Having FSDT LSZH installed or not, shouldn't make any difference to how the Approaches are shown, because FSDT LSZH doesn't include ANY approaches, and it's set to NOT disable any existing Approaches in the simulator.
To verify this, I made the following test, and made a flight plan from EDDM to LSZH, choosing IFR with Low level airways and ILS28 with no arrival, repeated 3 times, with the following different conditions:
1) With FSDT LSZH installed, and Microsoft LSZH not installed
2) With Microsoft LSZH installed only
3) Without even Microsoft LSZH installed, just the default (bare) LSZH
Of course, I restarted the sim each time before every test, and as expected, in ALL 3 cases, what I got was EXACTLY like your screenshot "With LSZH installed", yes, even when FSDT LSZH wasn't installed.
I had a suspicion that the Microsoft LSZH might have added different approaches not otherwise included in the sim by itself, but that wasn't the case, since I always get the same result, that rectangular approach that must have been created by the sim with dummy waypoints on the fly, instead of the real procedure which would require reaching the airport on a 81° heading, then turning around in the opposite direction towards CF28->RAMEN and then back to the final runway heading, the one "Without LSZH installed", which is the real approach.
But since I always got the wrong one in all 3 cases, that excludes also the possibility Microsoft might have added the correct Approach only to the handcrafted Zurich.
That leaves with only one possible reason why you are getting the right one in some cases, and it's because it's coming from another scenery, most likely Navigraph, since it doesn't seem the right approach is ever included in the default Navdata in the sim. But if it's coming from Navigraph, then it MIGHT be affected by its priority compared to FSDT LSZH, that's why you might see a difference with/without FSDT installed. A difference that shouldn't even happen, because we explicitly asked NOT to delete or change any approaches.