Shared psychotic disorder (folie à deux) — MCQs

10 questions

A 29-year-old woman is brought to the physician by her father because of a change in her behavior over the past 8 months. The father says that his daughter has become increasingly withdrawn; she has not answered any phone calls or visited her family and friends. The patient says that she has to stay at home because a foreign intelligence service is monitoring her. She thinks that they are using a magnetic field to read her mind. Mental status exam shows disjointed and perseverative thinking. She is anxious and has a flat affect. Which of the following is the most likely diagnosis?

A 26-year-old woman thinks poorly of herself and is extremely sensitive to criticism. She is socially inhibited and has never had a romantic relationship, although she desires one. Which of the following is the most likely diagnosis?

Two dizygotic twins present to the university clinic because they believe they are being poisoned through the school's cafeteria food. They have brought these concerns up in the past, but no other students or cafeteria staff support this belief. Both of them are average students with strong and weak subject areas as demonstrated by their course grade-books. They have no known medical conditions and are not known to abuse illicit substances. Which statement best describes the condition these patients have?

A 20-year-old male is involuntarily admitted to the county psychiatric unit for psychotic behavior over the past three months. The patient's mother explained to the psychiatrist that her son had withdrawn from family and friends, appeared to have no emotions, and had delusions that he was working for the CIA. When he spoke, his sentences did not always seem to have any connection with each other. The mother finally decided to admit her son after he began stating that he "revealed too much information to her and was going to be eliminated by the CIA." Which of the following diagnoses best fits this patient's presentation?

A 57-year-old man is brought to the emergency department by the police after he was found running around a local park naked and screaming late at night. During intake, the patient talks non-stop about the government spying on him and his family, but provides little useful information besides his name and date of birth. Occasionally he refers to himself in the third person. He refuses to eat anything and will only drink clear fluids because he is afraid of being poisoned. A medical records search reveals that the patient has been treated for psychotic behavior and occasional bouts of severe depression for several years. Today, his heart rate is 90/min, respiratory rate is 19/min, blood pressure is 135/85 mm Hg, and temperature is 37.0°C (98.6°F). On physical exam, he appears gaunt and anxious. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. CMP, CBC, and TSH are normal. A urine toxicology test is negative. What is the most likely diagnosis?

A 4-year-old girl is brought to the physician because her mother is concerned that she has been talking to an imaginary friend for 2 months. The child calls her friend 'Lucy' and says “Lucy is my best friend”. The child has multiple conversation and plays with the 'Lucy' throughout the day. The girl attends preschool regularly. She can copy a circle, tells stories, and can hop on one foot. Her maternal uncle has schizophrenia. Her parents are currently divorcing. The child's father has a history of illicit drug use. Physical examination shows no abnormalities. The mother is concerned about whether the child is acting out because of the divorce. Which of the following is the most appropriate next best step in management?

A 23-year-old man is brought to the emergency department by the police after attempting to assault a waiter with a broom. The patient states that the FBI has been following him his entire life and that this man was an agent spying on him. The patient has a past medical history of irritable bowel syndrome. His temperature is 98.0°F (36.7°C), blood pressure is 137/68 mmHg, pulse is 110/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is deferred due to patient combativeness. The patient is given haloperidol and diphenhydramine. The patient is later seen in his room still agitated. Intraosseous access is obtained. Which of the following is the best next step in management?

A 24-year-old woman presents with her husband to a physician with the complaints of fever, cough, and cold for the past 5 days. When the physician asks her if she has taken any medication for her symptoms, she answers, “My husband and I possess great powers to heal sickness. So I tried to cure my symptoms with my power. However, due to some divine cause, it did not work this time, so I thought I should seek medical advice”. Upon asking her husband about this, he says, "I have always had an immense ability to heal others through my powerful thoughts. It is only after I married her that she came to realize the powers within herself.” The physician examines her and prescribes appropriate medications for her symptoms. A year later, the woman presents again to the same physician with a cough and cold for 2 days. The physician asks her why did she not use her ‘power’ this time. She replies, “I separated from my husband 6 months ago, and I no longer believe that I nor my husband had any special power.” The woman denies any hallucinations, mood disturbances, and socio-occupational impairment to date. Which of the following conditions was this patient most likely suffering from?

