Remediation and Cognitive Enhancers in Schizotypal Personality Disorder

Abstract

Individuals with schizotypal personality disorder (SPD) often present with cognitive impairment similar, but of a lesser magnitude to, what is seen in schizophrenia. Cognitive dysfunction combined with social and perceptual disturbances, which are the hallmarks of this disorder, are directly related to substantially lower functioning. There is no FDA-approved medication for cognitive deficits in SPD; however, potential agents, including α2a and dopamine agonists, are under investigation. Cognitive remediation therapy (CRT) is a behavioral treatment that has been shown to improve cognitive and psychosocial functioning in individuals with schizophrenia. Application of CRT in this population is novel and more large-scale studies are needed, but this treatment holds promise for the cognitive and social deficits of SPD. There may be a synergy between cognitive remediation and cognitive enhancers such as the α2a agonist guanfacine; research in this area is nascent. Lifestyle modifications such as the use of memory aids, planners, and structured schedules, as well as exercise, may be beneficial for cognitive functioning in this population. Additionally, social skills training in a psychotherapeutic setting can be helpful. Patients frequently present with comorbid mood and anxiety symptoms, and standard SSRI treatment to ameliorate symptoms can have a positive secondary effect on cognitive functioning. For the patient with psychotic-like features, treatment with atypical antipsychotics may also improve overall functioning.