Schizophreniform Disorder

Primer

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.

DSM-5 Diagnostic Criteria

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.”)

Comparison of Psychotic Disorders

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.

DSM-IV to DSM 5 Psychotic Disorder Criteria Changes

Substance Abuse and Mental Health Services Administration. Table 3.20, DSM-IV to DSM-5 Psychotic Disorders

Comparison of Psychotic Disorders

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 At least 2 of:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behaviour
• Negative symptoms 		No Required
Schizoaffective disorder Can be prodromal Major mood episode
+ 2 weeks of isolated psychotic symptoms + predominantly mood symptoms over course of illness 		• Delusions or hallucinations for 2 or more weeks, which 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