A 44-year-old man is brought to the clinic by his wife insisting that her husband has been acting strange lately. He is a dentist by profession and has no known medical conditions. For the past 6 weeks, he has insisted on listening to the 6 PM news on the radio. He is adamant that the news anchor is referencing his life during the broadcasts. Apart from this, his wife states that her husband is fine. He and his wife deny the use of any prescribed medications or illicit drugs. He is a non-smoker and drinks alcohol only on social occasions. Physical examination and routine laboratory investigations are normal. What is the most likely diagnosis?

Q10

A 45-year-old man visits a psychiatrist with his wife asking for help with their ongoing family problem. The couple has been married for 20 years and the last 2 months the patient is fully convinced that his wife is cheating on him. He has hired numerous private investigators, who deny any such evidence for an extramarital affair. This persistent belief has begun to stress both sides of the family. The spouse has never in the past nor currently shown any evidence of infidelity. He is still able to hold a steady job and provide for his 2 children. Which of the following statements below is a diagnostic criterion for the above condition?

Shared psychotic disorder (folie à deux) US Medical PG Practice Questions and MCQs

Question 1: A 29-year-old woman is brought to the physician by her father because of a change in her behavior over the past 8 months. The father says that his daughter has become increasingly withdrawn; she has not answered any phone calls or visited her family and friends. The patient says that she has to stay at home because a foreign intelligence service is monitoring her. She thinks that they are using a magnetic field to read her mind. Mental status exam shows disjointed and perseverative thinking. She is anxious and has a flat affect. Which of the following is the most likely diagnosis?

A. Delusional disorder
B. Schizophrenia (Correct Answer)
C. Paranoid personality disorder
D. Schizophreniform disorder
E. Schizoid personality disorder

Explanation: ***Schizophrenia*** - The patient's presentation with **delusions of persecution and thought broadcasting**, accompanied by **disjointed, perseverative thinking**, and **flat affect** for 8 months, is highly indicative of schizophrenia. - Schizophrenia is characterized by a combination of positive symptoms (delusions, hallucinations, disorganized speech), negative symptoms (flat affect, social withdrawal), and cognitive symptoms (disorganized thinking) lasting for at least 6 months. *Delusional disorder* - Delusional disorder is characterized by the presence of **non-bizarre delusions for at least 1 month** without other significant psychotic symptoms or marked impairment in functioning. - The patient's symptoms include **disorganized thinking and flat affect**, which are not typical of delusional disorder and suggest a broader psychotic illness. *Paranoid personality disorder* - Characterized by a pervasive distrust and suspicion of others, where their motives are interpreted as malevolent, but **without the presence of frank delusions or other psychotic symptoms**. - The patient is experiencing **fixed, false beliefs (delusions)** involving mind reading and foreign intelligence, which goes beyond the pervasive distrust seen in paranoid personality disorder. *Schizophreniform disorder* - Schizophreniform disorder presents with symptoms identical to schizophrenia, but the **duration is between 1 and 6 months**. - Since the patient's symptoms have been present for **8 months**, it exceeds the diagnostic criteria for schizophreniform disorder, making schizophrenia a more likely diagnosis. *Schizoid personality disorder* - Characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of expression of emotions in interpersonal settings. - While the patient exhibits social withdrawal, this condition does **not involve delusions, disorganized thinking, or other psychotic features**.

Question 2: A 26-year-old woman thinks poorly of herself and is extremely sensitive to criticism. She is socially inhibited and has never had a romantic relationship, although she desires one. Which of the following is the most likely diagnosis?

