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2024 NR 547 DIFFERENTIAL DX MIDTERM EXAM WITH CORRECT ANSWERS
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2024 NR 547 DIFFERENTIAL DX MIDTERM EXAM WITH CORRECT ANSWERS
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2024 NR 547 DIFFERENTIAL DXMIDTERM EXAM WITH CORRECT
ANSWERS
Thought disorder (schizophrenia) - CORRECT-ANSWERSdisorganized,
irrational thinking
Examples of thought disorder include: - CORRECT-ANSWERSincoherent
speech
loose associations
meaningless words
perseveration
disorganized behavior (schizophrenia) - CORRECT-ANSWERSacting in strange
or unusual ways, including strange movement of limbs, bizarre speech, and
inappropriate self-care, such as failing to dress properly or bathe
Examples of disorganized behavior include: - CORRECT-ANSWERSchildlike
silliness
unpredictable agitation
inappropriate clothing for the weather
poor hygiene
schizophrenia are at risk of premature mortality due to co-occurring medical
conditions that are often undiagnosed or undertreated - CORRECT-
ANSWERSCommon comorbidities include heart and liver disease and
diabetes. Approximately half of the individuals with schizophrenia have co-
occurring mental and/or behavioral health disorders (NIMH, n.d.). Those with
schizophrenia are at increased risk for suicide
At what age does schizophrenia typically first appear? - CORRECT-
ANSWERS25
What may precipitate symptoms of schizophrenia in those already vulnerable
- CORRECT-ANSWERSStressful life events, such as the loss of a loved one,
the end of a relationship, abuse, or substance use
Positive vs negative symptoms in schizophrenia - CORRECT-
ANSWERSPositive symptoms tend to come and go throughout the illness
,while negative symptoms tend to be more stable throughout life. Cognitive
symptoms impact a client's ability to function independently.
positive vs negative symptoms - CORRECT-ANSWERSpositive: something
added (such as delusions, hallucinations, disorganized speech)
negative: something removed (lack of emotion)
Prodromal phase of schizophrenia - CORRECT-ANSWERSusually develop
before the first psychotic episode over a few days to a few months and may
persist for a year or more before the onset of overt psychotic symptoms
Symptoms that occur in the prodromal phase of the illness - CORRECT-
ANSWERSare typically negative and may be overlooked due to their
similarity to other conditions, such as depression
Clients may begin to show an interest in abstract ideas, philosophy, and
occult or religious questions. Other prodromal signs and symptoms include
noticeably strange behavior, abnormal affect, unusual speech, bizarre ideas,
and odd perceptual experiences.
The pattern of illness during the first _____ years after the diagnosis generally
indicates the client's course. Each relapse leads to further decline in client
functioning. - CORRECT-ANSWERSFive
Over time, __________ symptoms tend to become less severe while
_____________ symptoms may increase in severity - CORRECT-
ANSWERSPositive; negative
schizoaffective disorder - CORRECT-ANSWERSPsychotic disorder featuring
symptoms of both schizophrenia and major mood disorder, such ad a bipolar
disorder.
Schizoaffective disorder is associated with? - CORRECT-ANSWERSDepression
and often misdiagnosed at MDD.
What is the diagnosis requirement of Schizoaffective disorder? - CORRECT-
ANSWERSAt least TWO psychotic episodes lasting 2 weeks or more. With one
of these episodes must happen without depressive or manic symptoms
Minh is a 19-year-old who presents to the emergency department after a
suicide attempt. She is medically stable. She states that she has experienced
auditory hallucinations for the past 3-4 weeks and "could not take them
anymore." She also complains of depressed mood, loss of interest in
activities, and feelings of hopelessness for the past few months. Her
toxicology reports on admission were negative - CORRECT-
ANSWERSRationale: Minh presents with major depressive episode concurrent
,with hallucinations. This disturbance is not attributable to a substance. The
most appropriate diagnosis for Minh is schizoaffective disorder depressive
type F25.1.
schizophreniform disorder - CORRECT-ANSWERSPsychotic disorder involving
the symptoms of schizophrenia but lasting less than 6 months but more than
1 month. This condition is differentiated from schizophrenia based on the
length if time symptoms have been present
Holden is a 14-year-old who presents to the clinic with his parents. His
mother notes that he has stopped showering, seems disinterested in
activities in which he had previously engaged and in peer interaction, and
echoes words that others have said. These behaviors have increased over
the past two months. Holden's urine toxicology is negative.
