A patient presents with features of both major depressive episodes and schizophrenia simultaneously. Psychotic symptoms have been present for a total of 8 months; mood episodes were present for 6 of those 8 months. According to DSM-5, what is the MOST appropriate diagnosis?

• A Schizoaffective disorder, depressive type ✓
• B Schizophrenia with depressive features
• C Major depressive disorder with psychotic features
• D Bipolar I disorder with psychotic features

Explanation

DSM-5 Schizoaffective Disorder requires: (1) an uninterrupted period during which criterion A of schizophrenia is met along with a major mood episode; (2) delusions or hallucinations present for at least 2 weeks WITHOUT the mood episode; and crucially (3) mood episodes are present for the MAJORITY of the total duration of the active and residual illness. Here, mood episodes lasted 6/8 months (75%), satisfying the majority criterion. If mood episodes occupied less than half the total duration, schizophrenia with comorbid depression would be more appropriate. The depressive subtype requires only major depressive episodes (no manic/hypomanic).

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

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