123-509: (Redirected from Schizoid Man ) " The Schizoid Man " could refer to: Schizoid personality disorder The Schizoid Man (The Prisoner) , an episode of The Prisoner The Schizoid Man (Star Trek: The Next Generation) , an episode of Star Trek: The Next Generation (which was named after the Prisoner episode). Schizoid Man (comics) , a character from Marvel Comics 21st Century Schizoid Man ,
246-534: A boxed warning stating that antidepressants may increase the risk of suicide in people younger than 25. This warning is based on a statistical analysis conducted by the FDA which found a 2-fold increase in suicidal thought and behavior in children and adolescents, and 1.5-fold increase in the 18–24 age group. For this analysis the FDA combined the results of 295 trials of 11 antidepressants in order to obtain statistically significant results. Considered in isolation, bupropion
369-404: A norepinephrine–dopamine reuptake inhibitor (NDRI) and negative allosteric modulator of several nicotinic acetylcholine receptors . Bupropion does not act as a norepinephrine–dopamine releasing agent . Pharmacological actions of bupropion, to a substantial degree, are due to its active metabolites hydroxybupropion , threo -hydrobupropion , and erythro -hydrobupropion that are present in
492-467: A norepinephrine–dopamine reuptake inhibitor (NDRI) and a nicotinic receptor antagonist . However, its effects on dopamine are weak and clinical significance is contentious. Chemically, bupropion is an aminoketone that belongs to the class of substituted cathinones and more generally that of substituted amphetamines and substituted phenethylamines . Bupropion was invented by Nariman Mehta , who worked at Burroughs Wellcome , in 1969. It
615-418: A 2022 systematic review and meta-analysis of bupropion for sexual desire disorder in women reported that although data were limited, bupropion appeared to be dose-dependently effective for the condition. Bupropion, when used for treating long term weight gain over a period of six to twelve months, results in an average weight loss of 2.7 kilograms (6.0 lb) over placebo. This is not much different from
738-616: A Moscow hospital found that schizoid individuals were the least common patients, while those with cluster B personality disorders were the most common. A study that looked at the body mass index (BMI) of a sample of both male adolescents diagnosed with SzPD and those diagnosed with Asperger syndrome found that the BMI of all patients was significantly below normal. Clinical records indicated abnormal eating behavior by some patients. Some patients would only eat when alone and refused to eat out. Restrictive diets and fears of disease were also found. It
861-512: A bupropion/ trazodone combination may improve some measures of sexual function in women who have hypoactive sexual desire disorder (HSDD) and are not depressed. According to an expert consensus recommendation from the International Society for the Study of Women's Sexual Health, bupropion can be considered as an off-label treatment for HSDD despite limited safety and efficacy data. Likewise,
984-635: A close relative on occasions. They usually prefer hobbies and activities that do not require interaction with others. People with SzPD may be averse to social situations due to difficulties deriving pleasure from physical or emotional sensations, rather than social anhedonia . One potential motivation for avoiding social situations is that they feel that it intrudes on their freedom. Relationships can feel suffocating for people with SzPD, and they may think of them as opportunities for entrapment. Patients with this disorder are often independent and turn to themselves as sources of validation. They tend to be
1107-420: A combination of cognitive-behavioral therapy and psychodynamic psychotherapy . These techniques can be used to help patients identify their defense mechanisms and change them. Therapists attempt to establish healthy relationships with their clients, helping to combat their internalized belief that relationships are harmful and unhelpful. Relationships with a therapist can seem terrifying and intrusive to
1230-847: A concept. He identified four subtypes of SzPD. Any schizoid individual may exhibit none or one of the following: American psychoanalyst Salman Akhtar provided a comprehensive phenomenological profile of SzPD in which classic and contemporary descriptive views are synthesized with psychoanalytic observations. This profile is summarized in the table reproduced below that lists clinical features that involve six areas of psychosocial functioning and are organized by "overt" and "covert" manifestations. "Overt" and "covert" are intended to denote seemingly contradictory aspects that may both simultaneously be present in an individual. These designations do not necessarily imply their conscious or unconscious existence. The covert characteristics are by definition difficult to discern and not immediately apparent. Additionally,
1353-544: A constitutional, probably genetic, basis." Research on heritability and this disorder is lacking. Twin studies with SzPD traits (e.g., low sociability and low warmth) suggest that these traits are inherited. Besides this indirect evidence, the direct heritability estimates of SzPD range from 50% to 59%. Earlier, less methodologically rigorous research had found the heritability rate to be 29%. The pathophysiology of SzPD remains unclear. Genetic relationships with people who have schizophrenia spectrum disorders increase
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#17328521943271476-447: A control group. In the 2012 study, it was noted that the DSM may complicate diagnosis by requiring the exclusion of a pervasive developmental disorder (PDD) before establishing a diagnosis of SzPD. The study found that social interaction impairments, stereotyped behaviors, and specific interests were more severe in the individuals with Asperger syndrome also fulfilling SzPD criteria, against
1599-412: A deep desire to connect with others, yet will be terrified by the dangers inherent in doing so. Avoidance of social situations may be a method of avoiding being hurt or rejected. Individuals with SzPD can form relationships with others based on intellectual, physical, familial, occupational, or recreational activities, as long as there is no need for emotional intimacy. Donald Winnicott explains this
1722-593: A defense mechanism to protect the patient from the outside world and its difficulties. Common themes in their internal fantasies are omnipotence and grandiosity . The related schizotypal personality disorder and schizophrenia are reported to have ties to creative thinking , and it is speculated that the internal fantasy aspect of SzPD may also be reflective of this thinking. Alternatively, there has been an especially large contribution of people with schizoid symptoms to science and theoretical areas of knowledge, including mathematics , physics , economics , etc. At
1845-633: A delayed onset of action for ADHD, and several weeks of treatment are required for therapeutic effects. This is in contrast to stimulants , such as amphetamine and methylphenidate , which have an immediate onset of effect in the condition. Bupropion is less likely than other antidepressants to cause sexual dysfunction . A range of studies indicate that bupropion not only produces fewer sexual side effects than other antidepressants but can actually help to alleviate sexual dysfunction including sexual dysfunction induced by SSRI antidepressants. There have also been small studies suggesting that bupropion or
