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Psychoses 01

Topic: Anatomy

Created on Friday, December 29 2006 by

Last modified on Friday, December 29 2006.

A 25 year-old male jalapeno pepper biologist is brought by ambulance to the emergency room.
He is uncooperative, disheveled, and insists that the Illuminati is trying to kill him.
He complains of seeing visions of coy red asses.
He is accompanied by his live-in masseuse, who states that he was lucid and rational until 9 months ago. He has been exhibiting these behaviors off and on since that time, often for weeks on end. During the periods that he has not been actively hallucinating or delusional, he has still been acting "odd."
There is no significant past medical or psychiatric history.
Apart from his mental status, physical exam is unremarkable.
Urine and serum toxicology screens are negative. Other lab work and imaging, including head CT and MRI, are normal.

Of the following, which is the most appropriate diagnosis?

A) Schizoaffective disorder

B) Substance-induced psychotic disorder

C) Schizophrenia

D) Delusional disorder

E) Schizophreniform disorder

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This question was created on December 29, 2006 by .
This question was last modified on December 29, 2006.

ANSWERS AND EXPLANATIONS

A) schizoaffective disorder

This answer is incorrect.

Schizoaffective disorder is a manifestation of both psychotic symptoms and mood disorder. The diagnosis requires a period of at least 2 weeks during which the patient suffers from hallucinations or delusions in the absence of prominent mood symptoms. This patient does not present with mood symptoms. (See References)


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B) substance-induced psychotic disorder

This answer is incorrect.

The diagnosis of substance-induced psychotic disorder is made when findings of delusions, hallucinations, disorganized speech, or grossly disorganized behavior are attributable to the direct physiological effects of a medication, drug of abuse, toxin, or other substance. His psychosis has no obvious organic cause. (See References)


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C) schizophrenia

This answer is correct.

The diagnosis of schizophrenia requires at least 6 months of continuous signs of psychological disturbance. This 6-month period must include at least 1 month of "active-phase" symptoms: delusions, halucinations, disorganized speech, grossly disorganized or catatonic behavior, or negative symptoms (affective flattening, alogia, or avolition). This patient is displaying psychotic symptoms of delusions and hallucinations. His psychosis has no obvious organic cause. He has been psychotic for more than 1 month. The total duration of symptoms has been more than 6 months. (See References)


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D) delusional disorder

This answer is incorrect.

In delusional disorder, the patient is delusional for at least 1 month, but has no other marked impariment of function. This patient's psychotic features are not limited to delusions. He is also hallucinating, and by history is functionally impaired. (See References)


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E) schizophreniform disorder

This answer is incorrect.

The diagnosis of schizophreniform disorder is made when psychotic symptoms last more than 1 month, but less than 6 months. After 6 months, a diagnosis of schizophrenia can be made. Prior to 1 month, a diagnosis of brief psychotic disorder should be considered. This patient's symptoms have lasted more than a total of 6 months. (See References)


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References:

1. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders Fourth Edition, Text Revision. American Pyschiatric Association, Washington, DC. (ISBN:0890420254)

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anatomy
Psychoses 01
Question ID: 12290600
Question written by . (C) FrontalCortex.com 2006-2009, all rights reserved. Created: 12/29/2006
Modified: 12/29/2006
Estimated Permutations: 0