Imagine an ASWB exam question like this: 

A social worker meets with a client who reports hearing voices and occasionally seeing shadows…

In other words, a client with psychotic symptoms. The question asks for the best diagnosis.

How do you answer?

You’re going to need to know the list of DSM-5 diagnoses which involve, in one way or another, psychotic symptoms. Here they are:

Schizophrenia Spectrum and Other Psychotic Disorders 

Schizophrenia: Involves a range of symptoms, including delusions (false beliefs), hallucinations (false sensory experiences), disorganized thinking and speech, and negative symptoms (such as social withdrawal and reduced emotional expression). To receive a diagnosis of schizophrenia, symptoms must persist for a significant portion of time, typically six months or more.

Schizophreniform Disorder: This diagnosis is given when an individual experiences symptoms similar to schizophrenia but for a shorter duration, typically between one and six months.

Schizoaffective Disorder: This diagnosis is made when an individual has symptoms of both schizophrenia and a mood disorder (e.g., major depressive disorder or bipolar disorder).

Brief Psychotic Disorder: This is diagnosed when an individual experiences a sudden onset of psychotic symptoms, but the duration is brief, typically less than one month.

Delusional Disorder: In this disorder, an individual primarily has non-bizarre delusions (beliefs that are plausible but false) without the prominent hallucinations or disorganized thinking seen in schizophrenia.

Bipolar Disorder 

While primarily a mood disorder, individuals with bipolar disorder can experience psychotic symptoms during manic or depressive episodes. These may include grandiose delusions during manic episodes or depressive psychosis during depressive episodes.

Major Depressive Disorder with Psychotic Features 

Some individuals with major depressive disorder can experience psychotic symptoms during severe depressive episodes, such as hallucinations or delusions related to their depression.

Substance-Induced Psychotic Disorder 

The use of certain substances, such as drugs or alcohol, can induce psychotic symptoms. This diagnosis is made when the psychotic symptoms are directly related to substance use.

Posttraumatic Stress Disorder (PTSD) 

While not primarily a psychotic disorder, individuals with PTSD can experience dissociation, which involves a disconnection from reality and one's own thoughts, feelings, or sensations.

Okay, so how to answer the question started above? 

You can’t. You need more info. Here’s the whole question:

A social worker meets with a client who reports hearing voices and occasionally seeing shadows ever since he turned 22, a few months ago. What is the most likely diagnosis for this client?

A) Schizophrenia

B) Major Depressive Disorder

C) Brief Psychotic Disorder

D) Schizophreniform Disorder

What’s your answer?

The elapsed time--a few months--is key. Schizophrenia requires more than six months of symptoms. Brief psychotic disorder requires less than a month of symptoms. Since there’s no mention of a mood component in the question, that leaves just one best answer: Schizophreniform disorder. 

Got it? Good! You're on your way to passing the social work licensing exam!

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August 21, 2023
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