Question

Differential Diagnosis Read through the case presentation. 1. Specify three diagnoses that best fit the case presentation. Limit these to disorders covered in Chapters 5 through 15. You must refer to the disorders by the diagnoses referenced in the DSM-5. Additionally, the diagnoses must significantly differ between each other. For example, you will not receive full credit if you choose PTSD and Acute Stress Disorder. For each diagnosis: 2. Identify THREE symptoms included in the case presentation that fit the diagnostic criteria for that diagnosis and WHY they fit (i.e., the symptom criteria you're referring to). 3. Identify AT LEAST ONE detail that does NOT fit with the disorder. 4. Specify THREE pieces of information you need to know to confirm the diagnosis based on diagnostic criteria or risk factors or epidemiological information that would make the disorder more or less likely.

Answer 1

1. The three diagnoses that best fit the case presentation are-

According to the DSM-5, a diagnosis of schizophrenia is made if a person has two or more core symptoms, one of which must be hallucinations, delusions, or disorganized speech for at least one month. The other core symptoms are gross disorganization and diminished emotional expression.

• Physical appearance: Neglects hygiene and personal appearance. As the disease advances, they may even lose weight and forget to shower. Though these signs will be obvious to you, the person afflicted may not notice. Individual appears preoccupied or interactive with own thoughts.    ( Mr. X appeared dishelved, poorly groomed and was malodororus. He made poor eye contact with the clinician and appeared mistrustful ).
• Hallucinations: These usually involve seeing or hearing things that don't exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination. ( Mr X stated that he heard and saw strange things for an extended period of time several months ago).
• Disorganized speech:  Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can't be understood, sometimes known as word salad. ( Mr. X appeared increasingly distressed and disoriented. He displayed mild psychomotor agitation and low, rapid impoverished speech).
• Delusions. These are false beliefs that are not based in reality. For example, you think that you're being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame. (Mr. X also stated that his recent job had involved working for the government as an undercover agent. He also stated that government was attempting to brainwash him in order to control his behavior so that he could not divulge top secret information).

2. Please refer to the point 1. for the detailed information of the symptoms which best fits the diagnostic criteria for diagnosis.

3. He denied both suicidal and homicidal ideation. which does not fit with the disorder (schizophrenia).

4. The presence of 2 (or more) of the following, each present for a significant portion of time during a 1-month period (or less if successfully treated), with at least 1 of them being (1), (2), or (3): (1) delusions, (2) hallucinations, (3) disorganized speech, (4) grossly disorganized or catatonic behavior, and (5) negative symptoms

Symptoms can vary in type and severity over time, with periods of worsening and remission of symptoms. Some symptoms may always be present.

In men, schizophrenia symptoms typically start in the early to mid-20s. In women, symptoms typically begin in the late 20s. It's uncommon for children to be diagnosed with schizophrenia and rare for those older than age 45.