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Psychoses 01

Topic: Anatomy

Created on Friday, December 29 2006 by

Last modified on Friday, December 29 2006.

A 23 year-old male sunflower observer is brought by ambulance to the emergency room.
He is uncooperative, disheveled, and insists that the LAPD is putting thoughts into his head.
He complains of seeing people in the room that nobody else sees.
He is accompanied by his gardener, who states that he was lucid and rational until 5 weeks ago. He has been exhibiting these behaviors fairly consistently since that time.
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) Schizoaffective disorder

B) Psychotic disorder NOS

C) Schizophrenia

D) Mood disorder with psychotic features

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) 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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B) 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 schizophreniform disorder. (See References)


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C) 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's symptoms have lasted less than a total of 6 months. (See References)


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D) 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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E) schizophreniform disorder

This answer is correct.

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 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 less than 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