A patient with Schizotypal Personality Disorder is MOST likely to respond to which pharmacological intervention for cognitive-perceptual symptoms (ideas of reference, magical thinking, perceptual distortions)?
- A High-dose SSRIs targeting obsessive-type features
- B Lithium augmentation to stabilise subclinical psychotic features
- C Low-dose atypical antipsychotics (e.g., risperidone 0.5–2 mg) ✓
- D Benzodiazepines for social anxiety reducing perceptual distortions
Correct answer: C. Low-dose atypical antipsychotics (e.g., risperidone 0.5–2 mg)
Explanation
Schizotypal PD is in the 'Cluster A' (odd-eccentric) group and is considered part of the schizophrenia spectrum. Low-dose atypical antipsychotics (risperidone, olanzapine) have evidence for reducing the cognitive-perceptual (quasi-psychotic) symptoms of schizotypal PD — ideas of reference, magical thinking, and illusions — without causing the side effects of full antipsychotic doses. SSRIs may help co-morbid anxiety/depression but do not target the core perceptual features. Lithium is not indicated.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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