Sunday, March 18, 2012

Autism or/ and Childhood Schizephrenia?

With in the context of viewing Jani's story for the purpose of a hypothetical differential diagnosis the first step would be to get clear and complete pictures of each diagnosis.  Autistic Disorder defined by DSM IV is a combination of a at least 6 listed symptoms with at least 2 being deficits in social behavior, 1 a deficit in communication, and 1 characteristic of stereotypy. The  DSM IV Criteria for Schizophrenia is also a combination of 2 symptoms. In this diagnostic criteria there is a note about autism that reads : F. Relationship to Pervasive Developmental Disorder: If there is a history of Autistic Disorder or another Pervasive Developmental Disorder, the additional diagnosis of Schizophrenia is made only if prominent delusions or hallucinations are also present for at least a month (or less if successfully treated).  
In other words, in order to receive a co morbid diagnosis of autism and schizophrenia you must first fully have autism and then have periods of hallucinations and delusions.  
In the analysis of Jennies home videos, behavior during the interview, and parents report the following image represents her symptoms.
In summary,  Jani does have some symptoms of autism, she seems to have marked impairments in the use of nonverbal communication.  This is evident in her frequent shifts in facial expression and darting eye contact.  She also seems to have failed in developing peer relationships at an appropriate developmental level, this is more difficult to find evidence of because she was participating in her pool party in the film.  However her problematic relationship with her brother lends itself to be at an inappropriate developmental level for her age.  These two symptoms meet the social criteria for Autistic disorder.  The communicative criteria is also satisfied because Jani seems to have an encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal in intensity or focus.  Jani had a number of hallucinations all of which were named either by a number or day of the week.  The focus of numbers or days of the week is abnormal.  Jani also seems to have some stereotypical behaviors, during the interview Jani was observed to engage in a hand flapping.  The problem with a diagnosis of autism is that Jani exhibited four symptoms of Autistic Disorder and in order to have the diagnosis you must have six.  Schizophrenia has a similar diagnostic criteria in that it also has certain requisites of symptoms.  Jani clearly had hallucinations and delusions which meets the requirement of two of the first subset of symptoms.  Also in order for a diagnosis of schizophrenia there needs to be a social/ occupational dysfunction.  The fact that Jani's family has to rent two apartments to keep her sibling safe is evidence of a social dysfunction. There is also a duration criteria of six months of the disturbance during which there must be one month of active symptoms. Jani's parents attest to there being signs of the disturbance during her entire life and as she was actively describing hallucinations during the interview and at various times in the past it seems evident that she meets the duration criteria.  It is unclear whether or not schizo affective and mood disorder have been ruled out as the diagnosis demands, however aside from that (as there is no way to further access her record) Jani clearly has the whole package of a schizophrenia diagnosis.  

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