Schizophreniform

disorder

Schizophreniform disorder is a ment al disorder diagnosed when sympt oms of schizophrenia

are present for a significant port ion of t ime (at least a mont h), but signs of dist urbance are not
present for t he full six mont hs required for t he diagnosis of schizophrenia.

Schizophreniform disorder

Specialty Psychiatry

The sympt oms of bot h disorders can include delusions, hallucinat ions, disorganized speech,
disorganized or cat at onic behavior, and social wit hdrawal. While impairment in social,
occupat ional, or academic funct ioning is required for t he diagnosis of schizophrenia, in
schizophreniform disorder an individual's level of funct ioning may or may not be affect ed. While
t he onset of schizophrenia is oft en gradual over a number of mont hs or years, t he onset of
schizophreniform disorder can be relat ively rapid.

Like schizophrenia, schizophreniform disorder is oft en t reat ed wit h ant ipsychot ic medicat ions,
especially t he at ypicals, along wit h a variet y of social support s (such as individual psychot herapy,
family t herapy, occupat ional t herapy, et c.) designed t o reduce t he social and emot ional impact
of t he illness. The prognosis varies depending upon t he nat ure, severit y, and durat ion of t he
sympt oms, but about t wo-t hirds of individuals diagnosed wit h schizophreniform disorder go on t o
develop schizophrenia.[1]

Signs and symptoms

Schizophreniform disorder is a t ype of ment al illness t hat is charact erized by psychosis and
closely relat ed t o schizophrenia. Bot h schizophrenia and schizophreniform disorder, as defined by
t he Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), have t he same
sympt oms and essent ial feat ures except for t wo differences: t he level of funct ional impairment
and t he durat ion of sympt oms. Impairment in social, occupat ional, or academic funct ioning is
usually present in schizophrenia, part icularly near t he t ime of first diagnosis, but such impairment
may or may not be present in schizophreniform disorder. In schizophreniform disorder, t he
sympt oms (including prodromal, act ive, and residual phases) must last at least 1 mont h but not
more t han 6 mont hs, while in schizophrenia t he sympt oms must be present for a minimum of 6
mont hs.[2]

Cause

The exact cause of t he disorder remains unknown, and relat ively few st udies have focused
exclusively on t he et iology of schizophreniform disorder. Like ot her psychot ic disorders, a
diat hesis–st ress model has been proposed, suggest ing t hat some individuals have an underlying
mult ifact orial genet ic vulnerabilit y t o t he disorder t hat can be t riggered by cert ain environment al
fact ors. Schizophreniform disorder is more likely t o occur in people wit h family members who
have schizophrenia or bipolar disorder.

Diagnosis

If t he sympt oms have persist ed for at least one mont h, a provisional diagnosis of
schizophreniform disorder can be made while wait ing t o see if recovery occurs. If t he sympt oms
resolve wit hin 6 mont hs of onset , t he provisional qualifier is removed from t he diagnosis.
However, if t he sympt oms persist for 6 mont hs or more, t he diagnosis of schizophreniform
disorder must be revised. The diagnosis of brief psychot ic disorder may be considered when t he
durat ion of sympt oms is less t han one mont h.

The main sympt oms of bot h schizophreniform disorder and schizophrenia may include:[1]
 delusions,

hallucinat ions,

disorganized speech result ing from formal t hought disorder,

disorganized or cat at onic behavior, and negat ive sympt oms, such as

an inabilit y t o feel a range of emot ions (flat affect ),

an inabilit y t o experience pleasure (anhedonia),

impaired or decreased speech (aphasia),

a lack of desire t o form relat ionships (asocialit y), and

a lack of mot ivat ion (avolit ion).

Treatment

Various modalit ies of t reat ment , including pharmacot herapy, psychot herapy, and various ot her
psychosocial and educat ional int ervent ions, are used in t he t reat ment of schizophreniform
disorder. Pharmacot herapy is t he most commonly used t reat ment modalit y as psychiat ric
medicat ions can act quickly t o bot h reduce t he severit y of sympt oms and short en t heir durat ion.
The medicat ions used are largely t he same as t hose used t o t reat schizophrenia, wit h an at ypical
ant ipsychot ic as t he usual drug of choice. Pat ient s who do not respond t o t he init ial at ypical
ant ipsychot ic may benefit from
being swit ched t o anot her at ypical ant ipsychot ic, t he addit ion of
a mood st abilizer such as lit hium or an ant iconvulsant , or being swit ched t o a t ypical
ant ipsychot ic.[1]

Treat ment of schizophreniform disorder can occur in inpat ient , out pat ient , and part ial
hospit alizat ion set t ings. In select ing t he t reat ment set t ing, t he primary aims are t o minimize t he
psychosocial consequences for t he pat ient and maint ain t he safet y of t he pat ient and ot hers.
While t he need t o quickly st abilize t he pat ient 's sympt oms almost always exist s, considerat ion
of t he pat ient 's severit y of sympt oms, family support , and perceived likelihood of compliance
wit h out pat ient t reat ment can help det ermine if st abilizat ion can occur in t he out pat ient set t ing.
Pat ient s who receive inpat ient t reat ment may benefit from a st ruct ured int ermediat e
environment , such as a sub-acut e unit , st ep-down unit , part ial hospit al, or day hospit al, during t he
init ial phases of ret urning t o t he communit y.[1]

