Chapter 17. Other Psychotic Disorders

Essentials of Diagnosis

DSM-IV-TR Diagnostic Criteria

1. Criteria A, D, and E of schizophrenia must be met.

2. 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

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

(Reprinted, with permission, from the Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Text Revision. Washington, DC: American Psychiatric Association, 2000)

General Considerations

Epidemiology

Diagnostically, schizophreniform disorder is “positioned” in time between brief psychotic disorder (discussed later in this chapter), which lasts 1 month or less, and schizophrenia (see Chapter 16), which by definition continues beyond 6 months. Although many patients eventually will be shown to have schizophrenia, a small but significant number of patients with persisting psychotic disorders will show complete recovery of their illness. The proportion of recovery is likely to be small, although the exact percentage is unknown. Those who do show recovery typically exhibit characteristics known to predict better outcome in other diagnostic categories (e.g., acute onset, brief prodrome, lack of psychosocial deterioration, and prominent mood symptoms).

Etiology

Schizophreniform disorder is a heterogeneous category; therefore, in all likelihood, it has several distinct etiologies. Because most patients with this disorder will proceed on to meet diagnostic criteria for schizophrenia, the etiologies will be the same as for that condition, discussed in detail in Chapter 16. Some patients with this disorder appear to recover significantly and thus represent a manifestation that is distinct from typical schizophrenia.

Genetics

Because schizophreniform disorder is likely to be an etiologically heterogeneous disorder, genetic relationships are unclear. Those persons who proceed on to manifest typical schizophrenia show genetic predispositions that are similar to this condition. Those who recover completely may have increased family histories of both psychotic and affective disorders, especially bipolar disorder.

Clinical Findings

Signs & Symptoms

Patients with schizophreniform disorder exhibit symptoms consistent with Criterion A of schizophrenia (i.e., typically hallucinations; delusions; negative symptoms; disorganization of thought, speech, and behavior) that last between 1 and 6 months. Patients with these symptoms may proceed on to a typical pattern of schizophrenia and should be diagnosed as such if the symptoms are present for more than 6 months. However, others may proceed to complete or near-complete ...