Schizophreniform disorder
Encyclopedia
Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia
are present for a significant portion of the time within a one-month period, but signs of disruption are not present for the full six months required for the diagnosis of schizophrenia.
The symptoms of both disorders can include delusion
s, hallucination
s, disorganized speech
, disorganized or catatonic behavior
, and social withdrawal. While impairment in social, occupational, or academic functioning is required for the diagnosis of schizophrenia, in schizophreniform disorder an individual's level of functioning may or may not be affected. While the onset of schizophrenia is often gradual over a number of months or years, the onset of schizophreniform disorder can be relatively rapid.
Like schizophrenia, schizophreniform disorder is often treated with antipsychotic
medications
, especially the atypicals
, along with a variety of social supports (such as individual psychotherapy, family therapy
, occupational therapy
, etc.) designed to reduce the social and emotional impact of the illness. The prognosis varies depending upon the nature, severity, and duration of the symptoms, but about two-thirds of individuals diagnosed with schizophreniform disorder go on to develop schizophrenia.
that is characterized by psychosis
and closely related to schizophrenia
. Both schizophrenia and schizophreniform disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR), have the same symptoms and essential features except for two differences: the level of functional impairment and the duration of symptoms. Impairment in social, occupational, or academic functioning
is always present in schizophrenia, but such impairment may or may not be present in schizopheniform disorder. In schizophreniform disorder, the symptoms (including prodromal, active, and residual phases) must last at least 1 month but not more than 6 months, while in schizophrenia the symptoms must be present for a minimum of 6 months.
If the symptoms have persisted for at least one month, a provisional diagnosis of schizophreniform disorder can be made while waiting to see if recovery occurs. If the symptoms resolve within 6 months of onset, the provisional qualifier is removed from the diagnosis. However, if the symptoms persist for 6 months or more, the diagnosis of schizophreniform disorder must be revised. The diagnosis of brief psychotic disorder
may be considered when the duration of symptoms is less than one month.
The main symptoms of both schizophreniform disorder and schizophrenia can include:
:
The presence of negative symptoms and poor eye contact both appear to be prognostic of a poor outcome. Many of the anatomic and functional changes seen in the brain
s of patients with schizophrenia also occur in patients with schizophreniform disorder. However, at present there is no consensus among scientists regarding whether or not ventricular enlargement, a poor prognostic factor in schizophrenia, has any prognostic value in patients with schizophreniform disorder. According to the American Psychiatric Association
, approximately two-thirds of patients diagnosed with schizophreniform disorder are subsequently diagnosed with schizophrenia
.
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
are present for a significant portion of the time within a one-month period, but signs of disruption are not present for the full six months required for the diagnosis of schizophrenia.
The symptoms of both disorders can include delusion
Delusion
A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
s, hallucination
Hallucination
A hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s, disorganized speech
Thought disorder
In psychiatry, thought disorder or formal thought disorder is a term used to describe incomprehensible language, either speech or writing, that is presumed to reflect thinking. There are different types...
, disorganized or catatonic behavior
Catatonia
Catatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
, and social withdrawal. While impairment in social, occupational, or academic functioning is required for the diagnosis of schizophrenia, in schizophreniform disorder an individual's level of functioning may or may not be affected. While the onset of schizophrenia is often gradual over a number of months or years, the onset of schizophreniform disorder can be relatively rapid.
Like schizophrenia, schizophreniform disorder is often treated with antipsychotic
Antipsychotic
An antipsychotic is a tranquilizing psychiatric medication primarily used to manage psychosis , particularly in schizophrenia and bipolar disorder. A first generation of antipsychotics, known as typical antipsychotics, was discovered in the 1950s...
medications
Psychiatric medication
A psychiatric medication is a licensed psychoactive drug taken to exert an effect on the mental state and used to treat mental disorders. Usually prescribed in psychiatric settings, these medications are typically made of synthetic chemical compounds, although some are naturally occurring, or at...
, especially the atypicals
Atypical antipsychotic
The atypical antipsychotics are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia...
, along with a variety of social supports (such as individual psychotherapy, family therapy
Family therapy
Family therapy, also referred to as couple and family therapy, family systems therapy, and family counseling, is a branch of psychotherapy that works with families and couples in intimate relationships to nurture change and development. It tends to view change in terms of the systems of...
, occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
, etc.) designed to reduce the social and emotional impact of the illness. The prognosis varies depending upon the nature, severity, and duration of the symptoms, but about two-thirds of individuals diagnosed with schizophreniform disorder go on to develop schizophrenia.
Symptoms and Diagnosis
Schizophreniform disorder is a type of mental illnessMental illness
A mental disorder or mental illness is a psychological or behavioral pattern generally associated with subjective distress or disability that occurs in an individual, and which is not a part of normal development or culture. Such a disorder may consist of a combination of affective, behavioural,...
that is characterized by psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
and closely related to schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
. Both schizophrenia and schizophreniform disorder, as defined by the Diagnostic and Statistical Manual of Mental Disorders
Diagnostic and Statistical Manual of Mental Disorders
The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...
