Schizophreniform Disorder

What Causes Schizophreniform Disorder?

The exact cause of schizophreniform disorder is unknown. Like schizophrenia, it’s likely caused by a combination of factors, including genetics, chemical interactions in the brain, and external environmental situations or events.

People with a family history of SD or schizophrenia are more likely to develop the disorder. The brains of people with schizophrenia have been shown through imaging studies to function differently from healthy brains. These findings suggest that the condition has a genetic component and involves physical dysfunction in the brain. However, the precise mechanism by which these factors come together to produce schizophrenia has not yet been discovered.

Is Schizophreniform Disorder Hereditary?

There is a consensus among scientists that genetics play a significant role in the development of schizophrenia, and the same genetic factors are likely at play in schizophreniform disorder. Several studies have estimated that between 50% and 80% of the risk of developing schizophrenia comes from inherited genetic traits. A broader study in 2017 put the heritability rate at the top end of that range, suggesting that about 80% of the risk comes from an individual’s genes.

A family history of schizophrenia is a significant risk factor. If an individual has a parent or sibling with schizophrenia, they are six times more likely to develop the disorder themselves.

Scientists have not yet determined which genes introduce a schizophrenia risk, and the risk probably comes from a complex interaction of multiple genes.

How Is Schizophreniform Disorder Detected?

Early detection, diagnosis, and treatment of schizophreniform disorder are crucial. Identifying the condition and pursuing an effective treatment plan can help prevent potentially life-threatening complications.

Warning signs of SD include:

• Depression, apathy, or lethargy
• Withdrawal from social situations or daily activities
• Decline in performance at school
• Irritability or agitation
• Sleep disruptions

The symptoms should be addressed immediately if they interfere with normal functioning. Seek professional help immediately if there is evidence of self-harm, suicidal thoughts, or suicide attempts.

How Is Schizophreniform Disorder Diagnosed?

The symptoms of schizophreniform disorder can be similar to those of other neurological conditions or illnesses, substance abuse, other mental illnesses, or various medical issues. Therefore, the initial diagnostic process involves ruling out these other potential causes of the symptoms.

Diagnostic steps will probably include:

• Physical exam. This exam will look for physical problems or illnesses that might explain the symptoms.
• Laboratory tests and imaging exams. These tests and exams may be ordered if the doctor suspects an underlying medical condition could account for the symptoms.
• Psychological assessment. If medical causes are ruled out, the doctor may call for a psychiatric evaluation to rule out other mental health conditions or to confirm a diagnosis of schizophreniform disorder. The mental health practitioner will use the diagnostic criteria for SD laid out in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine if a diagnosis is appropriate.

The diagnostic criteria for schizophreniform disorder include:

• Presence of two or more symptoms, including delusions, hallucinations, disorganized speech, disorganized or catatonic movement, or negative symptoms. Delusions, hallucinations, or disorganized speech must be present, and symptoms must be present most of the time for at least a month if untreated.
• Symptoms last at least a month but less than six months.
• Mood disorders and schizoaffective disorder have been ruled out.
• Symptoms are not caused by substance use or a medical condition.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Schizophreniform Disorder Treated?

Treatment of schizophreniform disorder is primarily based on medications used to control symptoms. In addition, psychotherapy may be used to build coping skills and improve functioning once symptoms are brought under control by medication. People deemed a risk to themselves or others may be hospitalized during the initial treatment.

Medications

Antipsychotic drugs are used to manage the symptoms of schizophreniform disorder. Typically, doctors will attempt to use the minimum dosage of medications required to keep symptoms under control.

Drugs commonly used to treat schizophreniform disorder include newer antipsychotic medications known as atypical antipsychotics or second-generation antipsychotics. These medications include:

• Risperidone
• Clozapine
• Quetiapine
• Ziprasidone
• Olanzapine
• Iloperidone
• Paliperidone
• Asenapine
• Lurasidone

Treatment with antipsychotics typically continues until symptoms are under control and for up to 12 months afterward with gradually decreasing doses. During this phase, it is essential to continue to follow the treatment plan prescribed by your doctor and be vigilant for signs of relapse.

Psychotherapy

After a successful treatment plan using medications has been established, various therapies may provide further support. For example, individual psychotherapy, group therapy, family therapy, vocational rehabilitation, and social therapies are often used.

How Does Schizophreniform Disorder Progress?

Untreated schizophreniform disorder may lead to severe consequences. The symptoms commonly drive the sufferer away from loved ones and social support systems, putting them at risk of situations that can profoundly impact their health.

