Skip to main content

Advertisement

Log in

How does studying schizotypal personality disorder inform us about the prodrome of schizophrenia?

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

An increasing emphasis in the schizophrenia literature has been on the prodromal phase of the illness. The study of schizophrenia spectrum illness, including schizotypal personality disorder, has added important insight into the etiology, neuropathology, and treatment of schizophrenia, which can facilitate early identification, intervention, and perhaps prevention of the illness. The heterogeneity of the schizophrenia spectrum makes its definition elusive at best. The primary aim of the Cognitive Assessment and Risk Evaluation Program at the authors’ institution is to combine the current knowledge of clinical and demographic risk factors for schizophrenia with the rapidly emerging data on vulnerability markers, or endophenotypes, that are associated with schizophrenia. The use of brain-based vulnerability markers may help to identify neurobiologically and clinically meaningful subgroups within this heterogeneous population of individuals in the early stages of schizophrenia. Another important aim of the Cognitive Assessment and Risk Evaluation program is to thoroughly assess those individuals who have not converted to psychosis to understand potential protective factors, reduce the rate of false positives, and decrease disability. The current review details a strategy for researching the schizophrenia prodrome by using information gained from research in schizotypal personality disorder.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Meehl PE: Schizotaxia, schizotypy, schizophrenia. Am Psychol 1962, 17:827–838.

    Article  Google Scholar 

  2. Tsuang MT, Stone WS, Tarbox SI, et al.: An integration of schizophrenia with schizotypy: identification of schizotaxia and implications for research on treatment and prevention. Schizophr Res 2002, 54:169–175.

    Article  PubMed  Google Scholar 

  3. Fanous AH, Kendler KS: The genetic relationship of personality to major depression and schizophrenia. Neurotox Res 2004, 6:43–50.

    Article  PubMed  Google Scholar 

  4. Yung AR, Phillips LJ, Yuen HP, McGorry PD: Risk factors for psychosis in an ultra high-risk group: psychopathology and clinical features. Schizophr Res 2004, 67:131–142. This article identifies factors that may predict transition to psychosis within a prodromal sample and discusses prevention and treatment strategies.

    Article  PubMed  Google Scholar 

  5. Mason O, Startup M, Halpin S, et al.: Risk factors for transition to first episode psychosis among individuals with ‘at-risk mental states’. Schizophr Res 2004, 71:227–237.

    Article  PubMed  Google Scholar 

  6. Cadenhead KS: Vulnerability markers in the schizophrenia spectrum: implications for phenomenology, genetics, and the identification of the schizophrenia prodrome. Psychiatr Clin North Am 2002, 25:837–853.

    Article  PubMed  Google Scholar 

  7. Cornblatt BA: The New York high risk project to the Hillside recognition and prevention (RAP) program. Am J Med Genet 2002, 114:956–966.

    Article  PubMed  Google Scholar 

  8. Hafner H, Maurer K, Ruhrmann S, et al.: Early detection and secondary prevention of psychosis: facts and visions. Eur Arch Psychiatry Clin Neurosci 2004, 254:117–128.

    Article  PubMed  Google Scholar 

  9. Klosterkotter J, Hellmich M, Steinmeyer EM, Schultze-Lutter F: Diagnosing schizophrenia in the initial prodromal phase. Arch Gen Psychiatry 2001, 58:158–164.

    Article  PubMed  CAS  Google Scholar 

  10. Miller TJ, McGlashan TH, Rosen JL, et al.: Prodromal assessment with the structured interview for prodromal syndromes and the scale of prodromal symptoms: predictive validity, interrater reliability, and training to reliability. Schizophr Bull 2003, 29:703–715.

    PubMed  Google Scholar 

  11. Myles-Worsley M, Ord L, et al.: P50 sensory gating in adolescents from a pacific island isolate with elevated risk for schizophrenia. Biol Psychiatry 2004, 55:663–667.

    Article  PubMed  Google Scholar 

  12. Miller TJ, McGlashan TH, Rosen JL, et al.: Prospective diagnosis of the initial prodrome for schizophrenia based on the Structured Interview for Prodromal Syndromes: preliminary evidence of interrater reliability and predictive validity. Am J Psychiatry 2002, 159:863–865.