1968-671: A desire to destroy or put down others. Additionally, schizoid individuals do not go out of their way to achieve social validation. Unlike narcissists, schizoid people will often keep their creations private to avoid unwelcome attention or the feeling that their ideas and thoughts are being appropriated by the public. When forced to rely on others, a person with SzPD may feel panic or terror. Patients with SzPD often feel unreal, empty, and separate from their own emotions. They tend to perceive themselves as fundamentally different from others and can believe that they are fundamentally unlikeable. Other people often seem strange and incomprehensible to
2091-524: A feeling of failure and negatively impacting their willingness to continue to commit to treatment. Clinicians tend to worry that they are incapable of properly treating the patient. It is rare for someone with this disorder to voluntarily seek treatment without a comorbid disorder or pressure from family or friends. In treatment, people with SzPD are usually disinterested and often minimize symptoms. Patients with SzPD may fear losing their independence through therapy. Many schizoid individuals will avoid making
2214-478: A hard time forming a good working relationship with a therapist. SzPD is a poorly studied disorder, and there is little clinical data on SzPD because it is rarely encountered in clinical settings. Studies have generally reported a prevalence of less than 1%. It is more commonly diagnosed in males than in females. SzPD is linked to negative outcomes, including a significantly compromised quality of life , reduced overall functioning even after 15 years, and one of
2337-750: A lack of sexual definition but rather a combination of several strong fixations to cope with the same conflicts. People with SzPD are often able to pursue any fantasies with content on the Internet while remaining completely unengaged with the outside world. Sensory or emotional experiences typically provide little enjoyment for people with SzPD. They rarely display strong emotions or react to anything. People with SzPD can have difficulty expressing themselves and seem to be directionless or passive. Individuals with SzPD can also experience anhedonia . They can also have difficulty understanding others' emotions and social cues . It can be hard for people with SzPD to assess
2460-457: A large city often considered a magnet for disenfranchised people. A University of Colorado Colorado Springs study comparing personality disorders and Myers–Briggs Type Indicator types found that the disorder had a significant correlation with the Introverted (I) and Thinking (T) preferences. Perfectionist and hypercritical parenting or cold, neglectful, and distant parenting contribute to
2583-410: A lower risk of substance abuse issues than people with other personality disorders . They may form relationships with their substances as a substitute for human contact or to cope with emotional issues. People with SzPD may desire psychedelic drugs more than other kinds. Many schizoid individuals display an engaging, interactive personality, contradicting the observable characteristic emphasized by
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#17328521943272706-432: A mixture of anti-inflammatory and pro-inflammatory activity through modulation of the immune system . One such mechanism underlying these effects may be reduced levels of the pro-inflammatory cytokine tumor necrosis factor alpha (TNFα). The catecholaminergic actions of bupropion may be involved in its immunomodulatory effects. After oral administration, bupropion is rapidly and completely absorbed reaching
2829-407: A more distant emotional proximity. If that is true, then many of the more problematic reactions these individuals show in social situations may be partly accounted for by the judgments commonly imposed on people with this style. Similarly, John Oldham , using a dimensional approach , thinks that most people with schizoid character features do not have a full-blown personality disorder. Impairment
2952-403: A notable exception, bupropion does not seem to affect the concentrations of CYP2D6 substrates fluoxetine and paroxetine. Bupropion lowers the seizure threshold, and therefore can potentially interact with other medications that also lower it, such as antipsychotics , tricyclic antidepressants , theophylline , and systemic corticosteroids . The prescribing information recommends minimizing
3075-451: A participant in life, an inability to tolerate emotional expectations of others, apparent indifference when praised or criticized, all forms of asexuality , and idiosyncratic moral or political beliefs. Symptoms typically start in late childhood or adolescence. The cause of SzPD is uncertain, but there is some evidence of links and shared genetic risk between SzPD, other cluster A personality disorders , and schizophrenia . Thus, SzPD
3198-566: A person with SzPD. They may feel as if they need to alter or hide their feelings to meet the therapist's demands or expectations. To combat this, therapists try to gradually increase their patient's emotional expression. Expressing too much too early can lead to their ending therapy. Treatment must be person centered , with clients feeling understood and well regarded. This can allow them to connect with and understand their emotions. When people with SzPD do not have their feelings validated, this will confirm their belief that expressing themselves
3321-494: A person with SzPD. Reality can feel unenjoyable and uninteresting to people with SzPD. They have difficulty finding motivation and lack ambition. Patients with SzPD often feel as if they are "going through the motions" or that "life passes them by." Many describe feeling as if they are observing life from a distance. Aaron Beck and his colleagues report that people with SzPD seem comfortable with their aloof lifestyle and consider themselves observers, rather than participants in
3444-496: A potentially effective medication for SzPD. Originally, low doses of atypical antipsychotics like risperidone or olanzapine were used to alleviate social deficits and blunted affect. However, a 2012 review concluded that atypical antipsychotics were ineffective for treating personality disorders. Antidepressants , SSRIs , anxiolitics , bupropion , modafinil , benzodiazepines , and biofeedback may also be effective treatments. Treatment for this disorder uses
3567-677: A robot" or "going through life in a dream". People with SzPD may try to avoid all physical activity in order to become nobody and disconnect from reality. This can lead to the patient spending a large quantity of time sleeping and ignoring bodily functions such as hygiene . Although this disorder does not affect the patient's capacity to understand reality, they may engage in excessive daydreaming and introspection . Their daydreams can grow to consume most of their lives. Real life can become secondary to their fantasy , and they can have complex lives and relationships which exist entirely inside of their internal fantasy. These daydreams may constitute
3690-421: A schizoid disorder. Theodore Millon restricted the term "schizoid" to those personalities who lack the capacity to form social relationships. He characterizes their way of thinking as being vague and void of thoughts and as sometimes having a "defective perceptual scanning". Because they often do not perceive cues that trigger affective responses, they experience fewer emotional reactions. For Millon, SzPD
