Aug 2026· Journal of Clinical and Diagnostic Research· 0 citations
Abstract
Schizotypal Personality Disorder (SPD) is characterised by pervasive social and interpersonal deficits, cognitive–perceptual distortions, and eccentric behaviour, and is frequently misdiagnosed due to symptom overlap with schizophrenia, anxiety, and obsessive-compulsive symptoms. It occupies a distinct position across diagnostic systems, being placed within schizophrenia spectrum disorders in the International Classification of Diseases, 11th Revision (ICD-11), while the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies it under Cluster A personality disorders. This case describes a 25-yearold male who initially presented with social anxiety and ritualistic behaviours and was diagnosed with social anxiety disorder with obsessive-compulsive features. In subsequent visits, additional diagnoses of depression and psychosis were considered based on the evolving symptom profile. He responded poorly to treatment despite multiple trials of medications and inpatient care. On his fourth admission, a comprehensive evaluation with diagnostic psychometry was undertaken, incorporating birth and developmental history and thorough tracking of the longitudinal course of symptoms, which revealed an enduring pattern of eccentric behaviour, persistent odd beliefs, impaired interpersonal functioning, constricted affect, transient stress-related suspiciousness, and poor treatment adherence, leading to significant occupational and social impairment. The diagnosis was revised to SPD, and he was treated with psychotherapy and pharmacotherapy. The case highlights the importance of a Kraepelinian longitudinal approach to evaluation in psychiatry, which is often neglected in contemporary practice.
Borderline Personality Disorder (BPD) is characterized by emotional instability, impulsivity, and significant impairment in interpersonal relationships, making its diagnosis challenging due to high symptomatic overlap with other mental disorders. This study aimed to synthesize scientific evidence on clinical criteria and psychopathological assessment used in BPD diagnosis. This is a narrative literature review conducted in the PubMed database using the descriptors Borderline Personality Disorder and Diagnosis, including articles published in the last five years in Portuguese and English languages. The analyzed studies showed a transition from categorical diagnostic models to dimensional approaches, such as the DSM-5 Alternative Model and ICD-11, as well as the importance of differential diagnosis in the face of frequent psychiatric comorbidities. Advances were also identified in understanding the psychopathological and neurobiological markers of the disorder, although these still lack routine diagnostic application. It is concluded that the integration of rigorous clinical assessment, dimensional models, and analysis of comorbidities contributes to greater diagnostic accuracy and favors the definition of more individualized therapeutic strategies.
Darlan Santos da Silva, Yasmin Leal Maron, Lívia Maria de Almeida dos Santos et al.· ARACÊ· 0 citations
Schizoaffective disorder, depressive type, is a severe psychiatric condition characterized by the coexistence of psychotic symptoms and a major depressive episode, with substantial functional impairment and potential suicide risk. Diagnostic and therapeutic complexity may increase when the disorder co-occurs with schizoid personality disorder, particularly because social withdrawal, restricted affect, and anhedonia can resemble negative or depressive symptoms. This case report describes a 33-year-old woman diagnosed with schizoaffective disorder, depressive type, with comorbid schizoid personality disorder. Clinical assessment included psychiatric interviews, collateral information from family members, mental status examination, behavioral observation, reconstruction of symptom chronology, and review of psychosocial history. The patient developed auditory hallucinations and persecutory ideas approximately four weeks before admission, followed by prominent depressive symptoms and suicidal ideation after the sudden death of a primary support figure. Long-standing social detachment, preference for solitary activities, restricted emotional expression, and limited interpersonal relationships were present since early adulthood and preceded the psychotic episode, supporting the diagnosis of schizoid personality disorder. Inpatient management consisted of risperidone, sertraline, and low-intensity supportive psychosocial interventions adapted to the patient’s preference for limited interpersonal engagement. During approximately 14 days of hospitalization, hallucinations and suicidal ideation decreased and basic self-care improved. At two-week follow-up, no recurrent suicidal ideation was reported, although mild auditory hallucinations and social withdrawal persisted. This case emphasizes the importance of longitudinal assessment and collateral information in distinguishing enduring personality characteristics from state-related negative or depressive symptoms. Individualized treatment that combines pharmacological stabilization with appropriately paced psychosocial engagement may improve treatment acceptability and functional stabilization in complex psychiatric comorbidity.
Unknown authors· Sinergi International Journa...· 0 citations
Background: Schizoaffective disorder is a complex psychiatric condition characterized by the concurrent presence of psychotic symptoms and mood disturbances. Cases presenting with pronounced emotional dependence on family members and prominent psychosomatic manifestations are infrequently documented in Indonesia, posing diagnostic and therapeutic challenges. Case Presentation: A 36-year-old unmarried male presented with a 10-year history of uncontrolled emotions, auditory and visual hallucinations, persistent fear, chest heat sensation, and an impending sense of death. Symptoms were exacerbated when anticipating separation from his parents. The patient had experienced occupational decline, marital dissolution due to aggressive behavior, and progressive social withdrawal. Clinical assessment using DSM-5 criteria established a diagnosis of schizoaffective disorder, depressive type, comorbid with paranoid schizophrenia. The patient exhibited significant emotional dependence on his parents and impaired psychosocial functioning. Management and Outcome: A comprehensive biopsychosocial approach was implemented, comprising pharmacotherapy (risperidone, chlorpromazine, lorazepam, and clozapine), cognitive-behavioral therapy, psychoeducation, and family therapy. Multidisciplinary interventions resulted in reduced psychotic symptom severity, improved emotional regulation, and enhanced family support systems. Conclusion: Schizoaffective disorder with psychosomatic manifestations and emotional dependence necessitates an integrated biopsychosocial framework. Combined pharmacotherapy, psychotherapy, psychoeducation, and family-centered interventions are essential to promote patient autonomy, improve social functioning, and enhance overall quality of life. This case underscores the importance of recognizing caregivers as integral partners in psychiatric rehabilitation.
