Chapter 16: Other Psychotic Disorders

SCHIZOPHRENIFORM DISORDER

General Considerations

A. 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 15), 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).

B. 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 15. Some patients with this disorder appear to recover significantly and thus represent a manifestation that is distinct from typical schizophrenia.

C. 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

A. 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 resolution of their symptoms. These patients generally have good premorbid function, acute onset (often after a stressor), and complete resolution without residual deficits in psychosocial function. In addition, mood symptoms tend to be more prominent, and a family history of mood disorder is common in these patients.

B. Psychological Testing

Psychological testing will reveal a pattern of symptoms more typical of schizophrenia (see Chapter 15). These findings will include the common symptoms of thought disorganization, hallucinations, and delusions. However, overt cognitive impairment (including memory problems) is uncommon, and prominent mood symptoms may occur. Persons with schizophreniform disorder may demonstrate frontal cortical regional deficits such as impaired performance on the Wisconsin Card Sorting Test.

C. Laboratory Findings & Neuroimaging

Brain imaging studies may show the same results ...