Read pages 101- 138 in the  DSM-5-TR 

 Read Boland, R., & Verduin, M. (2022). Kaplan  Chapter 5: Schizophrenia Spectrum and Other Psychotic Disorders

Zuckerman, E. (2019). Clinician’s Thesaurus: The Guide to Conducting Interviews and Writing Psychological Reports. (8th ed.). The Guilford Press. o Review Part 1: Chapters 1-3, pg. 35-50 Mental Status Exam Special emphasis on: • Chapters 3: 3.9, 3.11, 3.16, 3.17, 3.20, 3.20, 3.24 • Chapter 12: 12.8, 12.10, 12.15, 12.18, 12.22, 12.30

Read Morrison and Flegel: Chapter 12

Reply to the following discussion board post 

Compare and contrast delusional disorder with brief psychotic disorder. For this discussion, you will need to place particular emphasis on how comprehensive assessment could help us to arrive at the correct diagnosis.

DSM-5 criteria to be diagnosed with brief psychotic disorder is sudden onset of psychotic behavior that lasts less than one month followed by complete remission, with possible future relapses. At least one of the psychotic symptoms must be hallucinations, delusions, and disorganized thoughts with abrupt onset; therefore, the differentiation between the two is duration of symptoms

DSM-5 criteria to be diagnosed with delusional disorder is characterized as the presence of one or more delusions for a month or longer in a person who, except for the delusions and their behavioral ramifications, does not appear odd and is not functionally impaired (American Psychiatric Association, 2013.

One defining difference between these disorders is duration of symptoms.  Delusions that persist for 1 month or more support a diagnosis of delusional disorder. Brief psychotic disorders take on more of a sudden onset but typically last less than 1 month.  Another difference exists in observable behaviors.  Patients with delusional disorder may exist all around us in society.  They may not exhibit obviously odd or bizarre behavior, unless confronted with reality orientation.  Those with a presumed brief psychotic disorder may require supervision as their behavior shifts drastically different from their baseline.  Safety is of paramount priority as there is an increased risk for suicidal behavior during an acute episode.

As a clinician completing a comprehensive assessment, I would thus focus on the patient’s timeline of symptoms.  Chronic symptoms most likely would indicate more of a primary psychiatric issue. In comparing delusional disorder with brief psychotic disorder and their typical presentations with a longer duration of symptomology, I would be ruling out a differential diagnosis more consistent with schizophrenia.  Acute-onset symptoms, generally more of a change from a nonpsychotic state to a psychotic state, would involve determining if presentation is substance-induced versus medical etiology versus stress-induced response.  Any return to a baseline level of functioning within that month timeline would promote the brief psychotic disorder diagnosis.  Furthermore, I could also consider their age.  Most psychiatric illnesses caused by new-onset psychosis are more likely to develop in adolescence and young adulthood, and more on the differential for young children and older adults, (Vyas, et al. 2023).  Lastly, in ruling out other assessment factors that may influence a differential diagnosis, I would per routine assessment, evaluate for any family psychiatric history, personal medical history and or substance abuse history.

This discussion analysis was fascinating to me in myriad of ways. Despite years and years’ experience in the mental health setting, I was unaware that the origins of delusional disorder derive from paranoia.  In 1987, DSM-III-R reintroduced the concept with a new name: delusional disorder, (Gonzalez-Rodriguez, et al. 2022).  Paranoia, no longer in stature as a stand-alone diagnosis was for years considered a treatment-resistant condition.  Delusional disorder is now with the advent of antipsychotic medications and psychotherapy very much considered a treatable condition in today’s time.  However, with delusional disorder patients generally being older, imagine how many older married couples set in their ways and beliefs, some socially isolated and some not, may exist in our everyday society.  I’m going to presume that these instances of ‘shared psychosis’ or folie a deux are more prevalent than not.  They are a functional unit that despite the likely presence of fixed delusions, possibly persecutory with religious connotations in rural settings, manage to exist without further manifestations of psychiatric illness.   

• References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5-TR(5th ed.). American Psychiatric Association

González-Rodríguez, A., Monreal,  J. A., Natividad, M., & Seeman, M.V.  (2022). Seventy years of treating delusional disorder with antipsychotics: A historical perspective. Biomedicines, 10(12):3281. doi: 10.3390/biomedicines10123281. PMID: 36552037; PMCID: PMC9775530.