As the symptoms prevent the sufferer from functioning in a safe, productive way, the likelihood that they will develop social, legal, and health problems becomes greater.

Left untreated, SD can lead to complications that include:

• Suicidal thoughts, suicide attempts, or successful suicide
• Alcohol and substance abuse
• Lack of success at school or work
• Depression and anxiety
• Financial problems
• Homelessness
• Exposure to dangerous situations and crime
• Legal problems

In rare cases, schizophreniform disorder can produce aggressive, violent behavior. Sufferers are also at risk of coming into conflict with law enforcement because their behavior is often treated as criminal rather than as a mental health issue.

How Is Schizophreniform Disorder Prevented?

Because the cause of schizophreniform disorder remains unknown, there’s no known way to prevent the disorder from occurring in the first place. However, once SD has been diagnosed and an effective treatment plan is in place, relapses of symptoms can often be successfully prevented.

It’s important to continue taking medications as directed by your healthcare providers, even after your symptoms have diminished. If the drug is causing side effects, it is much better to work with your provider to find a better solution than to stop taking the medication on your own.

Schizophreniform Disorder Caregiver Tips

When the symptoms of schizophreniform disorder are severe, sufferers may be incapable of safely taking care of themselves. The weight of responsibility on caregivers when their loved one is coping with the disorder is great.

To keep your loved one and yourself as safe and healthy as possible, keep these tips in mind:

• Be an active advocate for your loved one’s treatment. SD patients often don’t have an accurate perception of their disorder or how to treat it. It’s up to caregivers to ensure that treatment plans are working and that they’re being followed. Don’t depend on your loved one’s judgment in seeking treatment.
• Take suicidal thoughts and attempts seriously. The suicide risk for people with SD is real. Don’t let your loved one be unsupported in risky situations, and seek professional help when you see signs of suicidal thoughts.
• Be safe in dangerous situations. There may be times when your loved one’s erratic or irrational behavior requires you to call 911 to get them the medical attention they need. Be aware that many law enforcement agencies are not effectively trained or equipped to deal with mental health situations. Provide as much information as possible to first responders to help keep your loved one safe.

People with schizophreniform disorder often suffer from different brain-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with SD:

• People with SD often have co-morbid depression, and having both disorders increases suicide risk.
• About two-thirds of people with schizophreniform disorder are later diagnosed with schizophrenia.
• Schizophreniform disorder may also evolve into bipolar disorder or schizoaffective disorder.

Schizophreniform Disorder Brain Science

There has been some debate in the scientific community over classifying schizophreniform disorder. Because outcomes differ from case to case, it is impossible to describe the disorder’s progression in a way that holds true for everyone who has it. Opinions about the nature of SD have included:

• SD may be a manifestation of schizophrenia in its early stages. The fact that a majority of people diagnosed with SD are later diagnosed with schizophrenia would seem to support this idea. However, a significant number of SD cases do not evolve into schizophrenia.
• SD may be an unusual form of a mood disorder such as bipolar disorder (BPD). Many people diagnosed with SD go on to be diagnosed with mood disorders, including BPD or schizoaffective disorder. However, as with schizophrenia, not every SD case has this outcome.
• SD may not be a single disorder but rather a group of disorders likely to have different outcomes. One subgroup may be a benign form that resolves with treatment and does not evolve into another mental illness.

Schizophreniform Disorder Research

Title: Enhancing Cognitive Training Through Exercise Following a First Schizophrenia Episode (CT&E-RCT)

Stage: Recruiting 

Principal Investigator: Keith H Nuechterlein, PhD     

University of California, Los Angeles

Los Angeles, CA

This is a confirmatory randomized controlled trial of the efficacy of a novel intervention combining neuroplasticity-based cognitive training with aerobic exercise, compared to the same systematic cognitive training alone. Treatment occurs for six months after randomization, with a follow-up assessment at 12 months. The investigators hypothesize that combining neuroplasticity-based computerized cognitive training and neurotrophin-enhancing physical exercise will produce neurotrophin increases and cognitive and functional improvements, even relative to cognitive training alone. The investigators target the period shortly after a first episode of schizophrenia to maximize the generalization of cognitive improvement to the functional outcome before chronic disability is established.

