Match each clinical presentation of psychotic and mood symptoms to the most accurate DSM-5 psychiatric diagnosis based on the symptom timeline and the temporal relationship between the affective and psychotic episodes.
- A 28-year-old man with a 36-month history of continuous auditory hallucinations and paranoia. During this entire period, he experienced two distinct 2-month episodes of severe depression. For the remaining 32 months, he has had no mood symptoms but continued to experience psychosis.Schizophrenia
- A 26-year-old woman with a 24-month history of prominent auditory hallucinations. She has concurrently met the criteria for a major depressive episode for 22 of those months. She had a single 4-week period where her mood was completely normal, but the hallucinations persisted.Schizoaffective disorder
- A 33-year-old man with a 6-week history of depressed mood, terminal insomnia, and significant weight loss. For the past 4 weeks, he has also heard voices stating he deserves to be punished. He has never experienced psychotic symptoms prior to this depressive episode.Major depressive disorder with psychotic features
- A 23-year-old woman who developed sudden-onset paranoid delusions and disorganized speech. Her symptoms persisted for 4 months, after which she experienced a full recovery with a short course of antipsychotic medication and returned to her previous level of baseline functioning.Schizophreniform disorder
Answer
The 36-month history with 4 months of depression matches Schizophrenia. The 24-month history with 22 months of depression and 4 weeks of isolated psychosis matches Schizoaffective disorder. The 6-week history of depression with 4 weeks of concurrent psychosis matches Major depressive disorder with psychotic features. The 4-month history of psychosis with full recovery matches Schizophreniform disorder.
The correct matches rely on the DSM-5 timeline criteria for psychotic disorders. Schizophrenia requires symptoms for >6 months, with any mood episodes accounting for a minority of the duration. Schizoaffective disorder requires mood symptoms for the majority of the illness, plus >2 weeks of isolated psychosis. Major depressive disorder with psychotic features requires psychosis only during the mood episode. Schizophreniform disorder requires psychotic symptoms lasting between 1 and 6 months.
Step-by-Step Solution
Key Concept
Differential diagnosis of psychotic disorders relies heavily on symptom duration (e.g., <1 month, 1-6 months, >6 months) and the temporal relationship between psychotic symptoms and mood episodes (majority vs. minority of illness duration).