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Name That Diagnosis

insectMore free practice from the Schizophrenia Spectrum and Other Psychotic Disorders section of the DSM. Answer this:

A client tells a social worker that her apartment is infested with tiny insects. "They want to change my thoughts," she reports. "They're invisible. Government scientists created them to watch people. A couple of times, I've felt them crawling under my skin." The social worker concludes that there is no insect infestation. What is the MOST likely diagnosis for the client?

A. Schizophrenia

B. Schizoaffective Disorder

C. Delusional Disorder

D. Psychotic Disorder

What's your answer?

Yes, there's not all that much information here, but you still have to give an answer. First thing to do, if you're not sure, is rule out the distractors. Schizoaffective disorder isn't a fit since there's no mention of the presence or absence of mood symptoms. Psychotic disorder can be scratched too, because, like the tiny insects in the client's apartment, it doesn't exist. It's not a DSM diagnosis. If it looks familiar, that may be because brief psychotic disorder is a DSM diagnosis (involving psychotic symptoms present for less than a month).

That leaves schizophrenia and delusional disorder. The client certainly seems  to meet criteria for schizophrenia. A schizophrenia diagnosis requires two or more of the following: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and/or negative symptoms.  (Symptoms have to be present for more than six months, but this stem offers no time frame, so sufficient time has to be assumed.) A diagnosis of delusional disorder requires one or more delusions and the client can't have met criteria of schizophrenia. (Symptoms need to have been present at least one month.)

So which is it?

Take a look at this note--a small caveat--that's part of the delusional disorder diagnosis: "Hallucinations, if present, are not prominent and are related to the delusional theme (e.g., the sensation of being infested with insects associated with delusions of infestation.") Aha! Eureka! That settles it. An answer.

In this case, though the client's sensation of insects crawling beneath her skin is a hallucination. But since it's a hallucination that's directly connected to the client's invisible-thought-changing insect delusion, and has only occurred "a couple of times," the best of the offered diagnoses here is C) Delusional Disorder."

"Aw, come on!" you may be shouting. "How'm I supposed to remember a little note like that?!" You're right. There are lots of little notes scattered through the DSM that you're just not going to be able to memorize and that you shouldn't even try to memorize. But this little note about how hallucinations can sometimes fit within delusional disorder, you don't have to remember it. Now you know it!

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"OMG! Guess who passed her LCSW!"

smile Text of the day:

OMG! Guess who passed her LCSW! Me! Thank you so much....going through your program....reviewing the way questions are asked....reading the rationale....so helped me!

Congratulations, LLR, and all recently licensed social workers! Way to go!

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Psychotic Disorders and the Social Work Exam

pinched Let's look now to the Schizophrenia Spectrum and Other Psychotic Disorders chapter of DSM-5 as a source for some free ASWB-exam-style practice questions. The disorders covered in the chapter are:

  • Schizotypal (Personality) Disorder
  • Delusional Disorder
  • Brief Psychotic Disorder
  • Schizophreniform Disorder
  • Schizophrenia
  • Schizoaffective Disorder
  • Substance/Medication-Induced Psychotic Disorder
  • Psychotic Disorder Due to Another Medical Condition
  • Catatonia Associated with Another Mental Disorder
  • Catatonia Disorder Due to Another Medical Condition
  • Other Specified Schizophrenia Spectrum and Other Psychotic Disorder
  • Unspecified Schizophrenia Spectrum and Other Psychotic Disorder

Symptoms overlap disorder-to-disorder in this chapter, so knowing a little bit about the details will help you answer a question drawn from this chapter if it appears on the social work licensing exam. For example:

A man tells a social worker that for the last three months, he's been hearing voices telling him he's an awful person. He has lost his job due the voices and his girlfriend no longer answers his calls. He reports this without apparent emotion. What is the MOST likely diagnosis for this client?

A. Schizophrenia

B. Schizophreniform Disorder

C. Schizoaffective Disorder

D. Brief Psychotic Disorder

Got it? How'd you know?

The answers are all psychotic disorders, so the symptoms in the vignette (hallucinations and flat affect) are less crucial to ascertaining the correct answer than another small detail--duration. The client reports hearing voices "for the last three months." We have our clue!

The essential difference in the criteria for many psychotic disorders is duration. In brief psychotic disorder, symptoms have been present for less than one month. A diagnosis of schizophrenia requires the presence of symptoms going back at least six months. Schizoaffective disorder is less concerned with time, but requires a major mood episode alongside psychotic symtpoms--not what's described here.

That leaves one answer, the correct answer, answer B).

Schizophreniform disorder is diagnosed when two or more symptoms (either delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms) are present for between one and six months. Just like what's described.

If you didn't know, now you do!

For more reading about schizophreniform disorder and other psychotic disorders, try:

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"Thank you so much for your tests!"

graduation

"Thank you so much for your tests! The aswb was structured exactly like the 4 practice tests I took! Because of that I passed my bachelor's exam on the first try!"

Congratulations, Courtney, and all recently licensed social workers--at all exam levels!

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Labor Day Coupon

laborThanks for all the work you do.

Here's a little something for the long weekend to help you save on practice tests: Use coupon code LABORDAY15 and save an additional 15% on all SWTP offerings.

Happy Labor Day and good luck on the exam!