Former "A" Student Now Failing and Behaving Oddly

Anne McBride, MD; Glen Xiong, MD


July 25, 2023

The psychotic symptoms of schizophrenia typically emerge between late adolescence and the mid-30s, with peak onset often in the early to mid-20s in males and the late 20s in females. The manifestations of schizophrenia often occur following a major stressor. In this case, the stress of going off to college may have been a precipitant. Cognitive impairment is commonly associated with schizophrenia and contributes to the disability associated with the disorder even when other symptoms are in remission. Approximately 20% of individuals with schizophrenia have a favorable course, with a smaller percentage completely recovering.[1]

The DSM-5 classifies 11 different conditions under "schizophrenia spectrum and other psychotic disorders." "Schizotypal personality disorder" describes a pervasive pattern of social and interpersonal deficits beginning by early adulthood (although sometimes by childhood or adolescence). Individuals with schizotypal personality disorder may have reduced capacity for close relationships, cognitive or perceptual disturbances, and behavioral eccentricities.

The DSM-5 criteria for delusional disorder include one or more prominent delusions (persistent false belief against logic) for 1 month or more, but no other significant psychotic symptoms. Delusions can include bizarre content.

Brief psychotic disorder includes similar criteria to schizophrenia but lasts more than 1 day and less than 1 month. Schizophreniform disorder includes the same criteria as schizophrenia, with the exception that the duration of the disorder is less than 6 months and functional decline is not required for the diagnosis.[1]

The DSM-5 criteria for schizoaffective disorder include an uninterrupted period during which a major mood episode, such as major depressive or manic episode, is concurrent with the active symptoms of schizophrenia. In addition, an individual has delusions or hallucinations for 2 or more weeks in the absence of a major mood episode, and symptoms that meet criteria for a major mood episode are present for most of the illness.

Psychotic disorders may be due to other conditions, such as substance/medication-induced psychotic disorders. Cannabis-induced psychosis is most commonly seen among frequent marijuana users and those who often use high-potency strains.[2] In substance-induced psychotic disorder, symptoms generally cease in a reasonable time after exposure to the substance, medication, or toxin is stopped.[1] A negative drug screen result combined with family and friends confirming a lack of drug use points away from such diagnosis here.

Catatonia may occur in different disorders, including neurodevelopmental, psychotic, affective, or other mental disorders or be due to another medical condition.[1]

"Other specified schizophrenia spectrum and other psychotic disorders" involve presentations in which symptoms do not meet the full criteria for another schizophrenia spectrum and other psychotic disorder, but they cause significant distress or functional impairment and the clinician chooses to specify why the disorder meets insufficient criteria.[1]

Examples of presentations that can be specified using the "other specified" designation include persistent auditory hallucinations, delusions with significant overlapping mood episodes, attenuated psychosis syndrome, and delusional symptoms in the partner of individual with delusional disorder.[1]

"Unspecified schizophrenia spectrum and other psychotic disorder" is a category that applies to presentations in which symptoms do not meet the full criteria for another schizophrenia spectrum and other psychotic disorder but cause significant distress or functional impairment, the clinician chooses not to specify why the disorder meets insufficient criteria, or there is insufficient information is insufficient to make a more specific diagnosis.[1]


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