Psychoses 01

Topic: Anatomy

Created on Friday, December 29 2006 by

Last modified on Friday, December 29 2006.

A 31 year-old male lawyer is brought by ambulance to the emergency room.
He is uncooperative, disheveled, and insists that Elmo wants him to convert all the peccaries to Rastafarianism.
He complains of seeing people in the room that nobody else sees.
He is accompanied by his spouse, who states that he was lucid and rational until 6 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) Substance-induced psychotic disorder

B) Schizoaffective disorder

C) Psychotic disorder NOS

D) Schizophrenia

E) Delusional 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) 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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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) psychotic disorder NOS

This answer is incorrect.

Psychotic disorder NOS is only made when a patient is psychotic, but does not meet the criteria for another diagnosis. This patient's symptoms meet the criteria for schizophrenia. (See References)


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D) 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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E) 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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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