Vyas, C.M., Petriceks, A.H., Paudel, S., et al. (2023) Acute psychosis: differential diagnosis, evaluation, and management. The Primary Care Companion for CNS Disorders,25(2):22f03338.  Retrieved at https://doi.org/10.4088/PCC.22f03338

Read pages 101- 138 in the  DSM-5-TR 

 Read Boland, R., & Verduin, M. (2022). Kaplan  Chapter 5: Schizophrenia Spectrum and Other Psychotic Disorders

Zuckerman, E. (2019). Clinician’s Thesaurus: The Guide to Conducting Interviews and Writing Psychological Reports. (8th ed.). The Guilford Press. o Review Part 1: Chapters 1-3, pg. 35-50 Mental Status Exam Special emphasis on: • Chapters 3: 3.9, 3.11, 3.16, 3.17, 3.20, 3.20, 3.24 • Chapter 12: 12.8, 12.10, 12.15, 12.18, 12.22, 12.30

Read Morrison and Flegel: Chapter 12

Reply to the following discussion board post 

Compare and contrast delusional disorder with brief psychotic disorder. For this discussion, you will need to place particular emphasis on how comprehensive assessment could help us to arrive at the correct diagnosis.

DSM-5 criteria to be diagnosed with brief psychotic disorder is sudden onset of psychotic behavior that lasts less than one month followed by complete remission, with possible future relapses. At least one of the psychotic symptoms must be hallucinations, delusions, and disorganized thoughts with abrupt onset; therefore, the differentiation between the two is duration of symptoms

DSM-5 criteria to be diagnosed with delusional disorder is characterized as the presence of one or more delusions for a month or longer in a person who, except for the delusions and their behavioral ramifications, does not appear odd and is not functionally impaired (American Psychiatric Association, 2013.

One defining difference between these disorders is duration of symptoms.  Delusions that persist for 1 month or more support a diagnosis of delusional disorder. Brief psychotic disorders take on more of a sudden onset but typically last less than 1 month.  Another difference exists in observable behaviors.  Patients with delusional disorder may exist all around us in society.  They may not exhibit obviously odd or bizarre behavior, unless confronted with reality orientation.  Those with a presumed brief psychotic disorder may require supervision as their behavior shifts drastically different from their baseline.  Safety is of paramount priority as there is an increased risk for suicidal behavior during an acute episode.

As a clinician completing a comprehensive assessment, I would thus focus on the patient’s timeline of symptoms.  Chronic symptoms most likely would indicate more of a primary psychiatric issue. In comparing delusional disorder with brief psychotic disorder and their typical presentations with a longer duration of symptomology, I would be ruling out a differential diagnosis more consistent with schizophrenia.  Acute-onset symptoms, generally more of a change from a nonpsychotic state to a psychotic state, would involve determining if presentation is substance-induced versus medical etiology versus stress-induced response.  Any return to a baseline level of functioning within that month timeline would promote the brief psychotic disorder diagnosis.  Furthermore, I could also consider their age.  Most psychiatric illnesses caused by new-onset psychosis are more likely to develop in adolescence and young adulthood, and more on the differential for young children and older adults, (Vyas, et al. 2023).  Lastly, in ruling out other assessment factors that may influence a differential diagnosis, I would per routine assessment, evaluate for any family psychiatric history, personal medical history and or substance abuse history.

This discussion analysis was fascinating to me in myriad of ways. Despite years and years’ experience in the mental health setting, I was unaware that the origins of delusional disorder derive from paranoia.  In 1987, DSM-III-R reintroduced the concept with a new name: delusional disorder, (Gonzalez-Rodriguez, et al. 2022).  Paranoia, no longer in stature as a stand-alone diagnosis was for years considered a treatment-resistant condition.  Delusional disorder is now with the advent of antipsychotic medications and psychotherapy very much considered a treatable condition in today’s time.  However, with delusional disorder patients generally being older, imagine how many older married couples set in their ways and beliefs, some socially isolated and some not, may exist in our everyday society.  I’m going to presume that these instances of ‘shared psychosis’ or folie a deux are more prevalent than not.  They are a functional unit that despite the likely presence of fixed delusions, possibly persecutory with religious connotations in rural settings, manage to exist without further manifestations of psychiatric illness.   

• References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5-TR(5th ed.). American Psychiatric Association

González-Rodríguez, A., Monreal,  J. A., Natividad, M., & Seeman, M.V.  (2022). Seventy years of treating delusional disorder with antipsychotics: A historical perspective. Biomedicines, 10(12):3281. doi: 10.3390/biomedicines10123281. PMID: 36552037; PMCID: PMC9775530.

Vyas, C.M., Petriceks, A.H., Paudel, S., et al. (2023) Acute psychosis: differential diagnosis, evaluation, and management. The Primary Care Companion for CNS Disorders,25(2):22f03338.  Retrieved at https://doi.org/10.4088/PCC.22f03338