Differential Diagnosis of Schizophrenia and Depression

Schizophrenia Differential Diagnosis

• Paranoid: Preoccupation with 1+2 delusions or frequent auditory hallucinations
• Disorganized: Disorganized speech & behavior. Flat or inappropriate affect.
• Catatonic: 2 motoric negatives, mutism, excessive activity

Treatment Options

• Psychotherapy
• Neuroleptics (5-HTA12 antagonist)
• Electroconvulsive therapy

Depression

Major Depression

• At least 5 symptoms for 2 weeks
• Depressed mood
• Loss of pleasure, anhedonia
• Appetite disturbance (up or down)
• Hypersomnia or insomnia
• Psychomotor agitation
• Fatigue, loss of energy every day
• Feelings of worthlessness
• Decreased ability to concentrate
• Recurrent thoughts of death
• Clinically significant distress
• Not explained by substance use
• No schizoaffective disorder
• Never been a manic episode

Types:

• Recurrent vs. non-recurrent

Treatment:

• Antidepressants
• Psychotherapy
• Talk therapy
• Prevention of episodes by avoiding triggers

Alcohol Withdrawal Stages

Stage I (6-36 hours):

• High blood pressure
• Increased heart rate
• Low-grade fever
• Diaphoresis

Stage II (12-48 hours):

• Visual, auditory, tactile hallucinations
• Increased heart rate
• Pallor
• Seizures
• Alcohol withdrawal delirium

Stage III (6-48 hours):

• Grand mal seizures

Stage IV (48-96 hours):

• Most severe
• Delirium tremens
• Paranoid delusions
• Severe autonomic nervous system hyperactivity
• Tachycardia
• High blood pressure
• Fever

General Symptoms:

• Anxiety
• Depression
• Irritation
• Fatigue
• Tremor
• Palpitations
• Sweating
• Headache
• Vomiting
• Seizures

Types of Hallucinations:

• Elementary
• Simple
• Complex (multiple senses)
• Induced (same hallucination to a group of people)
• Stereotype (same voice and image)
• Hypnagogic (while falling asleep)
• Hypnopompic (while waking up)

Medical Conversation Stages:

O-C-D-C

• Orientation Stage:
  • Reasons to visit the doctor
  • Ask open questions (What happened? How can I help you?)
  • Observe non-verbals
  • Goal: Find the ailment
• Clarification Stage:
  • Differentiation in progress
  • Doctor takes initiative
  • Semi-open/closed questions
  • Diagnosis clears up
• Definition Stage:
  • Collaboration
  • Explain the etiology of the disease, treatment, and diagnosis
• Conclusion:
  • Prescription, filling document

Personality Disorders

• Psychiatry: Personality disorders (28-34)
• Diagnosis criteria of specific personality disorders:
  • Changes in one’s personality that are different from that of society
  • Stereotypic behavior that affects social & occupational function
  • Stereotypic features begin
  • May cause distress
• Not an ER problem
• Person rarely knows there is a problem
• 10 personality disorders grouped according to clusters A, B, and C

Cluster A:

• Definition:
  • Paranoid (accusative)
  • Schizoid (aloof)
  • Schizotypal (awkward)

• Paranoid (accusative):
  • Assume others are out to get them, manipulate them, or talk behind their back.
  • Best to be honest with them.
  • Hold grudges.
• Schizoid (aloof):
  • Superficial relationships
  • In isolation
  • Not interested in others, not because they can’t communicate properly or fear rejection (social anxiety)
  • Physical contact less pleasurable (sexual activity, holding hands)
  • Prefer to be alone
  • Blunt emotions (not positive or negative)
• Schizotypal (awkward):
  • Appear awkward
  • Excessive magical thinking
  • Superficial mystical beliefs
  • Self-centered; everything that happens in the world is somehow related to them.
  • Leads to overconfidence and self-centered way of speaking.
  • Few social relationships but have a strong desire to have them but not maintain them due to their magical thinking.

Cluster B:

• Types:
  • Antisocial
  • Borderline
  • Histrionic
  • Narcissistic
• Genetic relationship with mood disorders: depression and bipolar
• Substance abuse disorder

• Antisocial:
  • Does not always mean they are not social.
  • They can be charming and charismatic.
  • Disregard moral values and societal norms.
  • Little empathy.
  • Poor impulse control.
  • Willing to hurt others if it helps their agenda.
  • Must be 18+
• Borderline:
  • Unstable mood
  • Intense joy to rage in a short period of time
  • Relationships are very dramatic and unstable
  • Splitting: things are completely good or completely bad
  • Threatened by abandonment
• Histrionic:
  • Attention-seeking
  • Excessive emotionality
  • Manipulate situations to draw attention to themselves
  • Want to be the center of attention
  • Plenty of superficial relationships but no deep connections
  • People view them as shallow