On an inpatient unit, a 31-year-old single woman reports experiencing auditory and visual hallucinations for 1 month, followed by a full major depressive episode for 2 months. The psychotic symptoms and depressive symptoms occurred concurrently for 3 months, until the depressive symptoms resolved with pharmacotherapy and psychotherapy. The psychotic symptoms persisted for 2 more weeks, at which time the patient checked herself into the hospital. Which diagnosis best fits this clinical picture?
Schizoaffective disorder
Bipolar disorder with psychotic features
Major depressive disorder with psychotic features
Schizophrenia and unspecified depressive disorder
The Correct Answer is A
Choice A reason: Schizoaffective disorder is diagnosed when psychotic symptoms occur both during and outside of mood episodes. In this case, the patient had psychosis before, during, and after a major depressive episode, fulfilling the criteria for schizoaffective disorder, depressive type.
Choice B reason: Bipolar disorder with psychotic features requires the presence of manic or mixed episodes, which are not described here. The absence of mania excludes bipolar disorder from consideration.
Choice C reason: Major depressive disorder with psychotic features involves psychosis that occurs exclusively during depressive episodes. Since the patient’s psychotic symptoms persisted beyond the resolution of depression, this diagnosis is not appropriate.
Choice D reason: Schizophrenia requires at least 6 months of continuous symptoms, including 1 month of active-phase symptoms. The timeline here is insufficient for schizophrenia, and the depressive symptoms are not “unspecified”—they meet criteria for a major depressive episode.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A reason: This question is designed to assess for manic or hypomanic episodes, where decreased need for sleep is a hallmark symptom. While related to sleep, it is more specific to mood disorders and not a general sleep assessment.
Choice B reason: This question targets hallucinations and is part of the psychosis screening. It does not relate to sleep patterns or quality.
Choice C reason: This question assesses for dissociative symptoms, such as amnesia or identity disturbances. It is unrelated to sleep.
Choice D reason: This question directly addresses sleep adequacy and quality, making it the most appropriate for evaluating the sleep domain in a psychiatric ROS. It helps identify insomnia, hypersomnia, or other sleep disturbances.
Correct Answer is D
Explanation
Choice A reason: Bipolar disorder with psychotic features requires the presence of manic or depressive episodes that meet full diagnostic criteria, with psychotic symptoms occurring exclusively during mood episodes. This patient’s psychosis is chronic and independent of mood symptoms, which rules out bipolar disorder.
Choice B reason: Schizoaffective disorder requires mood episodes (either depressive or manic) that meet full diagnostic criteria and occur concurrently with psychotic symptoms. Additionally, psychotic symptoms must persist for at least two weeks in the absence of mood symptoms. Since the depressive symptoms in this case do not meet criteria for major depression, schizoaffective disorder is not appropriate.
Choice C reason: Schizophreniform disorder is diagnosed when schizophrenia-like symptoms persist for more than one month but less than six months. This patient has had symptoms for four years, which exceeds the time frame for this diagnosis.
Choice D reason: Schizophrenia with unspecified depressive disorder is the most accurate diagnosis. The patient has a chronic course of schizophrenia and has experienced depressive symptoms that do not meet full criteria for major depressive disorder. This combination fits the clinical picture.
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