Schizophrenia Spectrum Disorders

The word "schizophrenia" can have different meanings. Schizophrenia itself is a mental health condition. Specific symptoms must be present for a doctor to make this diagnosis.¹

Schizophrenia is also used to describe a group of similar mental health conditions. Among others, these include:^1-4

• Brief psychotic disorder
• Schizophreniform disorder
• Delusional disorder
• Schizotypal personality disorder
• Schizoaffective disorder
• Catatonia (which can occur on its own or as a symptom of an underlying disorder)

Diagnosing schizophrenia

To be diagnosed with schizophrenia itself, a person must have at least 2 of the following:^1-5

• Hallucinations – Hearing, seeing, or sensing things that are not actually there
• Delusions – Firm belief in things that are not actually happening, like being followed or that the person is someone else or has some mission to pursue (status delusion)
• Speech that is disorganized or difficult to understand
• Negative symptoms – A lack of emotion, expression, motivation, socialization, or pleasure
• Disorganization – Disorganized thoughts, nonlinear thinking
• Catatonic behavior – A variety of physical symptoms that may include lack of movement, holding specific body positions, or not responding to others

Overall, symptoms must be present and interfere with daily life for at least 6 months. And at least 1 of the symptoms must be having hallucinations, delusions, or disorganized speech. Doctors need to rule out other medical issues, like mood disorders or drug side effects, too.^1,5

Other schizophrenia spectrum disorders have similar symptoms. But a person with one of these disorders will not meet the exact criteria for a schizophrenia diagnosis. Often, the difference lies in the length of time symptoms occur.¹

Brief psychotic disorder

Brief psychotic disorder has the same symptoms as schizophrenia. The main difference is that symptoms last less than 1 month. After this, the person returns to their previous mental state. In some cases, brief psychotic disorder occurs in response to a stressful or traumatic event. In other cases, it may be the result of another medical condition.^1,4

Schizophreniform disorder

Schizophreniform disorder falls in between brief psychotic disorder and schizophrenia in terms of length. It has all of the same criteria for diagnosis. However, symptoms are present anywhere from 1 month to 6 months. If symptoms last longer than 6 months, the diagnosis will likely be updated to schizophrenia.^1,2,4

It is possible to move from brief psychotic disorder to schizophreniform disorder and then to schizophrenia. About 2 out of every 3 people with schizophreniform disorder eventually will be diagnosed with schizophrenia.⁴

Brief psychotic disorder and schizophreniform disorder are treated similarly to schizophrenia. Doctors generally prescribe antipsychotic drugs and therapy to manage symptoms.⁶

Delusional disorder

Delusional disorder shares one major symptom with schizophrenia – delusions. Delusions are fixed, untrue beliefs that a person believes are real. A delusion must be present for at least 1 month.¹

There are several common types of delusions. Some delusions may be a mix of these types. Types of delusions include:^1,7

• Grandiose – Delusions of having extreme power, knowledge, or discovery that others do not recognize
• Erotomanic – Delusions of others being in love with the person or that they are in a relationship with someone they are not
• Ideas of reference – Belief that the TV and/or media are talking to or targeting the person.
• Persecutory (sometimes called paranoid) – Delusions that involve feeling threatened, spied on, followed, or in danger
• Jealous – Delusions centering on a partner or loved one’s loyalty
• Somatic – Delusions involving bodily sensations or functions

Delusions are different from hallucinations. They can be realistic, like a spouse cheating. They can also be classified as bizarre, like being abducted or followed by aliens.¹

In terms of a person’s behavior, only the things they do in response to their delusion may change. They might otherwise have no changes to their daily life or behavior.⁷

Delusions do not always respond to antipsychotic drugs. So, one of the main types of treatment for delusional disorder is therapy.⁷

Schizotypal personality disorder

Personality disorders are long-term patterns of behavior that are different from what is expected. They impact the way a person thinks, feels, and interacts with others. Personality disorders can make daily life challenging.¹

In schizotypal personality disorder, a person has a hard time making close friendships. People with this disorder often have unusual, imaginative beliefs. They may speak using vague phrases or metaphors in a way that is hard for others to follow. They also may have eccentric tastes.^1,8,9

Each person’s experience with schizotypal personality disorder is different. However, hallucinations or delusions are not usually present. In fact, people with this disorder often can be convinced of what is real versus not real. Therapy as a treatment may be helpful for people with this disorder. Medication is not typically used in the event hallucinations or negative symptoms are not present. But others may need different treatments.⁹

Schizoaffective disorder

In schizoaffective disorder, schizophrenia symptoms and mood symptoms overlap. "Schizo" refers to schizophrenia, and "affective" refers to mood disorders.^1,10

The 2 main mood disorders involved are major depressive disorder (depression) and bipolar disorder. Depression involves periods of low energy, low mood, and a lack of interest in activities. Bipolar disorder involves alternating episodes of depression and of mania. Mania often involves having high energy, getting little sleep, feeling invincible, and having racing speech or thoughts.^1,2,4,10

To be diagnosed with schizoaffective disorder, a person must have delusions or hallucinations alone for at least 2 weeks. These must occur without any other mood symptoms. Outside of these periods, mood symptoms may come and go.^1,10

Schizoaffective disorder is treated similarly to schizophrenia. However, people with schizoaffective disorder may need other drugs like antidepressants or mood stabilizers, too.^1,10

There is an opposite health issue where mood-related symptoms are the main issue and schizophrenia symptoms come and go. These conditions are named after the mood disorder followed by “with psychotic features.” An example is bipolar disorder with psychotic features.¹

Catatonia

Catatonia is a complex disorder with many different symptoms. Most of these symptoms impact the way the body moves.^1,11

Catatonia can be its own condition or a symptom of schizophrenia. It can also occur along with other health issues. These issues include seizure disorders, autism, stroke, dementia, and Parkinson’s disease. Catatonia can also come as a side effect of certain drugs (prescription and recreational).^1,11

Common catatonia symptoms include:^1,11

• Little to no body movement
• Little to no talking (mutism)
• Little to no response to instructions or the environment
• Mimicking the speech of others
• Mimicking the movements of others
• Repetitive, abnormal, frequent movements
• Uncomfortable facial expressions or grimaces
• Holding an uncomfortable posture or position against gravity (doctors use the term “waxy flexibility”)
• Agitation

Treating catatonia involves treating the underlying issue causing it. Drugs called benzodiazepines are the first-line treatment. Electroconvulsive therapy (ECT) is sometimes used, too. This treatment involves electrically stimulating certain parts of the brain.¹¹

Other schizophrenia spectrum disorders

Other combinations of symptoms do not quite meet the full criteria for schizophrenia. In these cases, a doctor may diagnose a person with an “unspecified schizophrenia spectrum disorder” or “other schizophrenia spectrum disorder.” Treatment depends on what symptoms are present.¹