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Schizophrenia spectrum disorders
Other Resources UpToDate PubMed

Schizophrenia spectrum disorders

Contributors: Sarah Korones, Abhijeet Waghray MD, Richard L. Barbano MD, PhD
Other Resources UpToDate PubMed

Synopsis

Schizophrenia spectrum disorder is a heterogeneous clinical syndrome marked by disruptions in perception, language, thinking, and social activity. The disorder is characterized by positive symptoms of hallucinations, delusions, disorganized thinking, and abnormal movements and negative symptoms such as loss of functioning in daily life, decreased emotional expression, diminished social engagement, and impaired concentration. Diagnosis is made when a patient demonstrates at least 2 of the above symptoms for at least 6 months and when these symptoms have begun to significantly impact daily functioning.

The disorder typically begins in late adolescence with an insidious onset, progressing from social withdrawal to an active phase consisting of perceptual perturbations, recurrent delusions, and hallucinations. Patients typically experience the first psychotic episode in the early- to mid-20s. Onset before adolescence is rare but can occur and is associated with a less favorable prognosis. Schizophrenia is typically a chronic disorder with significant impairments in functioning throughout the lifespan, although antipsychotics are up to 70% effective in reducing symptoms.

Risk factors for developing schizophrenia include winter birth, increasing paternal age, and family history of schizophrenia. Schizophrenia is seen in 6.6% of all first-degree relatives of the affected parent, and if both parents are affected, the risk of schizophrenia in the offspring is 40%.

Patients with this disorder may have an increased risk of various general medical conditions.

Codes

ICD10CM:
F20.9 – Schizophrenia, unspecified

SNOMEDCT:
58214004 – Schizophrenia

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Schizophrenia is often a diagnosis of exclusion and is made clinically based on a constellation of signs and symptoms that impairs social functioning. Before making the diagnosis, other psychiatric disorders and psychotic disorders due to medical conditions or substances must first be ruled out. Symptoms must also be present for a sufficient amount of time in order to exclude time-limited conditions such as brief psychotic disorder.
  • Schizoaffective disorder – associated with mood episodes (mania or depression) as well as at least 2 weeks of delusions and hallucinations without mood symptoms
  • Major depressive disorder with psychotic features – psychotic symptoms only occur during depressive episodes
  • Brief psychotic disorder – psychotic symptoms of more than 1 day but less than 1 month
  • Schizophreniform disorder – symptoms of schizophrenia lasting less than 6 months
  • Delusional disorder – at least 1 month of delusions with no other psychotic symptoms
  • Schizotypal personality disorder
  • Substance-induced psychotic disorder – look for physiologic signs of substance abuse such as changes in heart rate, blood pressure, and pupil size
  • Psychosis due to a general medical condition

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Therapy

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References

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Last Reviewed:10/09/2019
Last Updated:09/17/2020
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Schizophrenia spectrum disorders
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Schizophrenia spectrum disorders : Irritability, Delusions
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