Schizophreniform Disorder: Exception Proves the Rule

As part of an ongoing prospective follow-up study of patients with first-episode psychotic disorders, we have been conducting longitudinal reevaluations of diagnoses. Among 115 such patients, 15 met an initial (4-week assessment) diagnosis of schizophreniform disorder—provisional. Upon reevaluation at 6 months, 14 patients were rediagnosed with schizophrenia on the basis of their fulfilling the duration criteria of 6 or more months of illness (including prodromal, active, and residual phases).

The one exception was Ms. A, a 37-year-old single Caucasian woman who was a college graduate and worked as a nutritional therapist. She was admitted for a 2-week history of auditory hallucinations, referential and persecutory delusions, anxiety, sleeplessness, and agitation. Following treatment with risperidone (up to 4 mg per day), she gradually improved. She continued to experience mild ideas of reference for 2 to 3 months; then her symptoms completely subsided. She returned to full-time work and functioned well without any symptoms while on a low dose (2 mg) of risperidone. Two years later, she enrolled in a study of gradual medication withdrawal under close supervision. Auditory hallucinations returned within a week after her last dose of risperidone. Upon reinstitution of her medication, her symptoms gradually improved over the following month.