Schizophreniform vs brief psychotic disorder

Both schizophreniform disorder and brief psychotic disorder belong in the psychotic disorder classification in the DSM-5, but they are separate conditions. The primary difference between the two is the duration of symptoms ^[1].

What is schizophreniform?

Schizophreniform disorder is a psychotic disorder that appears very similar in presentation to schizophrenia. The primary difference between the two is that schizophreniform disorder is shorter in duration.

To be diagnosed with schizophrenia, a person must show symptoms of a mental health disturbance for at least six months, and at least one month must include active psychotic symptoms. On the other hand, a schizophreniform disorder diagnosis requires a disturbance lasting at least one month but less than six months ^[1].

What is brief psychotic disorder?

Brief psychotic disorder, as its name might suggest, is a short-lasting form of psychosis. A person with brief psychotic disorder shows symptoms for at least one day but not longer than one month, and they return to their baseline level of functioning after symptoms subside ^[1].

Schizophreniform vs Brief Psychotic Disorder: Symptoms

The symptoms of schizophreniform and brief psychotic disorder are quite similar, but there are some distinctions between the two. For a diagnosis of schizophreniform disorder, a person must meet the following symptom-related criteria ^[1]:

• Delusions (false beliefs that persist, even when provided with evidence that they are untrue)
• Hallucinations (hearing, seeing, feeling, tasting, or smelling things that are not actually present)
• Disorganized or incoherent speech patterns
• Odd behavior (strange movements, catatonia, etc.)
• Negative symptoms, such as social withdrawal, lack of motivation, loss of pleasure

To be diagnosed with schizophreniform disorder, a person must show at least two of the above symptoms, and one of the symptoms must be delusions, hallucinations, or disorganized speech ^[1].

The primary differences between brief psychotic disorder vs. schizophreniform disorder are as follows ^[1].

• A person with schizophreniform disorder shows a mental disturbance for at least one month but less than six months.
• A person with brief psychotic disorder shows symptoms for at least one day, but less than one month total, and returns to a baseline level of functioning.
• A diagnosis of schizophreniform disorder requires that a person show two or more symptoms, whereas a person with brief psychotic disorder must show just one symptom of psychosis to be diagnosed.
• Negative symptoms, such as social withdrawal and lack of motivation, are included in the diagnostic criteria for schizophreniform disorder, but they are not included for brief psychotic disorder.

Differential diagnosis

When a clinician is diagnosing mental health conditions like schizophreniform disorder or brief psychotic disorder, they will also engage in the process of differential diagnosis, or ruling out similar diagnoses that could also explain a patient’s symptoms.

Some differential diagnoses that may be considered with schizophreniform disorder and brief psychotic disorder include:

• Schizophrenia: The primary difference between schizophrenia vs. schizophreniform disorder or brief psychotic disorder is the duration of symptoms. Patients with schizophrenia show a mental health disturbance lasting at least six months, with a period of at least one month during which a person shows active psychotic behaviors. If a person shows only brief symptoms (lasting less than a month), brief psychotic disorder is expected. Similarly, an illness lasting at least one month but less than six months is indicative of schizophreniform disorder ^[1].
• Depression with psychotic features: Patients who have depression with psychotic features experience the low mood, lack of pleasure, feelings of worthlessness, concentration difficulties, and low energy levels that come with a depressive episode, along with delusions. These delusions typically center on the person’s belief that something bad will happen ^[2].
• Schizoaffective disorder: Schizoaffective disorder also belongs to the psychotic disorders classification. Patients with this diagnosis show the psychotic symptoms of schizophrenia, combined with mood disorder symptoms, which can manifest as either depression or mania. To be diagnosed, a person must at some point experience psychotic symptoms in the absence of mood symptoms for at least a two-week period, but mood disorder symptoms must be present for most of the duration of the mental illness ^[3].

Schizophreniform vs Brief Psychotic Disorder: Causes

Both schizophreniform disorder and brief psychotic disorder can be caused by genetic risk factors ^{[4] [5]}. It is often difficult to determine one specific cause for a mental health disorder, and this is the case with both schizophreniform and brief psychotic disorder. Generally, there are multiple risk factors that can lead to the development of a psychotic disorder.

In the case of schizophreniform disorder, the following risk factors have been identified ^[5]:

• Imbalance of neurotransmitters, particularly dopamine
• Nutritional deficiencies during pregnancy that lead to problems in the developing child, and increased risk of psychiatricdisorders later in life
• Negative experiences in the family of origin (e.: exposure to poverty or domestic violence)
• Unemployment
• Substance misuse
• General stress

Some risk factors that have been identified for brief psychotic disorder include ^[4]:

• Exposure to a stressor or a traumatic event
• Giving birth (in which case the disorder is specific as brief psychotic disorder with postpartum onset)

While a traumatic or stressful event can lead to the development of brief psychotic disorder symptoms, sometimes people develop this condition in the absence of a traumatic event ^[4].

Schizophreniform vs Brief Psychotic Disorder: Treatment

Treatment for both schizophreniform disorder and brief psychotic disorder typically involves a combination of medication and psychosocial services. However, there may be some differences in the way the two conditions are treated ^{[4] [5]}.

Treatment options for schizophreniform disorder typically include ^[5]:

• Medication: Antipsychotic drugs like risperidone, aripiprazole, and quetiapine are commonly used to treat schizophreniform disorder. Some patients may benefit from taking mood stabilizers like Lithium, or antidepressant drugs.
• Psychosocial services: Counseling for both the patient and the family is also helpful. During counseling sessions, a mental health professional can provide education to the patient and family and help the patient to cope with distress.

Treatment options for brief psychotic disorder typically include ^[4]:

• Medication: Like schizophreniform disorder, brief psychotic disorder is often treated with antipsychotic medications. Second generation antipsychotics such as quetiapine, risperidone, aripiprazole, and olanzapine are typically preferred but first generation medications, such as haloperidol may also be used. Some patients may benefit from taking anti-anxiety medications called benzodiazepines if they present with agitation. However, benzodiazepines carrya risk of dependence and will only be prescribed as a short term solution and not as a first line option for tr
• Psychosocial services: Psychosocial services commonly include education provided to the patient and their family, as well as counseling to help the patient learn to cope with stress.

Can you have schizophreniform and brief psychotic disorder at the same time?

It would be impossible to be diagnosed with both schizophreniform disorder and brief psychotic disorder simultaneously, as these are mutually exclusive diagnoses. A person must show symptoms for at least one month but less than six months to be diagnosed with schizophreniform disorder, whereas symptoms are present for at least one day but less than one month with brief psychotic disorder ^[1].