Schizophreniform Disorder

Schizophreniform disorder has the symptoms of schizophrenia lasting at least 1 month but under 6 months.

• Lifetime prevalence 0.2%; about two thirds eventually meet criteria for schizophrenia or schizoaffective disorder, one third recover.
• Good prognostic features: acute onset, confusion, good premorbid function, preserved affect, absence of blunting.
• Provisional diagnosis changed if symptoms persist beyond 6 months.

• Delusions, hallucinations, disorganised speech, grossly abnormal behaviour or catatonia, and negative symptoms.
• Functional impairment is not required for diagnosis.
• Mood symptoms may be present but brief.

• DSM-5 symptom criteria with duration 1 to 6 months.
• Exclude substance induced psychosis, delirium, epilepsy, encephalitis, thyroid disease, autoimmune and metabolic causes, mood disorder with psychotic features, brief psychotic disorder, schizoaffective disorder.
• Baseline work up: toxicology, TSH, electrolytes, HIV, syphilis, MRI, metabolic baseline, ECG.
• Risk assessment.

• Antipsychotic monotherapy: risperidone 2 to 4 mg, olanzapine 10 to 15 mg, aripiprazole 10 to 20 mg.
• Continue for 12 months after remission before gradual discontinuation, with monitoring for relapse.
• Psychosocial interventions: psychoeducation, family work, CBT for psychosis, substance misuse treatment.
• Short term lorazepam 1 to 2 mg for agitation or insomnia.
• Monitor metabolic parameters; re-evaluate diagnosis at 6 months.
• Early intervention service engagement.