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Zorluk: ZorSchizophrenia and Psychotic Disorders

A 19-year-old male college student is brought to the psychiatric clinic by his parents. Eight weeks ago, he was admitted to the emergency department with severe agitation, paranoia, and auditory hallucinations after using synthetic cathinones at a party. He was hospitalized, and his acute intoxication resolved over 3 days. However, his parents report that since his discharge 7 weeks ago, he has continued to hear voices and firmly believes that his professors have planted listening devices in his dormitory. For the past 7 weeks, he has been living at home under strict parental supervision with no access to drugs or alcohol, and weekly random urine toxicology screens have been consistently negative. Over the last two weeks, he has also developed a markedly blunted affect and speaks only in short, one-word answers. Which of the following is the most likely diagnosis?

  1. A
    Brief psychotic disorder
  2. B
    Delusional disorder
  3. C
    Schizophrenia
  4. Schizophreniform disorderCevap
  5. E
    Substance-induced psychotic disorder

Cevap

Schizophreniform disorder
The patient presents with delusions, auditory hallucinations, and negative symptoms (blunted affect, alogia), which fulfill Criterion A for a schizophrenia spectrum disorder. Although the psychotic episode was initially triggered by synthetic cathinone use, the symptoms have persisted for 7 weeks despite documented, continuous abstinence. According to the DSM-5, a substance-induced psychotic disorder should only be diagnosed if the symptoms resolve within approximately 1 month of the cessation of acute intoxication or withdrawal. Because the symptoms have persisted beyond this 1-month threshold in a clear sensorium, the etiology is reclassified as a primary psychotic disorder. The total duration of the illness is 8 weeks (more than 1 month but less than 6 months), which strictly meets the diagnostic criteria for schizophreniform disorder.

Adım Adım Çözüm

1
Analyze the patient's presenting symptoms.
The patient exhibits delusions, auditory hallucinations, and negative symptoms (blunted affect, alogia), meeting Criterion A for a schizophrenia spectrum disorder.
Establishing the clinical syndrome is the first step in psychiatric diagnosis.
2
Evaluate the etiology by assessing the timeline relative to substance use.
The symptoms began after synthetic cathinone use but have persisted for 7 weeks despite documented continuous abstinence.
Substance-induced psychotic disorder requires symptoms to resolve within approximately 1 month after the cessation of acute intoxication or withdrawal. Persistence beyond this indicates a primary psychotic disorder.
3
Apply duration criteria to classify the primary psychotic disorder.
The total duration of the illness is 8 weeks. This falls within the 1-month to 6-month timeframe.
A duration of 1 to 6 months defines schizophreniform disorder, distinguishing it from brief psychotic disorder (<1 month) and schizophrenia (≥6 months).

Anahtar Kavram

Psychotic symptoms that persist for longer than 1 month after the cessation of substance intoxication or withdrawal represent a primary psychotic disorder, which is then classified based on total illness duration (e.g., schizophreniform disorder for 1-6 months).
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Konular

Schizophrenia and Psychotic Disorders

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