A 20-year-old man repeatedly cross-dresses in privacy. He experiences sexual arousal during cross-dressing but has a normal sexual relationship with his girlfriend otherwise.
Which of the following is the appropriate diagnosis?
B. The patient described in this question achieves sexual arousal by cross-dressing and retains heterosexual relationships. He is exhibiting fetishistic transvestism, a paraphilia or disorder of sexual preference. A patient with gender identity disorder will have dysphoria for biologically assigned gender (most often male sex) and will strongly prefer to change his appearance to that of opposite sex, through hormonal treatment or corrective surgeries. Sexual dysfunction of arousal phase refers to sexual aversion or lack of interest in having sexual intercourse. The scenario does not reflect the person’s sexual orientation. Sexual orientation refers to homosexuality, heterosexuality, or bisexuality preference of an individual.
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A 19-year-old boy shows recent onset avolition, flat affect, preoccupation with religion and philosophy. He preferred being solitary most of his childhood. Most probable diagnosis include:
C. The disorganised or hebephrenic schizophrenia is characterized by significant disruption in behaviour with some disinhibition. It characteristically has an earlier onset – around adolescence. These patients have pronounced formal thought disturbances, often with inappropriate emotional responses and incongruity of expression. In negative schizophrenia a deficit state starts without any positive psychotic symptoms. Residual schizophrenia is characterized by a history of florid positive symptoms in the past with current presentation suggestive of a negative syndrome. Schizoaffective disorder will have florid affective symptoms at the same time as prominent psychotic features.
Which of the following with regard to cannabis use in schizophrenia is incorrect?
E. Cannabis intoxication can alter perceptual accuracy; colours may seem brighter with subjective slowing of the time. Depersonalization and derealization could occur. Cannabis-induced psychotic disorder is rare; transient paranoid ideation is more common. Hemp insanity refers to transient psychosis associated with heavy use of very potent cannabis. This is very rare and does not mimic schizophrenia in its course. It is generally believed that earlier onset of heavy potent cannabis use for a long duration can result in schizophrenia, at least in a group of genetically predisposed individuals. Cannabis can induce a sense of euphoria and relaxation, prompting self medication in patients with established schizophrenia.
A 38-year-old man had his most recent episode of schizophrenic relapse 6 months ago. Though he responded well to antipsychotics he still hears occasional voices. Currently he has lost sleep, appetite, and weight and complains of low energy and pervasive anhedonia with low mood.
This description best fits which of the following diagnosis?
C. Post schizophrenic depression is recognized in ICD-10 as a major depressive episode which starts within 12 months of the most recent psychotic episode; while residual psychotic symptoms can be present they must not be prominent. It is noted that such patients are likely to have had poor premorbid adjustment, schizoid traits, and more insidious onset of their psychotic symptoms. Family history of a mood disorder can increase the likelihood of developing post schizophrenic depression. It may be associated with a less-favourable prognosis, higher relapse, and a higher rate of suicide. DSM-IV TR considers postschizophrenic depression only as a research category.
A 37-year-old lady has an eccentric hobby of preserving animal carcasses found on roadside. She also has suspiciousness, magical thinking, and obsessive ruminations though she does not resist them. She has never had a diagnosis of schizophrenia.
B. Persons with schizotypal (personality) disorder are strikingly peculiar, with magical thinking, occult beliefs, referential ideas, illusions, and obsessions without resistance. A significant number of patients claim paranormal experiences and clairvoyance. It occurs in about 3% of the population. A strikingly higher incidence is noted in those who are biological relatives of patients with schizophrenia. This disorder is so close to schizophrenia that ICD still includes schizotypal disorder together with other schizophrenia syndromes in Chapter F20–29.
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