An 18-year-old man is brought to the clinic by his mother due to increasingly bizarre behavior over the past 2 months. The patient is in his first semester at an out-of-state college and has had difficulty adjusting to being away from home. For the past few weeks, he has not been attending classes, and he no longer socializes with friends. The patient spends most of his time alone in his dorm room and eats very little because he believes the cafeteria food is poisoned. He has no significant medical or psychiatric history and does not use alcohol or illicit drugs. Physical examination is unremarkable. On mental status examination, he appears disheveled with unwashed hair, makes poor eye contact, and shouts "leave me alone" in response to unseen people. Which of the following is the most likely diagnosis in this patient?

Question

An 18-year-old man is brought to the clinic by his mother due to increasingly bizarre behavior over the past 2 months.  The patient is in his first semester at an out-of-state college and has had difficulty adjusting to being away from home.  For the past few weeks, he has not been attending classes, and he no longer socializes with friends.  The patient spends most of his time alone in his dorm room and eats very little because he believes the cafeteria food is poisoned.  He has no significant medical or psychiatric history and does not use alcohol or illicit drugs.  Physical examination is unremarkable.  On mental status examination, he appears disheveled with unwashed hair, makes poor eye contact, and shouts "leave me alone" in response to unseen people.  Which of the following is the most likely diagnosis in this patient?

Quizplus · Accepted Answer

11ec160b_363e_a853_9249_e9d7048986ae_MD0001_00 This patient's 2-month history of progressive social withdrawal, paranoid ideation, and auditory hallucinations suggests schizophreniform disorder. These patients exhibit the same symptoms as individuals with schizophrenia (delusions, hallucinations, disorganized speech and behavior, negative symptoms) but for a shorter duration (≥1 month and <6 months). Functional decline, although often present, is not required for diagnosis. As with all psychotic disorders, diagnosis requires ruling out medical and substance-induced etiologies. Schizophreniform disorder is often a provisional diagnosis that requires longitudinal monitoring, as approximately two-thirds of patients with this disorder are eventually diagnosed with schizophrenia or schizoaffective disorder. (Choice A) Adjustment disorder is characterized by increased anxiety, depressive symptoms, and/or disruptive behavior (eg, agitation, property destruction) that develops within 3 months of an identifiable stressor and lasts no more than 6 months after the stressor ends. Symptoms of acute psychosis are not present in patients with adjustment disorder. (Choices B and E) This patient's symptom duration of 2 months rules out these disorders. In brief psychotic disorder, psychotic symptoms last at least 1 day but <1 month, with full return to premorbid functioning. A diagnosis of schizophrenia requires symptom duration of ≥6 months. (Choice C) In delusional disorder, other psychotic symptoms (eg, hallucinations, disorganized speech and behavior) are not present, behavior is not obviously bizarre, and functioning is not markedly impaired apart from the impact of the delusion. (Choice D) There are insufficient symptoms to diagnose a major depressive episode. This patient's social withdrawal is a negative symptom characteristic of psychosis, and his appetite disturbance is due to the paranoid delusions about food being poisoned. Educational objective: Schizophreniform disorder is characterized by psychotic symptoms (delusions, hallucinations, disorganized speech and behavior, negative symptoms) lasting ≥1 month and <6 months. __________ References: Schizophrenia and other psychotic disorders in DSM-5. (http://www.ncbi.nlm.nih.gov/pubmed/23538289)

An 18-Year-Old Man Is Brought to the Clinic by His