Symptoms similar to those of schizophrenia except that they last at least 1 month and resolve within 6 months and then return to baseline level of functioning.

Little is known about the incidence, prevalence, and sex ratio of schizophreniform disorder. The disorder is most common in adolescents and young adults and is less than half as common as schizophrenia. A lifetime prevalence rate of 0.2% and a 1-year prevalence rate of 0.1% have been reported.

In general, schizophreniform patients have more mood symptoms and a better prognosis than schizophrenic patients. Schizophrenia occurs more often in families of patients with mood disorders than in families of patients with schizophreniform disorder. Cause remains unknown.

A rapid-onset psychotic disorder with hallucinations, delusions, or both. Although many patients with schizophreniform disorder may experience functional impairment at the time of an episode, they are unlikely to report a progressive decline in social and occupational functioning. See Table 13-1.

Good prognostic features include absence of blunted or flat affect, good premorbid functioning, confusion and disorientation at the height of the psychotic episode, shorter duration, acute onset, and onset of prominent psychotic symptoms within 4 weeks of
any first noticeable change in behavior. Most estimates of progression to schizophrenia range between 60% and 80%. Some will have a second or third episode during which they will deteriorate into a more chronic condition of schizophrenia. Others remit and then have periodic recurrences.

Antipsychotic medications should be used to treat psychotic symptoms. Consideration can be given to withdrawing or tapering the medication if the psychosis has been completely resolved for 6 months. The decision to discontinue medication must be individualized based on treatment response, side effects, and other factors. A trial of lithium (Eskalith), carbamazepine (Tegretol), or valproate (Depakene) may be warranted for treatment and prophylaxis if a patient has a recurrent episode. Psychotherapy is critical in helping patients to understand and deal with their psychotic experiences. Electroconvulsive therapy may be indicated for some patients, especially those with marked catatonic or depressed features.

A disorder with concurrent features of both schizophrenia and mood disorder that cannot be diagnosed as either one separately.

Lifetime prevalence is less than 1%. The depressive type of schizoaffective disorder may be more common in older persons than in younger persons, and the bipolar type may be more common in young adults than in older adults. The prevalence of the disorder has been reported to be lower in men than in women, particularly married women; the age of onset for women is later than that for men, as in schizophrenia. Men with schizoaffective disorder are likely to exhibit antisocial behavior and to have a markedly flat or inappropriate affect.

Some patients may be misdiagnosed; they are actually schizo phrenic with prominent mood symptoms or have a mood disorder with prominent psychotic symptoms. The prevalence of schizophrenia is not increased in schizoaffective families, but the prevalence of mood disorders is. Patients with schizoaffective disorder have a better prognosis than
patients with schizophrenia and a worse prognosis than patients with mood disorders.

There will be signs and symptoms of schizophrenia coupled with manic or depressive episodes. The disorder is divided into two subtypes: (1) bipolar, if there is both a manic and depressive cycling, and (2) depressive, if the disturbance only includes major depressive episodes. See Table 13-2.

Any medical, psychiatric, or drug-related condition that causes psychotic or mood symptoms must be considered.

Poor prognosis is associated with positive family history of schizophrenia, early and insidious onset without precipitating factors, predominance of psychotic symptoms, and poor premorbid history. Schizoaffective patients have a better prognosis than schizophrenic patients and a worse prognosis than mood disorder patients. Schizoaffective patients respond more often to lithium and are less likely to have a deteriorating course than are schizophrenic patients.

Antidepressant or antimanic treatments should be used combined with antipsychotic medications to control psychotic signs and symptoms. Selective serotonin reuptake inhibitors (SSRIs, e.g., fluoxetine [Prozac] and sertraline [Zoloft]) are often used as first-line agents. In manic cases, the use of electroconvulsive therapy should be considered. Patients benefit from a combination of family therapy, social skills training, and cognitive rehabilitation.

Disorder in which the primary or sole manifestation is a nonbizarre delusion that is fixed and unshakable. The delusions are usually about situations that can occur and are possible in real life, such as being followed, infected, or loved at a distance. Bizarre delusions are considered
impossible, such as being impregnated by an alien being from another planet.

Delusional disorders account for only 1% to 2% of all admissions to inpatient mental health facilities. The mean age of onset is about 40 years, but the range for age of onset runs from 18 years of age to the 90s. A slight preponderance of female patients exists. Men are more likely to develop paranoid delusions than women, who are more likely to develop delusions of erotomania. Many patients are married and employed, but some association is seen with recent immigration and low socioeconomic status. See Table 13-3.

No laboratory test can confirm the diagnosis. Projective psychological tests reveal a preoccupation with paranoid or grandiose themes and issues of inferiority, inadequacy, and anxiety.

No known pathophysiology except when patients have discrete anatomic defects of the limbic system or basal ganglia.

Defenses used: (1) denial, (2) reaction formation, and (3) projection. Major defense is projection—symptoms are a defense against unacceptable ideas and feelings. Patients deny feelings of shame, humiliation, and inferiority; turn any unacceptable feelings into their opposites through reaction formation (inferiority into grandiosity); and project any unacceptable feelings outward onto others.

Delusions last at least 1 month and are well systematized and nonbizarre, as opposed to fragmented and bizarre. The patient’s emotional response to the delusional system is congruent with and appropriate to the content of the delusion. The personality remains intact or deteriorates minimally. The fact that patients often are hypersensitive and hypervigilant may lead to social isolation despite their high-level functioning capacities. Under nonstressful circumstances, patients may be judged to be without evidence of mental illness. See Table 13-4.