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Psychoses 01

Topic: Anatomy

Created on Friday, December 29 2006 by

Last modified on Friday, December 29 2006.

A 26 year-old male zookeeper is brought by ambulance to the emergency room.
He is uncooperative, disheveled, and insists that Interpol is putting thoughts into his head.
He complains of hearing voices telling him to feed the kangaroos.
He is accompanied by his second cousin twice removed, who states that he was lucid and rational until 8 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) Schizophrenia

B) Psychotic disorder due to a general medical condition

C) Mood disorder with psychotic features

D) Substance-induced psychotic 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) 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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B) psychotic disorder due to a general medical condition

This answer is incorrect.

The diagnosis of psychotic disorder due to a general medical condition is made when findings of delusions, hallucinations, disorganized speech, or grossly disorganized behavior are attributable to the direct physiological effects of a general medical condition. His psychosis has no obvious organic cause. (See References)


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C) 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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D) 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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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