Question

Differential Diagnosis

Read through the case presentation.

1. Specify three diagnoses that best fit the case presentation. Limit these to disorders covered in Chapters 5 through 15. You must refer to the disorders by the diagnoses referenced in the DSM-5. Additionally, the diagnoses must significantly differ between each other. For example, you will not receive full credit if you choose PTSD and Acute Stress Disorder.  

For each diagnosis:

2. Identify THREE symptoms included in the case presentation that fit the diagnostic criteria for that diagnosis and WHY they fit (i.e., the symptom criteria you're referring to).
3. Identify AT LEAST ONE detail that does NOT fit with the disorder.
4. Specify THREE pieces of information you need to know to confirm the diagnosis based on diagnostic criteria or risk factors or epidemiological information that would make the disorder more or less likely.

Mr. X is a 36 year-old male. During his intake interview, he appeared disheveled, poorly groomed, and was malodorous. He made poor eye contact with the clinician, appearing guarded and mistrustful during the interview. He stated that things had been “off” for the past six months. Mr. X stated that he “heard and saw strange things” for an extended period of time several months ago, and that this had resulted in losing his job and being kicked out of his apartment for not paying his rent. Additionally, he reported that his most recent job had involved “working for the government as an undercover agent” and stated that he now believed the government was attempting to brainwash him in order to control his behavior so that he could not divulge “top secret” information. Mr. X appeared increasingly distressed and disoriented as the interview progressed. He displayed mild psychomotor agitation and low, rapid, impoverished speech. He reported feeling extremely “tired” because he didn't sleep well, except on nights when he managed to get a hold of a fifth of whiskey, and explained that he often stays up feeling “worried about his safety”. When asked how much he drinks on an average day, Mr. X laughed and said, “as much as I can get!” but quickly added, “I mean, I’m kidding, I only drink so I can sleep.” He denied both suicidal and homicidal ideation.

Answer 1

Following are the diagnoses that might fit the case-

1- Schizophrenia-

He has "heard and seen strange things"- hallucinations.

He has delusions that he works for government as an undercover agent.

He appeared disoriented as the interview progressed, along with impoverished speech.

2- Antisocial personality disorder-

Impulsive behavior- drinks as much as he gets.

Lying or deceiving for self amusement- he initially said he drinks a fifth of whiskey, then said he drinks as much as he gets, later on he says that he is kidding that he only drinks so that he can sleep. Well, a disoriented person probably would not be oriented enough to make a joke that is consistent and not disorganized about why and how much he drinks.

A pattern of irresponsibility- because he has not paid rent and hence has been kicked out, also he has lost the job he worked. Which could possibly be due to schizophrenia if he really has schizophrenia.

3- Anxiety- Anxiety may be comorbid with schizophrenia.

Because he is paranoid- as he appears guarded and mistrustful.

He also is unable to sleep because he worries for his safety.

He also had psychomotor agitation