A 24-year-old man awaiting trial for assault reports hearing continuous voices commanding him to escape. On separate assessments his symptom descriptions change markedly, he gives exact textbook details when asked about delusions but becomes evasive about personal experiences, and his 'hallucinations' vanish entirely when he believes no one is observing him. These findings most strongly suggest:

• A Schizoaffective disorder
• B Malingering ✓
• C Brief psychotic disorder
• D Factitious disorder

Explanation

Symptoms that fluctuate with legal context, textbook-perfect descriptions paired with evasion about lived experience, and improvement when unobserved are classic red flags for malingering, where symptoms are consciously fabricated for an external incentive such as avoiding prosecution. Factitious disorder involves deliberate production of symptoms but for the sick role without external gain, while genuine psychosis shows internal consistency across time and observers.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.