Schizophreniform disorder

Question 1

Schizophreniform disorder - dx

Answer 1

A. >2 of the following, each present for a significant portion of time during a 1mo period (or less if successfully tx). At least one of these must be 1, 2 or 3:
1. Delusions
2. Hallucinations
3. Disorganised speech (e.g. frequent derailment or incoherence)
4. Grossly disorganised or catatonic behaviour
5. Negative symptoms
B. An episode of the disorder lasts >1mo or but

Question 2

Schizophreniform disorder - more information

Answer 2

• Basically refers to schizophrenia-like psychosis that fails to fulfil duration criterion for schizophrenia
• May resolve or develop into schizophrenia

Question 3

Schizophreniform disorder - mx (same as for first psychotic episode - 3)

Answer 3

1. Psychiatric hx, MSE, physical ex (with neurological focus), ix (FBE, UEC + ca, LFTs, FBG, serum lipids, TFTs, prolactin, urine toxicology, CT/MRI brain, immunological screen/EEG if indicated). Conduct blood tests before commencing antipsychotics, if possible
2. Risk assessment - to themselves, risk of violence, insight + ability to accept treatment. Assess need for hospital admission and suitability of the ward environment (clinical condition of pt + availability of both community mental health resources and family or other social supports; be aware of drug-induced/drug-withdrawal state). Regular review in first 72 hours
3. Emergency tx of behavioural disturbance (3):
   a. Oral lorazepam 1-2mg + oral antipsychotic (e.g. haloperidol 10-20mg, chlorpromazine 50-100mg)
   b. IM lorazepam + haloperidol if oral medication refused/failed
   c. If immediate tranquilisation necessary (exceptional circumstances) = IV benzodiazepines (e.g. diazepam 10mg slow IV bolus