Schizophreniform disorder: symptoms, causes and treatment

Schizophrenia is a widely known mental disorder, considered the most representative of all psychotic disorders.

However, within these we find other disorders that resemble to a lesser or greater extent, such as schizoaffective disorder, the chronic delusional disorder or the disorder that concerns us in this article: schizophreniform disorder.

The latter is a psychological disorder that is difficult to define and has unclear limits, given that its Differences with the rest of psychotic disorders are more quantitative than qualitative, as we will see.

• Related article: "What is psychosis? Causes, symptoms and treatment "

What is schizophreniform disorder?

The diagnosis of schizophreniform disorder is made in all those cases in which at least hallucinations, delusions and / or altered speech appear and disorganized for more than a month but less than six. However, in some cases it is not clear whether it is a schizophreniform disorder or any other type of mental disorder on the psychotic spectrum.

The dividing lines between these concepts are blurred, and can provoke debate; These definitions serve primarily as a reference for guidance in the clinical setting. For this reason, some researchers have criticized the concept of schizophreniform disorder for being raised in a similar way a category "mixed bag", that is, one in which to include cases that are difficult to classify and that do not have to have much in common.

On the other hand, as occurs in all psychological disorders and psychiatric syndromes, the diagnosis of the disorder schizophreniform can only be carried out by mental health professionals with training and accreditations adequate.

Symptoms

Symptoms of schizophreniform disorder are varied, especially considering that the way in which the disconnection with reality is presented makes the way in which the person reacts change a lot.

However, the symptoms do not last as long as in the case of schizophrenia, and over time they can 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 have increased activity and impulsivity, acting in a chaotic way, and a variable level of disconnection with reality. Catatonia or negative symptoms such as abulia or bradypsychia. The appearance 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 and acute psychotic disorder less than a month in duration) and by the fact that it does not usually leave sequelae or cause deterioration (unless it ends up leading to another disorder). That is why it usually has a much better prognosis than this one.

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

A third of the patients achieve a complete recovery, without presenting more symptoms and sequelae., even many times without treatment (although that does not mean that you should not seek professional help; moreover, it is essential to do so). However, in the other two thirds the schizophreniform disorder may end up evolving into schizophrenia or the disorder schizoaffective, especially when it is not treated (although it must be taken into account that the phenomenon explained in the previous paragraph also influences it). You can also veer into a schizotypal personality disorder.

Causes of this disorder

The etiology (causes) of this disorder is not fully known, considering different hypotheses when respect that largely coincide with those of other psychotic disorders such as schizophrenia.

Default, It is assumed that the roots of schizophreniform disorder lie not in a single cause, but in many, and some of them have to do not so much with biological characteristics of the patient, but with the context in which he lives and the way in which he gets used to interacting with his physical environment and Social.

The existence of correlations has been observed that suggest that at least part of the subjects with this disorder present inherited genetic alterations, being frequent that a relative presents alterations of the state of the mood or schizophrenia. The experience of traumatic situations by someone with genetic vulnerability can trigger the onset of the disorder, as well as substance use. For example, common drugs such as cannabis are known to significantly increase likelihood of developing psychotic disorders, and schizophreniform disorder forms part of these.

At the brain level, it is observed, as in schizophrenia, that alterations in the dopaminergic pathways may arise, specifically in the mesolimbic and mesocortical. In the first of them there would be a dopaminergic hyperarousal that would cause positive symptoms such as hallucinations, and in the mesocortical a hypoactivation due to the lack of sufficient levels of this hormone that would generate abulia and other negative symptoms. However, although schizophrenia has a generally chronic course in schizophreniform disorder the symptoms end remitting with the treatment or even in some cases by themselves, with which the alteration in said systems could be temporary.

Good prognostic factors

The various studies carried out regarding schizophreniform disorder highlight the existence of some factors that tend to be linked to a good prognosis.

Among them, they stand out that there was a good premorbid adjustment (that is, that the subject did not present difficulties prior to the outbreak and was well socio-occupationally integrated), that feelings of confusion or strangeness appear between the symptoms, that positive psychotic symptoms begin within the first four weeks after the first changes appear and there are no affective blunting or other symptoms negatives.

This does not mean that those who do not have these characteristics necessarily have a worse development, but it does mean that those who do have them will have a more difficult time developing the disorder.

Treatment

The treatment to be applied in cases of schizophreniform disorder is practically identical to that of schizophrenia. What has been shown to be more effective in combating this disorder is the combined use of therapy pharmacological and psychological, the prognosis being better the earlier treatment is started mixed.

Here we go over 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 positive symptoms, generally recommended the use of atypical due to its minor side effects.

This treatment is performed both to initially stabilize the patient in the acute phase and afterwards. A lower maintenance dose is usually required than in schizophrenia, as well as less maintenance time. In cases of risk of causing harm or self-harm, hospitalization may be necessary until the patient stabilizes.

However, administering drugs (always under medical indication) and trusting that these work is not a good idea; its effects must be constantly monitored and assess its side effects in patients.

2. Psychological

On a psychological level, the treatment will be carried out once the patient has stabilized. Therapies such as problem solving and coping skills training are helpful, as well as psychosocial support.

The presence of hallucinations and delusions can be treated by targeting therapy (if you hear voices) and techniques such as cognitive restructuring. In addition, behavioral therapy can help de-link the occurrence of hallucinations with the function that it has adopted this phenomenon given the context of the patient (for example, as a response mechanism to situations stressful).

It should be borne in mind that after experiencing a psychotic break, excessive stimulation can be initially harmful, with which it is advised that the return to daily life be gradual. In any case, social and community reinforcement is very useful for improving the state of the patient, being essential to carry out psychoeducation with both the affected person and their her surroundings.

Through the psychoeducational process, both the patient and her family are informed about the implications of this disorder, and on what lifestyle habits to adopt to offer the best well-being possible.

Finally, it is necessary to bear in mind that each case must be periodically monitored so as to prevent the possible evolution towards another psychological or psychiatric disorder. This involves scheduling visits to the therapist's office on a regular but not weekly basis, unlike the intervention phase to treat symptoms.

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