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Schizophreniform disorder

295.40 Schizophreniform Disorder

Diagnostic Features

The essential features of Schizophreniform Disorder are identical to those of Schizophrenia (Criterion A) except for two differences: the total duration of the illness (including prodromal, active, and residual phases) is at least 1 month but less than 6 months (Criterion B) and impaired social or occupational functioning during some part of the illness is not required (although it may occur). The duration requirement for Schizophreniform Disorder is intermediate between that for Brief Psychotic Disorder (in which symptoms last for at least 1 day but for less than 1 month) and Schizophrenia (in which the symptoms persist for at least 6 months). The diagnosis of Schizophreniform Disorder is made under two conditions. In the first, the diagnosis is applied without qualification to an episode of illness of between 1 and 6 months' duration from which the individual has already recovered. In the second instance, the diagnosis is applied when a person who, although symptomatic, has been so for less than the 6 months required for a diagnosis of Schizophrenia. In this case, the diagnosis of Schizophreniform Disorder should be qualified as "Provisional" because there is no certainty that the individual will actually recover from the disturbance within the 6-month period. If the disturbance persists beyond 6 months, the diagnosis would be changed to Schizophrenia.

Specifiers

The following specifiers for Schizophreniform Disorder may be used to indicate the presence or absence of features that may be associated with a better prognosis:

With Good Prognostic Features. This specifier is used if at least two of the following features are present: onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning, confusion or perplexity at the height of the psychotic episode, good premorbid social and occupational functioning, and absence of blunted or flat affect.
Without Good Prognostic Features. This specifier is used if two or more of the above features have not been present.

Associated Features and Disorders

Also see the discussion in the Associated Features and Disorders section for Schizophrenia, p. 304. Unlike Schizophrenia, impairment in social or occupational functioning is not required for a diagnosis of Schizophreniform Disorder. However, most individuals do experience dysfunction in various areas of daily functioning (e.g., work or school, interpersonal relationships, and self-care).

Specific Culture, Age, and Gender Features

For additional discussion of culture, age, and gender factors relevant to the diagnosis of Schizophreniform Disorder, see the Specific Culture, Age, and Gender Features section for Schizophrenia (p. 306). There are suggestions that in developing countries, recovery from Psychotic Disorders may be more rapid, which would result in higher rates of Schizophreniform Disorder than of Schizophrenia.

Prevalence

Available evidence suggests variations in incidence across sociocultural settings. In the United States and other developed countries, the incidence is low, possibly fivefold less than that of Schizophrenia. In developing countries, the incidence is substantially higher, especially for the subtype "With Good Prognostic Features"; in some of these settings Schizophreniform Disorder may be as common as Schizophrenia.

Course

There is little available information on the course of Schizophreniform Disorder. Approximately one-third of individuals with an initial diagnosis of Schizophreniform Disorder (Provisional) recover within the 6-month period and receive Schizophreniform Disorder as their final diagnosis. Of the remaining two-thirds, the majority will progress to the diagnosis of Schizophrenia or Schizoaffective Disorder.

Familial Pattern

Few family studies have focused on Schizophreniform Disorder. Available evidence suggests that relatives of individuals with Schizophreniform Disorder have an increased risk for Schizophrenia.

Differential Diagnosis

Because the diagnostic criteria for Schizophrenia and Schizophreniform Disorder differ primarily in terms of duration of illness, the discussion of the differential diagnosis of Schizophrenia (p. 309 ) also applies to Schizophreniform Disorder. Schizophreniform Disorder differs from Brief Psychotic Disorder, which has a duration of less than 1 month.

Diagnostic criteria for 295.40 Schizophreniform Disorder

Criteria A, D, and E of Schizophrenia are met.

An episode of the disorder (including prodromal, active, and residual phases) lasts at least 1 month but less than 6 months. (When the diagnosis must be made without waiting for recovery, it should be qualified as "Provisional.")

Specify if:

Without Good Prognostic Features
With Good Prognostic Features: as evidenced by two (or more) of the following:
onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning
confusion or perplexity at the height of the psychotic episode
good premorbid social and occupational functioning
absence of blunted or flat affect