Schizophreniform Disorder Clinical Presentation

Updated: Dec 11, 2018
  • Author: Ravinder N Bhalla, MD; Chief Editor: David Bienenfeld, MD  more...
  • Print
Presentation

History

A detailed history (which may require the assistance of family members or others familiar with the patient) should be obtained, focusing on the following:

  • Time of symptom onset

  • Course

  • Premorbid functioning

  • Precipitants

  • Physical health

  • Use of medications

  • Use of alcohol and other substances

  • Family history

  • Previous episodes (if any)

Distinguishing schizophreniform disorder from other medical and psychiatric conditions that may present in a floridly psychotic state can be challenging. [11] Such conditions include schizophrenia; brief psychotic disorder; substance-induced mood disorders, depression, and mania; bipolar affective disorder; and depression (see DDx).

The symptom profile of a schizophreniform disorder is identical to that of schizophrenia; however, the total duration of illness, including prodromal or residual phases, must be less than 6 months. Also, a deterioration in social or occupational functioning, which is required to make the diagnosis of schizophrenia, is not required for schizophreniform disorder.

A diagnosis of brief psychotic disorder requires that symptoms last at least 1 day but no longer than 1 month. A diagnosis of schizophreniform disorder, like a diagnosis of schizophrenia, requires that symptoms be present for at least 1 month.

Although substance-induced psychoses frequently resolve in less than 1 month, sustained substance-induced psychoses in abstinent persons may be indistinguishable from schizophreniform disorder. In the absence of objective diagnostic criteria, the distinction is made on the basis of the extent to which the clinician believes substances have contributed to the current symptom profile.

In bipolar disorder and major depression with mood-incongruent features, the affective symptoms are clearly more prominent. In mood disorder, the psychotic symptoms are secondary and less intense if present. Sometimes, in the absence of an accurate history, diagnosis must be deferred until longitudinal observation or a more accurate history is available.

Next:

Physical Examination

The often abrupt onset of symptoms, in many cases coupled with the lack of previous episodes, underscores the need for a toxicologic and medical evaluation.

A full Mental Status Examination helps establish the diagnosis. Mental status is likely to manifest as a neutral or blunted mood and affect. Evidence of paranoia, ideas of reference, delusions, and hallucinations are usually present. The patient is usually fully oriented with intact memory. A strong possibility of homicidal and even suicidal ideation exists.

An attempt should be made to elicit command hallucinations because these could drive a patient to hurt himself or herself, as well as others. Disorientation and difficulties with recall suggest an organic psychosis rather than a schizophreniform disorder.

Previous