Schizophreniform disorder: Difference between revisions
No edit summary
 
(2 intermediate revisions by 2 users not shown)
Line 1: Line 1:
==Background==
==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
*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<ref>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</ref>, CAD<ref>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. </ref>, DM<ref>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.
</ref>, cancer<ref>https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm</ref>, HIV, HCV<ref>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.</ref>


==Clinical Features==
==Clinical Features==
Line 9: Line 12:
**4. Grossly disorganized or catatonic behavior
**4. Grossly disorganized or catatonic behavior
**5.  Negative symptoms (i.e., diminished emotional expression or avolition)
**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.”
*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.
*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.
*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.


Line 20: Line 25:
*[[Encephalitis]]
*[[Encephalitis]]
*[[Thyroid (Main)]]
*[[Thyroid (Main)]]
*Toxin ingestion
*[[Toxicology (main)|Toxin ingestion]]
*Medication effect
*Medication effect


==Evaluation==
==Evaluation==
Rule out other organic causes including substance abuse, medication effect or other medical conditions. Consider emergency psychiatric evaluation in addition to medical evaluation.  
*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.  


{{General ED Psychiatric Workup}}
{{General ED Psychiatric Workup}}
Line 32: Line 38:


==Disposition==
==Disposition==
*Home with outpatient psychiatric services if stable, versus inpatient psychiatric admission if unstable
*Generally may be discharged
*May require admission if unable to care for self or other indication for psychiatric hold


==See Also==
==See Also==
Line 42: Line 49:


==External Links==
==External Links==


==References==
==References==

Latest revision as of 15:02, 11 October 2019

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]

Clinical Features

  • 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.

Differential Diagnosis

Psychiatric Disorders with Psychotic Symptoms

Organic Causes

Evaluation

  • 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.

General ED Psychiatric Workup

Management

General ED Psychiatric Management

Disposition

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

See Also

External Links

References

  1. ↑ 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
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ https://www.cdc.gov/mentalhealth/data_stats/mental-illness.htm
  5. ↑ 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.
  6. ↑ American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Retrieved from "https://www.wikem.org/w/index.php?title=Schizophreniform_disorder&oldid=233021"