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

C. i.e. 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 impairedQ (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.

C i.e. Persistent delusional disorder

Important difference b/w schizophrenia & delusional disorder is that

Behaviour, Personality & Contact with reality is                      Behaviour, Personality & contact with reality is

markedly disturbedQ in all areas in case of                          disturbed in delusional area other wise person is

schizophrenia                                                                        normalQ 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.

A >> B, C

The presence of one of these Schneider’s first rank symptoms (SFRS) in the absenc 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 disorderQ 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 disordersQ (CDTP) Classification of schizophrenia like disorders include cases that resemble schizophrenia in some respects and yet do not meet the criteria for dia^gnosis. These include

Ans. Nihilistic delusion

Ans. is ‘c’ i.e., Nihilistic delusions

Types of delsions

• Based on the contents of delusions, they are divided into :-

1. Persecutory delusions (paranoid) : – The patient feels that he is being persecuted against. There is false belief that one is being harmed, threatened, cheated, poisoned, harassed or spied on or is a victim of conspiracy to damage his reputation. The supposed persecutor of the patient may be people in the environment (e.g., members of family, neighbours, former friend) or may be political or religious groups. These delusions occur in schizophrenia (especially paranoid), severe affective disorders (sever mania or severe depression), and organic brain syndrome. This is the most common type of delusion. Delusion of persecution may occur in the context of primary delusional experiences, auditory hallucinations, bodily hallucinations or experiences of passivity.
2. Grandiose delusion (expansive delusions) : – False belief that one is exceptionally powerful, talented or important. These delusions seen most commonly in mania, However, can also occur in schizophrenia and organic states.
3. Delusions of reference : – False belief that certain objects, people or events have intense personal significance and refer specifically to one self, e.g., believing that a television news reader is talking directly about oneself, or people walking on the road are talking about him. These delusions are seen in schizophrenia, mania and organic states.
4. Religious delusions : – False belief pertaining to a religious theme, often grandiose in nature, e.g., believing that one is a special messenger from God. These delusions are seen in schizophrenia.
5. Delusions of love (erotomania) : – False belief that another person is in love with one (commoner in woman). In one form, termed de clerambault sydrome, a woman (usually) believes that a man, frequently older and of higher status, is in love with her.
6. Delusion of infidility (morbid jealousy, othello syndrome :- False belief that one’s lover has been unfaithful. These are seen in schizophrenia, alcohol related psychosis, organic states.
7.  Delusion of misidentification : – a) Capgras syndrome (Delusion of double) : – Belief that a familiar person has been replaced by an exact double i.e. an impostor. b) Fregoli syndrome : – Belief that a complete stranger is actually a familiar person already known to one.
8. Delusion of self accusation or guilt : – False feeling of remorse of guilt. It occur in Depression.
9. 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 occurs 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.
10. Hypochondriacal delusions : – False belief about one’s health, patient wrongly believes that he has severe medical illness, contrary to the all medical evidences. It is seen in depression.
11. Delusion of infestations : – False belief that one is infested with small but visible organisms. As a monosymptomatic delusional disorder this is called EKBOM SYNDROME. It is seen in acute confusional state (due to drugs or alcohol withdrawal), in schizophrenia, in dementing illness, and as delusional eloboration of tactile hallucinatory experiences (secondary to formication).
12. Delusion of control : – Belief that his actions, impulses or thoughts are controlled by an outside agency and accordingly called as made action, made impulse or made affect. Also called somatic passivity experiences (passivity phenomenon). Commonly seen in schizophrenia.
13. Delusions concerning possession of thoughts – Patients with delusions about possession of thoughts may lose the conviction that their thoughts are their own. Most commonly seen in schizophrenia.

• Delusions of thought insertion – thoughts have been implanted by an outside agency.
• Delusions of thought withdrawal – thoughts are being taken out of their mind. This is usually accompanied by “thought block”.
• Delusions of thought broadcast – unspoken thoughts are known to other people through radio, telepathy or in some other way.

Ans:D. Occurs at early age.

• 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).