Studying Real-World Functioning in Patients with Schizotypal Personality Disorder

Psychiatrists investigate real-world functioning in patients with this condition on the schizophrenia spectrum

Schizotypal personality disorder (SPD) is a condition on the schizophrenia spectrum that causes difficulties with relationships and cognitive functioning including memory, inhibition, and processing. While the disorder is biologically related to schizophrenia, patients with SPD have less severe deficits and do not exhibit symptoms of psychosis. As a result, little research has been done to assess how well these patients function on a daily basis in areas like employment status, education, and independent living.

Researchers in the Department of Psychiatry at Mount Sinai School of Medicine are trying to change that by understanding how patients with SPD function in the real world. As part of a completed study, investigators evaluated 46 SPD patients, 38 individuals with avoidant personality disorder, and 55 healthy control subjects. Participants were evaluated for cognitive functioning, real world functioning (including employment and residential status), and functional capacity using a cognitive battery of tests and the UPSA, a performance-based skills assessment. The results found that individuals with SPD performed significantly worse than the control group in cognitive functioning, and were less likely to be employed and living independently when compared with both groups.

“SPD patients exhibit impaired functioning suggesting that deficits in real-world functioning extend across the schizophrenia spectrum,” says Margaret McNamara McClure, PhD, Assistant Professor of Psychiatry at Mount Sinai, Clinical Psychologist at the James J. Peters VA Medical Center. “This knowledge is important as we try to treat SPD and develop therapies to enhance cognitive functioning.”

This is the first study examining functional capacity performance in SPD. Since the disease is not well understood and the symptoms are less severe than schizophrenia, many psychiatrists believe the disorder is underdiagnosed.

“This research shows that the effects of SPD are often underappreciated,” says Larry J. Siever, Professor of Psychiatry, Director of the Special Evaluation Program for Mood and Personality Disorders, and Vice-Chair for Veteran Affairs at Mount Sinai. “The illness is typically not severe enough that patients are in the hospital, but they have significant impairments in working memory, cognition, and social isolation that are just as severe as people who are schizophrenic. As psychiatrists, we need to do a better job of identifying this disorder and getting patients into treatment.”

What’s more, Dr. Siever says, studying this non-psychotic schizophrenia spectrum condition may help us understand the brain basis of cognitive impairment and how to intervene to improve it.