What Is Schizophreniform Disorder?

Overview

Schizophreniform disorder is a form of psychotic disorder with the same symptoms as schizophrenia. These include delusions, hallucinations, disorganised speech, odd behaviours, and other impaired mood-related and social symptoms. 

The difference with schizophrenia only lies in the symptom duration: people diagnosed with schizophreniform disorder only exhibit symptoms for up to 6 months, while schizophrenia is a permanent disorder. In terms of duration, schizophreniform disorder also differs from brief psychotic disorder, in which patients also exhibit the same schizophrenia-like symptoms, but for a shorter duration - only up to 1 month.

Symptoms and diagnosis

Schizophreniform disorder shares symptoms with schizophrenia, which involves the patient’s thoughts and beliefs regarding reality and mood.¹ 

The symptoms are usually grouped into three categories: 

• the positive symptoms, which involve hallucinations and delusions. 
• the negative symptoms, which are concerned with depressed mood and social withdrawal. 
• the cognitive functions, which are reduced in aspects such as learning, memory and attention.¹ 

Usually, the symptoms that are most concerning for the patient and lead them to consult a clinician are the psychotic symptoms, which fall under the positive symptoms category.¹ To diagnose the disorder, the main symptoms to detect include disorganised speech and behaviour, catatonic behaviour and diminished emotional expression.¹ 

Schizophreniform disorder is characterised by the fact that these symptoms are present for up to 6 months, including the prodromal phase. The prodromal phase is a period in which the initial hallucinations, confusion, and mood impairments start to appear, but the disorder has not yet been diagnosed or the psychotic outbursts are not yet severe.² 

The diagnosis of schizophreniform disorder consists of having at least one of these schizophrenia-like symptoms: hallucinations, delusions, disorganised speech, disorganised or catatonic behaviour, or diminished emotional expression.¹ In a case where the person’s delusions or hallucinations are more bizarre or overwhelming, just one of the symptoms is required for diagnosis.³

The main distinction between schizophreniform disorder and schizophrenia is that schizophrenia is a longer-lasting condition, but shares the same symptoms. The prognosis for schizophreniform disorder is better than the one for schizophrenia, as the distinguishing characteristic of schizophreniform disorder is the duration of its symptoms. It is, however, important not to generalise this finding regarding the prognosis of schizophreniform disorder to every patient, as the predominant symptoms can change for every patient, and will determine the prognosis after the first 6 months.¹

When reading about schizophreniform disorder, it is important to notice that the disorder name has been used interchangeably with another condition related to schizophrenia, which is schizoaffective disorder. This disorder indicates the overlap between schizophrenia and mood disorders.¹ Although this nomenclature overlaps in the literature, schizophreniform disorder is considered to share the identical symptoms only of schizophrenia, and differ only in the duration of symptom appearance.¹ However, a subtype of schizophreniform disorder patient may show prominent mood-related symptoms, and for this reason, the overlap between schizoaffective disorder and schizophrenia symptoms is not always clear in every patient.¹

Treatment

The first line of treatment for psychosis is antipsychotic drugs.⁴ Psychotic symptoms can be treated by taking ‘typical’ or first-generation antipsychotic drugs to diminish the hallucinations and the other positive symptoms of schizophreniform disorder and schizophrenia. ⁴ Typical antipsychotics were developed in the ‘50s and act by reducing the transmission of the neurotransmitter dopamine, which is thought to be responsible for the positive symptoms.⁵ 

These drugs are not responsible for treating other symptoms of the disorder, which include the negative symptoms, such as the mood and social withdrawal aspects, and the cognitive impairment symptoms.⁵ For this reason, ‘atypical’ or second-generation antipsychotic drugs were later introduced. These drugs do not aim to reduce dopamine transmission, but to enhance it in different brain areas while also acting on serotonin transmission, leading to an improvement of the negative symptoms as well.⁶

More recent research is focussing on introducing drugs that act on NMDA receptors: this is because, although dopamine excess in the brain leads to hallucinations and related symptoms, the underlying pathology of the disease could be explained by the under-activity of NMDA receptors.⁷ NMDA receptors are excited by the main excitatory neurotransmitter found in our brain, which is glutamate. Drugs that can improve glutamate transmission might be able to correct for the NMDA receptor under-activity that seems to underlie schizophrenia symptoms.⁷ In fact, the drugs that act on these receptors seem to improve all the range of symptoms of schizophrenia and schizophreniform disorder, and the development of these drugs would be a great step forward, especially for patients who do not respond well to antipsychotics. 

Different studies aim to understand whether atypical antipsychotics have already been a step forward in the treatment of schizophrenia, schizophreniform disorder, or schizoaffective disorder. ⁴ The data from these studies show a potential benefit from atypical antipsychotics. However, discontinuation of taking the drugs by the patients is not always correlated with actual symptom improvement, so it is difficult to establish the actual benefit in symptoms experienced by the patients.⁴

Together with drug treatment, schizophreniform disorder patients can be advised to participate in psychotherapy sessions with professionals, who will most likely use practices such as cognitive behavioural therapy (CBT) to manage the symptoms.

Overall, schizophreniform disorder is a treatable disorder as symptoms are manageable with the current drugs and therapies available. In addition, the disorder does not have, by definition, a duration longer than 6 months.

Recurrence and schizophrenia diagnosis

The prognosis of the disorder is not consistent in the literature. This is because schizophreniform disorder is a schizophrenia-like disorder. Therefore it can exhibit a spectrum of symptoms, ranging from subtypes with more prominent psychosis symptoms or with greater mood-related symptoms.³ In fact,  schizophreniform disorder is often diagnosed in patients with more prominent mood-related symptoms than schizophrenia symptoms.³ A more accurate prognosis would be possible if the different subtypes of schizophrenia and schizophreniform disorder had more precise diagnosis definitions to differentiate them.³

Although the symptoms of schizophreniform disorder are categorised as the same as schizophrenia, studies have found that often schizophreniform disorder patients who exhibit mainly mood-related symptoms, are more likely to have good prognostic outcomes, in comparison with patients with mainly psychotic symptoms.³

Summary 

Schizophreniform disorder is a distressing condition in which the subject who is diagnosed with the condition has a deeply changed experience of reality, which impairs thoughts and beliefs regarding reality, and consequently, the patient’s mood and behaviour. This experience is referred to as psychosis, which can be treated with antipsychotic drugs and psychotherapy, and can therefore be managed, to a certain extent. Schizophreniform disorder notably lasts for up to 6 months: if the symptoms persist for longer, we are possibly facing a diagnosis of schizophrenia, while shorter outbreaks (for only up to 1 month) are considered a consequence of a different disorder, called brief psychotic disorder. The range of symptoms found in patients with schizophreniform disorder is the same as those seen in schizophrenia. These symptoms include positive symptoms, (which include hallucinations, confused thoughts, confused speech, and delusions), negative symptoms, (which refer to negative mood and social isolation), and a certain degree of cognitive impairment.

Disorders which lead to psychosis can be very distressing for those who experience them, as the way reality is perceived and engaged appears different. It can also be difficult to help or understand when people around us start displaying some of the psychotic symptoms. To get help and support in these circumstances different helplines and resources have been created for this purpose. 

The research on NMDA receptors for the treatment of schizophrenia-like symptoms is an up-and-coming area of study. For further interest here are some free resources:

• Past and present research in the field
• Schizophrenia Bulletin

In addition, as a psychosis outbreak might not be easy to identify by someone who has never experienced it, here are the indications of what to expect from a first episode of psychosis.