A. Schizoid personality disorder
B. Paranoid personality disorder
C. Depression
D. Dysthymia
E. Avoidant personality disorder (Correct Answer)

Explanation: ***Avoidant personality disorder*** - Characterized by **social inhibition**, feelings of **inadequacy**, and **hypersensitivity to negative evaluation**, leading to avoidance of social interactions despite a desire for connection. - The patient's self-perception, sensitivity to criticism, and absence of romantic relationships are classic signs. *Schizoid personality disorder* - Individuals with schizoid personality disorder exhibit a pervasive pattern of **detachment from social relationships** and a restricted range of emotional expression. - Unlike avoidant personality disorder, they typically **do not desire social connection** and are indifferent to criticism or praise. *Paranoid personality disorder* - Marked by pervasive **distrust and suspiciousness of others**, interpreting their motives as malevolent. - This patient's symptoms are more focused on self-perception and social anxiety rather than paranoid ideation. *Depression* - Depression involves a sustained period of **low mood**, loss of interest or pleasure, and other vegetative symptoms, which are not explicitly described as the primary, long-standing issue here. - While feelings of worthlessness can occur in depression, the chronic, pervasive social inhibition and desire for relationships point away from a primary depressive episode as the sole diagnosis. *Dysthymia* - Dysthymia, or persistent depressive disorder, is characterized by a chronically depressed mood for at least two years, but it usually includes more pervasive depressive symptoms like low energy and anhedonia. - While it can involve poor self-esteem, it doesn't fully explain the specific pattern of social avoidance and hypersensitivity to criticism, especially the patient's desire for social connection, which is often dampened in dysthymia.

Question 3: Two dizygotic twins present to the university clinic because they believe they are being poisoned through the school's cafeteria food. They have brought these concerns up in the past, but no other students or cafeteria staff support this belief. Both of them are average students with strong and weak subject areas as demonstrated by their course grade-books. They have no known medical conditions and are not known to abuse illicit substances. Which statement best describes the condition these patients have?

A. A trial separation is likely to worsen symptoms.
B. The disorder is its own disease entity in DSM-5.
C. Antipsychotic medications are rarely beneficial.
D. Can affect two or more closely related individuals. (Correct Answer)
E. Cognitive behavioral therapy is a good first-line.

Explanation: ***Can affect two or more closely related individuals.*** - The shared delusional belief in **folie à deux**, also known as **shared psychotic disorder**, typically occurs in two or more people who are closely associated. - In this case, the **dizygotic twins** sharing the same delusional belief about being poisoned from cafeteria food fits this pattern. *A trial separation is likely to worsen symptoms.* - **Separating the individuals** involved in **folie à deux** is often a crucial step in treatment, as it can help break the cycle of shared delusion and allow for individual therapy. - Separation typically IMPROVES rather than worsens symptoms by removing the reinforcement of the shared delusion. *The disorder is its own disease entity in DSM-5.* - In the **DSM-5**, **folie à deux** is no longer considered a separate diagnostic category. - Instead, it is classified under **Other Specified Schizophrenia Spectrum and Other Psychotic Disorder** or **Unspecified Schizophrenia Spectrum and Other Psychotic Disorder**, with the specific context of shared delusion noted. *Antipsychotic medications are rarely beneficial.* - **Antipsychotics** are actually commonly used in treating folie à deux, particularly for the **primary individual** who initially developed the delusion. - They can be an important component of treatment, often combined with separation and psychotherapy. *Cognitive behavioral therapy is a good first-line.* - **Cognitive Behavioral Therapy (CBT)** can be beneficial, particularly after separation, to help individuals challenge and reframe their delusional beliefs. - However, the **first-line intervention** for shared psychotic disorder is **separation of the involved individuals**, followed by individual therapy (which may include CBT) and medication as needed.

Question 4: A 20-year-old male is involuntarily admitted to the county psychiatric unit for psychotic behavior over the past three months. The patient's mother explained to the psychiatrist that her son had withdrawn from family and friends, appeared to have no emotions, and had delusions that he was working for the CIA. When he spoke, his sentences did not always seem to have any connection with each other. The mother finally decided to admit her son after he began stating that he "revealed too much information to her and was going to be eliminated by the CIA." Which of the following diagnoses best fits this patient's presentation?