As improvement progresses during t reat ment , help wit h coping skills, problem-solving
t echniques, psychoeducat ional approaches, and event ually occupat ional t herapy and vocat ional
assessment s are oft en very helpful for pat ient s and t heir families. Virt ually all t ypes of individual
psychot herapy are used in t he t reat ment of schizophreniform disorder, except for insight -
orient ed t herapies as pat ient s oft en have limit ed insight as a sympt om of t heir illness.[1]

Since schizophreniform disorder has such rapid onset of severe sympt oms, pat ient s are
somet imes in denial about t heir illness, which also would limit t he efficacy of insight -orient ed
t herapies. Support ive forms of psychot herapy such as int erpersonal psychot herapy, support ive
psychot herapy, and cognit ive behavioral t herapy are part icularly well suit ed for t he t reat ment of
t he disorder. Group psychot herapy is usually not indicat ed for pat ient s wit h schizophreniform
disorder because t hey may be dist ressed by t he sympt oms of pat ient s wit h more advanced
psychot ic disorders.[1]

Prognosis

The following specifiers for schizophreniform disorder may be used t o indicat e t he presence or
absence of feat ures t hat may be associat ed wit h a bet t er prognosis:

Wit h Good Prognost ic Feat ures, used if at least t wo of t he following feat ures are present :
Onset of prominent psychot ic sympt oms wit hin 4 weeks of t he first not iceable change in
usual behavior or funct ioning

Confusion or perplexit y at t he height of t he psychot ic episode

Good premorbid social and occupat ional funct ioning

Absence of blunt ed or flat affect

Wit hout Good Prognost ic Feat ures, used if t wo or more of t he above feat ures have not been
present .

The presence of negat ive sympt oms and poor eye cont act bot h appear t o be prognost ic of a
poor out come.[3] Many of t he anat omic and funct ional changes seen in t he brains of pat ient s
wit h schizophrenia also occur in pat ient s wit h schizophreniform disorder. However, at present
t here is no consensus among scient ist s regarding whet her or not vent ricular enlargement , which
is a poor prognost ic fact or in schizophrenia, has any prognost ic value in pat ient s wit h
schizophreniform disorder.[1] According t o t he American Psychiat ric Associat ion, approximat ely
t wo-t hirds of pat ient s diagnosed wit h "provisional" schizophreniform disorder are subsequent ly
diagnosed wit h schizophrenia; t he remaining keep a diagnosis of schizophreniform disorder.[1]
 Epidemiology

Schizophreniform disorder is equally prevalent among men and women. The most common ages
of onset are 18–24 for men and 18–35 for women. While t he sympt oms of schizophrenia oft en
develop gradually over a period of years, t he diagnost ic crit eria for schizophreniform disorder
require a much more rapid onset .[1]

Available evidence suggest s variat ions in incidence across sociocult ural set t ings. In t he Unit ed
St at es and ot her developed count ries, t he incidence is low, possibly fivefold less t han t hat of
schizophrenia. In developing count ries, t he incidence is subst ant ially higher, especially for t he
subt ype "Wit h Good Prognost ic Feat ures". In some of t hese set t ings schizophreniform disorder
may be as common as schizophrenia.

References

1. Schizophreniform Disorder (https://emedicine.medscape.com/article/292885-overview) at eMedicine

2. American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, (4th
ed., text revision). Washington, DC: American Psychiatric Association.

3. Troisi A, Pasini A, Bersani G, Di Mauro M, Ciani N (May 1991). "Negative symptoms and visual behavior
in DSM-III-R prognostic subtypes of schizophreniform disorder". Acta Psychiatr Scand. 83 (5): 391–4.
doi:10.1111/j.1600-0447.1991.tb05562.x (https://doi.org/10.1111%2Fj.1600-0447.1991.tb05562.x) .
PMID 1853733 (https://pubmed.ncbi.nlm.nih.gov/1853733) . S2CID 41079944 (https://api.semanticsc
holar.org/CorpusID:41079944) .

External links

St rakowski SM (June 1994). "Diagnost ic validit y of schizophreniform disorder" (ht t p://ajp.psych

iat ryonline.org/cgi/pmidlookup?view=long&pmid=8184991) . Am J Psychiatry. 151 (6): 815–24.
doi:10.1176/ajp.151.6.815 (ht t ps://doi.org/10.1176%2Fajp.151.6.815) . PMID 8184991 (ht t p
s://pubmed.ncbi.nlm.nih.gov/8184991) .

Clinical Trials in Schizophrenia, Schizoaffect ive, or Schizophreniform Disorder (ht t p://www.mc.v

anderbilt .edu/psych_ research/schizophrenia/)

Schizophreniform Disorder (ht t p://www.healt h.am/psy/more/schizophreniform_ disorder/)

Pat ient informat ion
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