3813-449: A single personality disorder. It has also been argued due to the poor consistency and efficiency of diagnosis due to overlapping traits that SzPD should be removed altogether from the DSM. A 2012 article suggested that two different disorders may better represent SzPD: one affect-constricted disorder (belonging to schizotypal PD) and a seclusive disorder (belonging to avoidant PD). They called for
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3936-417: A solitary or sheltered lifestyle, secretiveness, emotional coldness, detachment, and apathy . Affected individuals may be unable to form intimate attachments to others and simultaneously possess a rich and elaborate but exclusively internal fantasy world . Other associated features include stilted speech , a lack of deriving enjoyment from most activities, feeling as though one is an "observer" rather than
4059-475: A song by King Crimson Topics referred to by the same term [REDACTED] This disambiguation page lists articles associated with the title The Schizoid Man . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=The_Schizoid_Man&oldid=892182344 " Category : Disambiguation pages Hidden categories: Short description
4182-419: A variety of receptors , including α- and β-adrenergic , dopamine , serotonin , histamine , and muscarinic acetylcholine receptors . The occupancy of dopamine transporter (DAT) by bupropion (300 mg/day) and its metabolites in the human brain as measured by several positron emission tomography (PET) studies is approximately 20%, with a mean occupancy range of about 14 to 26%. For comparison,
4305-448: Is 0.4% at the dose 300–450 mg per day; the incidence climbs almost ten-fold for the higher than recommended dose of 600 mg. For comparison, the incidence of unprovoked seizure in the general population is 0.07–0.09%, and the risk of seizure for a variety of other antidepressants is generally 0–0.5% at the recommended doses. Cases of liver toxicity leading to death or liver transplantation have been reported for bupropion. It
4428-419: Is also known structurally as 3-chloro- N - tert -butyl-β-keto-α-methylphenethylamine, 3-chloro- N - tert -butyl-β-ketoamphetamine, or 3-chloro- N - tert -butylcathinone. The clinically used bupropion is racemic , that is a mixture of two enantiomers : S -bupropion and R -bupropion. Although the optical isomers on bupropion can be separated, they rapidly racemize under physiological conditions. Bupropion
4551-462: Is as effective as nicotine replacement therapy but inferior to varenicline . Combining bupropion and nicotine replacement therapy does not improve the quitting rate. In children and adolescents, the use of bupropion for smoking cessation does not appear to offer any significant benefits. The evidence for its use to aid smoking cessation in pregnant women is insufficient. In the United States,
4674-470: Is associated with higher doses of bupropion; many cases described are at higher than recommended doses. Concurrent antipsychotic medication appears to be protective. In most cases the psychotic symptoms are eliminated by reducing the dose, ceasing treatment or adding antipsychotic medication. Although studies are lacking, a handful of case reports suggest that abrupt discontinuation of bupropion may cause antidepressant discontinuation syndrome . Bupropion
4797-429: Is associated with lower levels of achievement, a compromised quality of life , and a worse outcome of treatment. Treatment for this disorder is under-studied and poorly understood. There is no widely accepted and approved psychotherapy or medication for this disorder. It is one of the most poorly researched psychiatric disorders. Professionals may misunderstand the disorder and the client, potentially reinforcing
4920-424: Is because schizoid individuals "prefer to make relationships on their own terms and not in terms of the impulses of other people." Failing to attain that, they prefer isolation. In general, friendship for schizoid individuals is usually limited to one other person, who is often also schizoid, forming what has been called a union of two eccentrics; "within it – the ecstatic cult of personality, outside it – everything
5043-630: Is being violated, and they commonly feel that masturbation or sexual abstinence is preferable to the emotional closeness they must tolerate when having sex. Significantly broadening this picture are notable exceptions of SzPD individuals who engage in occasional or even frequent sexual activities with others. Individuals with SzPD have long been noted to have an increased rate of unconventional sexual tendencies, though if present, these are rarely acted upon. Schizoid people are often labeled asexual or present with "a lack of sexual identity". Kernberg states that this apparent lack of sexuality does not represent
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5166-444: Is common amongst people with SzPD. This leads to them isolating themselves to avoid the discomfort and stimulation that emotional experiences offer. According to Guntrip , Klein, and others, people with SzPD may possess a hidden sense of superiority and lack dependence on other people's opinions. This is very different from the grandiosity seen in narcissistic personality disorder , which is described as "burdened with envy" and with
5289-529: Is considered moderately dangerous in overdose. According to an analysis of US National Poison Data System , adjusted for the number of prescriptions, bupropion and venlafaxine are the two new generation antidepressants (that is excluding tricyclic antidepressants ) that result in the highest mortality and morbidity . For significant overdoses, seizures have been reported in about a third of all cases; other serious effects include hallucinations, loss of consciousness, and abnormal heart rhythms . When bupropion
5412-432: Is considered to be a "schizophrenia-like personality disorder". It is diagnosed by clinical observation, and it can be very difficult to distinguish SzPD from other mental disorders or conditions (such as autism spectrum disorder , with which it may sometimes overlap). The effectiveness of psychotherapeutic and pharmacological treatments for the disorder has yet to be empirically and systematically investigated. This
5535-775: Is considered to be one of several antidepressants with greater risk of hepatotoxicity. The prescribing information warns about bupropion triggering an angle-closure glaucoma attack. On the other hand, bupropion may decrease the risk of development of open angle glaucoma . Bupropion use by mothers in the first trimester of pregnancy is associated with 23% increase of the odds in congenital heart defects in their children. Bupropion has rarely been associated with instances of Stevens–Johnson syndrome . Bupropion has not been associated with QT prolongation at therapeutic doses, but has been associated with QT prolongation in overdose . The US Food and Drug Administration (FDA) requires all antidepressants, including bupropion, to carry
5658-454: Is dangerous. Therapists attempt to avoid intruding on their patients' lives or restricting their freedoms, so as to prevent them from feeling as if therapy is intolerable. Because of this, therapy is usually less structured than treatment programs for other disorders. Patients may benefit from long-term treatment lasting several years. Inpatient care may be effective for treating SzPD and other Cluster A disorders. The original concept of
