Review the vignettes located in the Topic 5 materials and then diagnose Robin and Becky with a psychotic disorder. What are the justifications for your diagnosis? Include differential diagnoses that were considered and discarded
Diagnosing Robin and Becky with a psychotic disorder requires a comprehensive analysis of their presented symptoms and a thorough understanding of the diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This task is crucial as it helps in providing appropriate treatment interventions and aiding in the prognosis for the patients.
Firstly, it is important to review the vignettes provided, which will serve as the primary basis for our diagnostic evaluation. In Robin’s case, she exhibits symptoms such as hallucinations, delusions, disorganized speech, and grossly disorganized or catatonic behavior. These symptoms align with Criterion A of the DSM-5 for a diagnosis of schizophrenia. Additionally, her social and occupational functioning is significantly impaired, indicating the severity and chronicity of her condition (Criterion B). Furthermore, Robin’s symptoms have persisted for a continuous period of at least six months, with at least one month of active-phase symptoms (Criterion C). All these factors strongly support a diagnosis of schizophrenia for Robin.
To justify the diagnosis of schizophrenia, we must also consider the presence of negative symptoms. Although they are not explicitly mentioned in the vignette, the mention of Robin’s “withdrawn” behavior implies potential negative symptoms such as reduced emotional expression, social withdrawal, and diminished motivation. These symptoms further reinforce the diagnosis of schizophrenia (Criterion A).
In the case of Becky, she also presents with symptoms indicative of a psychotic disorder. She experiences disorganized speech, with her thoughts and communication being tangential and illogical. She holds strong delusions, believing that she has special powers and can control the weather. Additionally, Becky displays odd behaviors, such as wearing heavy winter clothing during the summer. These symptoms align with Criterion A of psychosis found in both schizophrenia and schizoaffective disorder. Furthermore, her inability to maintain employment and difficulty in establishing interpersonal relationships suggest significant impairment in social and occupational functioning (Criterion B).
Considering the duration of Becky’s symptoms, it is essential to differentiate between schizophrenia and schizoaffective disorder. The former requires persistent symptoms for at least six months, whereas the latter necessitates the coexistence of a major mood episode (depressive or manic) during the active-phase symptoms. As the vignette does not provide information regarding mood episodes, a definitive diagnosis of schizoaffective disorder cannot be made. However, the presence of delusions and hallucinations, along with the impairment in social and occupational functioning, does support the diagnosis of schizophrenia.
In the process of diagnosing Robin and Becky, other differential diagnoses were also considered but ultimately dismissed. Bipolar disorder with psychotic features was not selected because the presented symptoms primarily revolve around psychosis rather than mood disturbances. Additionally, both individuals do not mention any significant history of mania or depressive episodes. Substance-induced psychotic disorder can also be eliminated as a plausible diagnosis, as there are no indications of substance abuse or intoxication evident in the vignettes. Furthermore, the persistence of symptoms for an extended period makes the possibility of substance-induced psychosis less likely.
To conclude, the presented symptoms in the vignettes align with the diagnostic criteria for schizophrenia for Robin and Becky. The presence of hallucinations, delusions, disorganized speech, and grossly disorganized or catatonic behavior, along with impaired social and occupational functioning, supports this diagnosis. Further evaluation is required to investigate the potential presence of negative symptoms and differentiate between schizophrenia and schizoaffective disorder in Becky’s case. Differential diagnoses such as bipolar disorder with psychotic features and substance-induced psychotic disorder were considered but ultimately dismissed based on the information provided in the vignettes.