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Schizophrenia
53%
60/114
Schizotypal disorder
6%
7/114
Schizoaffective disorder
27%
31/114
Bipolar disorder
9%
10/114
Unipolar mania
4%
4/114
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This patient is suffering from schizoaffective disorder. Schizoaffective disorder is characterized by symptoms of schizophrenia plus mood changes such as mania or depression. In this case, the patient is hearing voices, consistent with schizophrenia, and is experiencing a manic episode with the classic symptoms of public nudity and decreased need for sleep. Importantly, a diagnosis of schizoaffective disorder requires that the patient experience psychotic symptoms WITHOUT mood disorder for at least 2 weeks. The patient's history is consistent with this requirement. Patients who consistently experience mood symptoms with symptoms of schizophrenia should receive a diagnosis of bipolar disorder with psychotic features. Schultz et al. review schizophrenia diagnosis and its chronic management. They differentiate between schizophrenia and schizophreniform disorder, which lasts 1-6 months and does not require a decline in functioning. The authors also distinguish schizotypal personality disorder as a pattern of eccentric behavior combined with some perceptual distortions and difficulty in interpersonal relations. The differential for schizophrenia also includes brief psychotic disorder, delirium, dementia, substance abuse, and many medical illnesses. Malhi et al. discuss the challenges of diagnosing schizoaffective disorder. There is controversy over whether it is a disease that arises from symptoms of co-occurring schizophrenia and bipolar disorder, or whether schizoaffective disorder is its own entity that exists on a continuum between schizophrenia and bipolar disorder. They argue that the diagnosis should be removed from future editions of the DSM in favor of diagnoses which discriminate between schizophrenia and bipolar disorder. Illustration A is an overview of the spectrum of disorders related to schizophrenia. Incorrect answers: Answer 1: Manic episodes are not typical of schizophrenia. Answer 2: Schizotypal disorder is characterized by voluntary social withdrawal, limited emotional expression, content with social isolation, AND odd thinking. Answer 4: Patients with bipolar disorder experience both depression and mania. The presence of schizophrenic symptoms in this patient suggests a diagnosis beyond bipolar disorder. Answer 5: Unipolar mania is not a generally accepted diagnosis. Mania is thought to occur in conjunction with depression as part of bipolar disorder.
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