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Difficulty: EasySchizophrenia and Psychotic Disorders

A 24-year-old man is brought to the clinic by his sister due to bizarre behavior. For the past 3 months, he has been hearing voices telling him that he is on a special mission, and he believes that the government is monitoring his thoughts. His sister notes that he has stopped going to work and spends most of his time in his room. He has no history of medical illnesses, and a urine toxicology screening is negative. He does not display any symptoms of depression or mania. Which of the following is the most likely diagnosis?

  1. A
    Brief psychotic disorder
  2. B
    Schizophrenia
  3. Schizophreniform disorderAnswer
  4. D
    Schizoaffective disorder
  5. E
    Delusional disorder

Answer

Schizophreniform disorder
The correct diagnosis is schizophreniform disorder. The patient exhibits active-phase symptoms of psychosis (delusions and auditory hallucinations) along with a decline in functioning. The most critical factor in this vignette is the duration of these symptoms, which is 3 months. According to diagnostic criteria, psychotic symptoms lasting between 1 month and 6 months define schizophreniform disorder.

Step-by-Step Solution

1
Analyze the patient's presenting symptoms.
The patient exhibits auditory hallucinations, delusions, and a significant decline in social and occupational functioning.
To establish that the patient is experiencing a primary psychotic episode.
2
Identify the total duration of the psychotic symptoms.
The history provided by the sister indicates that symptoms have been present for exactly 3 months.
Symptom duration is the primary criterion used to differentiate among acute psychotic disorders.
3
Apply the diagnostic criteria timelines for primary psychotic disorders.
A duration of 3 months falls precisely into the 1 to 6-month diagnostic window.
Brief psychotic disorder lasts less than 1 month, schizophreniform disorder lasts between 1 and 6 months, and schizophrenia lasts greater than 6 months.

Key Concept

The primary distinguishing factor among brief psychotic disorder, schizophreniform disorder, and schizophrenia is the duration of symptoms (less than 1 month, 1 to 6 months, and greater than 6 months, respectively).
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Topics

Schizophrenia and Psychotic Disorders

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