每日一题_2023.04.07

A 20-year-old man is seen by a physician for the third time in three months. At the first visit he was brought to the emergency department by his mother after swallowing toilet bowl cleaner. He told the doctor that he took the cleaning product to “cleanse his body from the aliens” that had “forced their entry” and “possessed” him. Today the patient appears un- clean and disheveled, and his mother reports that he has become progressively withdrawn and expressionless. Four months ago the pa- tient witnessed the gruesome death of his father in a drive-by shooting incident. Prior to this incident, he had a normal and healthy life. Which of the following is the most likely diagnosis?

一名20岁的男子三个月内第三次去看医生。第一次就诊时，他在吞下马桶清洁剂后被母亲带到急诊科。他告诉医生，他服用这种清洁产品是为了“清除强行进入他身体并“附身”的外星人。今天患者看起来不干净，蓬头垢面，他的母亲说他变得越来越孤僻，面无表情。四个月前，这位病人目睹了他父亲在一次驾车枪击事件中惨死的惨状。在此之前，他的生活正常健康。下列哪一项是最可能的诊断?

(A) Factitious disorder 人为障碍

(B) Schizophreniform disorder 类精神分裂症

(C) Schizophrenia精神分裂症

(D) Schizoaffective disorder 分裂情感障碍

(E) Shared delusional disorder 共有妄想障碍

答案解析：

在两次就诊过程中，患者表现出精神分裂症和相关障碍的精神症状和残余症状。然而，精神分裂症的诊断需要活动期(“阳性”)症状，也可能包括“阴性”症状，持续时间超过6个月。在这个案例中，病人的症状已经持续了4个月，并且可能是由一个创伤事件及其影响引起的。如果症状持续1个月，诊断为短暂的精神病性障碍是准确的;在这样的诊断中，大多数患者可以完全康复。在这个病人中，症状持续1个月但持续6个月，诊断为类精神分裂症样障碍。阴性症状使精神分裂症患者的预后恶化。

正确答案：B