271 Schizophreniform Disorder (295.40)

DSM-IV-TR criteria

• A. Criteria A, D, and E of Schizophrenia are met.
• B. An episode of the disorder (including prodromal, active, and residual phases) 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.”)
• Specify if:
  • Without Good Prognostic Features – this is used if two of more of the features below have not been present.
  • With Good Prognostic Features: as evidenced by two (or more) of the following:
    • (1) onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning.
    • (2) confusion or perplexity at the height of the psychotic episode
    • (3) good premorbid social and occupational functioning
    • (4) absence of blunted or flat affect

Associated Features

Also see the discussion in the Associated Features and Disorders section for Schizophrenia, p.304. Unlike Schizophrenia, impairment in social or occupational functioning is not required for a diagnosis of Schizophreniform Disorder.

However, most individuals do experience dysfunction in various areas of daily functioning such as: learning problems, hypoactivity, euphoric mood, guilt or obsession, sexually deviant behavior, or even Dependent and Antisocial Personality Disorders.

Child vs Adult Presentation

Criteria of Schizophreniform Disorder in DSM is listed as “referrence to Schizophrenia”.

Typically it is seen that this develops between the late teens and mid 30’s.

It is very rare to see these disorders develop or be diagnosed in children; however there have been cases reported with the onset of 5 and 6.

It is also rare to see this develop in a later stage in life, but again there have been cases reported with the onset of 60 years. It is still unclear if identifiable brain pathology defines late-onset illness.

Gender and culture differences in presentation

For additional discussion of cultural, age, and gender factors relevant to the diagnosis of Schizophreniform Disorder, see the Specific Culture, Age, and Gender Features section for Schizophrenia (p306).

There are suggestions that in developing countries, recovery from Psychotic Disorders may be more rapid, which would result in higher rates of Schizophreniform Disorder than of Schizophrenia

Epidemiology

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”; in some of these settings Schizophreniform Disorder may be as common as Schizophrenia.

There have been few studies of families where the focus has been Schizophreniform Disorder; however, there is available evidence that suggests that relatives of Schizophreniform Disorder have an increased risk for Schizophrenia.

Etiology

Approximately one-third of individuals with an initial diagnosis of Schizophreniform Disorder (Provisional) recover within the 6-month period and receive Schizophreniform Disorder as their final diagnosis of Schizophrenia or Schizoaffective Disorder.

The cause of it appears to be related to abnormalities in the structure and chemistry of the brain, and appears to have strong genetic links; but its course and severity can be altered by social factors such as stress or a lack of support within the family. It is less clear cut, but biological factors are also suspected

Empirically supported treatment

Treatment aims to protect and steady the patient, to minimize the psychosocial consequences, and to resolve the target symptoms with minimal adverse effects. The patient who may be at risk of harming himself, herself, or others requires hospitalization. This allows for complete diagnostic evaluation and helps to ensure the safety of the patient and others. A supportive environment with minimal stimulation is also helpful.

As improvement progresses, help with coping skills, problem-solving techniques, and psycho educational approaches may be added for patients and their families.

Patients may benefit from a structured intermediate environment, such as a day hospital, during the initial phases of returning to the community.

Pharmacotherapy for schizophreniform disorder is similar to that for schizophrenia. At this time, atypical antipsychotics, such as risperidone, olanzapine, quetiapine, and ziprasidone, are commonly used. In November 2003, a new atypical antipsychotic drug, aripiprazole (Abilify), was approved by the US Food and Drug Administration. Aripiprazole has a novel mechanism of action because it is a partial agonist at the dopamine receptors, unlike its predecessors.