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Psychoses 01

Topic: Anatomy

Created on Friday, December 29 2006 by

Last modified on Friday, December 29 2006.

A 22 year-old male spy is brought by ambulance to the emergency room.
He is uncooperative, disheveled, and insists that Buddha wants him to convert Interpol to Muppetology.
He complains of hearing voices telling him to feed the clams. He states that he hates his life and wants to kill himself.
He is accompanied by his niece, who states that he was lucid and rational until 6 months ago. He has been exhibiting these behaviors off and on since that time. The niece states that the patient is not always depressed when he is hearing voices telling him to feed the clams.
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) Schizophreniform disorder

B) Mood disorder with psychotic features

C) Delusional disorder

D) Schizoaffective disorder

E) Schizophrenia

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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) 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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B) 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's psychosis is not always present at the same time as the mood symptoms. (See References)


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C) 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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D) schizoaffective disorder

This answer is correct.

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 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 does not always coincide with the depression. (See References)


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E) 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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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