Schizophreniform Disorder

Schizophreniform disorder is a mental disorder diagnosed when symptoms of schizophrenia are present for a significant portion of time (at least a month), but signs of disturbance are not present for the full six months required for the diagnosis of schizophrenia.

The exact cause 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 genetic 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 or bipolar disorder.

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 six months of onset, the provisional qualifier is removed from the diagnosis. However, if the symptoms persist for six 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 may include

• delusions.
• hallucinations.
• disorganized speech resulting from thought disorder.
• disorganized or catatonic behavior.
• negative symptoms, such as:
  • an inability to express a range of emotions (flat affect),
  • an inability to experience pleasure (anhedonia),
  • impaired or decreased speech (aphasia),
  • a lack of desire to form relationships (asociality), and
  • a lack of motivation (avolition).

In order to be diagnosed with schizophreniform disorder, the person must be experiencing at least two of the symptoms listed, and at least one of them must be delusional thinking, hallucinations, or disorganized speech/thought disorder. 

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 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 across sociocultural settings. In the United States 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. Good prognostic features means that two of the following are met:

• symptom onset within four weeks of unusual behavior
• confusion or perplexity
• good pre-illness social and work functioning
• absence of a flat affect

Treatment

Various modalities of treatment, including pharmacotherapy, psychotherapy, 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 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; other alternative approaches include the addition of a mood stabilizer such as lithium or an anticonvulsant to current medications, or being switched to a typical (first-generation) antipsychotic.

Treatment of schizophreniform disorder can occur in inpatient, outpatient, and partial hospitalization 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 and vocational assessments are often beneficial 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 about their illness, which also would limit the efficacy of insight-oriented therapies. Supportive forms of psychotherapy, such as interpersonal psychotherapy, supportive psychotherapy, and CBT, are particularly well suited for the treatment of the disorder. Group psychotherapy is usually not indicated for patients with schizophreniform disorder because they may be distressed by the symptoms of patients with more advanced psychotic disorders.