Introduction

Schizophreniform disorder is a mental health illness that falls within the spectrum of schizophrenia mental health illnesses. This disorder results in an altered perception of one's reality. Those with the condition can experience delusions, hallucinations, and disordered speech and behaviour, which are positive symptoms, or can become socially withdrawn and display low mood and low motivation, which are negative symptoms.¹ Due to schizophreniform disorder lying within the spectrum of schizophrenia disorders, it shares clinical symptoms of schizophrenia but has a shorter duration of one to six months. Individuals tend to experience symptoms in adolescence or early adulthood.²

Clinical research has shown that poor mental health has a negative impact on one's quality of life and can affect how individuals socially function. Unfortunately, psychotic symptoms can be very disruptive to the lives of individuals. These factors play a large role in the recovery and overall health outcome of schizophreniform disorder.^3,4

This article looks to further examine both quality of life and social functioning, the determinants, and strategies to improve them.

Clinical features of schizophreniform disorder

Schizophreniform disorder is a psychotic disorder that lies on the spectrum of schizophrenia disorders. Individuals diagnosed with schizophreniform disorder experience symptoms between one and six months; symptoms lasting over six months are diagnosed as schizophrenia. Symptoms are divided into positive and negative. Positive symptoms describe features that are abnormally present, whereas negative symptoms describe features that are abnormally absent.

Positive symptoms^1,5

• Hallucinations: Individuals can hear, see, or feel things that are not objectively present in reality and cannot be experienced by others
• Delusions: Result in paranoia and exaggerated or distorted perceptions, beliefs, and behaviours
• Disordered speech: Speech that uses fabricated words, continually goes off-topic, contains words put together that make no sense, or uses rhyme and rhythm without purpose
• Disordered behaviour: Overall catatonic and disorganised behaviour

Negative symptoms^1,5

• Reduced emotion: Known as affect flattening, where speech and mood present as flat
• Reduced motivation: Known as avolition, this is where individuals are not motivated to complete tasks, including those required for self-preservation
• Lack of speech: Known as alogia, this is where individuals do not speak or use speech very sparingly

Prognosis

Research shows that about twenty-five percent of those diagnosed with schizophreniform disorder recover within six months. Often, looking back at an individual's first presentation of psychotic illness and their current mental state allows true schizophreniform disorder to be distinguished from a first presentation of schizophrenia. True schizophreniform disorder is associated with a better overall health outcome, in regard to improved mental health and reduced hospital admissions, when compared with schizophrenia.⁶

Quality of life in schizophreniform disorder

What is quality of life?

Quality of life can be defined by multiple factors, including health (encompassing physical, mental, and spiritual factors), as well as relationships, education status, social status, wealth, freedom, social belonging, and much more. Due to the multiple factors involved in quality of life, the elements that make a good or bad quality of life can vary greatly between individuals.

The World Health Organisation defines quality of life as a subjective evaluation of one's perception of reality relative to one's goals, as observed through the lens of one's culture and value system. In this article, quality of life is discussed in relation to physical health, relationships, and social belonging.⁷

Impact of schizophreniform disorder on quality of life

Health

Schizophreniform disorder, along with schizophrenia spectrum disorders, has a large effect on an individual's mental health as a result of the symptoms; this large effect also presents itself as a decline in physical health. The average life expectancy of an individual living with schizophrenia is about ten to twenty years less than that of the general population.⁸ Most individuals experience at least one chronic physical health condition, with almost fifty percent of people having high blood pressure or high cholesterol in their blood. Many antipsychotic drugs have side effects that lead to obesity, with three-quarters of people with schizophrenia classified as overweight or obese.⁹

Obesity can lead to a negative self-view, such as low self-esteem, self-stigma, and poor self-image, contributing to reduced mental health.¹⁰

Individuals can be less aware of physical health issues and reluctant to seek physical health support. Psychotic symptoms can also lead to reduced engagement in regular physical health appointments. This all contributes to a drastic decline in physical health.8

Positive symptoms, like hallucinations, can cause fear and distress, which can lead to anxiety.¹¹ Negative symptoms commonly result in individuals neglecting their personal needs, such as personal hygiene, including toileting, washing and brushing teeth, and feeding and drinking. This can lead to longer-term issues, such as tooth decay.¹²

This decline in physical health results in a reduced quality of life, which in turn results in reduced engagement with mental health treatment and a poor prognosis in terms of the duration and presentation of psychotic symptoms.