Retno Ayu Wulandari, Era Catur· Journal of Diverse Medical R...· 0 citations
Intellectual Developmental Disorder (IDD) is a neurodevelopmental disorder characterized by significant limitations in intellectual functioning and adaptive behaviour that originate during the developmental period [1,2]. Individuals with IDD are at increased risk of psychiatric comorbidities, particularly behavioral disturbances and psychotic disorders [3-5]. Distinguishing behavioral problems intrinsic to IDD from psychosis remains one of the greatest diagnostic challenges in psychiatric practice because communication deficits, cognitive impairment, and diagnostic overshadowing often obscure the clinical picture [4,5,6]. Misdiagnosis may result in unnecessary exposure to antipsychotic medications or delayed treatment of genuine psychotic illness [5,7]. This narrative review summarises the current literature about the epidemiology, clinical presentation, neurobiological mechanisms, neuropsychological characteristics, assessment, differential diagnosis, and management of behavioral problems and psychosis in individuals with IDD. A comprehensive literature search was conducted using PubMed, Google Scholar, Scopus, and WHO resources, focusing on studies published in English. Existing evidence indicates that behavioral disturbances are usually precipitated by environmental stressors, communication difficulties, sensory dysregulation, or learned maladaptive responses, whereas psychotic disorders are characterized by disturbances in perception, thought content, and reality testing with a noticeable decline from baseline functioning. Diagnostic overshadowing remains a significant barrier to early identification of psychiatric disorders in this population [5,7]. Structured clinical assessment, detailed caregiver interviews, longitudinal evaluation, and multidisciplinary management are essential for accurate diagnosis and appropriate intervention. Further research from low- and middle-income countries, particularly India, is required to improve culturally relevant assessment tools and strengthen evidence-based clinical practice.
Background
Intellectual Developmental Disorder (IDD) affects approximately 1–3% of the global population and represents one of the most common neurodevelopmental disorders [1,3,8]. Improvements in neonatal care and survival have increased the number of individuals with IDD reaching adulthood, making psychiatric comorbidity an increasingly important public health concern [7]. Behavioural disturbances and psychotic disorders contribute substantially to caregiver burden, reduced quality of life, institutionalization, and healthcare utilization [3,4,7]. Accurate differentiation between these conditions remains essential for effective management and prevention of inappropriate pharmacological treatment [5,7].
Archana Mohan Vijayalakshmi, Kothyala Bala Ravikumar· Journal of Psychiatry and Ps...· 0 citations
Differentiating obsessive–compulsive disorder (OCD) from psychotic disorders can be problematic, especially when OCD symptoms present with poor insight and psychotic-like intensity. This case report describes a 44-year-old white male, whose symptoms began in his late teens. Clinical documentation, however, began in 2009, when he was first hospitalized. Although he was initially diagnosed with psychosis, his intrusive quasi-delusional fears and compulsions, accompanied by experiences of being watched and abstract ideas about the “ego” with limited insight, led to diagnostic uncertainty. While antipsychotic treatment was ineffective, the initiation of paroxetine in 2011 resulted in substantial improvement, suggesting an OCD etiology. Despite later revision of his diagnosis (after more than 10 years following manifestation) toward an OCD spectrum disorder, the patient continued to believe he had psychosis and developed obsessive fears of becoming psychotic, likely influenced by prior clinical labeling. This case underscores the importance of careful differential diagnosis in OCD with poor insight. Early recognition of OCD can significantly alter prognosis and treatment course, avoiding prolonged exposures to neuroleptics.
Natalia Chechko, S. Weisenfeld, Susanne Nehls· Journal of Medical Case Repo...· 0 citations
The Alternative Model of Personality Disorder (AMPD) and the International Classification of Diseases, 11th edition's personality disorder nosologies reflect a shift from categorical to dimensional diagnosis. However, minimal research has investigated clinician perceptions and attitudes surrounding the diagnoses that dimensional models produce. The current study aimed to (a) investigate and directly compare the clinical utility of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, with the dimensional AMPD, from the perspective of clinicians, and (b) determine how these different diagnostic systems, and their variations in the portrayal of the same PD symptomology, may affect clinician-rated stigma. A sample of 89 psychologists read a series of case vignettes, with each vignette exhibiting a different variation of personality difficulties and accompanying diagnostic information. Clinicians answered a series of questions regarding clinical utility, their treatment recommendations, and stigma after each case vignette. A series of general linear models, post hoc analyses, and chi-squared tests were utilized. The AMPD was neither inferior nor superior to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, categorical model in terms of clinician-perceived clinical utility and stigma attitudes. Diagnostic information more broadly, regardless of the diagnostic system, was more clinically useful than a description-only, formulaic approach to conceptualizing personality difficulties. The absence of diagnostic information was associated with higher stigma among clinicians. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
