Psychotic disorders and schizophrenia are some of the most complicated and challenging diagnoses in the DSM. The symptoms of psychotic disorders may appear quite vivid in some patients; in others, symptoms may be barely observable. Additionally, symptoms may overlap among disorders. For example, specific symptoms, such as neurocognitive impairments, social problems, and illusions may exist in patients with schizophrenia but are also contributing symptoms of other psychotic disorders.

To Prepare:

Consider whether experiences of psychosis-related symptoms are always indicative of a diagnosis of schizophrenia. Think about alternative diagnoses for psychosis-related symptoms.
Complete your Comprehensive Psychiatric Evaluation, including your differential diagnosis and critical-thinking process to formulate a primary diagnosis.

THE QUESTION

Subjective:

Ø What details did the patient provide regarding their chief complaint and symptomology to derive your differential diagnosis?

Ø What is the duration and severity of their symptoms?

Ø How are their symptoms impacting their functioning in life?

Objective:

Ø What observations did you make during the psychiatric assessment? 

Assessment:

Ø Discuss the patient’s mental status examination results.

Ø What were your differential diagnoses?

Ø Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority.

Ø Compare the DSM-5-TR diagnostic criteria for each differential diagnosis and explain what DSM-5-TR criteria rule out the differential diagnosis to find an accurate diagnosis.

Ø Explain the critical-thinking process that led you to the primary diagnosis you selected. Include pertinent positives and pertinent negatives for the specific patient case.

Reflection notes:

Ø What would you do differently with this client if you could conduct the session over? 

Ø Include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!).

Ø Also include health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).