Priming Questions
A 23-year-old with hallucinations and social decline for 8 months. What’s the most likely diagnosis?
A man disappears after trauma, later found living under a new name with no memory of his past. What disorder does this suggest?
A student feels detached, like he’s outside his body, but knows it isn’t real. What condition fits best?
A woman has seizure-like episodes with eyes closed and a normal EEG. What’s the most likely diagnosis?
Schizophrenia Spectrum
Definition/Overview
- Disorders of distorted perception, thought, and behavior
- Core symptoms: delusions, hallucinations, disorganized speech/behavior, negative symptoms
- Exist along a time + mood spectrum
Clinical Presentation
- Positive symptoms: hallucinations (auditory > visual), delusions (persecutory, grandiose), disorganized speech/behavior
- Negative symptoms: flat affect, anhedonia, avolition, alogia, social withdrawal
- Cognitive: impaired attention, executive function
- Onset: late teens to mid-30s; earlier in men
Spectrum Breakdown (time + mood = key)
Brief psychotic disorder
- Duration: <1 month
- Sudden onset, often stress-related
- Full recovery is common
Schizophreniform
- Duration: 1–6 months
- Same symptoms as schizophrenia
- No functional decline required
- ~⅓ recover, ~⅔ progress to schizophrenia or schizoaffective
Schizophrenia
- Duration: ≥6 months (≥1 month active symptoms)
- Requires functional decline (social/occupational)
- Positive + negative symptoms
- Chronic, worse prognosis
Schizoaffective disorder
- Meets schizophrenia criteria + mood disorder (major depression or mania)
- ≥2 weeks psychosis without mood symptoms
- If psychosis only during mood episode → mood disorder with psychotic features (not schizoaffective)
Delusional disorder
- ≥1 month fixed delusion
- Functioning not markedly impaired
- No other psychotic features
Labs, Studies, and Physical Exam Findings
- Clinical diagnosis (DSM-5 criteria)
- Labs/imaging to rule out medical/substance causes: CBC, CMP, TSH, urine tox, neuroimaging if focal neuro deficits
Treatment
- First-line: atypical antipsychotics (risperidone, olanzapine, quetiapine, aripiprazole, ziprasidone)
- Acute agitation: haloperidol, lorazepam
- Clozapine: treatment-resistant schizophrenia (monitor CBC → agranulocytosis risk)
- Psychosocial: CBT, social skills, family therapy
- Hospitalization if danger to self/others
Schizophrenia Spectrum Timeline
Disorder
Duration
Key Features
Functional Decline
Mood Symptoms
Brief psychotic disorder
<1 month
Sudden onset, stress-related, recovery likely
No
None
Schizophreniform disorder
1–6 months
Same symptoms as schizophrenia
Not required
None
Schizophrenia
≥6 months (≥1 mo active)
Positive + negative symptoms
Required
None
Schizoaffective disorder
≥6 months