5781-408: Is different from Wikidata All article disambiguation pages All disambiguation pages Schizoid personality disorder Schizoid personality disorder ( / ˈ s k ɪ t s ɔɪ d , ˈ s k ɪ d z ɔɪ d , ˈ s k ɪ z ɔɪ d / , often abbreviated as SzPD or ScPD ) is a personality disorder characterized by a lack of interest in social relationships , a tendency toward
5904-434: Is distinguished from other personality disorders in that it is "the personality disorder that lacks a personality." He criticizes that this may be due to the current diagnostic criteria: They describe SzPD only by an absence of certain traits, which results in a "deficit syndrome" or "vacuum". Instead of delineating the presence of something, they mention solely what is lacking. Therefore, it is hard to describe and research such
6027-558: Is equivalent to that of SSRIs in the case of depression with low or moderate anxiety, whereas SSRIs show a modest effectiveness advantage in terms of response rates for depression with high anxiety. The addition of bupropion to a prescribed SSRI is a common strategy when people do not respond to the SSRI, and it is supported by clinical trials; however, it appears to be inferior to the addition of atypical antipsychotic aripiprazole . Prescribed as an aid for smoking cessation, bupropion reduces
6150-515: Is highly variable: the effective doses of bupropion received by persons who ingest the same amount of the drug may differ by as much as 5.5 times (with a half-life of 12–30 hours), while the effective doses of hydroxybupropion may differ by as much as 7.5 times (with a half-life of 15–25 hours). Based on this, some researchers have advocated monitoring of the blood level of bupropion and hydroxybupropion. The metabolism of bupropion also seems to follow biphasic pharmacokinetics:
6273-579: Is largely because people with SzPD rarely seek treatment for their condition. Originally, low doses of atypical antipsychotics were used to treat some symptoms of SzPD, but their use is no longer recommended. The substituted amphetamine bupropion may be used to treat associated anhedonia . However, it is not general practice to treat SzPD with medications, other than for the short-term treatment of acute co-occurring disorders (e.g. depression ). Talk therapies such as cognitive behavioral therapy (CBT) may not be effective, because people with SzPD may have
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#17328521943276396-466: Is mainly formulated as the hydrochloride salt but also as the hydrobromide salt. In addition to single-drug formulations, bupropion is formulated in combinations including naltrexone/bupropion (Contrave) for obesity and dextromethorphan/bupropion (Auvelity) for depression. The US Food and Drug Administration (FDA) prescription label advises that bupropion should not be prescribed to individuals with epilepsy or other conditions that lower
6519-577: Is mandatory for any behavior to be diagnosed as a personality disorder . Ralph Klein, Clinical Director of the Masterson Institute, delineates the following nine characteristics of the schizoid personality as described by Harry Guntrip : The description of Guntrip's nine characteristics should clarify some differences between the traditional DSM portrait of SzPD and the traditional informed object relations view. All nine characteristics are consistent. Most, if not all, must be present to diagnose
6642-496: Is metabolized in the body by a variety of pathways. The oxidative pathways are by cytochrome P450 isoenzymes CYP2B6 leading to R,R - and S,S -hydroxybupropion and, to a lesser degree, CYP2C19 leading to 4'-hydroxybupropion. The reductive pathways are by 11β-hydroxysteroid dehydrogenase type 1 in the liver and AKR7A2 / AKR7A3 in the intestine leading to threo -hydrobupropion and by yet unknown enzyme leading to erythro -hydrobupropion . The metabolism of bupropion
6765-429: Is not associated with weight gain and sleepiness , and it is more effective than SSRIs at improving symptoms of hypersomnia and fatigue. Bupropion, particularly the immediate release formulation, carries a higher risk of seizure than many other antidepressants, hence caution is recommended in patients with a history of seizure disorder. The medication is taken by mouth . Common adverse effects of bupropion with
6888-557: Is not involved. According to Fairbairn, the person disowns the part they are playing, and the schizoid individual seeks to preserve their personality intact and immune from compromise. The schizoid person's false persona is based on what those around them define as normal or good behavior, as a form of compliance. Further references to the secret schizoid come from Masud Khan , Jeffrey Seinfeld, and Philip Manfield. These scholars described secret schizoids as people who enjoy public speaking engagements but experience great difficulty during
7011-399: Is observed in some people taking bupropion, both with and without pre-existing hypertension. Safety of bupropion in people with cardiovascular conditions and its general cardiovascular safety profile remain unclear due to the lack of data. Seizure is a rare but serious adverse effect of bupropion. It is strongly dose-dependent: for the immediate release preparation, the seizure incidence
7134-540: Is preoccupied with one's inner experience). The DSM-II later updated the definition to include daydreaming , detachment from reality , and sensitivity. It was incorporated into the DSM-III as schizoid personality disorder to describe difficulties forming meaningful social relationships and a persistent pattern of disconnection and apathy. The diagnosis of SzPD made it to the DSM-IV and DSM-V. It remains unclear how prevalent
7257-440: Is sharply rejected and despised". Their unique lifestyle can lead to social rejection and people with SzPD are at a higher risk of facing bullying or homelessness . This social rejection can reinforce their asocial behavior. People with this disorder usually have little to no interest in sexual or romantic relationships. They rarely date or marry. Sex often causes individuals with SzPD to feel that their personal space
7380-831: Is the increase of bupropion and decrease of hydroxybupropion blood concentration. The reverse effect (decrease of bupropion and increase of hydroxybupropion) can be expected with CYP2B6 inducers such as carbamazepine , clotrimazole , rifampicin , ritonavir , St John's wort , and phenobarbital . Indeed, carbamazepine decreases exposure to bupropion by 90% and increases exposure to hydroxybupropion by 94%. Ritonavir, lopinavir/ritonavir , and efavirenz have been shown to decrease levels of bupropion and/or its metabolites. Ticlopidine and clopidogrel, both potent CYP2B6 inhibitors, have been found to considerably increase bupropion levels as well as decrease levels of its metabolite hydroxybupropion. Bupropion and its metabolites are inhibitors of CYP2D6 , with hydroxybupropion responsible for most of
7503-443: Is thought to be involved in species differences in its pharmacodynamic effects. For example, bupropion produces psychostimulant -like and reinforcing effects in rodents, whereas oral bupropion at therapeutic doses seems to have much less or no potential for such effects in humans. Bupropion is an aminoketone that belongs to the class of substituted cathinones and the more general class of substituted phenethylamines . It
