Schizophreniform and brief psychotic disorder — duration, prognosis and FEP care (MEQ)

(i) Working diagnosis. Schizophreniform disorder (provisional) — multi-domain Criterion A picture for about 3 weeks, already past the 1-month lower bound only if timing of first frank symptoms is confirmed at ≥1 month; if frank psychosis has truly lasted only 3 weeks, the cross-sectional label may still sit in the late brief psychotic / early schizophreniform border and must be dated carefully with collateral. Exam-safe line: if duration is ≥1 month and less than 6 months, schizophreniform is preferred over schizophrenia; if ≥1 day and less than 1 month with later full recovery, brief psychotic disorder. Do not diagnose schizophrenia at 3 weeks. Cannabis is a contributing risk factor, not automatically a pure substance-induced explanation after 10 days of documented abstinence with ongoing psychosis — revisit if timeline tightens.^[1][6][7]

(ii) Good prognostic features present. (1) Onset of prominent psychosis within weeks of first change / acute crisis (within 4-week rule if first change aligns); (2) perplexity; (3) good premorbid function; (4) no blunted affect. Meaning: higher hope for recovery and possible specifier “with good prognostic features,” not a reason to withhold acute treatment.^[1]

(iii) Acute assessment and investigations. Risk (suicide, violence, absconding), capacity, legal status under local statute, collateral for exact onset dates, substance timeline, sleep, mood screen for affective psychosis. Baseline: FBC, U&E/eGFR, LFT, glucose/HbA1c, lipids, ECG QTc, BMI/BP, pregnancy test if relevant; toxicology already done — interpret limits. Imaging/special tests if atypical features appear; none of fever/fluctuating attention here, but remain vigilant.^[4]

(iv) Treatment plan. FEP-style package: engagement, early-intervention intensity, family psychoeducation, cannabis cessation support. Example oral start: aripiprazole 5–10 mg daily toward 10–15 mg, or risperidone 1–2 mg titrating carefully, with metabolic/EPS/akathisia monitoring — EUFEST supports pragmatic antipsychotic choice in first-episode schizophrenia and schizophreniform samples. CBTp access when engageable; sleep hygiene; safety net.^[3][4][7]

(v) Instability and maintenance. Labels shift over years (schizophrenia, mood psychosis, or durable remission). After response, counsel that FEP discontinuation literature shows substantial recurrence risk if antipsychotics stop without a plan; any taper is individualised after consolidation, with early-warning signs and rapid re-access. Do not promise permanent cure from a short course.^[2][5][6]