    Article  PubMed  Google Scholar 

  13. Cornblatt B, Lencz T, Obuchowski M: The schizophrenia prodrome: treatment and high-risk perspectives. Schizophr Res 2002, 54:177–186.

    Article  PubMed  Google Scholar 

  14. McGorry PD, Yung AR, Phillips AJ, et al.: Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with subthreshold symptoms. Arch Gen Psychiatry 2002, 59:921–928.

    Article  PubMed  Google Scholar 

  15. Gleeson J, Larsen TK, McGorry P: Psychological treatment in pre- and early psychosis. J Am Acad Psychoanal Dyn Psychiatry 2003, 31:229–245.

    Article  PubMed  Google Scholar 

  16. Phillips LJ, Yung AR, Yuen HP, et al.: Prediction and prevention of transition to psychosis in young people at incipient risk for schizophrenia. Am J Med Genet 2002, 114:929–937.

    Article  PubMed  Google Scholar 

  17. Woods SW, Breier A, Zipursky RB, et al.: Randomized trial of olanzapine versus placebo in the symptomatic acute treatment of the schizophrenic prodrome. Biol Psychiatry 2003, 54:453–464.

    Article  PubMed  CAS  Google Scholar 

  18. Cornblatt BA, Lencz T, Kane JM: Treatment of the schizophrenia prodrome: is it presently ethical? Schizophr Res 2001, 51:31–38.

    Article  PubMed  CAS  Google Scholar 

  19. Larsen TK, Friis S, Haahr U, et al.: Early detection and intervention in first-episode schizophrenia: a critical review. Acta Psychiatr Scand 2001, 103:323–334.

    Article  PubMed  CAS  Google Scholar 

  20. McGorry PD, Yung A, Phillips L: Ethics and early intervention in psychosis: keeping up the pace and staying in step. Schizophr Res 2001, 51:17–29.

    Article  PubMed  CAS  Google Scholar 

  21. Perkins DO: Evaluating and treating the prodromal stage of schizophrenia. Curr Psychiatry Rep 2004, 6:289–295.

    Article  PubMed  Google Scholar 

  22. Cadenhead KS, Light GA, Guyer MA, et al.: Neurobiological measures of schizotypal personality disorder: defining an inhibitory endophenotype? Am J Psychiatry 2002, 159:869–871.

    Article  PubMed  Google Scholar 

  23. Lencz T, Smith CW, Auther A, et al.: Nonspecific and attenuated negative symptoms in patients at clinical high-risk for schizophrenia. Schizophr Res 2004, 68:37–48.

    Article  PubMed  Google Scholar 

  24. Weiser M, Reichenberg A, Rabinowitz J, et al.: Association between nonpsychotic psychiatric diagnoses in adolescent males and subsequent onset of schizophrenia. Arch Gen Psychiatry 2001, 58:959–964.

    Article  PubMed  CAS  Google Scholar 

  25. Fanous A, Gardner C, Walsh D, Kendler KS: Relationship between positive and negative symptoms of schizophrenia and schizotypal symptoms in nonpsychotic relatives. Arch Gen Psychiatry 2001, 58:669–673.

    Article  PubMed  CAS  Google Scholar 

  26. Cardno AG, Thomas K, McGuffin P: Clinical variables and genetic loading for schizophrenia: analysis of published Danish adoption study data. Schizophr Bull 2002, 28:393–399.

    PubMed  Google Scholar 

  27. Siever LJ, Davis KL: The pathophysiology of schizophrenia disorders: perspectives from the spectrum. Am J Psychiatry 2004, 161:398–413.

    Article  PubMed  Google Scholar 

  28. Yung A, Phillips L, et al.: Comprehensive Assessment of At Risk Mental States (CAARMS). Melbourne, Australia. The PACE Clinic, University of Melbourne, Department of Psychiatry, January 2002.

