Question

A 25-year-old man is brought to the Emergency Department by police for bizarre behavior. His family reports a change in his behavior about eight months ago. He denies drug or alcohol abuse. On examination, he exhibits a flat affect and appears to be responding to internal stimuli. His speech is disorganized, and he reports delusions of being pursued by Russian individuals who aim to steal his thoughts. Laboratory and urine studies are unremarkable. What is the most likely diagnosis?

a) Schizoaffective disorder
b) Schizophrenia
c) Schizophreniform disorder
d) Schizotypal personality disorder

Answer 1

Based on the symptoms such as flat affect, disorganized speech, and delusions without substance abuse factors or other laboratory findings, the most likely diagnosis is schizophrenia.

Step-by-step explanation:

The most likely diagnosis for the 25-year-old man described in the scenario, who exhibits symptoms such as a flat affect, responding to internal stimuli, disorganized speech, and persistent delusions without any significant findings on laboratory or urine studies, is schizophrenia. These symptoms are consistent with the diagnostic criteria for schizophrenia, which include the presence of delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and negative symptoms, such as a flat affect that persists for six months or more. In contrast, schizoaffective disorder includes mood disorder components, schizophreniform disorder is characterized by a shorter symptom duration (less than 6 months), and schizotypal personality disorder involves a pattern of social and interpersonal deficits marked by acute discomfort and reduced capacity for close relationships, without the hallmark symptoms of psychosis seen in schizophrenia.