Infroducfion

This chapter focuses on schizoaffective disorder and schizotypal personality disorder, including their clinical features, classification, diagnosis, epidemiology, aetiology, course, prognosis, and possibilities for prevention. Some areas will be emphasized, to reflect controversial issues or new developments. For example, the classification of both these disorders will be stressed to consider the heterogeneity apparent in each of them. The issue is an important one, for at least two reasons. First, it is crucial to develop reliable and valid diagnostic criteria in order to study the aetiology of the disorders and then utilize that knowledge to develop rational and testable treatment strategies. Heterogeneity adds variance to each of these steps that may reduce both the reliability of diagnosis and also the statistical power of experimental designs to detect treatment effects. Second, the development of newer generations of psychopharmacological treatments holds the promise of matching more appropriate and efficacious medications with specific syndromes or types of symptoms. This trend underscores the importance of differential diagnosis in determining what treatment a patient will receive. Heterogeneity within a diagnostic category complicates achievement of this goal. Another area to be emphasized involves the possibility of preventative, as well as palliative, treatments in the near future, for these disorders. In contrast, other areas such as the genetic aetiology of schizoaffective disorder and schizotypal personality disorder, and treatments for schizoaffective disorder, will receive less emphasis here, to avoid redundancies with other chapters in this volume. Each disorder will be considered separately, starting with a review of schizoaffective disorder, the more severe of the two spectrum conditions.

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