Borderline or Schizotypal? Differential Psychodynamic Assessment in Severe Personality Disorders.

Considerable overlap in symptoms between patients with borderline personality disorder (BPD) and schizotypal personality disorder (STPD) complicates personality diagnostics. Yet very little is known about the level of psychodynamic functioning of both personality disorders. Psychodynamic assessment procedures may specify personality characteristics relevant for differential diagnosis and treatment planning. In this cross-sectional study we explored the differences and similarities in level of personality functioning and psychodynamic features of patients with severe BPD or STPD. In total, 25 patients with BPD and 13 patients with STPD were compared regarding their level of personality functioning (General Assessment of Personality Disorder), current quasipsychotic features (Schizotypal Personality Questionnaire), and psychodynamic functioning [Developmental Profile (DP) interview and Developmental Profile Inventory (DPI) questionnaire]. Both groups of patients showed equally severe impairments in the level of personality functioning and the presence of current quasipsychotic features. As assessed by the DP interview, significant differential psychodynamic patterns were found on the primitive levels of functioning. Moreover, subjects with BPD had significantly higher scores on the adaptive developmental levels. However, the self-questionnaire DPI was not able to elucidate all of these differences. In conclusion, our study found significant differences in psychodynamic functioning between patients with BPD and STPD as assessed with the DP interview. In complicated diagnostic cases, personality assessment by psychodynamic interviewing can enhance subtle but essential differentiation between BPD and STPD.

Elevated levels of schizotypal features in parents of patients with a family history of schizophrenia spectrum disorders.

There is some evidence that schizotypal traits are related to a genetic or familial liability to develop schizophrenia. However, it is unclear whether the number of schizotypal traits is elevated in parents of schizophrenia patients compared with controls. This study used the Schizotypal Personality Questionnaire to investigate the difference in number of schizotypal traits between both parents of 36 patients with schizophrenia (n = 72 persons) and 26 healthy married control couples (n = 52 persons). Parents of patients had a lower score on the positive dimension of schizotypy than healthy controls. There was no difference on the negative or disorganization dimension between groups. The difference on the positive dimension might have been caused by a difference in response style between parents of patients and controls due to the fact that parents are more familiar with schizophrenia than controls. Of interest, parents with a family history of schizophrenia spectrum disorders had more positive and negative schizotypal traits than parents without a family history of schizophrenia spectrum disorders. Because these two groups of parents differ in only genetic risk, not familiarity with schizophrenia, results suggest that the negative and positive dimension of schizotypy are related to a familial or genetic vulnerability to schizophrenia.

Neurocognitive correlates of schizotypy in first degree relatives of schizophrenia patients.

We examined neurocognitive correlates of three dimensions of schizotypy in 63 healthy first degree relatives of schizophrenia patients. Neurocognitive measures of attention, verbal memory, and prefrontal functioning were combined with self-report and interview measures of schizotypy. State-psychopathology (anxiety and depression) was a strong predictor for positive schizotypy (PS) and negative schizotypy (NS). PS was slightly correlated to verbal long-term memory, therefore weakly supporting the hypothesis that temporal-limbic malfunctioning underlies PS. NS was not correlated to any prefrontal measure, and therefore no evidence was found for the hypothesis that prefrontal malfunctioning underlies NS. Disorganization schizotypy (DS) was strongly correlated to the false alarm variable of the Continuous Performance Test (CPT), probably supporting the hypothesis of orbitofrontal malfunctioning underlying DS. This correlational pattern of DS echoes closely two schizophrenia studies reporting a relationship between formal thought disorder and the false alarm CPT variable. This similarity, across schizophrenia and relatives samples, may be considered as evidence that false alarms on the CPT and (subtle) problems in goal directedness of thinking are indicators of a genetically determined vulnerability to schizophrenia.