    Google Scholar 

  29. Thaker GK: Defining the schizophrenia phenotype. Curr Psychiatry Rep 2000, 2:398–403.

    Article  PubMed  CAS  Google Scholar 

  30. Niznikiewicz MA, Friedman M, Shenton ME, et al.: Processing sentence context in women with schizotypal personality disorder: an ERP study. Psychophysiology 2004, 41:367–371.

    Article  PubMed  Google Scholar 

  31. Avila MT, Adami HM, McMahon RP, Thaker GK: Using neurophysiological markers of genetic risk to define the boundaries of the schizophrenia spectrum phenotype. Schizophr Bull 2003, 29:299–309. The authors examine eye tracking deficits within schizophrenia spectrum patients and their relatives to validate the use of reduced criteria in the identification of high-risk subjects.

    PubMed  Google Scholar 

  32. Heaton RK, Grant I, et al.: Demographic Influences on Neuropsychological Test Performance. In Neuropsychological Assessment of Neuropsychiatric Disorders, 2nd Edition. Edited by Grant I, Adams K. New York: Grune & Stratton; 1996.

    Google Scholar 

  33. Trestman RL, Keefe RSE, et al.: Cognitive function and biological correlates of cognitive performance in schizotypal personality disorder. Psychiatry Research 1995, 59:127–136.

    Article  PubMed  CAS  Google Scholar 

  34. Goldberg TE, Torrey EF, Gold JM, et al.: Genetic risk of neuropsychological impairment in schizophrenia: A study of monozygotic twins discordant and concordant for the disorder. Schizophr Res 1995, 17:77–84.

    Article  PubMed  CAS  Google Scholar 

  35. Cornblatt B, Obuchowski M: Update of high-risk research: 1987–1997. Int Rev Psychiatry 1997, 9:437–447.

    Article  Google Scholar 

  36. Hambrecht M, Lammertink M, Klosterkotter J, et al.: Subjective and objective neuropsychological abnormalities in a psychosis prodrome clinic. Br J Psychiatry Suppl 2002, 43:s30–37.

    Article  PubMed  Google Scholar 

  37. Hawkins KA, Addington J, Keefe RS, et al.: Neuropsychological status of subjects at high risk for a first episode of psychosis. Schizophr Res 2004, 67:115–122.

    Article  PubMed  CAS  Google Scholar 

  38. Green MF, Kern RS, Braff DL, Mintz J: Neurocognitive deficits and functional outcome in schizophrenia: are we measuring the "right stuff"? Schizophr Bull 2000, 26:119–136.

    PubMed  CAS  Google Scholar 

  39. Moriarty PJ, Harvey PD, Mitropoulou V, et al.: Reduced processing resource availability in schizotypal personality disorder: evidence from a dual-task CPT study. J Clin Exp Neuropsychol 2003, 25:335–347.

    Article  PubMed  Google Scholar 

  40. Wood SJ, Pantelis C, Proffitt T, et al.: Spatial working memory ability is a marker of risk-for-psychosis. Psychol Med 2003, 33:1239–1247.

    Article  PubMed  CAS  Google Scholar 

  41. Chapman LJ, Chapman JP, Raulin ML: Body-image aberration in schizophrenia. J Abnorm Psychol 1978, 87:399–407.

    Article  PubMed  CAS  Google Scholar 

  42. Matsui M, Sumiyoshi T, Kato K, Yoneyama E, et al.: Neuropsychological profile in patients with schizotypal personality disorder or schizophrenia. Psychol Rep 2004, 94:387–397.

    Article  PubMed  Google Scholar 

  43. Levitt JJ, Westin CF, Nestor PG, et al.: Shape of caudate nucleus and its cognitive correlates in neuroleptic-naive schizotypal personality disorder. Biol Psychiatry 2004, 55:177–184.

    Article  PubMed  Google Scholar 

  44. Weiser M, Noy S, Kaplan Z, et al.: Generalized cognitive impairment in male adolescents with schizotypal personality disorder. Am J Med Genet 2003, 116B:36–40. This article compares deficits within SPD and schizophrenia patient populations and characterizes generalized cognitive impairment with schizotypal symptoms, and without psychosis, as the central components of schizotaxia.

