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Zorluk: OrtaSchizophrenia and Psychotic Disorders

A 22-year-old woman is brought to the emergency department by her roommate due to increasingly bizarre behavior. The roommate reports that for the past 3 weeks, the patient has been locking herself in her room, claiming that foreign intelligence agents are transmitting messages into her brain through the electrical outlets. She has also been observed whispering to unseen entities and has stopped attending her college classes. The patient was previously healthy and highly functional until she experienced a sudden, traumatic breakup with her fiancé one month ago. She has no prior psychiatric or medical history. Vital signs are within normal limits, and a comprehensive physical examination is unremarkable. Urine toxicology screening is negative for illicit substances. The patient is admitted to the psychiatric unit and started on oral risperidone. Four days later, her psychotic symptoms completely resolve, and she is discharged with a full return to her baseline level of functioning. Which of the following is the most likely diagnosis?

  1. Brief psychotic disorderCevap
  2. B
    Schizophreniform disorder
  3. C
    Schizophrenia
  4. D
    Schizoaffective disorder
  5. E
    Delusional disorder

Cevap

Brief psychotic disorder
The correct diagnosis is brief psychotic disorder because the patient experienced sudden onset of positive psychotic symptoms (delusions and hallucinations) that lasted between 1 day and 1 month (25 days total) before completely resolving, allowing her to return to her baseline functioning. This condition is frequently triggered by a severe psychological stressor, such as the sudden end of a major relationship.

Adım Adım Çözüm

1
Identify the primary clinical syndrome.
The patient is experiencing positive psychotic symptoms, including delusions of persecution and auditory hallucinations, leading to functional impairment.
This establishes that the patient is suffering from a primary psychotic disorder, requiring differentiation among the schizophrenia spectrum disorders.
2
Determine the exact duration of the psychotic symptoms.
The symptoms began 3 weeks prior to presentation and resolved 4 days after admission, totaling 25 days.
Duration is the primary differentiator for acute psychotic presentations: <1 month (Brief psychotic disorder), 1-6 months (Schizophreniform disorder), >6 months (Schizophrenia).
3
Evaluate for the presence of concurrent mood episodes or specific features.
There is a precipitating stressor (breakup) but no evidence of a major depressive or manic episode. The patient returns to baseline functioning after symptom resolution.
This rules out schizoaffective disorder and supports the diagnosis of brief psychotic disorder, which is often stress-induced and followed by a full recovery.

Anahtar Kavram

The temporal criteria for diagnosing primary psychotic disorders are: Brief psychotic disorder (<1 month), Schizophreniform disorder (1 to 6 months), and Schizophrenia (>6 months).
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Konular

Schizophrenia and Psychotic Disorders

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