There are 484 questions on various topics in Neurology in the FrontalCortex neurology question bank.

Psychoses 01

Topic: Anatomy

Created on Friday, December 29 2006 by

Last modified on Friday, December 29 2006.

A 28 year-old male barracuda supplier is brought by ambulance to the emergency room.
He is uncooperative, disheveled, and insists that Scotland Yard is trying to kill him.
He complains of seeing people in the room that nobody else sees. He states that he hates his life and wants to kill himself.
He is accompanied by his second cousin twice removed, who states that he was lucid and rational until 7 months ago. He has been exhibiting these behaviors off and on since that time. The second cousin twice removed states that whenever the patient gets depressed, he starts seeing people in the room that nobody else sees. When he is feeling less depressed, the hallucinations and delusions improve.
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) Delusional disorder

B) Schizophreniform disorder

C) Mood disorder with psychotic features

D) Schizophrenia

E) Substance-induced psychotic 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) 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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B) 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, but he also has symptoms of a mood disturbance. (See References)


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C) mood disorder with psychotic features

This answer is correct.

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 is displaying psychotic symptoms of delusions and hallucinations, but also has symptoms of a major depressive disorer. His psychosis has no obvious organic cause. He has been psychotic for more than 1 month. The psychosis always coincides with the depression. (See References)


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D) 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, but he also has symptoms of a mood disturbance. (See References)


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E) 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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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