Schizophreniform
Disorder
Schizophreniform
Disorder is characterized by the presence of the symptoms of schizophrenia,
including delusions, hallucinations, disorganized speech, disorganized
or catatonic behavior, and negative symptoms. The disorder, including
its prodromal, active, and residual phases, lasts longer than 1 month
but less than 6 months.
For a material
part of at least one month (or less, if effectively treated) the patient
has had 2 or more of:
Delusions (only one symptom is required if a delusion is bizarre,
such as being abducted in a space ship from the sun).
Hallucinations (only one symptom is required if hallucinations are
of at least two voices talking to one another or of a voice that keeps
up a running commentary on the patient's thoughts or actions).
Speech that shows incoherence, derailment or other disorganization.
Severely
disorganized or catatonic behavior.
Any negative symptom such as flat affect, muteness, lack of volition.
This disorder is not the direct physiological result of a general medical
condition or the use of substances, including prescription medications.
A statement of
prognosis should be added to the diagnosis: With
Good Prognostic Features (2 or more of the following):
Actual psychotic
features begin within 4 weeks of the first noticeable change in the
patient's functioning or behavior.
The patient
is confused or perplexed when most psychotic.
Premorbid
social and job functioning are good.
Affect is
neither blunt nor flattened.
Differential
Diagnosis:
Some disorders
have similar or even the same symptom. The clinician, therefore, in
his diagnostic attempt has to differentiate against the following
disorders which he needs to rule out to establish a precise diagnosis.
Cause:
Schizophreniform
disorder appears to be related to abnormalities in the structure and
chemistry of the brain, and appears to have strong genetic links;
but its course and severity can be altered by social factors such
as stress or a lack of support within the family. The cause of schizoaffective
disorder is less clear cut, but biological factors are also suspected
Treatment:
Medication is
the most important part of treatment as it can reduce and sometimes
eliminate the psychotic symptoms. Case management is often needed
to assist with daily living skills, financial matters, and housing,
and therapy can help the individual learn better coping skills and
improve social and occupational skills.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Cognitive, behavior, and psychoanalytic therapies are used to treat
individuals with Schizophrenoform Disorder.
Antipsychotics
Special
Antipsychotic Adverse Reactions:
Neuroleptic
Malignant Syndrome. May occur at any point during the course of treatment.
Includes symptoms of autonomic instability, altered mental status, which
may progress to hyperthermia, stupor, and muscle hypertonicity. Death
may occur. Cause: Neuroleptics (phenothiazines, etc.) Characteristics.
Same symptoms as malignant hyperthermia (see below) but generally develops
over days instead of minutes. Treatment: As per malignant hyperthermia.
Malignant
Hyperthermia. Cause. 1:20,000 in response to a muscle-relaxing agent
(such as succinylcholine) or an inhaled anesthetic (such as halothane).
Is hereditary. May also be secondary to physical or emotional stress.
Characteristics. Hyperthermia, muscle rigidity, tachycardia, acidosis,
shock, coma, rhabdomyolysis. Treatment includes IV dantrolene 1 to 10
mg/kg IV titrated to effect, management of acidosis and shock, peripheral
cooling (see management of heat stroke below).
Tardive Dyskinesia. Involuntary movements of the tongue, face, mouth,
or jaw associated with long-term administration of antipsychotics. Elderly
females at highest risk. May be irreversible.
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