Psychotherapeutic and Pharmacologic Treatment of Schizotypal Personality Disorder

Abstract

Although the traditional emphasis on overt symptomatology leads readily to diagnosis, such categorization typically assumes a pathological process within the individual that may at best be managed or modified. Conceptualization of symptoms in terms of adaptive and functional considerations may facilitate and broaden options for treatment, potentially improving outcome. This case study provides an example of treatment of schizotypal personality disorder using such an approach. Psychotherapy and medication were directed toward alleviating symptoms of anxiety and depression producing functional impairment in memory, and development of interpersonal skills to increase prospects for reinforcement in interaction with others was implemented to decrease the need for fantasy as a means of obtaining such gratification. Psychotherapy focused on selectively reinforcing positive self-statements, social skills training, and anxiety reduction. Serendipitous peer modeling also facilitated therapeutic efforts. The anxiolytic buspirone, the serotonin-selective reuptake inhibitor citalopram, and the stimulants dextroamphetamine and amphetamine, and methylphenidate were effective in pharmacologic management. This treatment approach was found to be beneficial not only in terms of self-report and peer appraisal but also in results of psychological assessment, including a neuropsychological screening measure.