A 28 year old female presents with complains of reduced sleep with disorganized behaviour since 9 months. She feels there is a camera fixed behind her head which always follows her. Which of the following is likely diagnosis?
Ans. B. Paranoid schizophrenia. (Ref: Kaplan & Sadock's Synopsis of Psychiatry, Xth/Ch. 13, Pg. 476).A 28-year-old female presents with complain of reduced sleep with disorganized behavior since 9 months. She feels there is a camera fixed behind her head, which always follows her. The most likely diagnosis would be Paranoid schizophrenia.Discussion:Depending on the predominance of particular symptoms, four subtypes of schizophrenia are recognized: paranoid, disorganized, catatonic, and residual.The female in the question presents with the classic symptoms of paranoid schizophrenia. This subtype of schizophrenia is characterized by prominent hallucinations and delusional ideations with a relative preservation of affect and cognitive functions. Delusions are usually grandiose or persecutory or both, organized around a central coherent theme. Hallucinations, usually auditory, are frequent and related to the delusional theme. Anxiety, anger, argumentativeness, and aloofness are often present. Paranoid schizophrenia tends to develop later in life and is associated with a better prognosis.Kaplan, pg. 546......Patient with a major depression with psychotic features should have symptoms over two weeks (the minimum for the diagnosis), and symptoms include anhedonia, crying, anergia, decreased concentration, weight loss, and insomnia with early morning awakening. Patient also may have somatic delusions that are mood congruent and an auditory hallucination. The presence of psychotic phenomena that follow a clear mood disorder picture makes the diagnosis of major depression with psychotic features the most likely.Kaplan, pg. 512-520........The main feature of delusional disorder is the presence of one or more nonbizarre delusions without deterioration of psychosocial functioning and in the absence of bizarre or odd behavior. Auditory and visual hallucinations, if present, are not prominent and are related to the delusional theme. Tactile and olfactory hallucinations may also be present if they are incorporated in the delusional system (such as feeling insects crawling over the skin in delusions of infestation). Subtypes of delusional disorder include erotomanic, gran- diose, jealous, persecutory, and somatic (delusions of being infested with parasites, of emitting a bad odor, of having AIDS). Delusional disorder usually manifests in middle or late adult life and has a fluctuating course with periods of remissions and relapses.Additional Educational points:# Amphetamine intoxication can result in a psychosis very closely resembling acute paranoid schizophrenia, with symptoms including paranoid delusions and visual hallucinations.# Persons with a paranoid personality disorder characteristically show marked suspiciousness of others and are extremely sensitive to any potential threat or injustice. They frequently look for hidden motives or meanings, are contemptuous of the weak, and are very sensitive to issues of power and dominance. They often are moralistic or self- righteous and may be quite litigious. The percentage of affected persons who go on to develop schizophrenia is not known, but schizophrenia or paranoid psychosis is not the typical outcome.
Psychotic depression
Paranoid schizophrenia
Delusional disorder
Insomnia
Schizophrenia