The Cognitive Training and Exercise intervention consists of 24 weeks of systematic computerized cognitive training, 4 hours per week, plus aerobic exercise, 150 minutes per week. The Cognitive Training Intervention includes the same systematic cognitive training. The first 12 weeks involve neurocognitive training, using training exercises from Posit Science Brain HQ. The second 12 weeks involve social cognitive training, using the Posit Science SocialVille modules. Aerobic exercise occurs as two 45-minute sessions at the clinic and two 30-minute sessions at home weekly. The aerobic exercise intensity is tailored to maintain an individualized target heart rate zone and is monitored by a heart rate recorder. A weekly one-hour Bridging Skills Group with other members of the treatment condition is designed to aid the generalization of training to everyday life situations. The immediate target is brain-derived neurotrophic factor. The primary treatment outcomes are overall cognitive deficit level and global functioning level.

Title: Neuromodulation of Social Cognitive Circuitry in People With Schizophrenia Spectrum Disorders (ModSoCCS)

Stage: Recruiting 

Principal Investigator: Dielle Miranda, MA     

Centre for Addiction and Mental Health

Toronto, Ontario

In this study, the investigators will be examining the effects of repetitive transcranial magnetic stimulation (rTMS) and intermittent theta burst stimulation (iTBS) on social cognitive impairments in individuals with schizophrenia spectrum disorders. Participants will be chosen by chance to receive either active rTMS stimulation, active iTBS stimulation, sham rTMS, or sham iTBS. The investigators predict that active 10Hz and iTBS stimulation will improve social cognitive impairments compared to sham stimulation. We aim to identify which type of active stimulation is most effective at inducing changes in social cognition brain circuitry and, secondarily, which type of active stimulation is best tolerated and most effective at inducing changes in social cognitive performance.

This study is a randomized, double-blind, sham-controlled study that aims to use repetitive transcranial magnetic stimulation (rTMS), a form of neuromodulation, to target the neural circuitry of social cognitive (SCog) impairments in people with Schizophrenia Spectrum Disorders. We will randomize 60 people with SSDs to three groups: 20 to a conventional form of rTMS (i.e. 10 Hz rTMS); 20 to intermittent theta burst stimulation (iTBS); and 20 to either sham 10Hz rTMS stimulation or sham iTBS. We will determine whether these treatments can change the functional connectivity of key SCog brain circuits by targeting a brain region known as the dorsomedial prefrontal cortex (DMPFC). Since each person’s anatomical and functional brain profile is slightly different, we will optimize the orientation and location of coil placement in each individual. Overall, our proposal follows a target engagement framework, including specifics regarding testing brain stimulation parameters (i.e., rTMS vs. iTBS) and individualizing coil placement for optimal targeting. We anticipate that active 10 Hz rTMS or iTBS will demonstrate target engagement compared to sham and potentially ameliorate SCog deficits in people with SSDs. Our primary goal is to identify which treatment best induces a change in SCog brain circuitry and, secondarily, which treatment is best tolerated and induces changes in social cognitive performance.

Title: The Effects of Kynurenine Aminotransferase Inhibition in People With Schizophrenia (TrypNAC-II)

Stage: Recruiting 

Principal Investigator: Dielle Miranda, MA     

Centre for Addiction and Mental Health

Toronto, Ontario

Kynurenic acid (KYNA) is a naturally occurring chemical in the brain. Studies with rodents indicate that levels of KYNA can impact levels of the neurotransmitters glutamate and dopamine. One way to reliably increase KYNA levels is by ingesting the amino acid tryptophan. Tryptophan is a normal part of the human diet. Tryptophan gets metabolized/changed to other chemicals in the body- including KYNA. By giving people 6 grams of tryptophan, the investigators will be able to increase the KYNA level in a controlled way. The investigators will then be able to study the effects of KYNA on neurotransmitters by using cognitive tests and magnetic resonance imaging techniques (measuring brain activity and brain chemistry using the MRI magnet).

The study’s overall goal is to examine how the medication N-acetylcysteine (NAC), when added to tryptophan, affects various cognitive functions, such as verbal and visual memory. The investigators will also use magnetic resonance imaging (MRI) to examine how NAC affects brain activity and chemicals.

The purpose of the study is to examine whether high dose N-acetylcysteine (NAC) blocks the adverse effects of increased kynurenic acid (KYNA) on selected measures of brain chemistry, function, and behavior, through the inhibition of kynurenine aminotransferase (KAT) II, which converts kynurenine to KYNA. The study will be a double-blind, placebo-controlled, randomized cross-over challenge study, in which people with schizophrenia are pretreated with either high-dose NAC, 140 mg/kg up to a maximum of 15 g, or placebo, then receive tryptophan (TRYP), 6 gms.