Schizophreniform vs. Schizoaffective Disorder

Schizophreniform and schizoaffective disorders share many of the same characteristics, but the main difference is that schizophreniform disorder is characterized by primary symptoms of schizophrenia, while schizoaffective disorder has to include both schizophrenic and mood disorder characteristics. In schizophreniform disorder, either no major affective episodes have occurred during the active phase of symptoms, or their total duration has been brief (Bhalla, 2006), compared to schizoaffective disorder where the affective symptoms must have occurred for a significant part of the disorder normally at a minimum of 15-20% (Sadock, 2003).

For an individual to be diagnosed with schizophreniform disorder, the symptoms of psychosis, those affecting speech and behavior, and the negative symptoms will last at a minimum of one month. To be diagnosed with schizoaffective disorder, a patient only has to have psychosis for 2 weeks without symptoms of a mood disorder (Sadock, 2003).

Both disorders have a prognosis somewhere between schizophrenia and mood disorders (Sadock, 2003). While schizophreniform disorder has an equal distribution among the sexes, schizoaffective disorder is more predominant in women. The age of onset, in early adulthood, is comparable in both disorders (2003). Schizoaffective disorder is thought to be around 2.5 to 4 times as prevalent as schizophreniform disorder, 0.2% to .05-.08%. Perhaps this is because the majority of schizophreniform cases evolve into schizophrenia before consultation?

Individuals with schizophreniform disorder can have the same symptoms as those with schizophrenia, but the symptoms must only last between one to six months. However, the onset in schizophreniform disorder is usually more rapid than that of schizophrenia. Unfortunately, sixty to eighty percent of patients with schizophreniform disorder progress to full blown schizophrenia (Sadock, 2003), while this does not seem to be the case in schizoaffective disorder.

While there is much disagreement about whether schizophreniform and schizoaffective disorders should have two different sets of criteria, the different methods of treatment support the idea that these disorders are separate occurrences. In schizophreniform disorder, the mainstay of treatment is an atypical psychotic for a period of three to six months (Sadock, 2003). In schizoaffective disorder, a combination of anti-depressant and anti-psychotic for the depressed subtype, or a combination of mood stabilizer and antipsychotic is utilized for the manic subtype (Brannon, 2005). This coincides with the criteria that schizophreniform is composed of primarily schizophrenic symptoms, while schizoaffective disorder is composed of both schizophrenic and mood disorder symptoms.

If someone presented with his or her first episode of symptoms that resolved within six months, the diagnosis would still be based on the symptoms themselves. Schizophrenia is automatically ruled out because of the short length of time, but either schizophreniform or schizoaffective diagnoses could be made. Though it would be easy to jump to the conclusion that the patient was experiencing schizophreniform disorder, someone with schizoaffective disorder could be in remission. In the patient has an equal, or significant, proportion of mood symptoms occurring along with the schizophrenic criteria, then a diagnosis of schizoaffective disorder would be warranted. Otherwise, the diagnosis would be schizophreniform disorder.

References:

Bhalla, Ravinder. (2006). Schizophreniform Disorder. Retrieved November 15, 2006 from http://www.emedicine.com/med/topic3350.htm

Brannon, Guy E. (2005). Schizoaffective Disorder. Retrieved November 15, 2006 from http://www.emedicine.com/med/topic3514.htm

Sadock, Benjamin & Sadock, Virginia. (2003). Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences, Clinical Psychiatry (9th ed.). Philadelphia: Lippincott Williams & Wilkins.