Schizophreniform Disorder: Symptoms, Causes And Treatment

Schizophrenia is a widely known mental disorder, considered the most representative of all psychotic disorders.

However, within these we find other disorders that are similar to a lesser or greater extent, such as schizoaffective disorder, chronic delusional disorder or the disorder that concerns us in this article: schizophreniform disorder

The latter is a psychological alteration that is difficult to define and has unclear limits, given that its differences with the rest of psychotic disorders are more quantitative than qualitative, as we will see.

What is schizophreniform disorder?

The diagnosis of schizophreniform disorder is made in all cases in which at least hallucinations, delusions and/or altered speech appear and disorganized for more than a month but less than six. However, in some cases it is not clear whether it is a schizophreniform disorder or any other type of mental disorder on the psychotic spectrum.

The dividing lines between these concepts are blurred, and can spark debate; Mainly, these definitions serve as a reference to guide you in the clinical setting. For this reason, some researchers have criticized the concept of schizophreniform disorder for similarly presenting a “catch-all” category, that is, one that includes cases that are difficult to classify and that do not have much in common.

On the other hand, as is the case with all psychological disorders and psychiatric syndromes, the diagnosis of schizophreniform disorder can only be carried out by mental health professionals with appropriate training and accreditations.

Symptoms

The symptoms of schizophreniform disorder are varied especially taking into account that the way in which the disconnection with reality is presented makes the way in which the person reacts change a lot.

However, the symptoms are not as long-lasting as in the case of schizophrenia, and over time they can disappear completely or almost completely. That is why the fact of developing it can generate the feeling that there are emotional ups and downs and unforeseen problems.

It is not uncommon for people with schizophreniform disorder to have increased activity and impulsivity, acting chaotically, and a varying level of disconnection from reality. Catatonia or negative symptoms such as avolition or bradypsychia may also occur. The appearance of these symptoms tends to be sudden and acute, as well as their subsequent disappearance.

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Differences with schizophrenia

This brief definition may remind us of schizophrenia, from which it is mainly differentiated by the time window in which it appears (from one to six months, with the diagnosis of schizophrenia requiring at least six and the acute psychotic disorder lasting less than one month). and for the fact that it does not usually leave consequences or cause deterioration (unless it ends up leading to another disorder). That is why it usually has a much better prognosis than this.

It is common that when the diagnosis is made, if the problem has not already resolved, schizophreniform disorder is considered as a provisional diagnosis until it is determined whether it stops before six months or whether it can be considered schizophrenia. In fact, at the time some authors proposed that this diagnostic label could actually be encompassing those subjects with resolved and successfully treated schizophrenia.

A third of patients achieve a complete recovery, without presenting more symptoms and sequelae., often even without treatment (although that does not mean that you should not seek professional help; in fact, it is essential to do so). However, in the remaining two-thirds, schizophreniform disorder can end up evolving into schizophrenia or schizoaffective disorder, especially when it is not treated (although it must be taken into account that the phenomenon explained in the previous paragraph also influences this). It can also veer towards a schizotypal personality disorder.

Causes of this disorder

The etiology (causes) of this disorder is not completely known, with different hypotheses being considered in this regard that largely coincide with those of other psychotic disorders such as schizophrenia.

Default, It is assumed that the roots of schizophreniform disorder are not in a single cause, but in many and some of them have to do not so much with the patient’s biological characteristics, but with the context in which they live and the way in which they get used to interacting with their physical and social environment.

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The existence of correlations has been observed that suggests that at least some of the subjects with this disorder present inherited genetic alterations, and it is common for a family member to present mood disorders or schizophrenia. The experience of traumatic situations by someone with genetic vulnerability can trigger the onset of the disorder, as well as substance use. For example, it is known that drugs as common as cannabis significantly increase the chances of developing psychotic-type disorders, and schizophreniform disorder is one of these.

At the brain level, it is observed, as in schizophrenia, that Alterations may arise in the dopaminergic pathways, specifically in the mesolimbic and mesocortical pathways In the first of them there would be dopaminergic hyperexcitation that would cause positive symptoms such as hallucinations, and in the mesocortical there would be hypoactivation due to the lack of sufficient levels of that hormone that would generate avolition and other negative symptoms. However, although schizophrenia generally has a chronic course, in schizophreniform disorder the symptoms end up remitting with treatment or even in some cases on their own, so the alteration in these systems could be temporary.

Good prognostic factors

The various studies carried out regarding schizophreniform disorder highlight the existence of Some factors that tend to be linked to a good prognosis

Among them, they highlight that there was a good premorbid adjustment (that is, that the subject did not present difficulties prior to the outbreak and was well integrated socio-occupationalally), that sensations of confusion or strangeness appear among the symptoms, that the positive psychotic symptoms begin within the four first weeks after the first changes appear and there is no emotional dullness or other negative symptoms.

This does not mean that those who do not have these characteristics necessarily have a worse outcome, but it does mean that those who do have them will find it more difficult for the disorder to evolve.

Treatment

The treatment to be applied in cases of schizophreniform disorder is practically identical to that of schizophrenia. What has been shown to be most effective in combating this disorder is the combined use of pharmacological and psychological therapy, with the prognosis being better the earlier the mixed treatment is started.

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Below we review some of the most common and scientifically supported ways to treat schizophreniform disorder.

1. Pharmacological

At a pharmacological level, the administration of neuroleptics is prescribed in order to combat positive symptoms generally recommending the use of atypicals due to their fewer side effects.

This treatment is performed both to initially stabilize the patient in the acute phase and subsequently. A lower maintenance dose is usually required than in schizophrenia, as well as less maintenance time. In cases of risk of causing harm or self-harm, hospitalization may be necessary until the patient stabilizes.

However, administering drugs (always under medical indication) and trusting that they work is not a good idea; its effects must be constantly monitored and assess its side effects in patients

2. Psychological

On a psychological level, the treatment will be carried out once the patient is stabilized. Therapies such as problem-solving and coping skills training, as well as psychosocial support, are useful.

The presence of hallucinations and delusions can be treated through focusing therapy (if you hear voices) and techniques such as cognitive restructuring. Furthermore, behavioral therapy can help to unlink the appearance of hallucinations from the function that this phenomenon has adopted given the patient’s context (for example, as a response mechanism to stressful situations).

It must be taken into account that after experiencing a psychotic break, excessive stimulation can be initially harmful, so it is recommended that the return to daily life be gradual. In any case, social and community reinforcement is very useful for improving the patient’s condition, and it is essential to carry out psychoeducation both with the affected person and with their environment.

Through the psychoeducational process, both the patient and their family are informed about the implications of this disorder, and what lifestyle habits to adopt to offer the best possible well-being.

Finally, it is necessary to take into account that periodic monitoring of each case must be carried out in order to prevent the possible evolution towards another psychological or psychiatric disorder. This involves scheduling visits to the therapist’s office periodically but not weekly, unlike the intervention phase to treat symptoms.