Relationships

Relationships with others are greatly affected. Fixed delusions can cause tension, as the beliefs are not in line with reality. Research shows that conflict with others is very common in this group, which causes barriers to building relationships. Positive symptoms have been linked to a lower relationship satisfaction. Hallucinations are very real to the individual, and denial of these symptoms can result in a heightened emotional response, which can put a strain on social relationships. Their social network may be unaware of their diagnosis. Negative symptoms present with social withdrawal, where individuals with these symptoms do not seek out social relationships. Self-stigma leads individuals to feel that they may be socially excluded if others are aware of their diagnosis.¹³ Disorganised speech and behaviour that fall outside social norms contribute to social dysfunction in individuals on the schizophrenia spectrum.¹⁴

Social belonging

There is also a great amount of stigma surrounding psychotic mental health disorders. Research shows that those with schizophrenia feel socially isolated due to the negative thoughts others hold about them. Social rejection from family and their network results in negative self-thoughts. Shame, low self-esteem, and internalised stigma can lead individuals to reduce their social networks. Studies show that this reduction in social networks is also present in the carers of an individual.¹⁵

Social functioning in schizophreniform disorder

What is social functioning?

Social functioning is the ability to build and maintain interpersonal relationships. This refers to an individual's participation in work, family, and community. An element of social functioning is social cognition; this involves interpreting societally normal social cues.¹⁶

Impact of schizophreniform disorder on social functioning

Positive symptoms such as delusions or paranoia can cause avoidance and mistrust of others. There can also be some misinterpretation of social cues that can result in interpersonal conflict, which can negatively impact an individual's social functioning. In some cases, individuals can compensate for symptoms that alter reality by ignoring their beliefs during a social interaction, or while working in a retail clothing store. Disorganised speech and behaviour have been shown to have a greater effect on day-to-day functioning, as symptoms cause more disruption in daily functioning by interfering with the functional aspects of communication.¹⁷

Negative symptoms present with reduced motivation and flat affect, which weaken social bonds. The complete withdrawal from socialising results in very poor social functioning. Isolation results in a lack of participation in social networks. Commonly, in severe cases, individuals stop working, stop attending social events, and stop contributing to their local community. The severity of social functioning is worsened in those who have other socio-economic co-morbidities, such as homelessness.¹⁸

Studies show that individuals on the schizophrenia spectrum have impaired social cognition; this is evident in their inability to identify the emotions of others, feel connected to others, and interpret the thoughts and emotions of those around them. These impairments cause a reduction in social connections. The severity of impaired social cognition is directly related to the degree of impaired daily functioning. Those on the schizophrenia spectrum can be shown to lack empathy, which plays a large role in higher social cognitive function. Without this social processing, social functioning is greatly reduced. Research shows that improved social cognition can significantly improve social functioning and social skills in these individuals.¹⁹

Summary

Schizophreniform disorder is a mental health condition that lies on the spectrum of schizophrenia mental health illnesses. This disorder presents with positive and negative symptoms that can both affect an individual's quality of life and their social functioning. In general, schizophreniform disorder has a negative impact on the quality of life of individuals living with the condition. This negative impact can be seen in reduced physical health, difficulty forming and maintaining relationships, and a feeling of not belonging in society. Positive and negative symptoms can make it difficult to adhere to societally normal social cues, which can impact daily functioning when interacting socially with others. Symptoms of schizophreniform disorder result in an impaired ability to recognise and understand emotions, which plays a large role in social cognition.

Due to the poor impact of schizophreniform disorder on quality of life and social functioning, intervention and medical input should focus on addressing these issues as part of the overall management of these patients.