    Article  CAS  PubMed  Google Scholar 

  45. Ang YG, Tan HY: Academic deterioration prior to first episode schizophrenia in young Singaporean males. Psychiatry Res 2004, 121:303–307.

    Article  PubMed  Google Scholar 

  46. Shihabuddin L, Buchsbaum MS, Hazlett EA, et al.: Striatal size and relative glucose metabolic rate in schizotypal personality disorder and schizophrenia. Arch Gen Psychiatry 2001, 58:877–884.

    Article  PubMed  CAS  Google Scholar 

  47. Abi-Dargham A, Kegeles LS, Zea-Ponce Y, et al.: Striatal amphetamine-induced dopamine release in patients with schizotypal personality disorder studied with single photon emission computed tomography and [123I]iodobenzamide. Biol Psychiatry 2004, 55:1001–1006.

    Article  PubMed  CAS  Google Scholar 

  48. Laruelle M, Slifstein M, Huang Y: Positron emission tomography: imaging and quantification of neurotransporter availability. Methods 2002, 27:287–299.

    Article  PubMed  CAS  Google Scholar 

  49. Mitropoulou V, Goodman M, Sevy S, et al.: Effects of acute metabolic stress on the dopaminergic and pituitary-adrenal axis activity in patients with schizotypal personality disorder. Schizophr Res 2004, 70:27–31.

    Article  PubMed  Google Scholar 

  50. Dickey CC, McCarley RW, Voglmaier MM, et al.: A MRI study of fusiform gyrus in schizotypal personality disorder. Schizophr Res 2003, 64:35–39.

    Article  PubMed  Google Scholar 

  51. Job DE, Whalley HC, McConnell S, et al.: Voxel-based morphometry of grey matter densities in subjects at high risk of schizophrenia. Schizophr Res 2003, 64:1–13.

    Article  PubMed  Google Scholar 

  52. Seidman LJ, Pantelis C, Keshavan MS, et al.: A review and new report of medial temporal lobe dysfunction as a vulnerability indicator for schizophrenia: a magnetic resonance imaging morphometric family study of the parahippocampal gyrus. Schizophr Bull 2003, 29:803–830.

    PubMed  Google Scholar 

  53. Berger GE, Wood S, McGorry PD: Incipient neurovulnerability and neuroprotection in early psychosis. Psychopharmacol Bull 2003, 37:79–101.

    PubMed  Google Scholar 

  54. Neumann C and Walker E: Neuromotor functioning in adolescents with schizotypal personality disorder: associations with symptoms and neurocognition. Schizophrenia Bulletin 2003, 29(2):285–298.

    PubMed  Google Scholar 

  55. Moberg PJ and Turetsky BI: Scent of a disorder: olfactory functioning in schizophrenia. Curr Psychiatry Rep 2003, 5:311–119.

    Article  PubMed  Google Scholar 

  56. Kopala LC, Good KP, Morrison K, et al.: Impaired olfactory identification in relatives of patients with familial schizophrenia. Am J Psychiatry 2001, 158:1286–1290.

    Article  PubMed  CAS  Google Scholar 

  57. Brewer WJ, Wood SJ, McGorry PD, et al.: Impairment of olfactory identification ability in individuals at ultra-high risk for psychosis who later develop schizophrenia. Am J Psychiatry 2003, 160:1790–1794.

    Article  PubMed  Google Scholar 

  58. Koenigsberg HW, Reynolds D, Goodman M, et al.: Risperidone in the treatment of schizotypal personality disorder. J Clin Psychiatry 2003, 64:628–634.

    Article  PubMed  CAS  Google Scholar 

  59. Keshavan M, Shad M, Soloff P, Schooler N: Efficacy and tolerability of olanzapine in the treatment of schizotypal personality disorder. Schizophr Res 2004, 71:97–101.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Seeber, K., Cadenhead, K.S. How does studying schizotypal personality disorder inform us about the prodrome of schizophrenia?. Curr Psychiatry Rep 7, 41–50 (2005). https://doi.org/10.1007/s11920-005-0024-5

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-005-0024-5

Keywords

Navigation