Review Question - QID 107070

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Schizophrenia QID: 107070 (M1.PY.15.112703)

QID 107070 (Type "107070" in App Search)

A 23-year-old male is brought to the psychiatric inpatient clinic by his mother because of 7 months of gradual social withdrawal, occasional delusions of grandeur, and abnormal movements. She noted that he became less energetic over the past few months and would hold his body in abnormal positions for hours without any realization of what he was doing. When the mother would try to reposition him, he would resist and any attempt would be futile. Other times, he would resemble a parrot repeating words spoken by other people or mimicking their movements. Which subtype of schizophrenia does this male patient most likely have?

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Paranoid

0/43

Disorganized

4/43

Catatonic

74%

32/43

Undifferentiated

14%

6/43

Residual

1/43

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The male is displaying abnormal movements and sustained postures suggesting a diagnosis of catatonic schizophrenia.

Schizophrenia is a chronic disorder marked by periods of psychosis and disturbed behavior with a decline in function lasting > 6 months. It requires 2 or more positive or negative symptoms for the diagnosis. If the symptoms last for < 1 month, the diagnosis is brief psychotic disorder. If they last between 1-6 months, then it is schizophreniform disorder, and if > 6 months, it is schizophrenia. In this case, the individual is displaying abnormal movements and sustained postures while in a catatonic stupor. The male is also displaying echolalia (mimicking speech) and echopraxia (mimicking movements). Although he does have delusions of grandeur, the main symptoms in this male patient are catatonic movements suggestive of catatonic schizophrenia. Other symptoms include waxy flexibility where affected individuals permit someone to move their body parts and they maintain that position.

Schultz et al. reviews schizophrenia. Schizophrenia affects nearly 1% of the population regardless of ethnicity or gender. It is diagnosed by having positive (delusions, hallucinations, disorganized speech, or disorganized/catatonic behavior) or negative symptoms (flat affect, social withdrawal, lack of motivations, speech or thought). Schizophrenia can be treated with antipsychotics which may have significant side effects including but not limited to diabetes, hypercholesterolemia, and weight gain. Caution should be taken with schizophrenic patients as they have a significantly increased risk of attempting suicide.

Pompili et al. performed a systematic review on the indications for electroconvulsive therapy for schizophrenia. They recommend the use of ECT for patients with schizophrenia who are not responding to pharmacological therapy. ECT is also recommended for schizophrenic patients who exhibit catatonia, aggression, and suicidal behavior.

Incorrect Answers:
Answer 1: The dominant symptoms in paranoid schizophrenics are hallucinations and delusions.
Answer 2: The dominant symptoms in organized schizophrenics are disorganization of thought, speech and behavior.
Answer 4: Undifferentiated schizophrenia does not have any dominant symptoms but has elements of all types of schizophrenia and may actually fluctuate between them.
Answer 5: The residual subtype is when the patient, at the time of evaluation, no longer has extreme psychosis and the symptoms, including hallucinations and delusions, are lessened significantly.