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#17328521943277626-546: The DSM-5 and ICD-10 definitions of the schizoid personality. Guntrip (using ideas of Klein, Fairbairn, and Winnicott) classifies these individuals as "secret schizoids", who behave with socially available, interested, engaged, and involved interaction yet remain emotionally withdrawn and sequestered within the safety of the internal world. Klein distinguishes between a "classic" SzPD and a "secret" SzPD, which occur "just as often" as each other. Klein cautions one should not misidentify
7749-422: The effectiveness of bupropion over placebo for the treatment of depression. Some peer-reviewed studies suggest the quality of evidence is low. Some meta-analyses report that bupropion has an at-most small effect size for depression. One meta-analysis reported a large effect size. However, there were methodological limitations with this meta-analysis, including using a subset of only five trials for
7872-437: The frontal lobe , amygdala , and striatum . Traumatic brain injuries to the frontal lobe may also contribute to the onset of SzPD as that area of the brain controls areas such as emotion and socialization. Deficits in the right hemisphere of the brain may also be associated with SzPD. Lower levels of low-density lipoprotein cholesterol may be correlated with the presence of schizoid traits in women. Excess indices in
7995-406: The seizure threshold , such as anorexia nervosa , bulimia nervosa , or benzodiazepine or alcohol withdrawal . It should be avoided in individuals who are taking monoamine oxidase inhibitors (MAOIs). The label recommends that caution should be exercised when treating people with liver damage, severe kidney disease , and severe hypertension , and in children, adolescents and young adults due to
8118-689: The "schizoid condition", which roughly includes the DSM schizoid, avoidant and schizotypal personality disorders, is represented by "as many as forty percent of all personality disorders." Manfield adds: "This huge discrepancy [from the ten percent reported by therapists for the condition] is probably largely because someone with a schizoid disorder is less likely to seek treatment than someone with other axis-II disorders." A 2008 study assessing personality and mood disorder prevalence among homeless people at New York City drop-in centers reported an SzPD rate of 65% among this sample. The study did not assess homeless people who did not show up at drop-in centers, and
8241-467: The "shut-in" personality. Characteristics of it were reticence, reclusiveness, shyness and a preference for living in fantasy worlds, among others. In 1925, Russian psychiatrist Grunya Sukhareva described a "schizoid psychopathy" in a group of children, resembling today's SzPD and ASD . About a decade later Pyotr Gannushkin also included Schizoids and Dreamers in his detailed typology of personality types. The descriptive tradition began in 1925 with
8364-629: The DAT, bupropion's overall pharmacological profile in humans may end up making it effectively more of a norepinephrine reuptake inhibitor than a dopamine reuptake inhibitor. Accordingly, the clinical effects of bupropion are more consistent with noradrenergic activity than with dopaminergic actions. Bupropion has been claimed to be a sigma σ 1 receptor agonist . Its antidepressant-like effects in rodents depend on σ 1 receptor activation. They are enhanced and inhibited by σ 1 receptor agonists and antagonists, respectively. However, no data on
8487-482: The NDRI methylphenidate at therapeutic doses is thought to occupy greater than 50% of DAT sites. In accordance with its low DAT occupancy, no measurable dopamine release in the human brain was detected with bupropion (one 150 mg dose) in a PET study. Bupropion has also been shown to increase striatal VMAT2 , though it is unknown if this effect is more pronounced than other DRIs. These findings raise questions about
8610-528: The belief that their emotions are dangerous to themselves and others due to the negative responses received from others. In their status of isolation and emotional bluntness they can be self-sufficient and safe. Childhood trauma can also contribute to feelings of emptiness in adulthood. Alcoholism in parents is associated with a heightened risk of developing SzPD. Sula Wolff , who did extensive research and clinical work with children and teenagers with schizoid symptoms, stated that "schizoid personality has
8733-462: The binding or functional effects of bupropion at the human sigma receptors seem to be available. In any case, bupropion has been reported to bind to rodent σ 1 receptors with IC 50 Tooltip half-maximal inhibitory concentration values of 580 to 2,100 nM. In contrast to many other phenethylamines and amphetamines , bupropion is not an agonist of the trace amine-associated receptor 1 (TAAR1). Bupropion has been found to have
8856-420: The blood plasma at comparable or much higher levels. In fact, bupropion could accurately be conceptualized as a prodrug of these metabolites. Overall action of these metabolites, and particularly one enantiomer S,S -hydroxybupropion , is also characterized by inhibition of norepinephrine and dopamine reuptake and nicotinic inhibition (see the chart on the right). Bupropion has no meaningful direct activity at
8979-490: The brand name Wellbutrin among others, is an atypical antidepressant primarily used to treat major depressive disorder , seasonal affective disorder and to support smoking cessation . It is also popular as an add-on medication in the cases of "incomplete response" to the first-line selective serotonin reuptake inhibitor (SSRI) antidepressant. Bupropion has several features that distinguish it from other antidepressants: it does not usually cause sexual dysfunction, it
9102-465: The breaks when audience members would attempt to engage them emotionally. These references expose the problems in relying on outer observable behavior for assessing the presence of personality disorders in certain individuals. Several studies have reported an overlap or comorbidity with autism spectrum disorder and Asperger syndrome . Asperger syndrome had traditionally been called "schizoid disorder of childhood", and Eugen Bleuler coined both
9225-490: The criteria for SzPD than women. While 41% of the whole sample were unemployed with no occupation, this rose to 62% for the Asperger's and SzPD comorbid group. Tantam suggested that Asperger syndrome may confer an increased risk of developing SzPD. A 2019 study found that 54% of a group of males aged 11 to 25 with Asperger syndrome showed significant SzPD traits, with 6% meeting full diagnostic criteria for SzPD, compared to 0% of
9348-530: The description of observable schizoid behaviors by Ernst Kretschmer . He organized those into three groups of characteristics: These characteristics were the precursors of the DSM-III division of the schizoid character into three distinct personality disorders: schizotypal , avoidant and schizoid. Kretschmer himself, however, did not conceive of separating these behaviors to the point of radical isolation but considered them to be simultaneously present as varying potentials in schizoid individuals. For Kretschmer,
9471-452: The disorder is. It may be present in anywhere from 0.5% to 7% of the population and possibly 14% of the homeless population. Gender differences in this disorder are also unclear. Some research has suggested that this disorder may occur more frequently in men than women. SzPD is uncommon in clinical settings (about 2.2%) and occurs more commonly in males. It is rare compared with other personality disorders. Philip Manfield suggests that