(DSM-IV-TR), have the same symptoms and essential features except for two differences: the level of functional impairment and the duration of symptoms. Impairment in social, occupational, or academic functioning
Global Assessment of Functioning
The Global Assessment of Functioning is a numeric scale used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and...
is always present in schizophrenia, but such impairment may or may not be present in schizopheniform disorder. In schizophreniform disorder, the symptoms (including prodromal, active, and residual phases) must last at least 1 month but not more than 6 months, while in schizophrenia the symptoms must be present for a minimum of 6 months.
If the symptoms have persisted for at least one month, a provisional diagnosis of schizophreniform disorder can be made while waiting to see if recovery occurs. If the symptoms resolve within 6 months of onset, the provisional qualifier is removed from the diagnosis. However, if the symptoms persist for 6 months or more, the diagnosis of schizophreniform disorder must be revised. The diagnosis of brief psychotic disorder
Brief psychotic disorder
Brief psychotic disorder is a period of psychosis whose duration is generally shorter, non re-occurring, and not better accounted for by another condition....
may be considered when the duration of symptoms is less than one month.
The main symptoms of both schizophreniform disorder and schizophrenia can include:
- delusionDelusionA delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological...
s, - hallucinationHallucinationA hallucination, in the broadest sense of the word, is a perception in the absence of a stimulus. In a stricter sense, hallucinations are defined as perceptions in a conscious and awake state in the absence of external stimuli which have qualities of real perception, in that they are vivid,...
s, - disorganized speech resulting from formal thought disorder,
- disorganized or catatonic behaviorCatatoniaCatatonia is a state of neurogenic motor immobility, and behavioral abnormality manifested by stupor. It was first described in 1874: Die Katatonie oder das Spannungsirresein ....
, and negative symptoms, such as - an inability to show emotion (flat affect),
- an inability to experience pleasure (anhedoniaAnhedoniaIn psychology and psychiatry, anhedonia is defined as the inability to experience pleasure from activities usually found enjoyable, e.g. hobbies, exercise, social interaction or sexual activity....
), - impaired or decreased speech (aphasiaAphasiaAphasia is an impairment of language ability. This class of language disorder ranges from having difficulty remembering words to being completely unable to speak, read, or write....
), - a lack of desire to form relationships (asocialityAsocialityAsociality is a symptom frequently observed in schizophrenia patients. It is characterised by an inability to 'empathise', to feel intimacy with, or to form close relationships with others ....
), and - a lack of motivation (avolitionAvolitionAvolition is a psychological state characterized by general lack of drive, or motivation to pursue meaningful goals. A person may show little participation in work or have little interest in socializing. They may sit still for long periods of time...
).
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 prognosisPrognosis
Prognosis is a medical term to describe the likely outcome of an illness.When applied to large statistical populations, prognostic estimates can be very accurate: for example the statement "45% of patients with severe septic shock will die within 28 days" can be made with some confidence, because...
:
- With Good Prognostic Features, 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 functioningGlobal Assessment of FunctioningThe Global Assessment of Functioning is a numeric scale used by mental health clinicians and physicians to subjectively rate the social, occupational, and psychological functioning of adults, e.g., how well or adaptively one is meeting various problems-in-living. The scale is presented and...
, and - absence of blunted or flat affectAffect (psychology)Affect refers to the experience of feeling or emotion. Affect is a key part of the process of an organism's interaction with stimuli. The word also refers sometimes to affect display, which is "a facial, vocal, or gestural behavior that serves as an indicator of affect" .The affective domain...
.
- Without Good Prognostic Features, used if two or more of the above features have not been present.
The presence of negative symptoms and poor eye contact both appear to be prognostic of a poor outcome. Many of the anatomic and functional changes seen in the brain
Brain
The brain is the center of the nervous system in all vertebrate and most invertebrate animals—only a few primitive invertebrates such as sponges, jellyfish, sea squirts and starfishes do not have one. It is located in the head, usually close to primary sensory apparatus such as vision, hearing,...
s of patients with schizophrenia also occur in patients with schizophreniform disorder. However, at present there is no consensus among scientists regarding whether or not ventricular enlargement, a poor prognostic factor in schizophrenia, has any prognostic value in patients with schizophreniform disorder. According to the American Psychiatric Association
American Psychiatric Association
The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...
, approximately two-thirds of patients diagnosed with schizophreniform disorder are subsequently diagnosed with schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
.
Etiology
The exact etiology of the disorder remains unknown, and relatively few studies have focused exclusively on the etiology of schizophreniform disorder. Like other psychotic disorders, a diathesis–stress model has been proposed, suggesting that some individuals have an underlying multifactorial geneticGenetics
Genetics , a discipline of biology, is the science of genes, heredity, and variation in living organisms....
vulnerability to the disorder that can be triggered by certain environmental factors. Schizophreniform disorder is more likely to occur in people with family members who have schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
or bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
.
Prevalence
Schizophreniform disorder is equally prevalentPrevalence
In epidemiology, the prevalence of a health-related state in a statistical population is defined as the total number of cases of the risk factor in the population at a given time, or the total number of cases in the population, divided by the number of individuals in the population...
among men and women. The most common ages of onset are 18–24 for men and 18–35 for women. While the symptoms of schizophrenia often develop gradually over a period of years, the diagnostic criteria for schizophreniform disorder require a much more rapid onset.
