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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