Schizophreniform Disorder
- Author: Ravinder N Bhalla, MD; Chief Editor: Iqbal Ahmed, MBBS, FRCPsych (UK) more...
Background
Schizophreniform disorder is a serious mental disorder with symptoms similar to those of schizophrenia. Early diagnosis of this disorder is crucial, as is early intervention with medication, supportive therapy, and patient and family education.
Schizophreniform disorder is characterized by the presence of the criterion A symptoms of schizophrenia, including 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.
Unlike schizophrenia, in which prodromal symptoms may develop over several years, schizophreniform disorder requires, among other features, a rather rapid period from the onset of prodromal symptoms to the point at which all criteria for schizophrenia (except duration and deterioration) are met (within 6 mo).
As with schizophrenia, the prevalence of schizophreniform disorder is equally distributed between the sexes, with peak onset between the ages of 18-24 years in men and ages 24-35 years in women.
Go to Schizoaffective Disorder, Emergent Treatment of Schizophrenia, and Childhood-Onset Schizophrenia for complete information on these topics.
Pathophysiology
Patients with schizophreniform disorder and patients with schizophrenia share many anatomic and functional cortical deficits on neuropsychological studies, magnetic resonance imaging (MRI), single-photon emission computed tomography (SPECT), and positron emission tomography (PET).
A study of delay-dependent memory performed by Mathes et al found that patients with schizophreniform disorder and schizophrenia demonstrated a decreased ability to form an internal representation of complex objects.[1] Such neuropsychological tests help clinicians to further understand the psychopathology of the disorder.
This study investigated 55 patients with schizophreniform psychosis, 50 patients with established schizophrenia, and a control group of 56 healthy controls, using the delayed matching-to-sample task from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Performance deficits were found in both patient groups after controlling for age and premorbid intelligence quotient (IQ).
Even when simultaneous matching-to-sample ability (ie, perceptual matching) was controlled for, impaired performance in both patient groups was found as soon as the stimuli were removed. Impaired performance was not due to different types of performance errors in patients as compared with control individuals. Performance in the 2 patient groups was comparable, except for a slight decrease in overall task performance. These findings suggest that the deficit is relatively stable during the course of the illness.
Similar deficits notwithstanding, schizophreniform disorder is distinct from schizophrenia, as confirmed by a trial by Sautter et al that compared the course of illness of 36 patients who received a diagnosis of schizophreniform disorder or schizophrenia.[2] Approximately 3.5 and 4 years after their initial index hospitalization, 2 groups of patients were compared for “differences in positive and negative symptoms of psychosis, interpersonal and occupational role functioning, and other aspects of the deficit state.”
The patients with schizophreniform disorder showed a low level of negative symptoms at both follow-up examinations. The patients with schizophrenia “initially showed a higher level of negative symptoms, but these symptoms decreased significantly over time.” Data from this trial indicate that the course of schizophreniform disorder is “distinct from the course of schizophrenia.”
Prognosis
The persistence of symptoms beyond 6 months predicts a worse prognosis for schizophrenia as compared with schizophreniform disorder. Clarke and associates demonstrated that “[a] longer duration of untreated psychosis was associated with a significantly poorer functional and symptomatic outcome 4 years later.”[3]
Confusion and perplexity at the height of the psychotic episode in schizophreniform disorder correlates with better outcome. A significant risk of suicide exists in patients with schizophreniform disorder, especially when they are more likely to go into a depression after the psychotic period. Psychotherapy during this phase, aimed at helping patients understand the psychotic episodes, is likely to improve the prognosis and recovery. Drake et al found that patients ending up with better insight into their illness were less likely to experience relapse.[4]
Fraguas et al examined the diagnostic stability and the functional outcome of patients with early-onset psychosis, including schizophreniform disorder, over a 2-year follow-up period; they found a 50% predictability for future psychotic episodes for schizophreniform disorder and the presence of negative symptoms as a predictor of lower level of functioning at the end of 2 years.[5]
According to the American Psychiatric Association, approximately two thirds of patients diagnosed with schizophreniform disorder progress to a diagnosis of schizophrenia. According to Benazzi et al, patients with a good prognosis tend to be retrospectively associated with the affective spectrum of diagnoses rather than the schizophrenic.[6]
According to Troisi et al, in some patients with a schizophreniform disorder, the presence of negative symptoms and poor eye contact appear to be prognostic of a poor outcome.[7] Studies have not yet elicited a consensus about whether ventricular enlargement is predictive of poor outcome in patients with a schizophreniform disorder.
