More 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
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)
"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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