Schizophreniform disorder Health Article

Diagnosis

Despite the clarity of the DSM-IV-TRcriteria, identification of SFD is less than clear-cut. The emphasis on the length of time that symptoms have been evident and the presence or absence of good prognostic factors make SFD one of the most unusually defined of the DSM-IV-TRdisorders. While duration of symptoms is the major distinction among brief psychotic disorder, SFD and schizophrenia, it can be difficult to clearly determine the length of time symptoms have existed. An additional complication is that the cultural context in which the "psychotic symptoms" are experienced determines whether the behaviors are viewed as pathological or acceptable. When psychotic-like behaviors are expected to occur normally as part of the person's culture or religion, and when the behaviors occur in a culturally positive context such as a religious service, SFD would not be diagnosed.

Information about current and past experiences is collected in an interview with the client, and possibly in discussion with the client's family. Psychological assessment instruments, such as the Rorschach technique, the Minnesota Multiphasic Personality Inventory, and mood disorder questionnaires or structured diagnostic interviews may also be used to aid in the diagnosis.

Treatments

The main line of treatment for SFD is antipsychotic medication. These medications are often very effective in treating SFD. Mood-stabilizing drugs similar to those used in bipolar disorder may be used if there is little response to other interventions. Postpartum psychosis is also treated with antipsychotics and possibly, hormones. Supportive therapy and education about mental illness is often valuable. The most useful interventions in culture-bound syndromes are those that are societally prescribed; for example, a sacred ceremony to ease the restless spirits of deceased ancestors might be a usual method of ending the psychotic-like state, in that particular culture.

Prognosis

Given the large number of mental health consumers with SFD who go on to be diagnosed with a more chronic form of mental illness, the prognosis is fairly poor. As noted earlier, 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 suggest a better outcome.

Prevention

If the SFD is a persistent postpartum psychosis, a prevention option is to avoid having additional children. The physician may anticipate the postpartum problem and prescribe an antipsychotic medication regimen to begin immediately after delivery as a preventive measure. Although prevention of psychotic disorders is difficult to accomplish, the earlier treatment begins, the better the outcome. Therefore, efforts are more generally focused on early identification of SFD and other psychotic-spectrum disorders.

See also Delusional disorder; Dementia; Schizotypal personality disorder

BOOKS

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders.4th edition, text revised. Washington, DC: American Psychiatric Association,2000.

PERIODICALS

Ferfel D. "Rationale and guidelines for the inpatient treatment of acute psychosis." Journal of Clinical Psychiatry61, Suppl 14 (2000): 27–32.

Iancu, I, P. V. Dannon, R. Ziv, and E. Lepkifker. "A follow-up study of patients with DSM-IV schizophreniform disorder." Canadian Journal of Psychiatry47, no. 1 (2000): 56–60.

Kulhara, P., S. Chakrabarti. "Culture, schizophrenia and psychotic disorder." Psychiatric Clinics of North America 24, no. 3 (2001): 449–464.

Stocky A, J. Lynch. "Acute psychiatric disturbance in pregnancy and the puerperium." Baillere's Best Practices and Research in Obstetrics and Gynaecology14, no. 1(2000): 73–87.

Deborah Rosch Eifert, Ph.D.