A. Schizophrenia
B. Brief psychotic disorder
C. Schizophreniform disorder (Correct Answer)
D. Schizoid personality disorder
E. Schizotypal personality disorder

Explanation: ***Schizophreniform disorder*** - The patient exhibits classic symptoms of **psychosis**, including delusions, disorganized speech, flat affect, and social withdrawal, which are characteristic of schizophrenia spectrum disorders. - The duration of symptoms (3 months) fits the criteria for **schizophreniform disorder**, which is when psychotic symptoms last between 1 month and 6 months. *Schizophrenia* - Schizophrenia requires symptoms to be present for at least **6 months**, including at least 1 month of active-phase symptoms. - While this patient's symptoms are consistent with psychotic disorder, the **duration criteria** for schizophrenia have not yet been met. *Brief psychotic disorder* - Brief psychotic disorder is characterized by symptoms lasting from **1 day to 1 month**, with eventual full return to premorbid functioning. - The patient's symptoms have persisted for **3 months**, exceeding the maximum duration for brief psychotic disorder. *Schizoid personality disorder* - This disorder is characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of emotional expression. - While the patient exhibits social withdrawal, the presence of **delusions, disorganized speech, and flat affect** indicates a psychotic disorder, not merely a personality disorder. *Schizotypal personality disorder* - Schizotypal personality disorder involves pervasive social and interpersonal deficits with **cognitive or perceptual distortions** and eccentric behaviors. - While it can involve odd beliefs, it does not typically include the prominent, fixed, and systematized **delusions and disorganized speech** seen in this patient's presentation.

Question 5: A 57-year-old man is brought to the emergency department by the police after he was found running around a local park naked and screaming late at night. During intake, the patient talks non-stop about the government spying on him and his family, but provides little useful information besides his name and date of birth. Occasionally he refers to himself in the third person. He refuses to eat anything and will only drink clear fluids because he is afraid of being poisoned. A medical records search reveals that the patient has been treated for psychotic behavior and occasional bouts of severe depression for several years. Today, his heart rate is 90/min, respiratory rate is 19/min, blood pressure is 135/85 mm Hg, and temperature is 37.0°C (98.6°F). On physical exam, he appears gaunt and anxious. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. CMP, CBC, and TSH are normal. A urine toxicology test is negative. What is the most likely diagnosis?

A. Schizophrenia
B. Major depressive disorder
C. Schizoaffective disorder (Correct Answer)
D. Brief psychotic disorder
E. Bipolar 1 disorder

Explanation: ***Schizoaffective disorder*** - The patient exhibits features of both a **mood disorder** (severe depression) and a **psychotic disorder** (delusions, disorganized behavior, referring to himself in the third person), which are key characteristics of schizoaffective disorder. - The history of **psychotic behavior** and **severe depression** over several years, with current presentation involving both prominent mood symptoms (agitation, gaunt appearance suggesting poor self-care due to mood) and psychotic features (paranoia, disorganized speech), supports this diagnosis over other psychotic or mood disorders. *Schizophrenia* - While the patient exhibits **psychotic symptoms** (delusions, disorganization), the history of "occasional bouts of severe depression" suggests a more prominent and recurring mood component than typically seen in schizophrenia. - In schizophrenia, mood symptoms are often confined to brief periods relative to the duration of the psychotic illness or are not a prominent and defining feature. *Major depressive disorder* - This diagnosis is incorrect because the patient displays clear and pervasive **psychotic symptoms** such as paranoia, disorganized speech, and bizarre behavior (running naked, screaming), which are beyond what is typically seen in major depressive disorder with psychotic features (where psychosis is congruent with the depressive theme). - The historical pattern of **psychotic behavior** occurring separately from or alongside depressive episodes points away from a primary diagnosis of major depressive disorder. *Brief psychotic disorder* - This diagnosis is characterized by psychotic symptoms lasting **less than one month**, with an eventual full return to premorbid functioning. - The patient's history of **several years** of psychotic behavior and severe depression rules out this acute and time-limited condition. *Bipolar 1 disorder* - While bipolar 1 disorder can feature **psychotic symptoms** during manic or depressive episodes, the presentation here emphasizes persistent psychotic features (delusions of being spied on, fear of poisoning) that are not always directly tied to mood episodes or are more enduring than typical for bipolar disorder. - The long-standing history of both **psychotic and depressive episodes** suggests a more integrated condition of mood and psychosis rather than distinct episodes as seen in bipolar 1 disorder.

