Schizophreniform Disorder

1. Two (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated):
   
   1. delusions
   2. hallucinations
   3. disorganized speech (e.g., frequent derailment or incoherence)
   4. grossly disorganized or catatonic behavior
   5. negative symptoms, i.e., affective flattening, alogia, or avolition

   Note: Only one Criterion A symptom is required if delusions are bizarre or hallucinations consist of a voice keeping up a running commentary on the person's behavior or thoughts, or two or more voices conversing with each other.

2. Schizoaffective Disorder and Mood Disorder With Psychotic Features have been ruled out because either
   (1) no Major Depressive, Manic, or Mixed Episodes have occurred concurrently with the active-phase symptoms; or
   (2) if mood episodes have occurred during active-phase symptoms, their total duration has been brief relative to the duration of the active and residual periods.
3. The disturbance is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.
4. An episode of the disorder (including prodromal, active, and residual phases) 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.")

Specify if:

• Without Good Prognostic Features
• With Good Prognostic Features: as evidenced by two (or more) of the following:
  
  1. onset of prominent psychotic symptoms within 4 weeks of the first noticeable change in usual behavior or functioning
  2. confusion or perplexity at the height of the psychotic episode
  3. good premorbid social and occupational functioning
     absence of blunted or flat affect

Antipsychotics: Doses and Side Effects for Chronic Use

¹ Dry mouth, constipation, blurred vision, urinary retention.
² Extrapyramidal side effects (dystonia, parkinsonism, akathisia, tardive dyskinesia).

³ Requires weekly White Blood Cell (WBC) count because of risk of agranulocytosis.
Adapted from Bernstein JG: Handbook of drug therapy in psychiatry, ed 3, St. Louis, 1995, Mosby.

Special Antipsychotic Adverse Reactions

1. Neuroleptic Malignant Syndrome. May occur at any point during the course of treatment. Includes symptoms of autonomic instability, altered mental status, which may progress to hyperthermia, stupor, and muscle hypertonicity. Death may occur. Cause: Neuroleptics (phenothiazines, etc.)
   Characteristics. Same symptoms as malignant hyperthermia (see below) but generally develops over days instead of minutes. Treatment: As per malignant hyperthermia.
   
   
   • Malignant Hyperthermia.
     Cause. 1:20,000 in response to a muscle-relaxing agent (such as succinylcholine) or an inhaled anesthetic (such as halothane). Is hereditary. May also be secondary to physical or emotional stress.
     Characteristics. Hyperthermia, muscle rigidity, tachycardia, acidosis, shock, coma, rhabdomyolysis.
     Treatment includes IV dantrolene 1 to 10 mg/kg IV titrated to effect, management of acidosis and shock, peripheral cooling (see management of heat stroke below).

   
   

2. Tardive Dyskinesia. Involuntary movements of the tongue, face, mouth, or jaw associated with long-term administration of antipsychotics. Elderly females at highest risk. May be irreversible.

• Learning Problem
• Hypoactivity
• Psychosis
• Euphoric Mood
• Depressed Mood
• Somatic or Sexual Dysfunction
• Hyperactivity
• Guilt or Obsession
• Sexually Deviant Behavior
• Odd/Eccentric or Suspicious Personality
• Anxious or Fearful or Dependent Personality
• Dramatic or Erratic or Antisocial Personality

Some disorders have similar or even the same symptom. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which he needs to rule out to establish a precise diagnosis.

• Schizophrenia;
• Brief Psychotic Disorder.