Examkin

Soru

Zorluk: ZorSchizophrenia and Psychotic Disorders

A 21-year-old man is brought to the psychiatrist by his parents for a follow-up appointment. Eight weeks ago, the patient was a passenger in a severe motor vehicle collision in which he sustained minor physical injuries. One week after the accident (seven weeks ago), he abruptly began hearing unfamiliar voices conversing about his actions and developed the belief that local traffic lights were sending him coded government messages. He exhibited grossly disorganized behavior, prompting hospitalization. He was started on oral risperidone, and his parents report that his hallucinations and delusions completely resolved three weeks ago. However, since his positive symptoms ceased, he has remained socially withdrawn, speaks only in rare monosyllables, and exhibits a strikingly flat affect. He has not returned to his college classes or his part-time job, and spends most of his day staring blankly out the window. His physical examination and vital signs are unremarkable. A urine toxicology screen is negative. Which of the following is the most accurate diagnosis for this patient at this time?

  1. Schizophreniform disorderCevap
  2. B
    Brief psychotic disorder
  3. C
    Schizophrenia
  4. D
    Acute stress disorder
  5. E
    Major depressive disorder with psychotic features

Cevap

Schizophreniform disorder
The correct diagnosis is schizophreniform disorder because the total duration of the patient's illness is greater than 1 month but less than 6 months. When diagnosing schizophrenia-spectrum disorders, the timeline must account for the prodromal phase, the active phase (florid psychosis), and the residual phase. This patient had 4 weeks of active positive symptoms followed by 3 weeks of residual negative symptoms (alogia, avolition, flat affect), bringing the total continuous illness duration to 7 weeks.

Adım Adım Çözüm

1
Identify the onset and nature of the initial symptoms.
The patient developed positive psychotic symptoms (auditory hallucinations, delusions, disorganized behavior) 7 weeks ago.
Establishing the exact onset is required for diagnostic timeline criteria.
2
Determine the current clinical status and presence of ongoing symptoms.
Positive symptoms resolved 3 weeks ago, but negative symptoms (flat affect, alogia, avolition) and functional impairment have persisted for the last 3 weeks.
Residual negative symptoms count toward the total continuous duration of a psychotic illness.
3
Calculate the total continuous duration of the psychiatric disturbance.
4 weeks of active positive symptoms + 3 weeks of ongoing residual negative symptoms = 7 weeks total duration.
Psychiatric diagnoses in the schizophrenia spectrum are strictly delineated by total illness duration.
4
Apply DSM-5 duration criteria to determine the correct diagnosis.
The illness has lasted > 1 month but < 6 months, fitting the criteria for schizophreniform disorder.
Brief psychotic disorder is < 1 month with full recovery, and schizophrenia requires >= 6 months.

Anahtar Kavram

The total duration of a psychotic illness includes prodromal, active, and residual phases (such as ongoing negative symptoms). An episode lasting between 1 and 6 months is diagnosed as schizophreniform disorder, even if positive symptoms have resolved.
Bu soruyu puanla

Konular

Schizophrenia and Psychotic Disorders

Bu konudan daha fazla soru