I don’t know about all of you out there, but until I interned on an acute inpatient psychiatric unit, I really had no idea what a person experiencing psychosis really looked like (clinically speaking). This category of disorders, distinguished by the primary symptoms of delusions, prominent hallucinations, disorganized speech, or disorganized or catatonic behavior, is bound to come up on the exam in a variety of ways. Here’s just one:
A social worker in a community mental health clinic begins an intake on a 22 year-old male. During the course of the intake, the social worker learns that about 2 months ago, the client had a 2 week period in which he experienced paranoid delusions about his neighbors and auditory hallucinations. While he reports that he has had no symptoms since then, the client’s affect is blunted, he speaks in a monotonous voice and when prompted, reports that he still has not gone back to work and has gained 15 pounds. What is the most likely diagnosis in this case?
A. Brief Psychotic Disorder
B. Schizophreniform Disorder
D. Delusional Disorder
Schizophrenia, Schizophreniform Disorder, and Brief Psychotic Disorder all have similar symptom profiles, but differ in their duration of symptoms and in some of the fine details. In Brief Psychotic Disorder, the episode lasts for more than 1 day, but less than 1 month, and lacks the characteristic “negative” symptoms seen in the other two disorders; in addition, the person returns to premorbid functioning . In Schizophreniform Disorder, the episode (including prodromal, active phase, and residual phase) lasts for at least 1 month but less than 6 months. If the episode persists beyond the 6 month mark, a diagnosis of Schizophrenia is warranted. It is important in these disorders to rule out a substance abuse or general medical condition that could be causing the psychotic symptoms.
The answer to the question above is B; while the client’s positive symptoms only lasted two weeks, it appears that he is still suffering from negative symptoms, which means his total episode is in the 1-6 month time frame of Schizophreniform Disorder.
Coming up next week: Mood Disorders
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