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Difficulty: MediumSchizophrenia and Psychotic Disorders

For the following individuals presenting with psychiatric symptoms, select the most accurate diagnosis by pairing the clinical history with the corresponding condition.

  • A 22-year-old graduate student developed auditory hallucinations and the belief that the government is monitoring his thoughts. These symptoms have been present for 3 months, leading to a significant decline in his academic performance. He has no history of manic or depressive episodes.Schizophreniform disorder
  • A 47-year-old accountant firmly believes that a famous actor is secretly in love with her, sending her hidden messages through television interviews. She has held this belief for 8 months. She has no hallucinations, and her occupational functioning remains completely intact.Delusional disorder
  • A 28-year-old woman with a history of major depressive episodes presents with auditory hallucinations. Medical records show she experienced these hallucinations for a 4-week period last year during which her mood was entirely euthymic, followed by a severe depressive episode.Schizoaffective disorder
  • A 19-year-old college freshman abruptly develops disorganized speech, agitation, and paranoid delusions two days after surviving a severe car accident. The symptoms completely resolve within 18 days, and he returns to his baseline level of functioning.Brief psychotic disorder

Answer

The 22-year-old graduate student matches with Schizophreniform disorder; the 47-year-old accountant matches with Delusional disorder; the 28-year-old woman matches with Schizoaffective disorder; and the 19-year-old freshman matches with Brief psychotic disorder.
Each presentation strictly corresponds to DSM-5 timeline and criteria for psychotic disorders: <1 month is brief psychotic disorder, 1-6 months is schizophreniform disorder, >1 month of isolated delusions is delusional disorder, and psychosis independent of mood episodes characterizes schizoaffective disorder.

Step-by-Step Solution

1
Analyze the duration and symptom profile for the first presentation.
Symptoms match schizophrenia but have only lasted 3 months.
Duration between 1 and 6 months distinguishes schizophreniform disorder from schizophrenia (which requires >6 months).
2
Evaluate the second presentation focusing on functioning and symptom scope.
Isolated delusion for >1 month with preserved functioning.
These are the core criteria for delusional disorder.
3
Assess the third presentation for the relationship between psychosis and mood.
Psychosis occurs both with and without a mood episode (at least 2 weeks of psychosis without mood symptoms).
This temporal relationship is necessary to diagnose schizoaffective disorder.
4
Examine the fourth presentation's onset and duration.
Acute onset following a stressor, resolving within 18 days.
Psychotic symptoms lasting less than 1 month followed by full recovery characterize brief psychotic disorder.

Key Concept

Differentiating psychotic disorders based on symptom duration and the temporal relationship to mood episodes.
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Topics

Schizophrenia and Psychotic Disorders

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