Question 6: A 4-year-old girl is brought to the physician because her mother is concerned that she has been talking to an imaginary friend for 2 months. The child calls her friend 'Lucy' and says “Lucy is my best friend”. The child has multiple conversation and plays with the 'Lucy' throughout the day. The girl attends preschool regularly. She can copy a circle, tells stories, and can hop on one foot. Her maternal uncle has schizophrenia. Her parents are currently divorcing. The child's father has a history of illicit drug use. Physical examination shows no abnormalities. The mother is concerned about whether the child is acting out because of the divorce. Which of the following is the most appropriate next best step in management?

A. Reassure the mother (Correct Answer)
B. Perform MRI of the brain
C. Schedule psychiatry consult
D. Inform Child Protective Services
E. Screen urine for drugs

Explanation: ***Reassure the mother*** - Imaginary friends are a **normal developmental phenomenon** in preschool-aged children, often associated with creativity and good social skills. - The child's developmental milestones (copying a circle, hopping, telling stories) are appropriate for her age, indicating **healthy cognitive and motor development**. *Perform MRI of the brain* - There are **no neurological symptoms** or concerning signs in this case that would warrant an MRI of the brain. - Imaginary friends are not indicative of a brain abnormality or neurological disorder. *Schedule psychiatry consult* - A psychiatry consult is **not indicated** as the child's behavior is developmentally appropriate. - While there is a family history of schizophrenia and parental stress, the child is exhibiting typical childhood play and not symptoms of a mental health disorder. *Inform Child Protective Services* - There is **no evidence of child abuse or neglect** in the provided information. - Although the parents are divorcing and the father has a history of drug use, there are no specific concerns raised about the child's safety or well-being that would require CPS involvement. *Screen urine for drugs* - A drug screen is **not relevant** to the child's behavior or a concern for drug use by the child. - While the father has a history of illicit drug use, this does not automatically imply the child is being exposed to drugs, and the child's symptoms are unrelated to drug exposure.

Question 7: A 23-year-old man is brought to the emergency department by the police after attempting to assault a waiter with a broom. The patient states that the FBI has been following him his entire life and that this man was an agent spying on him. The patient has a past medical history of irritable bowel syndrome. His temperature is 98.0°F (36.7°C), blood pressure is 137/68 mmHg, pulse is 110/min, respirations are 15/min, and oxygen saturation is 99% on room air. Physical exam is deferred due to patient combativeness. The patient is given haloperidol and diphenhydramine. The patient is later seen in his room still agitated. Intraosseous access is obtained. Which of the following is the best next step in management?

A. Complete blood count
B. Urine toxicology (Correct Answer)
C. Thyroid stimulating hormone level
D. Assess for suicidal ideation
E. Syphilis screening

Explanation: ***Urine toxicology*** - A definitive diagnosis of **substance-induced psychosis** or **agitation** can be made through a urine toxicology screen, which is crucial given the patient's acute agitated state and paranoid delusions. - Identification of specific substances helps guide further management, as some intoxicants or withdrawal states require targeted interventions. *Complete blood count* - While a CBC assesses for infection or anemia, it is unlikely to reveal the primary cause of acute **agitation** and **paranoid delusions** in this context. - This diagnostic test would be more relevant if there were signs of infection (e.g., fever, localized pain) or significant blood loss. *Thyroid stimulating hormone level* - Although **thyroid dysfunction** can cause psychiatric symptoms, it typically manifests more gradually and rarely presents with such an acute onset of severe **agitation** and **paranoia**. - Other clinical signs of thyroid dysfunction, such as weight changes or altered energy levels, are also absent. *Assess for suicidal ideation* - While important in any psychiatric evaluation, assessing for **suicidal ideation** is a part of mental status examination. Given the patient's current severe agitation and combativeness, obtaining a reliable assessment of suicidal ideation is extremely difficult and secondary to managing the acute behavioral crisis and identifying immediate medical causes. - The immediate priority is to understand the etiology of his acute behavioral disturbance and ensure safety, before a full psychiatric history can be reliably obtained. *Syphilis screening* - **Neurosyphilis** can cause neuropsychiatric symptoms, including psychosis, but it is typically a chronic condition with a more insidious onset. - In an acutely agitated patient with sudden onset of paranoid delusions, syphilis is a less likely immediate cause compared to substance use.

