Q- A 36-year-old man presents to the emergency room asking for the removal of software implanted in his body by his neighbor. He tells you that his ex-wife is hiring this neighbor to spy on him. For the last 6 years, he has been hearing them talking about him and all the details of his life. He lives alone and he does not have any friends. He has no kids and one sister who does not visit him anymore since he accused her of spying on him. His physical examination and laboratory studies are unremarkable. A drug test is negative. What is the most likely diagnosis?
A-Brief psychotic disorder
B-Bipolar disorder
C-Major depressive disorder
D-Schizophrenia
E-Schizophreniform disorder
Answer:
The presentation suggests the presence of delusions (believing that the neighbor implanted software in his body to spy on him) and possible auditory hallucinations (hearing the neighbor and ex-wife talking about him), along with social withdrawal and impaired relationships with family members. These symptoms are indicative of a psychotic disorder.
Given the duration of symptoms (6 years) and the absence of mood episodes (such as mania or depression) described in the scenario, bipolar disorder and major depressive disorder are less likely.
Schizophrenia involves the presence of delusions, hallucinations, disorganized thinking, and other psychotic symptoms lasting for at least 6 months, which aligns with this patient’s presentation. However, the duration of symptoms in this case does not meet the criterion for a schizophrenia diagnosis.
Brief psychotic disorder is characterized by the sudden onset of psychotic symptoms, such as delusions, hallucinations, disorganized speech, or grossly disorganized or catatonic behavior, lasting for at least 1 day but less than 1 month, with eventual return to premorbid functioning. However, the duration of symptoms in this case exceeds the time frame for brief psychotic disorder.
Schizophreniform disorder shares similar symptoms with schizophrenia but has a shorter duration, with symptoms lasting between 1 to 6 months. Given the duration of symptoms in this case (6 years), schizophreniform disorder is less likely.
The correct answer is D
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