9594-439: The drug has been found to increase effort expenditure and improve motivational deficits in animal models . However, only limited benefits of bupropion in the treatment of apathy have been observed in clinical trials in various conditions. Bupropion has been used in the treatment of postural orthostatic tachycardia syndrome (POTS). Bupropion is available as an oral tablet in a number of different formulations. It
9717-434: The effect size calculation, substantial variability in effect sizes between the selected trials—which led the authors to state that their findings in this area should be interpreted with "extreme caution"—and general lack of inclusion of unpublished trials in the meta-analysis. Unpublished trials are more likely to be negative in findings, and other meta-analyses have included unpublished trials. Evidence suggests that
9840-399: The effectiveness of bupropion for depression is similar to that of other antidepressants. Over the autumn and winter months, bupropion prevents development of depression in those who have recurring seasonal affective disorder : 15% of participants on bupropion experienced a major depressive episode vs. 27% of those on placebo. Bupropion also improves depression in bipolar disorder , with
9963-411: The efficacy and risk of affective switch being similar to other antidepressants. Bupropion has several features that distinguish it from other antidepressants: for instance, unlike the majority of antidepressants, it does not usually cause sexual dysfunction, and the occurrence of sexual side effects is not different from placebo. Bupropion treatment is not associated with weight gain; on the contrary,
10086-604: The efforts required to establish a proper relationship with the therapist. It can be difficult for them to open up or discuss their emotions in therapy. Although people with this disorder can still improve, it is unlikely they will ever experience significant joy through social interaction. SzPD is associated with a dismissive-avoidant attachment style . People with this disorder will rarely maintain close relationships and often exclusively choose to participate in solitary activities. People with schizoid personality disorder typically have no close friends or confidants, except for
10209-634: The exposure to its main metabolite by 1.5-fold. As another example, the ratio of dextromethorphan (a drug that is mainly metabolized by CYP2D6) to its major metabolite dextrorphan increased approximately 35-fold when it was administered to people being treated with 300 mg/day bupropion. When people on bupropion are given MDMA , about 30% increase of exposure to both drugs is observed, with enhanced mood but decreased heart rate effects of MDMA. Interactions with other CYP2D6 substrates, such as metoprolol , imipramine , nortriptyline , venlafaxine , and nebivolol have also been reported. However, in
10332-527: The general population. One study found that significantly fewer boys with SzPD had alcohol problems than a control group of non-schizoid people. Another study evaluating personality disorder profiles in substance abusers found that substance abusers who showed schizoid symptoms were more likely to abuse one substance rather than many, in contrast to other personality disorders such as borderline , antisocial , or histrionic , which were more likely to abuse many. American psychotherapist Sharon Ekleberry states that
10455-418: The greatest difference from placebo are dry mouth , nausea , constipation , insomnia , anxiety , tremor , and excessive sweating . Raised blood pressure is notable. Rare but serious side effects include seizures , liver toxicity , psychosis , and risk of overdose . Bupropion use during pregnancy may be associated with increased likelihood of congenital heart defects . Bupropion acts as
10578-488: The happiest when in relationships in which their partner places few emotional or intimate demands on them and does not expect phatic or social niceties. It is not necessarily people they want to avoid, but negative or positive emotional expectations, emotional intimacy , and self-disclosure . Patients with SzPD can feel as if close emotional bonds are dangerous to themselves and others. They may have feelings of inadequacy or shame. Some people with SzPD may experience
10701-638: The impact of their actions in social situations. People with this condition are often indifferent towards criticism or praise and can appear distant, aloof, or uncaring to others. They may avoid others and expressing themselves as a method of keeping others distant and preventing themselves from being hurt. Remaining alone and expressionless can feel safe and comfortable for people with SzPD. Expressing themselves can make them feel shame or discomfort. People with SzPD may feel inadequate and can be sensitive, although they have difficulty expressing it. Alexithymia , or difficulties understanding one's own emotions,
10824-581: The impoverished social connections experienced by people with SzPD limit their exposure to the drug culture and that they have limited inclination to learn how to do illegal drugs. Describing them as "highly resistant to influence", she additionally states that even if they could access illegal drugs, they would be disinclined to use them in public or social settings, and because they would be more likely to use alcohol or cannabis alone than for social disinhibition , they would not be particularly vulnerable to negative consequences in early use. People with SzPD are at
10947-628: The increased risk of suicidal ideation . The common adverse effects of bupropion with the greatest difference from placebo are dry mouth, nausea, constipation, insomnia, anxiety, tremor, and excessive sweating. Bupropion has the highest incidence of insomnia of all second-generation antidepressants, apart from desvenlafaxine . It is also associated with about 20% increased risk of headache. Bupropion raises blood pressure in some people. One study showed an average rise of 6 mm Hg in systolic blood pressure in 10% of patients. The prescribing information notes that hypertension , sometimes severe,
11070-428: The inhibition. Additionally, bupropion and its metabolites may decrease expression of CYP2D6 in the liver. The end effect is a significant slowing of the clearance of other drugs metabolized by this enzyme. For instance, bupropion has been found to increase area-under-the-curve of desipramine , a CYP2D6 substrate, by 5-fold. Bupropion has also been found to increase levels of atomoxetine by 5.1-fold, while decreasing
11193-545: The lack of data on the frequency of many of the features makes their relative diagnostic weight difficult to distinguish at this time. However, Akhtar states that his profile has several advantages over the DSM in terms of maintaining historical continuity of the use of the word schizoid , valuing depth and complexity over descriptive oversimplification and helping provide a more meaningful differential diagnosis of SzPD from other personality disorders. Bupropion Bupropion , formerly called amfebutamone , and sold under
11316-458: The left hemisphere may also be related to SzPD. Traits of schizoid personality disorder appear in childhood and adolescence . Children with this disorder usually have poor relationships with others, social anxiety , internal fantasies, strange behavior, and hyperactivity . These behaviors can result in teasing and bullying at the hands of others. It is common for people with SzPD to have had major depressive disorder in childhood. SzPD
