Schizophreniform Disorder

Psychosis refers to symptoms such as delusions, hallucinations, disorganized thinking and speech, disorganized motor behavior (including catatonia), and negative symptoms (which indicate loss of contact with reality). To diagnose schizophreniform disorder, 2 of the above categories of symptoms (delusions, hallucinations, disorganized speech, disorganized behavior, and negative symptoms) must be present and must include at least 1 of the following: delusions, hallucinations, and disorganized thought/speech (1). Schizophreniform disorder is distinguished from schizophrenia by its shorter duration (between 1 and 6 months).

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 are indicated. After symptoms resolve, medication treatment is continued for 12 months or longer and then gradually tapered while the patient is closely monitored for the return of psychotic symptoms (2–4).