Question 8: A 24-year-old woman presents with her husband to a physician with the complaints of fever, cough, and cold for the past 5 days. When the physician asks her if she has taken any medication for her symptoms, she answers, “My husband and I possess great powers to heal sickness. So I tried to cure my symptoms with my power. However, due to some divine cause, it did not work this time, so I thought I should seek medical advice”. Upon asking her husband about this, he says, "I have always had an immense ability to heal others through my powerful thoughts. It is only after I married her that she came to realize the powers within herself.” The physician examines her and prescribes appropriate medications for her symptoms. A year later, the woman presents again to the same physician with a cough and cold for 2 days. The physician asks her why did she not use her ‘power’ this time. She replies, “I separated from my husband 6 months ago, and I no longer believe that I nor my husband had any special power.” The woman denies any hallucinations, mood disturbances, and socio-occupational impairment to date. Which of the following conditions was this patient most likely suffering from?

A. Brief psychotic disorder
B. Folie à deux (Correct Answer)
C. Culture-specific psychosis
D. Residual phase of schizophrenia
E. Schizophreniform disorder

Explanation: ***Folie à deux*** - This condition is characterized by a **shared delusional belief** between two or more people who are in a close relationship. One person, typically the dominant partner, has a primary psychotic disorder with delusions, and the other person adopts these delusions. - In this case, the husband likely initiated the delusional belief about healing powers, which his wife subsequently adopted. Her belief resolved when she separated from him, indicating the **dependent nature** of her delusion. *Brief psychotic disorder* - This disorder involves a sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech or behavior) lasting more than one day but less than one month, with eventual full return to premorbid functioning. - While the patient exhibited a delusional belief, the **shared nature** with her husband and the **resolution upon separation** are more characteristic of folie à deux than an independent brief psychotic episode. *Culture-specific psychosis* - This refers to psychotic symptoms and syndromes that are recognized within a particular culture and associated with specific cultural explanations. - Although some cultures may have beliefs in spiritual healing, the specific scenario of a **delusional belief shared between two individuals** in a close relationship points more directly to folie à deux rather than a broad culture-specific psychosis. *Residual phase of schizophrenia* - This phase occurs after an acute episode of schizophrenia, where prominent positive symptoms (delusions, hallucinations) have subsided, but milder negative symptoms (e.g., social withdrawal, blunted affect) or attenuated positive symptoms persist. - The patient explicitly **denies hallucinations, mood disturbances, and socio-occupational impairment**, and her delusional belief was directly linked to her husband, which does not fit the diagnostic criteria for a residual phase of schizophrenia. *Schizophreniform disorder* - This disorder is characterized by symptoms similar to schizophrenia (delusions, hallucinations, disorganized speech, negative symptoms) but lasts for more than one month and less than six months. - The patient's presentation does not describe the broad range of symptoms or the duration required for a schizophreniform disorder, and the **resolving nature of her delusion upon separation** is a key differentiating factor.

Question 9: A 44-year-old man is brought to the clinic by his wife insisting that her husband has been acting strange lately. He is a dentist by profession and has no known medical conditions. For the past 6 weeks, he has insisted on listening to the 6 PM news on the radio. He is adamant that the news anchor is referencing his life during the broadcasts. Apart from this, his wife states that her husband is fine. He and his wife deny the use of any prescribed medications or illicit drugs. He is a non-smoker and drinks alcohol only on social occasions. Physical examination and routine laboratory investigations are normal. What is the most likely diagnosis?