11439-543: The level of the inflammatory mediator TNF-alpha , there have been suggestions that it might be useful in treating inflammatory bowel disease , psoriasis , and other autoimmune conditions, but very little clinical evidence is available. Bupropion is not effective in treating chronic low back pain. The drug may be useful in the treatment of excessive daytime sleepiness (EDS) and narcolepsy . Bupropion has been used to treat disorders of diminished motivation , like apathy , abulia , and akinetic mutism . Accordingly,
11562-518: The lowest levels of "life success" of all personality disorders (measured as "status, wealth and successful relationships"). Bullying is particularly common towards schizoid individuals. Suicide may be a running mental theme for schizoid individuals, though they are not likely to attempt it. Some symptoms of SzPD (e.g. solitary lifestyle, emotional detachment, loneliness, and impaired communication), however, have been stated as general risk factors for serious suicidal behavior. The term schizoid
11685-480: The majority of schizoid people are not either oversensitive or cold, but they are oversensitive and cold "at the same time" in quite different relative proportions, with a tendency to move along these dimensions from one behavior to the other. The second path, that of dynamic psychiatry, began in 1924 with observations by Eugen Bleuler , who observed that the schizoid person and schizoid pathology were not things to be set apart. Ronald Fairbairn's seminal work on
11808-558: The majority of studies observed significant weight loss in bupropion-treated participants. Bupropion treatment also is not associated with the sleepiness that may be produced by other antidepressants. Bupropion is more effective than selective serotonin reuptake inhibitors (SSRIs) at improving symptoms of hypersomnia and fatigue in depressed patients. Bupropion is effective in the treatment of anxious depression and, contrary to common belief, does not exacerbate anxiety in this context. The effectiveness of bupropion for anxious depression
11931-723: The notion that social interaction skills are unimpaired in SzPD. The authors believe that a substantial subgroup of people with autism spectrum disorder or PDD have clear "schizoid traits" and correspond largely to the "loners" in Lorna Wing 's classification The autism spectrum ( Lancet 1997), described by Sula Wolff . The authors of the 2019 study hypothesized that it is extremely likely that historic cohorts of adults diagnosed with SzPD either also had childhood-onset autistic syndromes or were misdiagnosed. They stressed that further research to clarify overlap and distinctions between these two syndromes
12054-492: The onset of SzPD. For a person with SzPD, their parents likely were intolerant of their emotional experiences. They may have been forced to repress and compartmentalize their emotions, possibly resulting in the onset of difficulties expressing and processing emotional experiences. These difficulties lead to the child feeling rejected and developing the belief that the only safe environment is one where they are alone and inexpressive. People with SzPD may also have internalized
12177-532: The peak blood plasma concentration after 1.5 hours ( t max ). Sustained release (SR) and extended release (XL) formulations have been designed to slow down absorption resulting in t max of 3 hours and 5 hours, respectively. Absolute bioavailability of bupropion is unknown but is presumed to be low, at 5–20%, due to the first-pass metabolism . As for the relative bioavailability of the formulations, XL formulation has lower bioavailability (68%) compared to SR formulation and immediate release bupropion. Bupropion
12300-399: The rates of most other personality and mood disorders within the drop-in centers were lower than that of SzPD. The authors noted the limitations of the study, including the higher male-to-female ratio in the sample and the absence of subjects outside the support system or receiving other support (e.g., shelters ) as well as the absence of subjects in geographical settings outside New York City,
12423-654: The redistribution alpha phase with half-life of about 1 hour precedes the metabolism beta phase of about 12-30 hours. This might explain why abuse is unfeasible due to a short "high", as well as support the use of extended-release formulas to maintain a consistent concentration of bupropion. The metabolism of bupropion is highly species-dependent. As an example, oral bupropion results in hydroxybupropion levels that are 16-fold higher than those of bupropion itself in humans, whereas in rats, oral bupropion results in levels of bupropion that are 3.4-fold higher than those of hydroxybupropion. The species-dependent metabolism of bupropion
12546-467: The replacement of the SzPD category from future editions of the DSM with a dimensional model which would allow for the description of schizoid traits on an individual basis. Some critics such as Nancy McWilliams of Rutgers University and Panagiotis Parpottas of European University Cyprus argue that the definition of SzPD is flawed due to cultural bias and that it does not constitute a mental disorder but simply an avoidant attachment style requiring
12669-428: The risk of developing schizoid personality disorder. People with SzPD can have a history of schizotypy before developing the disorder. SzPD symptoms can be premorbid to schizophrenia. Prenatal malnutrition , premature birth , and low birth weight are all thought to play a role in the development of SzPD. SzPD is associated with reduced serotonergic and dopaminergic pathways in areas such as
12792-446: The role of dopamine reuptake inhibition in the pharmacology of bupropion, and suggest that other actions may be responsible for its therapeutic effects. No data are available on occupancy of the norepinephrine transporter (NET) by bupropion and its metabolites. However, due to the increased exposure of hydroxybupropion over bupropion itself, which has higher affinity for the NET than
12915-844: The same time, people with SzPD are helpless at many practical activities because of their symptoms. Symptoms of SzPD such as isolation and the blunted affect put people with schizoid personality disorder at a higher risk of suicide and non-suicidal self-harm . This may be because their reduced capacities for emotion prevent them from properly dealing with strife. Their solitary nature may contribute by preventing them from finding relief in relationships. Demonstrative suicides or suicide blackmail, as seen in cluster B personality disorders such as borderline , histrionic , or antisocial , are extremely rare among schizoid individuals. As in other clinical mental health settings, among suicidal inpatients, individuals with SzPD are not as well represented as some other groups. A 2011 study on suicidal inpatients at
13038-401: The schizoid character developed by Ernst Kretschmer in the 1920s comprised a mix of avoidant , schizotypal , and schizoid traits. It was not until 1980 and the work of Theodore Millon that led to splitting this concept into three personality disorders (now schizoid, schizotypal, and avoidant). This caused debate about whether this was accurate or if these traits were different expressions of
13161-402: The schizoid character, most notably from writers Nannarello (1953), Laing (1965), Winnicott (1965), Guntrip (1969), Khan (1974), Akhtar (1987), Seinfeld (1991), Manfield (1992) and Klein (1995). The DSM-I had the diagnosis of schizoid personality , which was defined by avoidance of close relationships, inability to express aggressive feelings, and autistic thinking (thinking which
