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CONTENTS

Instructions 2

Schizophrenia and other Psychotic Disorders 2

Diagnosis: Brief Psychotic Disorder 2

Diagnosis: Schizophrenia 3

Diagnosis: Schizophreniform Disorder 4

Diagnosis: Psychotic Disorder due to GMC (Seizure) 5

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Instructions
1. Identify the appropriate diagnosis using DSM-IV TR.
2. Defend your impression by listing down your evidence from the case.
3. Other than your primary impression give at least 1 other differential diagnosis
and explain how you were able to rule it out.
4. Then compare your answers with the correct ones provided after every case.

Schizophrenia and Other Psychotic disorders


Charming came back home to the Philippines after working abroad for 6 years. Upon
arriving home his relatives noted that he was acting strangely. He would stay mostly at
home and would have to be prodded to take a bath and go down to eat his meals. His
relatives also reported that he would talk to himself and have irrelevant remarks.
Charming’s sister Beauty, talked to him through the internet 3 days prior to his arrival
and noted no abnormal behavior. What is your diagnostic impression?

1. Diagnosis: Brief Psychotic disorder

2. Evidence: Duration of symptoms is NOT six months or longer, nor has it


been a month or more. Symptoms of psychosis: Anhedonia (Poor hygiene and
always at home), loose association (irrelevant remarks).

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3. Differential diagnosis: Substance induced Psychotic disorder or
Psychosis due to GMC, due to the acuteness of the symptoms should be ruled
out. A urine drug test and medical laboratory exams should be done, however,
due to the limitations of information (There was no attempt in the case to
enumerate anything that would point out to a medical/physiologic causes, thus
this would be highly unlikely).

Keipot’s husband left 10 months ago, since then she developed inappropriate behavior
described as “silly smiles” and decreased verbal output. For three months now, she
would claim that his husband’s decapitated head would telepathically talk to her from “a
land far… far away”. During the night she even claims that her husband’s hands would
make love to her during the night. A week prior to consult, she started placing her
husband underwear on a table and started praying over it. What is your diagnostic
impression?

1. Diagnosis: Schizophrenia

2. Evidence: History of positive (delusions) and negative symptoms (alogia).


Duration of symptoms is more than 6 months.

3. Differential diagnosis: Due to the nature of the stressor (loss of a


loved one) one may expect mood condition such as Major Depressive Disorder.
However Keipot’s delusions were very bizarre which would point out to more of a

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psychotic condition rather than a mood disorder. Again the case made no effort
to even just list down mood symptoms but enumerated a lot of psychotic
symptoms. Symptom duration rules out schizophreniform and brief psychotic
disorder.

Stephen D has been unemployed for 5 months after he was linked to a scandal in the
office. Since then he would have inappropriate remarks and behavior. He claimed that a
mother ship will come down from the heavens to punish his enemies from the office.
According to him his boss was taken over by an alien hybrid that seeks to conquer the
entire planet and only he could stop him. Because of these thoughts he tried to break
into the house of his boss in order to “capture the source of all evil”. When the police
caught him after this incident, he said that he hears the mother ship contacting him
through his mind. What is your diagnostic impression?

1. Diagnosis: Schizophreniform Disorder

2. Evidence: Duration of symptom is not yet 6 months (ruling out schizophrenia


for now though 60-80% of schizophreniform cases are diagnosed to have
schizophrenia later on). Symptoms of psychosis such as bizarre delusions, and
auditory hallucinations.

3. Differential diagnosis: Besides brief psychotic and Schizophrenia,


which are ruled out through duration of symptoms, it is also prudent to rule out a
Delusional disorder. However, since delusional disorder’s delusions are non-

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bizarre this is also eventually ruled out by the patients’ delusions (mother ship,
alien hybrid etc.), which are obviously bizarre.

Five months ago, Ibarra suffered from a head trauma. Since then he developed
inappropriate behavior. He would place his private belongings such as his cellular
phone inside the fridge. He also feels that other people are talking behind his back. He
felt bothered by this so he had to quit from his job. He would also have episodes of
seizures since the trauma, which occur at least twice a week. What is your diagnostic
impression?

1. Diagnosis: Psychotic Disorder due to GMC (seizure)

2. and 3. Evidence and differential diagnosis: The history of


trauma leads to the development of seizure. The disturbance in behavior is likely a
direct pathophysiological consequence of a medical condition (seizure). Before a
primary psychotic disorder (e.g. schizophreniform) is considered, you must first rule
out medical/physiological conditions that lead to the condition.

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