A. Persecutory delusions
B. Delusion of control
C. Erotomanic delusions
D. Delusion of reference (Correct Answer)
E. Grandiose delusions

Explanation: ***Delusion of reference*** - This is characterized by the belief that **events, objects, or people in the environment** have a particular and unusual significance, often of a negative or threatening nature, specifically directed at oneself. - The man's belief that the **news anchor is referencing his life** during broadcasts, despite no actual connection, is a classic presentation of a delusion of reference. *Persecutory delusions* - **Persecutory delusions** involve the belief that one is being tormented, followed, tricked, spied on, or ridiculed. - While the delusion involves external references, it does not explicitly state that the news anchor is actively *harming* or *conspiring against* him, making it less specific than a delusion of reference, which describes the belief that common occurrences refer to oneself. *Delusion of control* - This delusion involves the belief that **one's thoughts, feelings, impulses, or actions are not one's own** but are being imposed or controlled by some external force. - The patient's symptom is about external events referring to him, not about his internal experiences being controlled by an external force. *Erotomanic delusions* - This involves the belief that **another person, usually of higher status, is in love with the individual**. - There is no indication in the scenario that the man believes the news anchor is in love with him. *Grandiose delusions* - This is characterized by beliefs of **inflated worth, power, knowledge, identity, or a special relationship to a deity or famous person**. - The patient's delusion does not involve exaggerated self-importance or a belief in special abilities, but rather a misinterpretation of external communications.

Question 10: A 45-year-old man visits a psychiatrist with his wife asking for help with their ongoing family problem. The couple has been married for 20 years and the last 2 months the patient is fully convinced that his wife is cheating on him. He has hired numerous private investigators, who deny any such evidence for an extramarital affair. This persistent belief has begun to stress both sides of the family. The spouse has never in the past nor currently shown any evidence of infidelity. He is still able to hold a steady job and provide for his 2 children. Which of the following statements below is a diagnostic criterion for the above condition?

A. Delusions are better explained by another DSM-5 diagnosis
B. Must have prominent hallucinations in addition to delusions
C. Daily functioning must be impaired
D. Must have active symptoms for 1 month followed by 6 months total duration
E. Delusions must be non-bizarre (Correct Answer)

Explanation: ***Delusions must be non-bizarre*** - This is a key diagnostic criterion for **delusional disorder**, where the delusions are plausible and involve situations that could conceivably happen, even if they aren't true (e.g., being cheated on, followed, or having a disease). - The patient's belief that his wife is cheating on him, despite evidence to the contrary, is a **plausible but false belief**, fitting the definition of a non-bizarre delusion. *Delusions are better explained by another DSM-5 diagnosis* - This is an **exclusion criterion**; if delusions are better accounted for by another disorder (e.g., schizophrenia, mood disorder with psychotic features, substance-induced psychosis), then delusional disorder is not diagnosed. - The patient's presentation does not suggest other DSM-5 diagnoses that would better explain the delusions. *Must have prominent hallucinations in addition to delusions* - **Prominent hallucinations** are usually associated with disorders like **schizophrenia** or **schizoaffective disorder**. - In **delusional disorder**, hallucinations, if present, are not prominent and are typically related to the delusional theme. *Daily functioning must be impaired* - A distinguishing characteristic of delusional disorder is that **daily functioning is typically not markedly impaired**, and behavior is not obviously bizarre, apart from the direct impact of the delusion. - The patient in the vignette is able to hold a steady job and care for his children, which supports this point. *Must have active symptoms for 1 month followed by 6 months total duration* - This criterion (1 month active symptoms, 6 months total duration) is specific to the diagnosis of **schizophrenia**, not delusional disorder. - For delusional disorder, the duration of delusions is **1 month or longer**, without necessarily requiring a specific active phase or total duration like in schizophrenia.

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