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Zorluk: Çok zorSubstance-Related and Addictive Disorders

A 22-year-old man is brought to the psychiatrist by his parents due to ongoing behavioral changes. Six weeks ago, the patient was hospitalized in the psychiatric unit for 4 days after presenting with severe agitation, auditory hallucinations, and paranoid delusions about being monitored by the government. At that time, his urine toxicology screen was markedly positive for amphetamines. He was discharged after brief treatment with haloperidol. His parents report that since discharge, he has lived at home and has been completely abstinent from all illicit drugs, a claim corroborated by weekly negative urine toxicology screens over the past 5 weeks. Despite his abstinence, the patient continues to experience daily auditory hallucinations of voices conversing about him and firmly believes his neighbors are tracking his movements. He has no prior psychiatric history, and there is no family history of psychiatric illness. His mood is described as 'fine,' and he exhibits no depressive or manic symptoms. Vital signs and physical examination are unremarkable. Which of the following is the most likely diagnosis?

  1. Schizophreniform disorderCevap
  2. B
    Substance/medication-induced psychotic disorder
  3. C
    Schizophrenia
  4. D
    Brief psychotic disorder
  5. E
    Schizoaffective disorder

Cevap

Schizophreniform disorder
The correct diagnosis is schizophreniform disorder. While this patient's initial psychotic episode was undoubtedly triggered by amphetamine intoxication, his psychotic symptoms have persisted for 5 weeks despite documented, complete abstinence. According to DSM-5 criteria, if psychotic symptoms persist for more than 1 month after the cessation of acute substance intoxication or withdrawal, the condition must be reclassified as an independent, primary psychotic disorder rather than a substance-induced disorder. Because the patient's total duration of continuous illness is 6 weeks, the correct diagnosis is schizophreniform disorder. The timeline for schizophreniform disorder is defined as symptomatic manifestation lasting at least 1 month but less than 6 months.

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1
Determine the temporal relationship between the patient's substance use and his psychotic symptoms.
The psychotic symptoms began in the context of acute amphetamine use but have persisted for 5 weeks despite verified abstinence.
According to DSM-5 criteria, a substance-induced psychotic disorder usually resolves within 1 month of substance cessation. Persistence beyond 1 month indicates an independent, primary psychotic disorder.
2
Calculate the total duration of the continuous psychotic episode.
The patient has experienced continuous psychotic symptoms (hallucinations and delusions) for a total of 6 weeks.
The total duration of symptoms is required to accurately differentiate among the primary psychotic disorders.
3
Classify the primary psychotic disorder based on the 6-week timeframe.
The 6-week duration falls in the 1-to-6 month window, making schizophreniform disorder the correct diagnosis.
Brief psychotic disorder is diagnosed for episodes lasting less than 1 month, whereas schizophrenia requires a duration of 6 months or longer.

Anahtar Kavram

Psychotic symptoms that persist for greater than 1 month after the cessation of substance use or withdrawal should be considered an independent primary psychotic disorder, requiring chronological classification (e.g., schizophreniform disorder for a 1-to-6 month duration).
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Konular

Substance-Related and Addictive Disorders

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