A 22-year-old male engineering student is brought by his parents after a 7-month history of social withdrawal, declining academic performance, and increasingly odd beliefs. For the past 2 months he has reported hearing voices that comment on his actions, and he believes his classmates are transmitting thoughts into his head. He has never had a manic or depressive episode. Neurological examination and routine investigations are normal. What is the most likely diagnosis?
- A Schizophreniform disorder
- B Schizoaffective disorder
- C Schizophrenia ✓
- D Brief psychotic disorder
Correct answer: C. Schizophrenia
Explanation
Schizophrenia requires at least 6 months of continuous disturbance including at least 1 month of active-phase symptoms (two or more of delusions, hallucinations, disorganized speech, grossly disorganized behavior, or negative symptoms). This patient has had symptoms for 7 months, has two Schneiderian first-rank symptoms (third-person running commentary hallucinations and thought insertion), and lacks a mood episode, ruling out schizoaffective disorder. Schizophreniform disorder is diagnosed when the duration is 1–6 months.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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