robin082006
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You are an internist making your rounds at a nursing home in the locality. You find the nurses complaining about a 72-year-old male patient, who frequently masturbates in front of them. He has been on treatment with olanzapine for years, for schizophrenia. He frequently gets agitated and bangs his head against the wall. On interviewing him, you find his thought process devoid of any hallucinations or delusions. He laughs inappropriately when questioned during the interview. Based on his presentation, he falls into the category of:
A. Schizophrenia, catatonic type
B. Schizophrenia, undifferentiated type
C. Schizophrenia, disorganized type
D. Schizophrenia, paranoid type
E. Schizophrenia, residual type
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| ed222
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B
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| webjeee
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E. Schizophrenia, residual type?
his thought process devoid of any hallucinations or delusions
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| robin082006
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answer is c
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| blueocean
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I have to admit I picked E but if the patient takes olanzapine should be devoided by hallucinations; the key for the answer is disinhibited behavior= disorganized type .
I don't know if my logic is right!
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| dipsite
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See the age of the patient in above case is 72 years ..So exclude paranoid type and disorganised type.
Paranoid type-late twenties or thirties.
Disorganised type-age before 25.
Its correct that behaviour is devoid of Delusion/Hallucination so answer should be Residual type..Also "Laughs inappropriately" points to residual type..
But don't you think it to be "Excited catatonia"...
For undifferntiated type it should have characteristics of two or more types which is not the case above..
Bottomline : Answer strongly in favour of "Residual" Type.
Always make out the answer by exclusion it really helps like I excluded Paranoid and Disorganised in the very beginning.
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| dipsite
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Final Answer "undifferentiated type" because "he gets agitated" and "residual" type patients have "negative" symptoms predominantly...Also he frequently masturbates in front of people that is not a character of "Residual" type (I wonder how can a 72 year old man masturbate he he!!)..
Final Answer "undifferentiated type"
What is the answer?
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| Aashi
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The answer is C..and robin has already submitted the answer.. the BUZZ word in the hx---->that the pt 'masturbates' in front of the nurses--->this is a dis inhibited BIZZARE behaviour-->Which is the HINT to schizoprenia of disorganised type..none of the other classes of schizopherina has BIZZARE behaviour nor r they disinhibited, and so the answer here is defintely C...
GL
Edited by Aashi on 02/26/07 - 11:14 AM
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| mjl1717
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Aashi wrote:
The answer is C..and robin has already submitted the answer.. the BUZZ word in the hx---->that the pt 'masturbates' in front of the nurses--->this is a dis inhibited BIZZARE behaviour-->Which is the HINT to schizoprenia of disorganised type..none of the other classes of schizopherina has BIZZARE behaviour nor r they disinhibited, and so the answer here is defintely C...
GL
yes, this explaination is important and robin good q...
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| dipsite
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Some features of Disorganised type of Scizophrenia:-
1.Younger than 25 years
2.Flat or inapproppriate affect.
3.Poor-grooming,personal appearance and organisation
4.Bizzare behaviour
5.Mannerism(abnormal exaggeration of style,habit,speech or action)
6.Mirror Gazing for long periods.
7.Thought Disorder
8.Senseless giggling.
9.oddities of behaviour
10.Social Withdrawal.
Answer may be Disorganised type but age is 72 years..
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| dipsite
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Some characteristics of Paranoid Schizophrenia:-
1.Hallucinations have a persecutory or grandiose content.
2.Age of onset is late twenties or thirties.
3.NO disturbance of speech,affect,motor
4.Patient appears apprehensive.
Hope you guys find this info useful.
Reference:- Niraj Ahuja,High Yield Psychiatry,Kaplan Notes.
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| dipsite
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What is meant by "disinhibited behaviour"?
I am not at all satisfied with the answer.
Where did you take the question from?
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| mjl1717
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good topic to beat into the ground! Ill return..
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