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Schizophrenia and psychotic disorders
The psychotic disorders are told apart mainly by duration — less than a month, a month to 6 months, 6 months or more — and by the relation to mood episodes; treatment is an antipsychotic, and after two failures — clozapine.
Why it matters in the exam
Exam questions describe a person with delusions, hallucinations, disorganised speech or negative symptoms and ask for the diagnosis. The key is duration: brief psychotic disorder lasts less than a month, schizophreniform disorder a month to 6 months, and schizophrenia at least 6 months (including a month of active symptoms). Schizoaffective disorder requires a mood episode alongside psychosis, plus at least two weeks of psychosis without mood symptoms. Delusional disorder involves non-bizarre delusions with relatively preserved function.
Before any diagnosis, a medical cause or substance is excluded: delirium, steroids, amphetamines, cannabis, temporal lobe epilepsy and autoimmune encephalitis (anti-NMDA). In treatment, second-generation antipsychotics are first line, and the response is judged once 4–6 weeks have passed on an adequate dose. After two failed trials, switch to clozapine, which is also the only drug that reduces suicide in schizophrenia, but requires neutrophil monitoring. Long-acting injections help when adherence is poor. Good prognostic factors: acute and late onset, female sex, positive and mood symptoms, and good premorbid function.
Key points
- Duration separates: under a month, a month to 6 months, 6 months or more.
- Exclude substances, delirium and neurological disease.
- Second-generation antipsychotic; judge after 4–6 weeks.
- Resistance after 2 drugs → clozapine, with neutrophil monitoring.
- Good prognosis: acute and late onset, positive symptoms, good premorbid function.
Summary table
| Disorder | Duration | Deciding feature | Exam notes |
|---|---|---|---|
| Brief psychotic disorder | One day to less than a month | Full return to function | Sometimes after a stressor or childbirth |
| Schizophreniform disorder | A month to less than 6 months | Like schizophrenia but shorter | About a third recover |
| Schizophrenia | At least 6 months, including a month of active symptoms | At least 2 symptoms, one of them delusions, hallucinations or disorganised speech | Decline in function |
| Schizoaffective disorder | Psychosis with a mood episode | At least two weeks of psychosis without mood symptoms | Treat with an antipsychotic plus a stabiliser or antidepressant |
| Delusional disorder | At least a month | Non-bizarre delusions, preserved function | Usually no prominent hallucinations |
| Treatment-resistant schizophrenia | Failure of 2 antipsychotics at adequate dose and duration | Clozapine | Neutrophil monitoring; reduces suicide |
Free exam questions
ה איז מ בין הגורמים הבאים עשוי לשמש מגן מ?פני אובדנות בחולי סכיזופרניה (the question as examined, in Hebrew)
- א. חילוניות
- ב. גזע לבן
- ג. חשיבה מופשטת
- ד. סימנים שליליים ניכרים יש לבחור בתשובה אחת בלבד עבור כל שאלה
All of the following is considered appropriate treatment for Neuroleptic malignant syndrome (NMS), except for:
- A. Zuclopenthixol (Clopixol)
- B. Supportive Treatment
- C. Amantadine
- D. Dantrolene
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Sources
- DSM-5-TR, American Psychiatric Association, 2022 — Schizophrenia Spectrum and Other Psychotic Disorders
- APA Practice Guideline for the Treatment of Patients With Schizophrenia, 3rd edition (2020) — Pharmacotherapy; clozapine
- NICE guideline CG178, 2014 — Psychosis and schizophrenia in adults: prevention and management
- Kaplan and Sadock's Synopsis of Psychiatry, 12th edition (2021) — Schizophrenia Spectrum and Other Psychotic Disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.