Based on the DSM-5-TR, does Holden meet diagnostic criteria for
schizophreniform disorder?
yes
no
unable to determine - CORRECT-ANSWERSno (Correct answer)
Rationale: Holden's behaviors have lasted for at least one month, but less
than six months. His behaviors are not attributable to a substance. Holden
displays two of the five required symptoms for the diagnosis of
schizophreniform disorder. He displays catatonic behavior with echolalia and
has negative symptoms of asociality and avolition. He does not, however,
display one of the three required behaviors for diagnosis: delusions,
hallucinations, or disorganized speech. An alternate diagnosis should be
considered.
brief psychotic disorder - CORRECT-ANSWERSPsychotic disturbance involving
delusions, hallucinations, or disorganized speech or behavior but lasting less
than 1 month; often occurs in reaction to a stressor. Clients experience full
remission with a full return to function
Shelby is a 31-year-old who presents to the emergency department with her
husband. She is 32 weeks pregnant. Her husband noted that a few days ago,
she began having bizarre behaviors, including avoiding eye contact,
exhibiting tangential speech, and expressing delusions that she is being
followed and tracked by the CIA and that they are planning to steal her baby.
Shelby has no medical or psychiatric history, and she is not on any
medications. She has abstained from alcohol during pregnancy and does not
use other drugs.
Based on DMS-5-TR, does Shelby meet the criteria for brief psychotic
disorder?
, yes
no
Unable to determine - CORRECT-ANSWERSUnable to determine (Correct
answer)
(Correct answer)
Rationale: Shelby may meet diagnostic criteria for brief psychotic disorder
(298.8) with peripartum onset, but a diagnosis cannot be confirmed at this
time. Shelby exhibits delusions and disorganized speech. The symptoms
cannot be better explained by another medical or psychiatric illness or
substance. Shelby's symptoms began a few days ago. If symptoms resolve
within one month, this is an appropriate diagnosis. If not, an alternate
diagnosis should be considered.
delusional disorder - CORRECT-ANSWERSPsychotic disorder featuring a
persistent belief contrary to reality (delusion) but no other symptoms of
schizophrenia.Delusional disorder involves a person having prominent
delusions without hallucinations. Clients with delusional disorder tend to
have false beliefs that involve real-life situations such as the belief that they
are being followed or that others are plotting against them. Clients with
delusional disorder often retain their personalities and are more functional
socially and at work than with other psychotic disorders.
Geoff is two days post-op from knee surgery. He has been awake, alert,
oriented, and pleasant over the last few days and has shown no signs of
mental distress. The surgical team asked for a psychiatric consult after Geoff
became increasingly angry, argumentative, and agitated with nursing staff
when he was offered a flu shot. Geoff states that he was given a flu shot
against his will at work several years ago, and since then the government
has been tracking him and listening in on private conversations. He states
that taking another shot will "triple the power" of the surveillance. Upon
follow-up, Geoff's wife confirms that he has held this belief for many years.
He believes the same is true for other vaccines, but he does not hold other
delusions. He has maintained employment, relationships, and social
interactions.
Based on the DSM-5-TR, does Geoff meet diagnostic criteria for delusional
disorder?
Yes
No
Unable to - CORRECT-ANSWERSyes (Correct answer)
no
unable to determine
Rationale: Geoff has one belief that is irrational and fixed and has held the
delusion for several years. His functioning is not impaired. He meets
diagnostic criteria for delusional disorder (297.1), persecutory type.
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