Fragile self, mechanical world: mechanistic delusions and ego fragility in schizotypal–affective spectrum disorder—a CARE case report
Frontiers in Psychiatry July 16, 2026 Giovanna Azevedo Rodrigues, Fernando Martins Castanheira, Larissa Leite Vieira de Oliveira et al.
A 44-year-old Brazilian man with persecutory delusions of technological surveillance, ego fragility, and functional decline was not fully captured by prior diagnoses of bipolar disorder or schizophrenia. Dimensional psychopathological analysis suggests three interacting axes: structural ego weakness from impaired early attachment, a deficit in relational causality replaced by concrete-mechanistic reasoning, and limbic hyperactivation sustaining an anxiety-perplexity-paranoia loop. Laboratory findings showed severe dyslipidemia and marked hyperandrogenism (total testosterone 1,367 ng/dL). A multimodal regimen of risperidone, lithium, and psychotherapy attenuated paranoid reactivity and improved family engagement; the patient resumed guitar playing from day 3. Discharge included a referral for three-monthly paliperidone palmitate. The response supports the heuristic value of dimensional over categorical nosology.