to develop close relationships, and do not seem to derive much satisfaction from being part of a family or other social group.