COMPILATION OF PSYCHOTIC DISORDERS

The most likely diagnosis in this woman is schizoaffective disorder.

She describes a 6-month history of ideas of reference, delusions, and auditory hallucinations.

In addition, she has had clear manic symptoms for the past month, including an elevated mood, a decreased need for sleep, increased energy, increased goal-directed activities, and talkativeness.

Although she has symptoms consistent with schizophrenia, she has had a significant episode of mood disorder during her psychotic illness. Her psychotic symptoms, which preceded and occurred in the absence of mood symptoms, make primary mood disorder (mania) with psychotic features less likely.

Ref: CURRENT Diagnosis & Treatment: Psychiatry, 2e chapter 17

Ans:C-Delusional disorder

The lady is suffering from Erotomanic delusional disorder in which the content of delusion is that another person usually of higher status, is in love with the individual. Apart from delusional area, the personality, behaviour & functioning is not markedly impaired (almost normal) – characteristic of delusional disorder.

B i.e. Acute psychosis

–   Delusions or hallucinations (suchas hearing voices in this case) with grossly disorganized speech and behavior (such as muttering to self, gesticulation, aggressiveness in this case) of acute onset with normal cognition & consciousness indicate the diagnosis of acute psychosis (i.e. psychosis of acute onset). This acute psychosis may be d/t psychotic disorder d/t general medical condition (such as high fever as in this case) or d/t brief psychotic disorder (DSMIVTR), or d/t acute and transient psychotic disorder (ICD-10). So here the term acute psychosis is used to depict the clinical picture not the cause of that clinical picture.

Delirium can also present acute onset disorganized behavior (agitation) and speech (incoherent) with delusions or hallucinations but the delusions are poorly elaborated & transient, the course of disease is fluctuant (eg sun downing). And characteristically there is clouding of (disturbance in) consciousnesss (i.e. reduced clarity of awareness of the environment) and disorientation (change in cognition) in delirium. Just like psychosis clinical picture of delirium may also be d/t various reasons such as general medical condition / substance intoxication/ withdrawal.

– Dementia is a chronic slow/insiduous process presenting with decrement in intellectual abilities (such as short & long term memory, judgement, abstract thinking, impulse control, personal care and personality)Q.

–   Delusional disorder presents with nonbizarre delusions (involving situations that occur in real life) of at least 1 months durationQ. Apart from the impact of delusion (s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre (i.e. criteria. A of schizophrenia has never been met). However, tactile or olfactory hallucinations may be present if they are related to delusional theme.

C i.e. Delusional disorder 

In Delusional dysmorphophobia (delusional disorder) patient feels his body part or body ugly or mishappen.

B i.e. Paranoid 

Induced Delusional Disorder

• Characterized by sharing of delusions between usually two (Folie a deux)Q or rarely more (Folie a trois, Folic a quatre, Folie a famille) persons who usually have closely Knit emotional bond.
• Only one person has genuine delusions due to an underlying psychiatric disorder.
• On separation, dependant individual may give up their delusions and patient with genuine delusions: should be’ treated according to underlying disease.

Ans:C-Persistent delusional disorder

Important difference b/w schizophrenia & delusional disorder is that:

• Behaviour,perssonality & contact with reality is markedly disturbed in all areas incase of schizophrenia
• Behaviour,personality & contact with reality is disturbed in delusional area otherwise person is normal in delusional disorder.

A i.e. Delusional disorder

This lady is suffering from erotomanic delusional disorder in which the content of delusion is that another person usually of higher status, is in love with the individual.

Ans:D-A >> B, C

• The presence of one of these Schneider’s first rank symptoms (SFRS) in the absence of intoxication, brain injury or clear affective illness, was sometimes taken as sufficient for making diagnosis of schizophrenia (Kaplan).
• SFRS are not specifc for schizophrenia and may be seen in other psychiatric disorders such as mood disorder and organic psychiatric disordersQ (Ahuja)/affective psychosis (New oxford)
• Schneider first rank symptoms, which he believed were pathognomic of schizophrenia (& became the forerunner of notion of positive signs & symptoms ), are now known not to be specific for schizophrenia, for they may also occur in mania, drug induced states, other disorders (CDTP) Classification of schizophrenia like disorders include cases that resemble schizophrenia in some respects and yet do not meet the criteria for diagnosis. These include

• ICD-10	DSM – IV
  Schizoaffective disorder	Schizo affective disorder
  Persistent delusional disorder	Delusional disorder
  Induced delusional disorder	Shared psychotic disorder
  Acute & transient psychotic disorder	Brief psychotic disorders
  Acute schizophrenia like psychotic disorder	Schizophreniform disorder
  Unspecified non organic psychosis	Psychotic disorder not otherwise specified
  Schizotypal disorder, Other non organic psychotic disorders	‑

Ans.C- Nihilistic delusion

Nihilistic delusion (ND) is one of an assortment of narrowly defined monothematic delusions characterized by nihilistic beliefs about self’s existence or life itself.

It is estimated to occur in less than 1% of older adults, 3% of older adults with severe depression, and less than 1% of patients with psychotic disorders

Ans:C-Nihilistic delusions

Nihilistic delusions:- False belief that oneself, others or the world is non-existent or about to end. There are pessimistic ideas that the patient’s career is finished, he is about to die, world is doomed. These occur in severe depression. If nihilistic delusions are accompanied by ideas concerning bodily function failure, e.g., putrefaction of intestines, etc., the syndrome is called COTARD’s SYNDROME.

Ans:D. Occurs at an early age.

The delusional disorder may account for 1–2% of admissions to inpatient psychiatric hospitals.
Age at onset ranges from 18–90 years, with a mean age of 40 years

Ans. is’c’i.e., Erotomania

• Erotomania (Delusions of love): – False belief that another person is in love with one (commoner in woman).