Psychosis refers to symptoms such as delusions, hallucinations, disorganized thinking and speech, and bizarre and inappropriate motor behavior (including catatonia) that indicate loss of contact with reality. (See also Introduction to Schizophrenia and Related Disorders.)
At presentation, schizophrenia is likely to be suspected. Psychosis secondary to substance use or to a physical disorder must also be ruled out. Differentiating between schizophreniform disorder and schizophrenia in a patient without any prior psychotic symptoms is based on duration of symptoms. If duration of symptoms or disability exceeds 6 months, the patient no longer meets required diagnostic criteria for schizophreniform disorder, and the diagnosis is likely to be schizophrenia, although the acute psychosis may also evolve into a psychotic mood disorder, such as bipolar disorder or schizoaffective disorder. Longitudinal observation is often required to establish the diagnosis and appropriate treatment.
Treatment with antipsychotics and supportive psychosocial care is indicated. After symptoms resolve, drug treatment is continued for 12 months and then gradually tapered while closely monitoring for the return of psychotic symptoms.