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  #1  
Old 03-25-2011
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Psyche He believes he can control the weather!

1) A young man believes that he has the gift of being able to control the weather because he has been endowed with 'superhuman powers' . This belief is persistent an has been present for two months. his grandmother has passed away earlier that year. This young man is most likely suffering from the following disorder -

a) panic disorder
b) Seasonal affective disorder
c) adjustment disorder
d) schizophrenia
e) familial depression
f) psychosomatic disorder
g) bereavement
h) dysthymia
i) clinical depression
j) Bipolar depression
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Old 03-25-2011
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is the answer b?
please when u put the answer , add the explanation
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Old 03-25-2011
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Grandiousity is one of delusional disorder. The most likely answer for this question is D. Schizophrenia, although it is more appropriate to diagnose this patient having Schizophreniform because it's been persistent for only 2 months.
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Old 03-25-2011
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I would also choose D of the available answers - however, as harlesmd noted schizophrenia proper can only be diagnosed after 6 months. I would say somewhere in between delusional disorder and schizophreniform, too - superhuman weather control is a little too wacky to count as a non-bizarre belief (criterion of delusional disorder), but if the one fixed delusion is his only symptom, it seems a little bit of stretch to put him in the 'schizophrenic' box so quickly...
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Old 03-25-2011
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Stop use caution with behavioral sources!

N.B: If this is a question from a British source, then D is very appropriate, since the ICD-10 does not differentiate between schizophrenia and schizophreniform. I would caution FMG's against studying for USMLE behavioral from PLAB sources - the philosophies and criteria are rather different, and correct answers for PLAB will be incorrect for USMLE and vice-versa...
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Quote:
Originally Posted by earthpole View Post
is the answer b?
please when u put the answer , add the explanation
That happens in winter because you don't get enough sunshine!

As for the answer, how can we diagnose a 34 year old with schizo after death of close family? Is bevearment the best answer (occurs up to 6 months) but I admit, weather controlling properties aren't associated with bevearmnt lol
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Quote:
Originally Posted by Mondoshawan View Post
N.B: If this is a question from a British source, then D is very appropriate, since the ICD-10 does not differentiate between schizophrenia and schizophreniform. I would caution FMG's against studying for USMLE behavioral from PLAB sources - the philosophies and criteria are rather different, and correct answers for PLAB will be incorrect for USMLE and vice-versa...
Yes you are right, this is from a PLAB source. I saw the question and wanted to know the answer coz the answer wasn't posted! I was thinking between Bereavement or Schizophrenia but may be the question itself needs to include more specific choices such as Schizophreniform.
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Old 03-25-2011
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Default g. Bereavement

Right on patelMD, I agree with you.
Bereavement makes the most sense since the only two clues in the question stem are 1) delusion and 2) grandmother died earlier that year. They also say his symptoms have been going on for 2 months. This is consistent with pathological grief, which is defined as prolonged grief lasting >2 months and in which patient may experience depressive symptoms, delusions and hallucinations.

Other answer choices:
d) schizophrenia
True that delusions are a feature of schizophrenia also. However, remember that by definition schizophrenia requires 2 or more (in this case the guy only has 1, i.e. delusion) of the following symptoms
1. delusions
2. disorganized speech
3. disorganized behavior
4. hallucinations
5. negative symptoms
So even with the discrepancy with the timing, i.e. 6 months vs less in PLAB, this scenario doesn't meet the diagnostic criteria for schizophrenia.

ps I had to look this one up in First Aid
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Quote:
Originally Posted by heights View Post
Right on patelMD, I agree with you.
Bereavement makes the most sense since the only two clues in the question stem are 1) delusion and 2) grandmother died earlier that year. They also say his symptoms have been going on for 2 months. This is consistent with pathological grief, which is defined as prolonged grief lasting >2 months and in which patient may experience depressive symptoms, delusions and hallucinations.

Other answer choices:
d) schizophrenia
True that delusions are a feature of schizophrenia also. However, remember that by definition schizophrenia requires 2 or more (in this case the guy only has 1, i.e. delusion) of the following symptoms
1. delusions
2. disorganized speech
3. disorganized behavior
4. hallucinations
5. negative symptoms
So even with the discrepancy with the timing, i.e. 6 months vs less in PLAB, this scenario doesn't meet the diagnostic criteria for schizophrenia.

ps I had to look this one up in First Aid

Thanks for clearing the doubt and looking it up! Confusing bit of a question.
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yup..it is a confusing question!!
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Old 03-26-2011
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I like these confusing questions, when they're too easy you just answer without thinking about it. When they're confusing like this it makes you think about the concepts to try to understand it and learn from it; before this I didn't know grief could present with delusions!
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Old 03-26-2011
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Default But...

Quote:
Originally Posted by heights View Post
... before this I didn't know grief could present with delusions!
Delusions exclude normal grieving. Normal grieving might include appropriate illusions (seeing the deceased or hearing their voice), but delusions indicate a pathological state. I think the patient in this question is experiencing a schizophreniform disorder - whether it is secondary to grief would depend on further history.

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Quote:
Originally Posted by Mondoshawan View Post
Delusions exclude normal grieving. Normal grieving might include appropriate illusions (seeing the deceased or hearing their voice), but delusions indicate a pathological state. I think the patient in this question is experiencing a schizophreniform disorder - whether it is secondary to grief would depend on further history.

Check the "Grief" section on pg 61 of FA 2011 and let me know what you think.
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Great discussion everyone.

I agree with heights and patelMD. Even before looking at the discussion, I was leaning toward bereavement. Like heitghts said, we are only given a few facts:

1. Patient is suffering from delusions
2. Has been having symptoms for 2 months
3. Patient has lost a close family member within the past year

For the purpose of the USMLE, it cannot be schizoprenia because it is less than 6 months. If the answer choice was schizophreniform, then it could be a possibility. But even then, since the symptoms are in such close proximity to the death of a loved one, bereavement is much more likely.

Great question, even better discussion!
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Quote:
Originally Posted by heights View Post
Bereavement makes the most sense since the only two clues in the question stem are 1) delusion and 2) grandmother died earlier that year. They also say his symptoms have been going on for 2 months. This is consistent with pathological grief, which is defined as prolonged grief lasting >2 months and in which patient may experience depressive symptoms, delusions and hallucinations.
Quote:
Originally Posted by heights View Post
Check the "Grief" section on pg 61 of FA 2011 and let me know what you think.
I guess I interpret "pathological grief" as a pathology arising within (or beyond) the time period for normal grieving -but still a pathology and not normal grieving, whether it's depression (sad is normal, suicidal is pathological) or illusion/delusion ("I hear my wife's ghost talking to me" is normal, "the aliens took her away so I will lock my kids in the basement so the aliens can't get them" is pathological). Also time, of course (7 weeks is normal, 7 months is pathological)...

:thumbsup: You were clear that you were talking about pathological grief as per FA, I just wanted to make sure that we weren't confused into giving any pathology a "get out of jail free" card if it arises within two months of a personal loss. I don't think it would be this confusing on the real exam, anyway - I think that what makes this question hard is us studying for the USMLE and trying to choose between answer choices written for the PLAB...

Great discussion!
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Thanks guys for the great discussion on this question and even though the USMLE questions are hopefully made much proper than this one, it was still a good discussion and question to see what can show up. So the final answer if something like this does show up would be - Bereavement. But if schizophreniform is in the options then choose that one? Just to summarize it lol
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