Schizophreniform disorder

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Schizophreniform disorder
ICD-9 295.40

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Overview

Schizophreniform disorder is characterized by the presence of criterion A symptoms of schizophrenia. These include: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms. The disorder - including its prodromal, active, and residual phases - lasts longer than 1 month but less than 6 months.

Causes

At this time, the etiology is unknown. At least one study found similarities in brain structure abnormalities between schizophrenics and those with schizophreniform disorder.

Differential Diagnosis

  • Other mental disorders and medical conditions


Because the diagnostic criteria for schizophrenia and schizophreniform disorder differ primarily in terms of duration of illness, the discussion of the differential diagnosis of schizophrenia also applies to schizophreniform disorder. Schizophreniform disorder differs from brief psychotic disorder, which has a duration of less than 1 month.

Epidemiology and Demographics

Prevalence

Available evidence suggests variations in incidence across socio cultural settings. In the United States and other developed countries, the incidence is low, possibly five fold less than that of schizophrenia. In developing countries, the incidence is substantially higher, especially for the subtype "With Good Prognostic Features"; in some of these settings schizophreniform disorder may be as common as schizophrenia.

Risk Factors

  • Genetic predisposition[1]

Natural History,Complications, and Prognosis

Prognosis

The following specifiers for schizophreniform disorder may be used to indicate the presence or absence of features that may be associated with a better prognosis:

With Good Prognostic Features. This specifier is used if at least two of the following features are present: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning, confusion or perplexity at the height of the psychotic episode, good premorbid social and occupational functioning, and absence of blunted or flat affect.

Without Good Prognostic Features. This specifier is used if two or more of the above features have not been present.

Diagnostic Features

Schizophreniform disorder is a serious mental illness related to schizophrenia. It is a psychiatric disorder, as defined by the DSM-IV-TR.

The essential features of schizophreniform disorder are identical to those of schizophrenia except for two differences: the total duration of the illness (including prodromal, active, and residual phases) is at least 1 month but less than 6 months and impaired social or occupational functioning during some part of the illness is not required (although it may occur).

About half of those diagnosed with schizophreniform disorder are later diagnosed with schizophrenia. This disorder is more likely to occur in people if they have family members with schizophrenia or bipolar disorder (also called manic depression). The exact cause of the disorder is unknown.

The main criteria are the same as for schizophrenia. The main difference is the time course of the illness. Symptoms should be present for greater than one month but less than six months. This is opposed to schizophrenia where the illness has to have occurred for greater than six months. A brief psychotic disorder lasts for less than one month.

Treatment is similar to schizophrenia.

As with schizophrenia, this disorder can not be due to a general medical condition, or substance induced.

A full recovery from the disorder is probable. Medication and psychotherapy are used to treat schizophreniform disorder. In extreme cases, a patient may need to be hospitalized. It occurs equally in males and females.

Diagnostic Criteria

DSM-V Diagnostic Criteria for Schizophreniform Disorder[1]

  • A. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):
  • 1. Delusions.
  • 2. Hallucinations.
  • 3. Disorganized speech (e.g., frequent derailment or incoherence).
  • 4. Grossly disorganized or catatonic behavior.
  • 5. Negative symptoms (i.e., diminished emotional expression or avolition).

AND

  • B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.

AND

  • 1) No major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or
  • 2) If mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.

AND

  • D.The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.


Specify if:

  • With good prognostic features: This specifier requires the presence of at least two of the following features: onset of prominent psychotic symptoms within 4 weeks of the

first noticeable change in usual behavior or functioning; confusion or perplexity: good premorbid social and occupational functioning; and absence of blunted or flat affect.

  • Without good prognostic features: This specifier is applied if two or more of the above features have not been present.

Specify current severity:

  • Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behavior,and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present)to 4 (present and severe).

Note:Diagnosis of schizophreniform disorder can be made without using this severity specifier .

Familial Pattern

Few family studies have focused on schizophreniform disorder. Available evidence suggests that relatives of individuals with schizophreniform disorder have an increased risk for schizophrenia.

Management

The disorder is by definition self-limited. When symptoms cause severe impairment, treatment is similar to that for the acute treatment of psychosis in schizophrenia.

Summary of time course of select psychotic disorders

  • Less than one month: Brief psychotic disorder
  • >1 month, <6 months: Schizophreniform disorder
  • Greater than six months: Schizophrenia

Sources

Bibliography

  • Compton MT: Barriers to initial outpatient treatment engagement following first hospitalization for a first episode of nonaffective psychosis: a descriptive case series. J Psychiatr Pract 2005 Jan; 11(1): 62-9 [Medline]</a>.
  • Coryell W, Tsuang MT: Outcome after 40 years in DSM-III schizophreniform disorder. Arch Gen Psychiatry 1986 Apr; 43(4): 324-8 [Medline]</a>.
  • Strakowski SM: Diagnostic validity of schizophreniform disorder. Am J Psychiatry 1994 Jun; 151(6): 815-24 [Medline]</a>.

References

  1. 1.0 1.1 1.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.



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