Patient Education
Efforts should be made to educate both the patients and their families about the early signs of relapse and the need for continuing treatment. Those approaches advance the overall aim of helping patients regain productive roles in society while reducing the risk of relapse. Families with a high degree of emotional expression are likely to cause additional stress to the patient and to increase the likelihood of relapse.
The patient’s condition, the patient’s family, and the patient’s system of care are a few of the many factors that likely affect treatment engagement early in the course of schizophreniform disorder and schizophrenia. Clinicians should give special attention to these factors when caring for patients who experience their first episode.
The following links provide valuable information for patients and their families.
For patient education resources, see the Mental Health and Behavior Center, as well as Schizophrenia.
Mathes B, Wood SJ, Proffitt TM, Stuart GW, Buchanan JA, Velakoulis D, et al. Early processing deficits in object working memory in first-episode schizophreniform psychosis and established schizophrenia. Psychol Med. Jul 2005;35(7):1053-62. [Medline].
Sautter F, McDermott B, Garver D. The course of DSM-III-R schizophreniform disorder. J Clin Psychol. May 1993;49(3):339-44. [Medline].
Clarke M, Whitty P, Browne S, McTigue O, Kamali M, Gervin M, et al. Untreated illness and outcome of psychosis. Br J Psychiatry. Sep 2006;189:235-40. [Medline].
Drake RJ, Dunn G, Tarrier N, Bentall RP, Haddock G, Lewis SW. Insight as a predictor of the outcome of first-episode nonaffective psychosis in a prospective cohort study in England. J Clin Psychiatry. Jan 2007;68(1):81-6. [Medline].
Fraguas D, de Castro MJ, Medina O, Parellada M, Moreno D, Graell M, et al. Does diagnostic classification of early-onset psychosis change over follow-up?. Child Psychiatry Hum Dev. Jun 2008;39(2):137-45. [Medline].
Benazzi F, Mazzoli M, Rossi E. A follow-up and family study of DSM-III-R schizophreniform disorder with good prognostic features. Eur Arch Psychiatry Clin Neurosci. 1992;242(2-3):119-21. [Medline].
Troisi A, Pasini A, Bersani G, Di Mauro M, Ciani N. Negative symptoms and visual behavior in DSM-III-R prognostic subtypes of schizophreniform disorder. Acta Psychiatr Scand. May 1991;83(5):391-4. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.
Stromgren LS. Electroconvulsive Therapy in Aarhus, Denmark, in 1984: Its Application in Nondepressive Disorders. Convuls Ther. 1988;4(4):306-313.
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. Jan 2005;11(1):62-9. [Medline].
Leucht S, Komossa K, Rummel-Kluge C, Corves C, Hunger H, Schmid F, et al. A meta-analysis of head-to-head comparisons of second-generation antipsychotics in the treatment of schizophrenia. Am J Psychiatry. Feb 2009;166(2):152-63. [Medline].
Sajatovic M, Mullen JA, Sweitzer DE. Efficacy of quetiapine and risperidone against depressive symptoms in outpatients with psychosis. J Clin Psychiatry. Dec 2002;63(12):1156-63. [Medline].
Emsley RA. Risperidone in the treatment of first-episode psychotic patients: a double-blind multicenter study. Risperidone Working Group. Schizophr Bull. 1999;25(4):721-9. [Medline].
Sanger TM, Lieberman JA, Tohen M, Grundy S, Beasley C Jr, Tollefson GD. Olanzapine versus haloperidol treatment in first-episode psychosis. Am J Psychiatry. Jan 1999;156(1):79-87. [Medline].
Print