Available evidence suggests variations in incidence
Incidence (epidemiology)
Incidence is a measure of the risk of developing some new condition within a specified period of time. Although sometimes loosely expressed simply as the number of new cases during some time period, it is better expressed as a proportion or a rate with a denominator.Incidence proportion is the...
across sociocultural settings. In the United States
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...
and other developed countries, the incidence is low, possibly fivefold 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.
Treatment
Various modalities of treatment, including pharmacotherapyPsychopharmacology
Psychopharmacology is the scientific study of the actions of drugs and their effects on mood, sensation, thinking, and behavior...
, psychotherapy
Psychotherapy
Psychotherapy is a general term referring to any form of therapeutic interaction or treatment contracted between a trained professional and a client or patient; family, couple or group...
, and various other psychosocial and educational interventions, are used in the treatment of schizophreniform disorder. Pharmacotherapy is the most commonly used treatment modality as psychiatric medications can act quickly to both reduce the severity of symptoms and shorten their duration. The medications used are largely the same as those used to treat schizophrenia, with an atypical antipsychotic
Atypical antipsychotic
The atypical antipsychotics are a group of antipsychotic tranquilizing drugs used to treat psychiatric conditions. Some atypical antipsychotics are FDA approved for use in the treatment of schizophrenia...
) as the usual drug of choice. Patients who do not respond to the initial atypical antipsychotic may benefit from
being switched to another atypical antipsychotic, the addition of a mood stabilizer
Mood stabilizer
A mood stabilizer is a psychiatric medication used to treat mood disorders characterized by intense and sustained mood shifts, typically bipolar disorder.-Uses:...
such as lithium
Lithium pharmacology
Lithium pharmacology refers to use of the lithium ion, Li+, as a drug. A number of chemical salts of lithium are used medically as a mood stabilizing drug, primarily in the treatment of bipolar disorder, where they have a role in the treatment of depression and particularly of mania, both acutely...
or an anticonvulsant
Anticonvulsant
The anticonvulsants are a diverse group of pharmaceuticals used in the treatment of epileptic seizures. Anticonvulsants are also increasingly being used in the treatment of bipolar disorder, since many seem to act as mood stabilizers, and in the treatment of neuropathic pain. The goal of an...
, or being switched to a typical antipsychotic
Typical antipsychotic
Typical antipsychotics are a class of antipsychotic drugs first developed in the 1950s and used to treat psychosis...
.
Treatment of schizophreniform disorder can occur in inpatient, outpatient, partial hospitalization
Partial hospitalization
Partial hospitalization, also known as PHP , is a type of program used to treat mental illness and substance abuse. In partial hospitalization, the patient continues to reside at home, but commutes to a treatment center up to seven days a week...
settings. In selecting the treatment setting, the primary aims are to minimize the psychosocial consequences for the patient and maintain the safety of the patient and others. While the need to quickly stabilize the patient's symptoms almost always exists, consideration of the patient's severity of symptoms, family support, and perceived likelihood of compliance with outpatient treatment can help determine if stabilization can occur in the outpatient setting. Patients who receive inpatient treatment may benefit from a structured intermediate environment, such as a sub-acute unit, step-down unit, partial hospital, or day hospital, during the initial phases of returning to the community.
As improvement progresses during treatment, help with coping skills, problem-solving techniques, psychoeducational approaches, and eventually occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
and vocational assessments are often very helpful for patients and their families. Virtually all types of individual psychotherapy are used in the treatment of schizophreniform disorder, except for insight-oriented therapies as patients often have limited insight as a symptom of their illness.
Since schizophreniform disorder has such rapid onset of severe symptoms, patients are sometimes in denial
Denial
Denial is a defense mechanism postulated by Sigmund Freud, in which a person is faced with a fact that is too uncomfortable to accept and rejects it instead, insisting that it is not true despite what may be overwhelming evidence.The subject may use:* simple denial: deny the reality of the...
about their illness, which also would limit the efficacy of insight-oriented therapies. Supportive forms of psychotherapy such as interpersonal psychotherapy
Interpersonal psychotherapy
Interpersonal Psychotherapy is a time-limited psychotherapy that focuses on the interpersonal context and on building interpersonal skills. IPT is based on the belief that interpersonal factors may contribute heavily to psychological problems. It is commonly distinguished from other forms of...
, supportive psychotherapy
Supportive psychotherapy
Supportive psychotherapy is a psychotherapeutic approach that integrates psychodynamic, cognitive-behavioral, and interpersonal conceptual models and techniques. The objective of the therapist is to reinforce the patient's healthy and adaptive patterns of thought behaviors in order to reduce the...
, and cognitive behavior therapy are particularly well suited for the treatment of the disorder. Group psychotherapy
Group psychotherapy
Group psychotherapy or group therapy is a form of psychotherapy in which one or more therapists treat a small group of clients together as a group...
is usually not indicated for patients with schizophreniform disorder because they may be distressed by the symptoms of patients with more advanced psychotic disorders.