13284-516: The schizoid person as a result of the patient's defensive, compensatory interaction with the external world. He suggests one ask the person what their subjective experience is, to detect the presence of the schizoid refusal of emotional intimacy and preference for objective fact. A 2013 study looking at personality disorders and Internet use found that being online more hours per day predicted signs of SzPD. Additionally, SzPD correlated with lower phone call use and fewer Facebook friends. Descriptions of
13407-406: The schizoid personality as "hidden" behind an outward appearance of emotional engagement have been recognized since 1940, with Fairbairn's description of "schizoid exhibitionism", in which the schizoid individual can express a great deal of feeling and make what appear to be impressive social contacts yet, in reality, gives nothing and loses nothing. Because they are "playing a part", their personality
13530-468: The schizoid personality, from which most of what is known today about schizoid phenomena is derived, was presented in 1940. Here, Fairbairn delineated four central schizoid themes: Following Fairbairn's derivation of SzPD from a combination of derealization , depersonalization , splitting , the oral stage of making all subjects into partial objects , and intellectualization ; the dynamic psychiatry tradition has continued to produce rich explorations on
13653-404: The severity of craving for nicotine and withdrawal symptoms such as depressed mood, irritability, difficulty concentrating, and increased appetite. Initially, bupropion slows the weight gain that often occurs in the first weeks after quitting smoking. With time, however, this effect becomes negligible. The bupropion treatment course lasts for seven to twelve weeks, with the patient halting
13776-600: The terms "autism" and "schizoid" to describe withdrawal to an internal fantasy, against which any influence from outside becomes an intolerable disturbance. In a 2012 study of a sample of 54 young adults with Asperger syndrome, it was found that 26% of them also met the criteria for SzPD, the highest comorbidity out of any personality disorder in the sample (the other comorbidities were 19% for obsessive–compulsive personality disorder , 13% for avoidant personality disorder and one female with schizotypal personality disorder ). Additionally, twice as many men with Asperger syndrome met
13899-601: The treatment of attention deficit hyperactivity disorder (ADHD) is not an approved indication of bupropion, and it is not mentioned in the 2019 guideline on ADHD treatment from the American Academy of Pediatrics . Systematic reviews of bupropion for the treatment of ADHD in both adults and children note that bupropion may be effective for ADHD but warn that this conclusion has to be interpreted with caution, because clinical trials were of low quality due to small sizes and risk of bias. Similarly to atomoxetine , bupropion has
14022-400: The use of alcohol , since in rare cases bupropion reduces alcohol tolerance. Caution should be observed when combining bupropion with a monoamine oxidase inhibitor (MAOI), as it may result in hypertensive crisis . The mechanism of action of bupropion in the treatment of depression and for other indications is unclear. However, it is thought to be related to the fact that bupropion is
14145-488: The use of tobacco about ten days into the course. After the course, the effectiveness of bupropion for maintaining abstinence from smoking declines over time, from 37% of tobacco abstinence at 3 months to 20% at one year. It is unclear whether extending bupropion treatment helps to prevent relapse of smoking. Overall, six months after the therapy, bupropion increases the likelihood of quitting smoking by approximately 1.6 fold as compared to placebo. In this respect, bupropion
14268-522: The weight loss produced by several other weight-loss medications such as sibutramine or orlistat . The combination drug naltrexone/bupropion has been approved by the US Food and Drug Administration (FDA) for the treatment of obesity. Bupropion is not effective in the treatment of cocaine dependence , but it is showing promise in reducing drug use in treating amphetamine-type stimulant use and cravings. Based on studies indicating that bupropion lowers
14391-539: The world around them. But they also mention that many of their schizoid patients recognize themselves as socially deviant (or even defective) when confronted with the different lives of ordinary people – especially when they read books or see movies focusing on relationships. Even when schizoid individuals may not long for closeness, they can become weary of being "on the outside, looking in". These feelings may lead to depression, depersonalization , or derealization . If they do, schizoid people often experience feeling "like
14514-428: Was coined in 1908 by Eugen Bleuler to describe a human tendency to direct attention toward one's inner life and away from the external world. Bleuler labeled the exaggeration of this tendency the "schizoid personality". He described these personalities as "comfortably dull and at the same time sensitive, people who in a narrow manner pursue vague purposes". In 1910, August Hoch introduced a very similar concept called
14637-468: Was first approved for medical use in the United States in 1985. Bupropion was originally called by the generic name amfebutamone, before being renamed in 2000. In 2022, it was the 21st most commonly prescribed medication in the United States, with more than 25 million prescriptions. It is on the World Health Organization's List of Essential Medicines . The evidence overall supports
14760-413: Was not statistically different from placebo. Bupropion prescribed for smoking cessation results in 25% increase of the risk of psychiatric side effects, in particular, anxiety (about 40% increase) and insomnia (about 80% increase). The evidence is insufficient to determine whether bupropion is associated with suicides or suicidal behavior. In rare cases, bupropion-induced psychosis may develop. It
14883-617: Was one of several kinds of pills taken in an overdose, fever, muscle rigidity, muscle damage, hypertension or hypotension, stupor, coma, and respiratory failure have been reported. While most people recover, some people have died, having had multiple uncontrolled seizures and myocardial infarction. Since bupropion is metabolized to hydroxybupropion by the enzyme CYP2B6 , drug interactions with CYP2B6 inhibitors are possible: this includes such medications as paroxetine , sertraline , norfluoxetine (active metabolite of fluoxetine ), diazepam , clopidogrel , and orphenadrine . The expected result
15006-432: Was strongly warranted, especially given that high-functioning autism spectrum disorders are now recognized in around 1% of the population. There are no effective medications for schizoid personality disorder. However, certain medications may reduce the symptoms of SzPD and treat co-occurring mental disorders . Since the symptoms of SzPD mirror the negative symptoms of schizophrenia, antipsychotics have been suggested as
15129-452: Was suggested that the anhedonia of SzPD may also affect eating, leading schizoid individuals to not enjoy it. Alternatively, it was suggested that schizoid individuals may not feel hunger as strongly as others or not respond to it, a certain withdrawal "from themselves". Very little data exists for rates of substance use disorder among people with SzPD, but existing studies suggest they are less likely to have substance abuse problems than
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