Jul 2026· Annals of Indian Psychiatry· 0 citations· 5 references
TL;DR
A multidisciplinary approach proved essential for Ms. V’s recovery, offering insights into the management of complex psychiatric comorbidities and the challenges of diagnosing and treating comorbid psychiatric disorders, particularly when presentations are atypical.
Abstract
Schizotypal disorder is marked by pervasive social and interpersonal deficits, cognitive-perceptual distortions, and eccentric behaviors, often co-occurring with other psychiatric conditions. This case report presents a rare instance of schizotypal disorder comorbid with atypical anorexia nervosa and somatization disorder in a 19-year-old female. The patient, Ms. V, exhibited complex symptomatology including social withdrawal, odd beliefs, somatic complaints, and restrictive eating behaviors. Despite extensive medical investigations, her physical symptoms remained unexplained, leading to a psychiatric evaluation. She was diagnosed with schizotypal disorder, atypical anorexia nervosa, and somatization disorder per the International Classification of Diseases, Tenth Revision criteria. Initial treatment with risperidone was poorly tolerated, but she showed significant improvement with olanzapine, fluoxetine, and cognitive-behavioral therapy, resulting in better functioning and reduced somatic preoccupation. This case underscores the challenges of diagnosing and treating comorbid psychiatric disorders, particularly when presentations are atypical. A multidisciplinary approach proved essential for Ms. V’s recovery, offering insights into the management of complex psychiatric comorbidities.
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.
Amit Dattatraya Khune, S. Rajkumar, Anoop Jose Alappat et al.· Journal of Clinical and Diag...· 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
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
Psychosomatic disorders present diagnostic and therapeutic challenges in psychiatric practice, particularly when a psychological disorder is somatically expressed as persistent physical symptoms. We present a case of a 31-year-old female with recurrent major depressive disorder and anxiety, who gradually developed chronic widespread pain alongside multiple somatic complaints in the absence of any organic correlations. Her symptomatology has temporal associations with affective episodes and psychosocial stressors, notably bereavement, and persisted despite comprehensive medical management. Her clinical course was characterized by prominent somatization, illness preoccupation, functional impairment, and only transient or partial response to repeated pharmacological interventions. The biopsychosocial perspective supported her somatic complaints as part of a psychosomatic disorder linked to her underlying affective episodes. This case illustrates the importance of comprehensive psychiatric assessment in identifying somatic symptom presentations and highlights the limitations of a purely organ-focused medical approach. Recognition of psychosomatic mechanisms may reduce unnecessary investigations, and long-term outcomes can be improved by early psychiatric intervention, psychoeducation, and a multidisciplinary approach.
N. Vadhavekar, Hardik Sheth, Rashi Rakesh Shah et al.· Annals of Indian Psychiatry· 0 citations
Backgrounds/Objectives: Subsyndromal depressive symptoms are common during inter-episode periods in bipolar disorder and have been associated with functional impairment. This study aimed to examine their clinical and psychosocial correlates across multiple domains and to evaluate depressive symptom severity from both categorical and dimensional perspectives. Methods: This cross-sectional study included 133 outpatients with bipolar I disorder who had experienced no syndromal mood episode during the preceding six months. Patients were classified as having subsyndromal depressive symptoms (n = 61; HDRS 8–14 and YMRS < 8) or as euthymic (n = 72; HDRS < 8 and YMRS < 8). Clinical characteristics, functioning, impulsivity, internalized stigma, and anxiety were assessed. Results: The subsyndromal depressive group had higher total and depressive episode counts and more frequent histories of antidepressant-induced manic switch and suicide attempt than the euthymic group (all p < 0.05). They also showed lower functioning and higher impulsivity, internalized stigma, and anxiety (all p < 0.05). Within the subsyndromal depressive group, depressive symptom severity was associated with the number of depressive episodes and specific domains of functioning, impulsivity, internalized stigma, and anxiety. Conclusions: Subsyndromal depressive symptoms were associated with clinically relevant differences across multiple clinical and psychosocial domains during inter-episode periods in bipolar I disorder. The associations observed across specific domains also support considering depressive symptom severity dimensionally alongside categorical assessment.
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
We use cookies to run the site and, with your consent, for analytics and to show ads.
See our Cookie Policy.
