Schizophreniform disorder: symptoms, causes and treatment.

A disorder that is often confused with schizophrenia. We explain its common symptoms.

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 disorder difficult to define and with unclear limits, since 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 those cases in which at least hallucinations, delusions and/or altered and disorganized speech appear for more than one month but less than six months. and disorganized speech appear for more than one month but less than six months. However, in some cases it is not clear whether it is a schizophreniform disorder or any other type of mental disturbance on the psychotic spectrum.

The dividing lines between these concepts are blurred, and may give rise to debate; mainly, these definitions serve as a reference for clinical guidance. For this reason, some researchers have criticized the concept of schizophreniform disorder as a "catch-all" category, i.e. one in which to include cases that are difficult to classify and do not necessarily have much in common.

On the other hand, as with all psychological disorders and psychiatric syndromes, the diagnosis of schizophreniform disorder can only be made by appropriately trained and credentialed mental health professionals.

Symptoms

The symptoms of schizophreniform disorder are varied.The symptoms of schizophreniform disorder are varied, especially since the way in which the disconnection with reality presents itself changes the way the person reacts.

However, the symptoms are not as long-lasting as in the case of schizophrenia, and over time they may 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 show increased activity and impulsivity.The patient may also present catatonia, acting in a chaotic manner, and a variable level of disconnection with reality. Catatonia or negative symptoms such as abulia or bradypsychia may also occur. The onset of these symptoms tends to be sudden and acute, as well as their subsequent disappearance.

Differences with schizophrenia

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

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

One third of patients make a complete recovery, with no further symptoms and sequelae.. even often without treatment (although this does not mean that professional help should not be sought; indeed, it is essential to do so). However, in the remaining two thirds, schizophreniform disorder may eventually evolve into schizophrenia or schizoaffective disorder, especially when untreated (although it should be noted that the phenomenon explained in the previous paragraph also plays a role). It can also veer towards schizotypal personality disorder.

Causes of this disorder

The etiology (the causes) of this disorder is not fully known, with different hypotheses being put forward that coincide to a large extent with those of other psychotic disorders such as schizophrenia.

By default, it is assumed that the roots of schizophreniform disorder do not lie in a single cause, but in manySome of these have to do not so much with Biological characteristics of the patient, but with the context in which he lives and the way he is accustomed to interact with his physical and social environment.

The existence of correlations has been observed that suggest that at least part of the subjects with this disorder present inherited genetic alterations, with a family member frequently presenting mood disorders or schizophrenia. The experience of traumatic situations by someone with genetic vulnerability can trigger the onset of the disorder, as well as the consumption of substances. For example, it is known that common drugs such as cannabis significantly increase the probability of developing psychotic disorders, and schizophreniform disorder is one of these.

At the brain level, it is observed, as in schizophrenia, that alterations in the dopaminergic pathways, specifically in the mesolimbic and mesocortical pathways, may arise.. In the former there would be a 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 this hormone that would generate abulia and other negative symptoms. However, although schizophrenia usually has a chronic course, in schizophreniform disorder the symptoms eventually subside with treatment or even in some cases by themselves, so that the alteration in these systems could be temporary.

Prognostic factors

The various studies carried out on schizophreniform disorder have highlighted the existence of certain factors that tend to be associated with a good prognosis.

These include a good premorbid adjustment (i.e., the subject did not present difficulties prior to the outbreak and was well integrated socially and occupationally), that feelings of confusion or strangeness appear between symptoms, that positive psychotic symptoms begin within the first four weeks after the first changes appear, and that there is no affective dullness or other negative symptoms.

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

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 better the prognosis the earlier the mixed treatment is initiated.

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

1. Pharmacological

At the pharmacological level, the administration of neuroleptics is prescribed in order to combat the positive symptomatology.The use of atypicals is generally recommended due to their lesser side effects.

This treatment is used both to stabilize the patient initially 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 harm or self-harm, hospitalization may be necessary until the patient is stabilized.

However, administering drugs (always under medical indication) and relying on them to work is not a good idea; their effects must be constantly monitored and their side effects must be assessed. side effects on the patients..

2. Psychological

At the psychological level, 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 by focusing therapy (if he hears voices) and techniques such as cognitive restructuring. In addition, behavioral therapy can help to dissociate the occurrence of hallucinations with the function that this phenomenon has adopted given the patient's context (e.g., as a response mechanism to stressful situations).

It should be kept in mind that after experiencing a psychotic break, excessive stimulation may initially be detrimental to the patient.It is therefore advisable that reincorporation into daily life be gradual. In any case, social and community reinforcement is very useful for the improvement of the patient's condition, being essential to carry out psychoeducation both with the affected person and his or her environment.

Through the psychoeducational process, both the patient and his family are informed about the implications of this disorder, and about which life habits to adopt in order to offer the best possible well-being.

Finally, it is necessary to take into account that a periodic follow-up 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 on a periodic basis but not on a weekly basis, as opposed to the intervention phase to treat symptoms.

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