Examkin

Soru

Zorluk: OrtaSchizophrenia and Psychotic Disorders

A 25-year-old man is brought to the emergency department by his family due to severely erratic behavior. He is speaking rapidly, pacing the examination room, and claims he has not slept in a week because he is "solving the global energy crisis." He also reports hearing voices praising his supreme intellect. His family notes that he has a 4-year history of recurrent, severe depressive and manic episodes that have required multiple hospitalizations. Notably, 6 months ago, his mood was entirely stable and normal for a 4-week period, but he persistently heard voices and believed his neighbors were spying on him during that entire time. His vital signs and physical examination are unremarkable, and a urine toxicology screen is negative. Which of the following is the most likely diagnosis?

  1. A
    Bipolar I disorder with psychotic features
  2. B
    Schizophrenia
  3. Schizoaffective disorderCevap
  4. D
    Schizophreniform disorder
  5. E
    Delusional disorder

Cevap

Schizoaffective disorder
The correct answer is schizoaffective disorder. The diagnosis of schizoaffective disorder requires an uninterrupted period of illness during which there is a major mood episode (manic or depressive) concurrent with the active-phase symptoms of schizophrenia. Crucially, there must also be a history of delusions or hallucinations lasting for at least 2 weeks in the complete absence of a major mood episode. Finally, symptoms meeting criteria for a major mood episode must be present for the majority of the total duration of the active and residual portions of the illness. This patient presents with a manic episode and psychotic symptoms, has a 4-year history predominantly featuring mood episodes, and clearly experienced a 4-week period of psychosis while completely euthymic, perfectly fulfilling all criteria for schizoaffective disorder.

Adım Adım Çözüm

1
Identify the patient's current clinical presentation.
The patient is experiencing an acute manic episode (decreased need for sleep, rapid speech, grandiosity) with concurrent psychotic symptoms (auditory hallucinations).
Establishing the current syndrome is the first step in diagnosing psychiatric conditions.
2
Analyze the longitudinal psychiatric history.
The patient has a 4-year history dominated by major mood episodes, but also had a distinct 4-week period of active psychosis (hallucinations and paranoia) while his mood was completely normal (euthymic).
Psychiatric diagnoses depend heavily on the temporal relationship between different symptom clusters over the lifetime of the illness.
3
Differentiate between primary psychotic disorders and mood disorders with psychotic features.
The presence of psychotic symptoms for at least 2 weeks in the absence of a major mood episode distinguishes schizoaffective disorder from bipolar disorder with psychotic features.
This 2-week rule is the core diagnostic criterion separating schizoaffective disorder from mood disorders with psychotic features.

Anahtar Kavram

Schizoaffective disorder is differentiated from mood disorders with psychotic features by the presence of delusions or hallucinations for at least 2 weeks in the absence of a major mood episode during the lifetime duration of the illness.
Tahmini Süre:1m 30s
Bu soruyu puanla

Konular

Schizophrenia and Psychotic Disorders

Bu konudan daha fazla soru