Descriptive Psychopathology: The Signs and Symptoms of ...

386 Section 4: Evidence-based classificationAcute manics are typically psychotic, come to medical attention within days ora few weeks of episode onset, and with appropriate treatment remit quickly. 109Long-term follow-up studies consistently find that patients identified as havingschizophreniform disorder are clinically heterogeneous, that the diagnosis is notstable over time, and that many such patients have recurrences identified as mooddisorder or schizoaffective illness, but not schizophrenia. 110 Most such patientsbenefit from treatments for mood disorder. The category should be discarded.Schizoaffective disorderThe introduction of the schizoaffective construct was an effort to understand theunexpected variable outcomes of patients diagnosed as schizophrenic. 111 Suchpatients were defined by a long-term course in between the poor outcomes ofschizophrenia and the better outcomes of patients with manic-depression. Itsaddition to present classification was to provide a class for uncertain diagnosis,not because it was an established condition. Not surprisingly, reliability for thediagnosis is poor. 112 Efforts to refine it have been unsuccessful.For example, the psychotic episodes of patients with the schizoaffective labeland those with schizophrenia and manic-depression reveal overlapping featuresthat do not discriminate the conditions. 113 Long-term follow-up studies findschizoaffective patients to be more like those with manic-depressive illness thanlike those with schizophrenia. This is particularly so for patients with prominentcross-sectional features of depression or mania. The presence of psychotic featuresdoes not predict the course. 114 Patients with the diagnosis also respond bestto treatments typically prescribed for those with mood disorder. 115Family studies find the first-degree relatives of schizoaffective patients to haveincreased risks for schizophrenic, manic-depressive, and schizoaffective episodes,suggesting heterogeneity within patient samples. 116 Genetic linkage studies, relyingon poorly defined samples, find some overlap between schizophrenia and manicdepressiveillness on several chromosomes, roiling meaningful understanding ofdistinctions among psychotic patients. 117Overall, the data support the position that the schizoaffective category shouldbe eliminated or added to the mood disorders as a severity modifier. 118 A recentliterature review similarly concluded that schizoaffective disorder “is not a separate,‘bona-fide’ disease. Patients diagnosed with [it] likely suffer from a psychoticmood disorder. The diagnosis of schizoaffective disorder, which can result insubstandard treatment, should be eliminated”. 119Cycloid psychosis was introduced by Karl Leonhard as an alternative to the schizophreniformidea. He distinguished it from schizophrenia and manic-depressiveillness. 120 Its usage has waxed and waned since its introduction, and interest in it islimited to Europe.