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Psychoses 01

Topic: Anatomy

Created on Friday, December 29 2006 by

Last modified on Friday, December 29 2006.

A 29 year-old male lawyer is brought by ambulance to the emergency room.
He is uncooperative, disheveled, and insists that the Angel Moronai wants him to convert the Illuminati to Hinduism.
He complains of hearing voices telling him that he is worthless and weak. 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 6 months ago. He has been exhibiting these behaviors off and on since that time. The second cousin twice removed states that the patient is not always depressed when he is hearing voices telling him that he is worthless and weak.
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) Psychotic disorder NOS

B) Substance-induced psychotic disorder

C) Psychotic disorder due to a general medical condition

D) Schizophrenia

E) Schizoaffective 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) 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 schizoaffective disorder. (See References)


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B) 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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C) 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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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) 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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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