Descriptive Psychopathology: The Signs and Symptoms of ...

385 Chapter 16: An evidence-based classificationTable 16.2. Proposed revision of criterion A for schizophrenia (all must be present)1. Emotional blunting (loss of emotional expression and avolition)2. Any one of the following:Hallucinations of voicesDelusions of passivityFormal thought disorder3. Pre-psychosis features (any two):Long-standing emotional aloofnessPoor peer socializationNeuromotor developmental delays or other abnormalitiesPoor sustained attention without hyperactivityCognitive inflexibilityOdd word usageSchizophrenia, however, while a traditional term, has no scientific meaning.Bleuler coined it to indicate a splitting of mental functions, a non-specific notionwithout validity. Heterogeneity is likely among patients with the diagnosis evenwhen defined by the criteria above. Its usage only implies a nonaffective disorderwith psychosis. This alternative terminology should be considered. 103Schizophreniform psychosisKarl Langfeldt introduced the concept of schizophreniform psychosis in 1939,referring to patients who initially appeared to have a schizophrenic psychosis butwho did not devolve to a chronic defect state. Langfeldt hypothesized a psychogenicorigin for the condition. The original concept limited an episode to a fewmonths, but the “less than 6months, but more than a month” DSM criterion isarbitrary and can only be applied retrospectively. 104 Brief psychotic disorder is avariation of the schizophreniform notion.In reviewing Langfeldt’s original series, Fish concluded the sample was heterogeneous,with patients suffering from manic-depression, cycloid psychosis, andpersonality disorder. 105 In a five-year follow-up of 123 persons with a firstepisodepsychosis, for example, those with a schizophreniform diagnosis had morepositive symptoms, fewer negative symptoms, and more manic symptoms. 106Efforts to distinguish schizophreniform psychosis from schizophrenia focus onfirst ever episodes. Patients with first episodes lasting only a few weeks (briefpsychotic disorder) have a better long-term prognosis than those with first episodeslasting 6months or longer. 107 Thepresenceofmooddisorderfeaturesalsoindicatesa better prognosis. 108 Many such patients, however, cannot be meaningfully distinguishedfrom acutely ill manic patients on any clinical or laboratory variable.