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Schizophrenia or Schizophreniform or Schizoaffective Disorder

5K views 6 replies 4 participants last post by  Mondoshawan 
#1 · (Edited)
A 25-year-old woman was found walking nude in the shopping mall. When asked
why, she replied, "I know they all want me." She seemed quite undisturbed by her
behavior and mentioned that she had not slept for the last 9 days. Her speech
was pressured and she had some evidence of psychomotor agitation. She later informed
you that she had another episode a few months ago during which she heard voices
and believed that others were going to kill her. She presented with those symptoms
for approximately 7 months and was fired from her job due to the voices.

please give the reason for the most likely diagnosis you think? i am confused...:scared:
 
#4 ·
Schizoaffective

It sounds like schizoaffective disorder, bipolar type: mix of psychotic and mood symptoms, with a manic episode.

DSM IV-TR criteria:
  • Two (or more) of the following symptoms are present for the majority of a one-month period (or a shorter period of time if symptoms got better with treatment):
    • delusions
    • hallucinations
    • disorganized speech (e.g., frequent derailment or incoherence) which is a manifestation of formal thought disorder
    • grossly disorganized behavior (e.g. dressing inappropriately, crying frequently) or catatonic behavior
    • negative symptoms-e.g., affective flattening (lack or decline in emotional response), alogia (lack or decline in speech), avolition (lack or decline in motivation), anhedonia (lack or decline in ability to experience pleasure), social withdrawal (sometimes called social anhedonia).
    If the delusions are judged to be bizarre, or hallucinations consist of hearing one voice participating in a running commentary of the individual's actions or of hearing two or more voices conversing with each other, only that symptom is required to meet criterion A above. The speech disorganization criterion is only met if it is severe enough to substantially impair communication.
  • And at some time during the illness there is either one, two or all three of the following:
    • major depressive episode
    • manic episode
    • mixed episode
  • During the illness, delusions or hallucinations were present for a minimum of two weeks, without major mood symptoms.
  • For a substantial part of the overall duration of both the active and residual period of the illness, symptoms meeting criteria for a mood episode are present.
  • Symptoms are not caused by drug abuse, medication or another medical condition.

C and D are too complex to be included in a Step 2 stem, I think, and shouldn't be used to rule out psychoaffective disorder on the test. I'm not sure if psychoaffective will make it to the DSM-V or not; it may be split (along Kraepelin's lines of psychosis v. mood), since it seems like the two aspects are often treated separately.

Take-home criteria:
  • Criteria for schizophrenia met = schizophrenia
  • Plus manic, depressive, or mixed episode = schizoaffective
 
#5 ·
i think its schizoaffective disorder with mania....... she hasnt slept for days... pressured speech and the fact that her affact is blunted coz she doesnt care shes naked... also the onset of this episode is a few days...
i think the previous hx of having auditory halucinations is a distractor.... she may have had that in the past but right now she is here with diff symptoms and signs...
 
#7 ·
A 25-year-old woman was found walking nude in the shopping mall. When asked why, she replied, "I know they all want me." She seemed quite undisturbed by herbehavior and mentioned that she had not slept for the last 9 days. Her speech was pressured and she had some evidence of psychomotor agitation.
(This sounds like a manic episode - Mondoshawan)
She later informed you that she had another episode a few months ago during which she heard voices and believed that others were going to kill her.
(and this sounds like psychosis - M)
She presented with those symptoms for approximately 7 months and was fired from her job due to the voices.

tyagee said:
this q is from kaplan notes psychiatry and guess what? ans is schizophreniform!!! i cant believe...[ in chapter schizophrenia under heading schizophreniform]
any 1 please reply....
That's strange! I think of the timing as:
  • <1 month: brief psychotic disorder
  • 1-6 months: schizophreniform
  • >6 months: schizophrenia
So even if they didn't think they were describing a manic episode, the qualifier that she had had the symptoms for seven months should have put her in the schizophrenia category. Maybe there was a typo? Kaplan is usually pretty well edited :notsure:
 
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