Schizotypal personality disorder

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Target exams

Red flags

• Frank delusions, hallucinations, or marked functional collapse — treat on a psychosis pathway; do not dismiss as 'just schizotypal personality'
• Rapid functional decline with increasing conviction of odd beliefs — assess for clinical high risk / first-episode psychosis
• Late-onset eccentricity or personality change with neurological or systemic red flags — investigate organic disease before locking a lifelong PD label
• Severe self-neglect, exploitation vulnerability, or suicidal crisis with comorbid depression and isolation
• Therapeutic nihilism that withholds depression, anxiety, or substance treatment because the patient is 'odd'
• Unreviewed chronic antipsychotic polypharmacy for eccentricity without a target symptom or stop date