The schizotypal personality on an alcohol treatment unit.

D SM-III restricts the diagnosis of schizophrenia to those patients demonstrating overt evidence of a thought disorder or hallucination. The study describes seven patients on an inpatient alcohol treatment unit who met the criteria for schizotypal personality. Their age, mental status exam, family history, and response to medication were compatible with a schizophrenic spectrum concept of the schizotypal personality. The prompt diagnosis and treatment of psychiatric symptoms in alcoholic schizotypal personalities would aid in their rehabilitation. DSM-III has narrowed the diagnosis of schizophrenia by developing criteria that require explicit evidence of overt thought disorder or hallucination before the diagnosis can be made.’ Those individuals who may be preschizophrenic or mildly schizophrenic continue to exist in a diagnostic limbo which in the past was characterized by such terms as latent, pseudoneurotic, or ambulatory schizophrenia.* The Danish adoption studies of Kety et al., have introduced the concept of the “schizophrenic spectrum” in which milder forms of schizophrenia are manifested and which seem to show a genetic relationship to schizophrenic illness.3 DSM-III has divided the “borderline syndrome” into two diagnostic entities-the schizotypal personality drawn from the schizophrenic spectrum concept and the borderline personality developed from analytic concepts elaborated by Kernberg and associated with pathological ego states and acting-out character disorder (Table 1).4 Spitzer et al. found that these two diagnoses were capable of differentiating patients with the “borderline syndrome” into two distinct groups but that there was a significant degree of overlap.5 Recently, Kendler et al. have reanalyzed the original Danish data involving the relatives of schizophrenic children who were placed for adoption and have found a significantly higher incidence of schizotypal personality disorder in the biologic relatives of probands as compared to the biologic relations of controls.6 The diagnostic difficulties outlined above are only further complicated on an alcohol treatment unit. The acute effects of alcohol and subsequent withdrawal can mimic the entire spectrum of psychiatric symptomatology. The diagnosis of alcoholism is also not in any way exclusive, and once the acute effects of alcohol on the behavior and thinking of patients abates, a heterogenous group of personality and psychiatric diagnoses remain, including other axis I or axis II