Is Schizophreniform Disorder Related to Drug Use Problems?
The characteristic feature of schizophreniform disorder is that it is a time-limited condition that can only last between one month and six months. When the psychotic symptoms last more than one day but less than one month, the individual would receive a diagnosis of brief psychotic disorder. Otherwise, the symptoms of schizophreniform disorder are identical to schizophrenia, a very severe mental health disorder.
The diagnosis of the disorder is only made when the symptoms the person experiences last between one and six months. Thus, some individuals may be diagnosed with other psychotic disorders (e.g., schizophrenia) initially, but if the symptoms fully resolve within the six-month period of time, they would be given a corrected schizophreniform disorder diagnosis. This also means that in some cases, individuals initially presenting with the symptoms of schizophrenia may be diagnosed with schizophreniform disorder as a temporary diagnosis.
According to the American Psychiatric Association (APA), the symptoms of schizophreniform disorder include the following:
- Positive psychotic symptoms, such as hallucinations (the experience of sensory stimulation that is not really there such as hearing things that are not there or seeing things that are not there), delusions (very rigid beliefs that are not true and often bizarre), severely disorganized behavior or catatonia (silly unproductive behaviors or being stuck in specific positions as if one is frozen), and disorganized speech (very loose associations or incomprehensible speech)
- Negative psychotic symptoms, which include diminished expression of emotions, severely deficient motivation (amotivation), issues experiencing pleasure (anhedonia), and mutism
- An episode of psychosis lasting at least one month but less than six months
- Lack of other forms of mental illness that can produce psychosis
- Lack of physical conditions that can produce psychosis
- A psychosis that is not due to the direct effects of medications or substance abuse
Individuals who are diagnosed with this disorder must display either delusions, hallucinations, or disorganized speech as part of the psychotic symptoms that they display in order for the diagnosis to be made. Moreover, they must display at least two of the categories of positive and negative symptoms, and the symptoms must occur for a significant period of time (at least a one-month period unless the disorder is being treated with medication).
Schizophreniform disorder is considered to be extremely rare and significantly less prevalent than even schizophrenia. About one-third of people who are initially given a schizophreniform disorder diagnosis recover within the six-month period and have no further evidence of psychosis, whereas two-thirds of these individuals go on to be diagnosed with schizophrenia as their symptoms persist beyond six months. Thus, individuals who are given the provisional or temporary diagnosis of this disorder are at a high risk to be diagnosed with schizophrenia after the six-month time limit has expired.
Schizophreniform Disorder and Substance Abuse
Because the diagnostic criteria for schizophreniform disorder specifically state that the disorder cannot be due to the effects of drugs or alcohol, the symptoms of schizophreniform disorder cannot be directly associated with intoxication due to drug or alcohol use. Thus, someone under the influence of drugs or alcohol or with a chronic substance abuse problem who exhibits psychotic behaviors would have to be observed by licensed mental health clinicians to determine whether the psychotic behaviors are the result of the individual’s intoxication or whether they are present when the individual’s system is free from drugs and alcohol; this would also mean that individuals with physical dependence on drugs must be free of withdrawal symptoms.
Individuals expressing psychotic behaviors that are caused by the use of drugs or alcohol would be diagnosed with a substance/medication-induced psychotic disorder. Because there is often little difference in the expression of psychosis in individuals who have substance-induced psychotic disorders and schizophrenia, the use of laboratory tests to determine the presence of drugs or alcohol in the person’s system, as well as getting information from family members or close friends regarding the individual with the disorder, is the only way to differentiate between these two disorders. This means that clinicians must observe the individual who is intoxicated after the effects of drugs and alcohol have worn off in order to make a differential diagnosis. However, the issue of whether the use of drugs or alcohol can result in later psychotic behaviors or a diagnosis of a psychotic disorder is something that has been researched extensively.
One of the strongest relationships between substance use and the later development of a psychotic disorder like schizophrenia has been found in individuals who use cannabis products. There is a significant body of research that suggests that individuals who regularly use cannabis products as children or adolescents are at an increased risk to develop a psychotic disorder like schizophrenia later in life. The research does not suggest that cannabis usage causes the development of any type of psychotic disorder, and researchers and clinicians do not believe that this type of cause-and-effect relationship is valid. Nonetheless, there is an increased risk to develop a psychotic disorder like schizophrenia or schizophreniform disorder in individuals who chronically use cannabis products, particularly in early or late adolescence.
The reasons for this relationship are not well understood, but it has been suggested that individuals who are prone to developing psychotic disorders may receive some form of neurological stimulation from cannabis that is different than from other substances. However, it is important to understand that there is no evidence that the use of cannabis products causes later psychosis.
Because individuals who have a true schizophreniform disorder return to their previous level of functioning within the six-month time period, it is not correct to assume that schizophreniform disorder leads to significant issues with substance abuse if there were no substance abuse issues prior to the onset of the psychotic break. The differentiation between schizophreniform disorder and schizophrenia is that the disorder must fully resolve within six months of appearing. There is quite a bit of evidence to indicate that individuals who begin to experience psychotic symptoms may be at an increased risk to use drugs or alcohol, but there is no evidence that the use of drugs or alcohol causes schizophreniform disorder or more serious psychotic disorders such as schizophrenia.
Individuals who are diagnosed with schizophrenia are at an increased risk for substance abuse issues, particularly tobacco abuse, as there may be a self-medicating effect of nicotine in these individuals. In addition to cannabis and tobacco abuse, abuse of alcohol is also relatively common in individuals with psychotic disorders.
The Bottom Line
Even though there are higher rates of substance abuse with other mental health disorders that can also be associated with psychosis, such as bipolar disorder, clinical depression, and personality disorders, these disorders would not be diagnosed in the presence of schizophreniform disorder because the diagnostic specifications indicate that the symptoms of schizophreniform disorder cannot be better explained by some other form of mental illness. Thus, while it is well established that individuals who are undergoing a psychotic episode may be at an increased to risk use drugs or alcohol, there is little reliable evidence that use of drugs or alcohol can cause schizophreniform disorder or that having schizophreniform disorder can cause an individual to later develop a chronic substance abuse issue.