Schizophreniform disorder Health Article

Definition

Schizophreniform disorder (SFD) is a time-limited illness wherein the sufferer has experienced at least two of the major symptoms of psychosisfor longer than one month but fewer than six months. Hallucinations, delusions, and strange bodily movements or lack of movements (catatonic behavior) are all symptoms that may be observed. Additionally, minimal or peculiar speech, lack of drive to act on one's own behalf, bizarre behavior, a wooden quality to one's emotions or near-absent emotionality are all typical psychotic symptoms that may occur in SFD.

Part of defining SFD involves examining possible biological influences on the development of the individual's psychotic symptoms. When the psychotic features result from a physical disease, a reaction to medication, or intoxication with drugs or alcohol, then these symptoms are not considered SFD. Also, if hallucinations, delusions or other psychotic symptoms are experienced solely during episodes of clinical depression or mania, then SFD is not diagnosed. Instead, a mood disorder diagnosisis given.

The Diagnostic and Statistical Manual of Mental DisordersFourth Edition Text Revision, or DSM-IV-TR, produced by the American Psychiatric Association in 2000, outlines the diagnostic criteria for SFD.

Description

The person experiencing SFD shows at least two psychotic symptoms, which may be either "positive" or "negative" psychotic symptoms. The terms "positive" and "negative" are not used in their usual meanings of positive being good and negative being bad. In discussing psychosis, positive and negative are used with a more formal medical connotation. Medically, "positive" refers to a factor being present that does not normally occur, or to an excess of some factor or behavior. Positive symptomsof psychosis include hallucinations, delusions, strange bodily movements or frozen movement (catatonic behavior), peculiar speech and bizarre or primitive (socially inappropriate) behavior. Negative, when used in medical fashion, refers to an absence or deficiency of a factor that is usually at a reasonable level during normal functioning. Various deficiencies in behavior, emotionality or speech constitute the negative symptomsof psychosis which are observed in some cases of SFD. Negative symptoms of psychosis include avolition, affective flatteningand alogia.

Avolition is a lack of effort to act on one's own behalf or to engage in behaviors directed at accomplishing a purpose. Affective flattening or blunted affectrefers to a decrease or low level of emotion, shown as a wooden quality to one's emotions or a near absence of emotionality. Alogia derives from the Greek root term for speech or thought, and the "a" that begins the word indicates an absence. Thus, alogia refers to a disruption in thought process reflected in the person's speech. One form of alogia is poverty of speech. Impoverished speech is brief, limited, terse and generally emerges only in response to questions or prompts rather than flowing spontaneously. An impairment termed poverty of contentoccurs when the information or concepts that the individual is attempting to convey cannot be understood because of limitations in the method of communicating. The meaning behind the phrases is obscured or missing. Typically, in poverty of content, the person's speech, while comprehensible in terms of its orderliness of grammar and vocabulary, does not convey substantial meaning because the phrasing is overly concrete and literal or overly abstract and fanciful.

Among the various positive symptoms of psychosis that can be a part of SFD, delusions are a fairly common psychotic feature. Delusions are strongly held irrational and unrealistic beliefs that are highly resistant to alteration. Even when the person encounters evidence that would invalidate the delusion, the unjustified and improbable belief remains a conviction. Often, delusions are paranoid or persecutory in tone. In these types of delusions, the person is excessively suspicious and continually feels at the mercy of conspirators believed to be determined to cause harm to the sufferer. However, delusions can also take on other overtones. Some delusions are grandiose, or involve elaborate love fantasies (erotomanic delusions). Delusions may involve somatic content, or may revolve around extreme and irrational jealousy.

Peculiar or disorganized speech, catatonic behavior and bizarre or primitive behavior are all additional positive psychotic symptoms that may occur in SFD. Disorganized speech is seen in some cases of SFD. Speech disorganization can involve words blended together into incomprehensible statements, also known as "word salad." In some persons disorganized speech takes the form of echolalia, which is the repetition of another person's exact spoken words, restated either immediately after the initial speaker or after a delay of minutes to hours. Catatonic behavior or catatoniainvolves the presence of one of the possible extremes related to movement. Catalepsy is the motionless end of the catatonic spectrum; in catalepsy, a person may remain unmoving in one fixed position for long periods. The opposite end of the catatonia phenomenon is demonstrated in rapid or persistently repeated movements, recurrent grimacing and odd facial expressions, and contorted or strange gestures. Bizarre or primitive behavior in SFD ranges from child-like behaviors in unsuitable circumstances to unusual practices such as hoarding refuse items perceived by the sufferer to be valuable, caching food all over the home, or wandering purposelessly through the streets.

Only rarely would all these various psychotic symptoms be observed simultaneously in one person with SFD. Instead, each individual with SFD has a constellation of symptoms, practices and thought processes that is unique to that person. However, frequent occurrence of at least two of these psychotic symptoms persisting for one month to six months is considered to be SFD. A different diagnosis, which includes the presence of psychotic symptoms, is given if the symptoms have been present for longer than six months. Also, if there is some other psychiatric syndrome that better explains the behaviors, or if there are biological causes (such as a physical illness, like a braintumor) that caused the symptoms to appear, another diagnosis is utilized.

Unlike any other diagnoses offered in DSM-IV-TR, the SFD diagnosis always includes an indication of the patient's prognosis. Prognosis refers to the potential outcome for an individual with a particular illness, based on the features already observed and the usual course of the illness. If an individual with SFD has several positive prognostic factors, then there is a much higher likelihood of complete recovery without relapse into psychosis. Positive prognostic factors in SFD include: prominent confusion during the illness, rapid (rather than gradual) development of symptoms during a four-week period, good previous interpersonal and goal-oriented functioning, and lack of negative symptoms of psychosis.