NR 547 Differential Diagnosis in Psychiatric-Mental Health
across the Lifespan Practicum - Chamberlain
NR 547 Week 7
1. Rico is a 30-year-old who is referred to the clinic by his wife, Tracy. Rico and
Tracy have been married for eight years. She states that in the past year, his
behaviors have become disquieting. He constantly accuses her of cheating on
him. He often takes her phone and scrolls through her calls, texts, and social
media accounts. He is suspicious about texts she receives from coworkers
and other acquaintances. He starts frequent arguments with her about where
she has been and who she was with, and often replies to her responses
with sarcastic, "mean" comments. Tracy is concerned about Rico's paranoid
behavior.
Based on DSM-5-TR (APA, 2022) criteria, does Rico meet diagnostic criteria for
paranoid personality disorder?
yes
no
unable to determine: No
Rationale: Although Rico meets diagnostic criteria of preoccupation about his wife's
loyalty, reads into benign events, and has suspicions of his wife's fidelity, these
symptoms have developed within the past year. A diagnosis of paranoid personality
disorder requires the presence of symptoms by early adulthood and in a variety
of contexts. Alternate diagnostic considerations include substance use disorder,
schizophrenia, or bipolar or depressive disorder with psychotic features.
,2. Crispin is a 33-year-old who presents after experiencing auditory hallucina-
tions. He states he has heard voices "grumbling at him" about three or four
times in the past week, for about 15 minutes each time. He is employed as
a data analyst and works from home. He does not have hobbies or activities
outside of work. He does not use alcohol, marijuana, or illicit drugs; he smokes
cigarettes. He lives with his sister, who is getting married in a month; he will
be moving into an apartment with a roommate whom he found on Craigslist.
He is stressed about the move. He states he has no friends and prefers it that
way, and he has felt this way since adolescence. He is not looking forward
to his sister's wedding as he prefers to be alone. When asked if he would be
bringing a date to the wedding, he noted that he has never considered dating,
as he doesn't have use for it; he endorses a lack of interest in sex.
: Schizoid personality disorder
Rationale: Crispin meets DSM-5 criteria for schizoid personality disorder. He is
detached from social relationships, prefers solitary activities, lacks close friends,
and lacks interest in sexual experiences. He has experienced these traits since
adolescence. Clients with a schizoid personality disorder may have brief periods of
psychotic episodes when stressed.
3. Heloise is a 27-year-old who presents to the clinic with symptoms of de-
pressed mood. She states that she has been stressed by a recent wildfire that
started near her community. She believes that she caused the fire to spread
because she was thinking about it too much. She also says that she hears the
animals crying out to her as they are 2succumbing
/ 11
to the fire. She states she
has never had friends, other than her sister because she gets very anxious
around other people. She was teased throughout high school and labeled a
"weirdo" for her choice of clothing and speech patterns.
Which of the following diagnoses is the most appropriate for Heloise?
Schizotypal personality disorder
Schizoid personality disorder: Schizotypal personality disorder
, Rationale: Heloise meets diagnostic criteria for schizotypal personality disorder. She
exhibits ideas of reference, magical thinking, unusual perceptual experiences, has
an odd appearance and speech patterns, social anxiety, and lacks close friends. The
traits have been present since she was in high school.
4. Personality disorders involve:: -"an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the individual's culture" per
the Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5)
-pervasive unhealthy patterns of thinking, functioning, and behaving
-usually begins by late adolescence or early adulthood and causes distress or
problems in functioning
-affect at least two of these areas:
• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one's behavior
-Diagnosis is only applicable to individuals 18 or older
• People under 18, personalities are still developing
-3 clusters
• A, B, C
-occur in 10-20% of the general population and about 50% of psychiatric clients
5. personality disorders should not be diagnosed unless:: the symptoms are
long-standing and impact functioning.
6. Cluster A: Cluster A personality disorders are characterized by odd or eccentric
thinking or behavior.
