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Psychoses 01

Topic: Anatomy

Created on Friday, December 29 2006 by

Last modified on Friday, December 29 2006.

A 33 year-old male fisherman is brought by ambulance to the emergency room.
He is cooperative and well-groomed. In the course of discussing his history, he calmly mentions that the Illuminati is trying to kill him.
He is accompanied by his sister, who states that he has held this belief for at least 9 months. The sister asks if there isn't anything you can do about this behavior, since it has the rest of the family worried.
The patient feels well otherwise, and continues to do well in his job as a fisherman.
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) Schizophrenia
 
        B) Schizoaffective disorder
 
        C) Schizophreniform disorder
 
        D) Delusional disorder
 
        E) Mood disorder with psychotic features
 

 


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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) schizophrenia

This answer is incorrect.


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 psychotic, in that he has delusions, but he remains funcitonal and has no other psychotic symptoms, such as hallucinations, disorganized speech, or grossly disorganized behavior. A greater degree of psychosis is required for a diagnosis of schizophrenia or schizophreniform disorder.  (See References)

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B) 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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C) 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 is psychotic, in that he has delusions, but he remains funcitonal and has no other psychotic symptoms, such as hallucinations, disorganized speech, or grossly disorganized behavior. A greater degree of psychosis is required for a diagnosis of schizophrenia or schizophreniform disorder.  (See References)

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D) delusional disorder

This answer is correct.


In delusional disorder, the patient is delusional for at least 1 month, but has no other marked impariment of function. This patient is displaying psychotic symptoms of delusions. There are no hallucinations or mood symptoms. His psychosis has no obvious organic cause. He has had delusions for more than 1 month.  (See References)

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E) mood disorder with psychotic features

This answer is incorrect.


Like schizoaffective disorder, the diagnosis of mood disorder with psychotic features requires both psychotic and mood symptoms. However, in mood disorder with psychotic features, the psychotic features are never present without the mood symptoms. When patient mood normalizes, the psychotic features resolve. This patient does not present with mood symptoms.  (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)Advertising:
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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
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