Pharmacotherapy

The closer the clinical picture resembles “pure” schizoid personality, the less the likelihood there will be any target symptoms responsive to medication. Schizotypal patients, in contrast, may present with considerable levels of anxiety and may benefit from small doses of anxiolytics. Schizotypal patients with illusions, ideas of reference, and proneness to psychotic ideation have been noted to respond favorably to antipsychotics such as thiothixene, usually in lower doses than required in ambulatory schizophrenic patients. This is in line with the observation of Coccaro that schizotypal patients with prominent cognitive/perceptual distortions may respond favorably to antipsychotic medications. In a study by Hymowitz et al., half of schizotypal outpatients responded to low-dose haloperidol (2-12 mg/day), especially on measures of ideas of reference and odd communication. Patients with marked paranoid traits may react negatively to sedation, however, because of the lowering of their alertness to imagined dangers. Better-functioning schizotypal patients who display some oddities of speech but who are not prone to brief psychotic episodes may not require medication at any phase of their treatment. Within the last few years, use of “atypical” antipsychotics (risperidone, olanzapine, quetiapine) at small dosages has proven beneficial.

General Issues
Clinicians will encounter certain tendencies and symptom patterns with particular frequency among schizoid and schizotypal patients. These factors need attention, irrespective of the therapist’s main orientation. Some alluded to here, such as anhedonia, concreteness of thought, and the need for education about the world, are pertinent to both schizoid and schizotypal patients. Problems such as a sense of discontinuity of time, ego-boundary confusion, and misinterpretation of the psychological field are more likely with schizotypal patients. The latter are also more apt to show hypochondriasis or exhibitionism.

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Revision date: June 22, 2011
Last revised: by Andrew G. Epstein, M.D.