Schizophreniform Disorder

Prevalence
  • Incidence of schizophreniform disorder across sociocultural settings is likely similar to that observed in schizophrenia. In the United States and other developed countries, the incidence is low, possibly fivefold less than that of schizophrenia.
  • In developing countries, the incidence may be higher, especially for the specifier “with good prognostic features”; in some of these settings schizophreniform disorder may be as common as schizophrenia.
Risks

Genetic and physiological. Relatives of individuals with schizophreniform disorder have an increased risk for schizophrenia.

Criterion A

At least 2 of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated). At least one of these must be (1), (2), or (3):

  1. Delusions
  2. Hallucinations
  3. Disorganized speech (e.g., frequent derailment or incoherence)
  4. Grossly disorganized or catatonic behaviour
  5. Negative symptoms (i.e., diminished emotional expression or avolition)
Criterion B

An episode of the disorder 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.”

Criterion C

Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either:

  1. No major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or
  2. If mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
Criterion D

The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Specifiers

Specifiers

Specify if:

  • With good prognostic features: This specifier requires the presence of at least two of the following features: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning; confusion or perplexity: good premorbid social and occupational functioning; and absence of blunted or flat affect.
  • Without good prognostic features: This specifier is applied if two or more of the above features have not been present.
  • With catatonia (refer to the criteria for catatonia associated with another mental disorder).

Severity Specifier

Specify if: Severity is rated by a quantitative assessment of the primary symptoms of psychosis, including delusions, hallucinations, disorganized speech, abnormal psychomotor behaviour, and negative symptoms. Each of these symptoms may be rated for its current severity (most severe in the last 7 days) on a 5-point scale ranging from 0 (not present) to 4 (present and severe). (See Clinician-Rated Dimensions of Psychosis Symptom Severity in the chapter “Assessment Measures.”)

What is psychosis?

The term psychosis has been defined in various ways in the medical literature over time. The narrowest and current definition of psychosis is hallucinations and delusions, with the lack of reality testing or insight. A broader definition of psychosis would also include disorganized thought, emotions, and behaviour. This loose definition was more common in the past, and schizophrenia was often overdiagnosed as a result.

Comparison

Brief psychotic disorder
Onset Sudden
Length 1 day to 1 month
Psychotic Symptoms At least 1 of:
  • Delusions
  • Hallucinations
  • Disorganized speech
  • Grossly disorganized or catatonic behaviour
    Mood Symptoms No
    Functional Decline? Full resolution of symptoms
    Schizophreniform disorder
    Onset Can be prodromal
    Length 1 month to 6 months
    Psychotic Symptoms At least 2 of:
    • Delusions
    • Hallucinations
    • Disorganized speech
    • Grossly disorganized or catatonic behaviour
    • Negative symptoms
      Mood Symptoms No
      Functional Decline? Not required
      Schizophrenia
      Onset Can be prodromal
      Length > 6 months
      Psychotic Symptoms
      Mood Symptoms No
      Functional Decline? Required
      Schizoaffective disorder
      Onset Can be prodromal
      Length Major mood episode
      + 2 weeks of psychotic symptoms
      Psychotic Symptoms
      • Delusions or hallucinations for 2 or more weeks
      • Must be in absence of a major mood episode (depressive or manic) during the lifetime duration of the illness
        Mood Symptoms Required
        Functional Decline? Not required
        Delusional disorder
        Onset Can be prodromal
        Length > 1 month
        Psychotic Symptoms One or more delusions, with no other psychotic symptoms.
        Mood Symptoms No
        Functional Decline? Normal function aside from impact of delusions
        Type Onset Length Psychotic Symptoms Mood Symptoms Functional Decline?
        Brief psychotic disorder Sudden 1 day to 1 month At least 1 of:
        • Delusions
        • Hallucinations
        • Disorganized speech
        • Grossly disorganized or catatonic behaviour
          No Full resolution of symptoms
          Schizophreniform disorder Can be prodromal 1 month to 6 months At least 2 of:
          • Delusions
          • Hallucinations
          • Disorganized speech
          • Grossly disorganized or catatonic behaviour
          • Negative symptoms
            No Not required
            Schizophrenia Can be prodromal > 6 months No Required
            Schizoaffective disorder Can be prodromal Major mood episode
            + 2 weeks of psychotic symptoms
            • Delusions or hallucinations for 2 or more weeks
            • Must be in absence of a major mood episode (depressive or manic) during the lifetime duration of the illness
              Required Not required
              Delusional disorder Can be prodromal > 1 month One or more delusions, with no other psychotic symptoms. No Normal function aside from impact of delusions