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Zorluk: OrtaSchizophrenia and Psychotic Disorders

A 20-year-old man is brought to the emergency department by the police after he was found wandering on a busy highway, shouting at passing vehicles. In the emergency department, he is highly agitated, pacing the room, and stating that the cars are emitting radio waves to control his mind. His speech is disorganized, and he frequently pauses as if responding to unseen stimuli. The patient's parents are contacted and arrive at the hospital. They report that these severe, bizarre behaviors began only 2 weeks ago. However, they note that for the past 9 months, he has undergone a significant change. Previously a sociable and high-achieving college student, he gradually stopped seeing his friends, dropped out of his classes, and spent most of his days sitting in his darkened bedroom showing very little emotion. His medical history is unremarkable, and a urine toxicology screen is negative. Which of the following is the most likely diagnosis?

  1. SchizophreniaCevap
  2. B
    Schizophreniform disorder
  3. C
    Brief psychotic disorder
  4. D
    Major depressive disorder with psychotic features
  5. E
    Schizotypal personality disorder

Cevap

Schizophrenia
The diagnosis of schizophrenia requires the presence of at least two active-phase symptoms (e.g., delusions, hallucinations, disorganized speech) for a significant portion of a 1-month period, along with continuous signs of the disturbance persisting for at least 6 months. Crucially, this 6-month period must include prodromal, active, and residual phases. In this scenario, the patient has a 9-month history of prodromal negative symptoms (social withdrawal, lack of emotion, functional decline) followed by a 2-week active phase of frank psychosis (delusions, hallucinations, disorganized speech). Because the total duration of his illness exceeds 6 months, schizophrenia is the correct diagnosis.

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1
Identify the active phase symptoms.
The patient exhibits delusions, auditory hallucinations, and disorganized speech that have been present for 2 weeks.
Establishing the presence of active psychosis is the first step in differentiating psychotic disorders.
2
Identify any preceding symptoms indicating a prodromal phase.
The patient had a 9-month period of social withdrawal, avolition, and flat affect prior to the onset of acute psychosis.
Prodromal symptoms (often negative symptoms) must be accounted for when calculating the total duration of the illness.
3
Calculate the total duration of the illness.
9 months of prodromal symptoms + 2 weeks of active symptoms = total duration of > 9 months.
Total duration (prodromal + active + residual) is the key differentiator among brief psychotic disorder, schizophreniform disorder, and schizophrenia.
4
Apply DSM-5 diagnostic criteria based on the timeline.
Because the total duration is greater than 6 months, the correct diagnosis is schizophrenia.
Schizophrenia requires continuous signs of the disturbance for at least 6 months.

Anahtar Kavram

The DSM-5 diagnostic criteria for schizophrenia require continuous signs of the disturbance for at least 6 months, which includes prodromal, active, and residual phases.
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Schizophrenia and Psychotic Disorders

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