Kalloo, a 24-year-old occasional alcoholic shows a change in behaviours. He suspects that people are con-spiring in behaviors; he suspects that people are aspir-ing against him though his father states that there is no reason for his fears. He also gets hallucinations of voice commenting on his actions. What is the most probable diagnosis as per ICD-10?

1. A

   F20-F29

2. B

   F30-F39

3. C

   F40-F49

4. D

   F50-F59

Appeared in: NORCET -4 , 2023

Explanation

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• The patient's clinical presentation includes persecutory delusions (believing people are conspiring against him) and auditory hallucinations (hearing voices commenting on his actions).
• These are hallmark 'positive' symptoms of psychosis.
• In the International Classification of Diseases, 10th Revision (ICD-10), the code block F20-F29 is designated for 'Schizophrenia, schizotypal and delusional disorders'.
• Therefore, based on the classic psychotic symptoms described, the most probable diagnostic category is F20-F29.

Why Other Options Were Wrong

• Option B: This category is for Mood (affective) disorders. The patient's primary symptoms are delusions and hallucinations, not a primary disturbance of mood like mania or depression.
• Option C: This category covers Neurotic, stress-related, and somatoform disorders. These disorders do not typically feature prominent psychotic symptoms like delusions and hallucinations.
• Option D: This category is for Behavioral syndromes associated with physiological disturbances and physical factors. The patient's symptoms are related to thought and perception, not primarily physiological behaviors.

Related Visual

• Visual 1: Table - A summary table of the main ICD-10 'F' code blocks (F00-F99) with their corresponding disorder categories and examples. This helps learners quickly differentiate between the major classifications of mental and behavioral disorders.

Clinical Relevance

• Nursing practice connection: Use the key finding related to ICD-10 Classification of Mental Disorders to guide bedside assessment, documentation, and the next nursing action.
• Accurate diagnosis using standardized systems like ICD-10 is crucial for determining the correct treatment plan. Misclassifying a psychotic disorder as a mood or neurotic disorder could lead to ineffective treatment (e.g., using only anxiolytics instead of antipsychotics) and poor patient outcomes.
• Nurses play a key role in observing, documenting, and reporting patient behaviors and statements accurately, which provides the data needed for a correct diagnosis.
• What if? If the patient's symptoms (delusions and hallucinations) only occurred during periods of heavy alcohol use or withdrawal, the diagnosis would likely shift to F10.5 (Alcohol-induced psychotic disorder), which falls under the F10-F19 block for substance use disorders.

How to Approach the Question

• First, identify the key symptoms presented in the clinical vignette. Here, the key symptoms are persecutory thoughts ('people are conspiring against him') and auditory hallucinations ('voices commenting on his actions').
• Recognize these as 'positive' symptoms of a psychotic disorder.
• Next, recall or look up the major categories of the ICD-10 classification for mental and behavioral disorders (the 'F' codes).
• Match the patient's symptom cluster (psychosis) to the appropriate ICD-10 block.
• Evaluate the given options: F20-F29 covers schizophrenia and psychotic disorders, F30-F39 covers mood disorders, F40-F49 covers neurotic/anxiety disorders, and F50-F59 covers behavioral syndromes. The patient's symptoms clearly align with the F20-F29 category.

Concept Tested & Keywords

• Concept Tested: ICD-10 Classification of Mental Disorders
• Stem keywords: change in behaviours, suspects people are conspiring, hallucinations of voice, ICD-10
• Lead-in keywords: most probable diagnosis

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