WBR1138

Author	[[PageAuthor::Pratik Bahekar, MBBS [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Psychiatry
Sub Category	SubCategory::Psychiatry
Prompt	[[Prompt::34-year-old struggling actress, brought herself to the emergency room complaining of a progressively growing rash from last 1 week. When dermatological evaluation revealed no abnormality, when this was explained to her, she says that she can’t keep herself safe at home. She was obsessed with the idea of skin cancer. Her neurological examination, laboratory tests, and toxicology screen did not reveal any cause for psychosis. In the interview she demonstrated tangential thinking and constant concern about skin cancer. She described her mood as low. Her thoughts were overly and intensely concentrated on cancer. She suddenly started crying because she believed she felt her cancer crawling under skin and spreading to the eyes. She denied suicidal or homicidal idealization, hallucinations, ingestion of drugs or alcohol, family history of psychiatric illness, or any relevant medical problem. What is the most likely diagnosis?]]
Answer A	AnswerA::Brief psychotic disorder
Answer A Explanation	[[AnswerAExp::Brief psychotic disorder is a period of psychosis whose duration is generally shorter, non re-occurring, and not caused by another condition. The disorder is characterized by a sudden onset of psychotic symptoms, which may include delusions, hallucinations, disorganized speech or behavior, or catatonic behavior. The symptoms must not be caused by schizophrenia, schizoaffective disorder, delusional disorder or mania in bipolar disorder. There are three forms of brief psychotic disorder: Brief psychotic disorder with a stressor, such as a trauma or death in the family. Brief psychotic disorder without a stressor, there is no obvious stressor. Brief psychotic disorder with postpartum onset. Usually occurs about four weeks after giving birth.]]
Answer B	AnswerB::Schizophrenia
Answer B Explanation	[[AnswerBExp::n 2013, the American Psychiatric Association released the fifth edition of the DSM (DSM-5). To be diagnosed with schizophrenia, two diagnostic criteria have to be met over much of the time of a period of at least one month, with a significant impact on social or occupational functioning for at least six months. The person had to be suffering from delusions, hallucinations or disorganized speech. A second symptom could be negative symptoms or severely disorganized or catatonic behaviour. The definition of schizophrenia remained essentially the same as that specified by the 2000 version of DSM (DSM-IV-TR), but DSM-5 makes a number of changes. Subtype classifications such as catatonic and paranoid schizophrenia – are removed. These were retained in previous revisions largely for reasons of tradition, but had subsequently proved to be of little worth. Catatonia is no longer so strongly associated with schizophrenia. In describing a person's schizophrenia, it is recommended that a better distinction be made between the current state of the condition and its historical progress, to achieve a clearer overall characterization. Special treatment of Schneider's first-rank symptoms is no longer recommended. Schizoaffective disorder is better defined to demarcate it more cleanly from schizophrenia. An assessment covering eight domains of psychopathology such as whether hallucination or mania is experienced is recommended to help clinical decision-making.]]
Answer C	AnswerC::Delusional disorder
Answer C Explanation	[[AnswerCExp::The following features are found in delusional disorder: It is a primary disorder. It is a stable disorder characterized by the presence of delusions to which the patient clings with extraordinary tenacity. The illness is chronic and frequently lifelong. The delusions are logically constructed and internally consistent. The delusions do not interfere with general logical reasoning (although within the delusional system the logic is perverted) and there is usually no general disturbance of behavior. If disturbed behavior does occur, it is directly related to the delusional beliefs. The individual experiences a heightened sense of self-reference. Events which, to others, are nonsignificant are of enormous significance to him or her, and the atmosphere surrounding the delusions is highly charged.]]
Answer D	AnswerD::Schizoaffective disorder
Answer D Explanation	[[AnswerDExp::Schizoaffective disorder is defined by mood disorder-free psychosis in the context of a long-term psychotic and mood disorder. Psychosis must meet criterion A for schizophrenia which may include delusions, hallucinations, disorganized speech, thinking or behavior and negative symptoms. Both delusions and hallucinations are classic symptoms of psychosis. Delusions are false beliefs which are strongly held despite evidence to the contrary.]]
Answer E	AnswerE::Bipolar disorder with psychotic features
Answer E Explanation	AnswerEExp::The patient does not show any features of a mood disorder.
Right Answer	RightAnswer::C
Explanation	[[Explanation::In delusional disorder the patient is focused on a single delusion. Educational Objective: References: http://www.nlm.nih.gov/medlineplus/psychoticdisorders.html]]
Approved	Approved::No
Keyword	WBRKeyword::Delusional disorder
Linked Question	Linked::
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