-PARANOID PERSONALITY DISORDER
• long-standing, pervasive mistrust or suspicion of others and their motives
• may refuse to take responsibility for their feelings, often assigning responsibility to
others
• may appear angry, irritable, or hostile, perceiving innocent remarks as personal
across the Lifespan Practicum - Chamberlain
NR 547 Week 7
1. Rico is a 30-year-old who is referred to the clinic by his wife, Tracy. Rico and
Tracy have been married for eight years. She states that in the past year, his
behaviors have become disquieting. He constantly accuses her of cheating on
him. He often takes her phone and scrolls through her calls, texts, and social
media accounts. He is suspicious about texts she receives from coworkers
and other acquaintances. He starts frequent arguments with her about where
she has been and who she was with, and often replies to her responses
with sarcastic, "mean" comments. Tracy is concerned about Rico's paranoid
behavior.
Based on DSM-5-TR (APA, 2022) criteria, does Rico meet diagnostic criteria for
paranoid personality disorder?
yes
no
unable to determine: No
Rationale: Although Rico meets diagnostic criteria of preoccupation about his wife's
loyalty, reads into benign events, and has suspicions of his wife's fidelity, these
symptoms have developed within the past year. A diagnosis of paranoid personality
disorder requires the presence of symptoms by early adulthood and in a variety
of contexts. Alternate diagnostic considerations include substance use disorder,
schizophrenia, or bipolar or depressive disorder with psychotic features.
,2. Crispin is a 33-year-old who presents after experiencing auditory hallucina-
tions. He states he has heard voices "grumbling at him" about three or four
times in the past week, for about 15 minutes each time. He is employed as
a data analyst and works from home. He does not have hobbies or activities
outside of work. He does not use alcohol, marijuana, or illicit drugs; he smokes
cigarettes. He lives with his sister, who is getting married in a month; he will
be moving into an apartment with a roommate whom he found on Craigslist.
He is stressed about the move. He states he has no friends and prefers it that
way, and he has felt this way since adolescence. He is not looking forward
to his sister's wedding as he prefers to be alone. When asked if he would be
bringing a date to the wedding, he noted that he has never considered dating,
as he doesn't have use for it; he endorses a lack of interest in sex.
: Schizoid personality disorder
Rationale: Crispin meets DSM-5 criteria for schizoid personality disorder. He is
detached from social relationships, prefers solitary activities, lacks close friends,
and lacks interest in sexual experiences. He has experienced these traits since
adolescence. Clients with a schizoid personality disorder may have brief periods of
psychotic episodes when stressed.
3. Heloise is a 27-year-old who presents to the clinic with symptoms of de-
pressed mood. She states that she has been stressed by a recent wildfire that
started near her community. She believes that she caused the fire to spread
because she was thinking about it too much. She also says that she hears the
animals crying out to her as they are 2succumbing
/ 11
to the fire. She states she
has never had friends, other than her sister because she gets very anxious
around other people. She was teased throughout high school and labeled a
"weirdo" for her choice of clothing and speech patterns.
Which of the following diagnoses is the most appropriate for Heloise?
Schizotypal personality disorder
Schizoid personality disorder: Schizotypal personality disorder
, Rationale: Heloise meets diagnostic criteria for schizotypal personality disorder. She
exhibits ideas of reference, magical thinking, unusual perceptual experiences, has
an odd appearance and speech patterns, social anxiety, and lacks close friends. The
traits have been present since she was in high school.
4. Personality disorders involve:: -"an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the individual's culture" per
the Diagnostic and Statistical Manual on Mental Disorders, Fifth Edition (DSM-5)
-pervasive unhealthy patterns of thinking, functioning, and behaving
-usually begins by late adolescence or early adulthood and causes distress or
problems in functioning
-affect at least two of these areas:
• Way of thinking about oneself and others
• Way of responding emotionally
• Way of relating to other people
• Way of controlling one's behavior
-Diagnosis is only applicable to individuals 18 or older
• People under 18, personalities are still developing
-3 clusters
• A, B, C
-occur in 10-20% of the general population and about 50% of psychiatric clients
5. personality disorders should not be diagnosed unless:: the symptoms are
long-standing and impact functioning.
6. Cluster A: Cluster A personality disorders are characterized by odd or eccentric
thinking or behavior.
-PARANOID PERSONALITY DISORDER
• long-standing, pervasive mistrust or suspicion of others and their motives
• may refuse to take responsibility for their feelings, often assigning responsibility to
others
• may appear angry, irritable, or hostile, perceiving innocent remarks as personal
