Schizophreniform disorder

Tollefson GD, Beasley CM, Tran PV (1997). Olanzapine versus haloperidol in the treatment of schizophrenia and schizoaffective and schizophreniform disorders results of an international collaborative trial. Am J Psychiatry 154, 457-65. 

Mood-incongruent psychosis (e.g., schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified). 

Schizophreniform disorder in DSM-FV is somewhat different from schizotypal disorder in ICD-10. The diagnosis of schizophreniform disorder requires the identical criteria of schizophrenia (criterion A), except for two differences the total duration of the illness is at least 1 month, but less than 6 months (criterion B), and impaired social or occupational functioning during some part of the illness is not required. The delusional disorder in DSM-IV corresponds more or less to the category persistent delusional disorder of ICD-10, and brief psychotic disorder (DSM-IV) is similar to the ICD-10 category acute and transient psychotic disorder, whereas the shared psychotic disorder of DSM-IV corresponds to induced delusional disorder of ICD-10. 

Another hypothesis (Crow, 1982) involves a division of schizophrenias into two types Type I corresponds to acute schizophrenia or schizophreniform disorder in which one observes more positive symptoms of hallucinations and delusions with a good prognosis and excellent response to neuroleptics... Type II represents chronic schizophrenia with affective flattening, poverty of speech and loss of drive, the so-called negative symptoms of schizophrenia. Type II patients respond less well to neuroleptics... (Snyder, 1982). Type I patients would fit into the dopamine hypothesis whereas a pathophysiological basis other than dopaminergic hyperactivity must be assumed for type II patients. However, as pointed out by Snyder (1982). "one should be cautious about drawing such a distinction. ... 

Coryell WH, Tsuang MT. DSM-III schizophreniform disorder comparisons with schizophrenia and affective disorder. Arch Gen Psychiatry 1982 39 66-69. 

An international, multicenter, double-blind trial addressed the acute efficacy and safety of a single-dose range of olanzapine (5 to 20 mg/day) compared with a single-dose range of haloperidol (5 to 20 mg/day) (11.6). A total of 1996 patients with a DSM-lll-R diagnosis of schizophrenia (83.1%), schizophreniform disorder (1.9%), or schizoaffective disorder (15%) participated in this study. The primary overall efficacy analysis (i.e., the difference in baseline to endpoint (last observation carried forward [LOCF]) mean change on the BPRS) found olanzapine to be statistically superior to haloperidol (HPDL) (i.e., -10.98 -7.93 p < 0.015). 

Because there is some evidence that lithium may help patients with schizoaffective or schizophreniform disorders, the question of whether lithium added to an antipsychotic would produce a better overall response has been studied. For example, Biederman et al. ( 371) compared HPDL alone with FlPDL plus lithium in a group of 36 schizoaffective patients and found four of 18 improved with FlPDL alone, versus 11 of 18 on the combination. 

A limited body of evidence indicates that lithium helps atypical mania, schizoaffective disorder, or schizophreniform disorder, both as an acute treatment and for prevention of recurrence. There are younger patients who demonstrate both schizophrenic and manic features early in the course of their illness. When in doubt about the diagnosis, lithium may be preferable for an acute episode because, if successful, it will most likely be an effective prophylaxis as well. Clearly, some patients are so disturbed that the clinician cannot wait until lithium becomes fully effective, and an antipsychotic must be added, but often it can be discontinued after a brief period to determine whether lithium alone is sufficient. 

Little work has been done on the drug treatment of schizophreniform or brief reactive psychosis. Flirschowitz et al. ( 374) further explored the range of lithium s efficacy by systematically treating patients with schizophrenic or schizophreniform disorders. They found that poor-prognosis schizophrenia rarely responded to lithium. 

This group investigated patients presenting with acute schizophrenic symptoms who underwent a drug-free washout period, received lithium only initially, and then antipsychotics later (374). Lithium was ineffective for classic schizophrenia, but some patients who met criteria for schizophreniform disorder did respond to lithium. Whether schizophreniform illness is a variant of mood disorders (a reasonable hypothesis in view of their lithium response) or a separate entity that is lithium-sensitive is still unclear. It is known that these patients have family histories that include mood-disordered as well as schizophrenic relatives. In a small pilot study, physostigmine (a drug with possible antimanic but no antipsychotic properties) benefited schizophreniform patients who responded to lithium, but had no effect in those who did not (Carver DL, personal communication). 

Lithium or alternate treatments, such as valproate or carbamazepine, for bipolar, manic schizoaffective and schizophreniform disorders (alternate nonneuroleptic interventions may be better in light of reports that affectively disordered patients with psychotic features may be more susceptible to TD and NMS). 

Schizophrenia-related disorders, such as schizophreniform disorder, can closely mimic an acute exacerbation of mania. Attention to premorbid personal and family history may help differentiate them from mood disorders. A definitive diagnosis may not be possible, however, until the course of the illness is followed for a period of time. Clinical clues include the propensity of bipolar manics (in contrast to schizophrenics) to demonstrate pressured speech, flight of ideas, grandiosity, and overinclusive thinking. Hallucinations are less common than delusions in both mania and depression, with delusions normally taking on the qualities of expansivity, hyperreligiosity, or grandiosity. Delusions are also relatively less fixed than in schizophrenia. 

Those disorders that require the presence of psychosis (Table 10—1) as a defining feature of the diagnosis include schizophrenia, substance-induced (i.e., drug-induced) psychotic disorder, schizophreniform disorder, schizoaffective disorder, delusional disorder, brief psychotic disorder, shared psychotic disorder, and psychotic disorder due to a general medical condition. Disorders that may or may not have psychotic symptoms (Table 10—2) as an associated feature include mania and depression as well as several cognitive disorders such as Alzheimer s dementia. 

Weinberger, D., De Lisi, L., Perman, G., Targum, S., Wyatt, R. (1982). Computed tomography in schizophreniform disorder and other acute psychiatric disorders. Archives of General Psychiatry, 39, 778—783. 

Huq Z-U, on behalf of the RIS-GBR-31 investigators. A trial of low doses of risperidone in the treatment of patients with first-episode schizophrenia, schizophreniform disorder, or schizoaffective disorder. J Clin Psychopharmacol 2004 24 220-4. 

History of favorable response to ECT Schizoaffective disorder Schizophreniform disorder... 

Olanzapine (n — 172) has been compared with risperidone (n — 167) in an international, multicenter, double-blind, parallel-group, 28-week prospective study in 339 patients who met DSM-IV criteria for schizophrenia, schizophreniform disorder, or schizoaffective disorder (81). Both olanzapine (starting dosage 15 mg/ day) and risperidone (starting dosage 1 mg bd) were effective in the management of psychotic symptoms. 

Visuomotor testing has been performed in 76 patients with schizophrenia or a schizophreniform disorder receiving haloperidol (n = 23 mean dose 10 mg/day), olanzapine (n = 26 10.6 mg/day), or risperidone... 

Gervin M, Browne S, Lane A, Clarke M, Waddington JL, Larkin C, O Callaghan E. Spontaneons abnormal involnn-tary movements in first-episode schizophrenia and schizophreniform disorder baseline rate in a gronp of patients from an Irish catchment area. Am J Psychiatry 1998 155(9) 1202-6. 

Brief reactive psychosis Delusional disorder Schizophrenia Schizophreniform disorder Schizoaffective disorder Induced psychotic disorder... 

Schizophrenia refers to a disorder of longer than six months duration with prominent psychotic symptoms. This disorder is discussed in detail below. Schizophreniform disorder has the same criteria as schizophrenia, but is of less than six months duration. 

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