Schizophreniform disorder

Background

A mental disorder with characteristic symptoms identical to schizophrenia, distinguished by the total duration of illness of at least 1 month but less than 6 months
- Be wary of diagnostic overshadowing (e.g. erroneously attributing symptoms to psychiatric disorder when etiology is in fact organic)
- Patients with serious mental illness have significantly higher rates of stroke[1], CAD[2], DM[3], cancer[4], HIV, HCV[5]

A. Two (or more) of the following, each present for a significant portion of time during a 1 month period (or less if successfully treated). At least one of these must be (1), (2), or (3):[6]
- 1. Delusions
- 2. Hallucinations
- 3. Disorganized speech (e.g., frequent derailment or incoherence)
- 4. Grossly disorganized or catatonic behavior
- 5. Negative symptoms (i.e., diminished emotional expression or avolition)
B. An episode of the disorder lasts at least 1 month but less than 6 months. When the diagnosis must be made without waiting for recovery, it should be qualified as “provisional.”
C. Schizoaffective disorder and depressive or bipolar disorder with psychotic features have been ruled out because either:
- 1) no major depressive or manic episodes have occurred concurrently with the active-phase symptoms, or
- 2) if mood episodes have occurred during active-phase symptoms, they have been present for a minority of the total duration of the active and residual periods of the illness.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition.

Rule out other organic causes/exacerbating factors including substance abuse, medication effect or other medical conditions.
Consider emergency psychiatric evaluation in addition to medical evaluation.

Non-pharmacologic
- Verbal de-escalation
- Offer comforting items: blanket, meal, pillow, etc
- Quiet room
- Physical restraints (should administer medications if restraints used, as decreases restraint time)
Pharmacologic: Goal is to calm patient without oversedation
- No history of psychosis
  - Haloperidol 0.5mg-5mg +/- lorazepam 0.25-2mg (PO/IM/IV)
    - Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)
  - Consider risperidone 0.5-2mg PO or olanzapine 2.5-20mg (PO/IM/SL) or ziprasidone 10-20mg IM
- Known or suspected underlying psychotic illness
  - Continue treatment with previous antipsychotic or
  - PO: olanzapine 5-10mg or risperidone 0.5-2mg +/- lorazepam: 0.5-2mg
  - IM: olanzapine 2.5-20mg or ziprasidone 10-20mg or
  - (PO/IM/IV) Haloperidol 0.5-5mg +/- lorazepam 0.5-2mg
    - Consider adding benztropine 0.5-2mg or diphenhydramine 25-50mg (PO/IV/IM) (reduces dystonia or extrapyramidal reaction)

Generally may be discharged
May require admission if unable to care for self or other indication for psychiatric hold

Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333
Leucht S, Burkand T, Henderson J, Maj M, Sartorius N (2007) Physical illness and schizophrenia: a review of the literature. Acta Psychiatr Scand 116: 317– 333.
Mai Q, D’Arcy C, Holman J, Sanfilippo FM, Emery JD, et al. (2011) Mental illness related disparities in diabetes prevalence, quality of care and outcomes: a population-based longitudinal study. BMC Med 9: 118.
https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm
Disability Rights Commission (2006) Equal Treatment: Closing the Gap. A Formal Investigation into Physical Health Inequalities Experienced by People with Learning Disabilities and/or Mental Health Problems. Disability Rights Commission. London.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

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