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Zorluk: OrtaSchizophrenia and Psychotic Disorders

A 48-year-old woman is evaluated in the outpatient psychiatry clinic at the insistence of her husband. For the past 9 months, she has been absolutely convinced that her neighbors are piping toxic gases into her home through the ventilation system to force her to move out. She has sealed all the vents in her house with duct tape and frequently sleeps in her car to "escape the fumes." She denies hearing voices, and her thoughts are otherwise logical and goal-directed. She continues to work successfully as a freelance graphic designer and maintains her close friendships, provided she does not discuss her neighbors. Her husband reports her mood has been generally stable, though she is understandably frustrated by the "gas attacks." Physical examination, neurological evaluation, and laboratory studies are unremarkable. Which of the following is the most accurate diagnosis for this patient?

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

Cevap

Delusional disorder
The correct answer is Delusional disorder. This diagnosis requires the presence of one or more delusions for at least one month, without ever meeting the full criteria for schizophrenia (which requires at least two psychotic symptoms such as hallucinations, disorganized speech, or negative symptoms). Importantly, apart from the direct impact of the delusion itself, the patient's functioning is not markedly impaired, and her behavior is not obviously bizarre or odd. This patient has had a persistent persecutory delusion for 9 months but continues to work successfully and maintain friendships, which makes delusional disorder the most accurate diagnosis.

Adım Adım Çözüm

1
Analyze the core psychiatric symptom presented in the vignette.
The patient exhibits a fixed, false belief (that neighbors are poisoning her with gas) which represents a clear delusion.
Establishing the presence and type of psychosis is the first step in differentiating psychotic disorders.
2
Assess the timeline and the presence of any other psychotic or mood symptoms.
The delusion has been present for 9 months. There are no hallucinations, disorganized speech, disorganized behavior, or major mood episodes.
The duration of symptoms and the presence or absence of criteria A symptoms for schizophrenia strictly define the diagnostic categories.
3
Evaluate the patient's overall level of functioning.
Apart from the direct impact of the delusion (sleeping in her car, taping vents), her psychosocial and occupational functioning is remarkably preserved.
Schizophrenia requires a significant decline in functioning, whereas delusional disorder does not typically cause marked functional impairment outside the delusion.

Anahtar Kavram

Diagnosis of Delusional Disorder
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Konular

Schizophrenia and Psychotic Disorders

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