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  #1  
Old 06-21-2011
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Arrow Major depression vs Schizoaffective disorder

A 77 yo man comes to the physcian because a 3 month history of fatigue and decreased apetite resulting in a4.5 Kg weight loss. He also has depressed mood and decreased concentration. He is no longer interested in participating in his weekly golf outing and rarely attemps to visit with friends. He is no longer motivated to clean the house and keep up with his bills. He says he can hear his wife who has been dead for 4 years telling him that his lost of appetite is due to cancer and he should end his life before he suffers a painful death like she did. Physical examination shows no abnormalities. Mental status examination shows depressed mood. He is able to recall 3/5 objects after 5 min. There is no evidence of suicide ideation. Which of the following is the most likely diagnosis:
a. Adjustment disorder with depressed mood
b. Dysthymic disorder
c. Major depressive disorder with psychotic features
d. Pathological bereavement
e. Schizoaffective disorder

The answer is supossed to be E but I think is C unless he doesn't have all the criteria for major depression.

How to differentiate this 2 entities and which one is the correct answer?
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  #2  
Old 09-24-2012
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Sorry for interfering late

But what is the answer ?

How to differentiate between psychotic depression and schizoaffective disorder ?? I know there should be psychotic features IN absence of mood disturbances for at least 2 weeks, the question did not mention that ! So is the diagnosis psychotic depression ??
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Old 09-24-2012
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Quote:
Originally Posted by Verocita View Post
A 77 yo man comes to the physcian because a 3 month history of fatigue and decreased apetite resulting in a4.5 Kg weight loss. He also has depressed mood and decreased concentration. He is no longer interested in participating in his weekly golf outing and rarely attemps to visit with friends. He is no longer motivated to clean the house and keep up with his bills. He says he can hear his wife who has been dead for 4 years telling him that his lost of appetite is due to cancer and he should end his life before he suffers a painful death like she did. Physical examination shows no abnormalities. Mental status examination shows depressed mood. He is able to recall 3/5 objects after 5 min. There is no evidence of suicide ideation. Which of the following is the most likely diagnosis:
a. Adjustment disorder with depressed mood
b. Dysthymic disorder
c. Major depressive disorder with psychotic features
d. Pathological bereavement
e. Schizoaffective disorder
Difficult question.

Schizoaffective disorder because his psychosis (delusion telling him to end his life) is there for 4 years (? not sure) and depressive symptoms are only for 3 months.

Major depressive disorder with psychotic features because his delusion only appeared after he developed depressive symptoms.
What makes C more likely is that for Schizoaffective disorder to be diagnosed the patient must have psychosis for at least 2 weeks without a mood disorder.
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Last edited by Novobiocin; 09-24-2012 at 11:13 AM.
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Old 03-09-2013
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Quote:
Originally Posted by Novobiocin View Post
Difficult question.

Schizoaffective disorder because his psychosis (delusion telling him to end his life) is there for 4 years (? not sure) and depressive symptoms are only for 3 months.

Major depressive disorder with psychotic features because his delusion only appeared after he developed depressive symptoms.
What makes C more likely is that for Schizoaffective disorder to be diagnosed the patient must have psychosis for at least 2 weeks without a mood disorder.
What does it mean when you say "the patient must have psychosis for at least 2 weeks without a mood disorder?"

I know that a criteria for schizoaffective disoder has something to do w/ "previous psychotic episodes in the absence of significant mood symptoms in the past."

I don't understand the "mood symptoms" part. How would they change the question or what would they have to add in to tell you that the patient has "mood symptoms"...therefore, cannot be diagnosed as schizoaffective disorder.

Thank you.
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Old 03-11-2013
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Quote:
Originally Posted by luschka View Post
What does it mean when you say "the patient must have psychosis for at least 2 weeks without a mood disorder?"

I know that a criteria for schizoaffective disoder has something to do w/ "previous psychotic episodes in the absence of significant mood symptoms in the past."

I don't understand the "mood symptoms" part. How would they change the question or what would they have to add in to tell you that the patient has "mood symptoms"...therefore, cannot be diagnosed as schizoaffective disorder.

Thank you.
Hey Luschka,
To break it down for you, in major depresion with psychosis, patient will have met the criteria for depression ie 5 or more symptoms of SIGECAPS, and then in addition to that has hallucinations or delusions.

However is schizoaffective disorder, patient will have background psychosis in which mood symptoms will be superimoposed upon. Note that in this case, this might be just 2 or 3 mood symptoms so the mood symptoms is not enough to diagnose major depression.


I think this concept is enough to correctly answer most questions, however if you want to take in a strep further, in schizoaffective disorder, patient should have at least a 2 week period of psychotic symptoms where there are no mood symptoms.
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Old 03-11-2013
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Thank your for your reply!

I understand this part from your explanations..."in schizoaffective disorder, patient should have at least a 2 week period of psychotic symptoms where there are no mood symptoms."

I'm not clear on the "mood symptoms." Can you please give me examples? If I have examples of mood symptoms, then I can decypher that the question stem does/does not mention "mood symptoms."
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Old 03-11-2013
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Default Mood symptoms

Mood symptoms could be either depressive or manic symptoms.

For depression, the mood symptoms I'm refering to is SIGECAPS

For mania, it could be - pressured speech, hypersexuality, increased spending, lack of sleep etc etc etc
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