A 19-year-old college student develops sudden onset of auditory hallucinations, persecutory delusions, and disorganized speech 1 day after a major academic examination. Her parents confirm she had no psychiatric symptoms prior to this event. After 8 days all symptoms resolve completely and she returns to baseline. A full medical and neurological workup is negative. What is the most accurate diagnosis?

• A Schizophreniform disorder
• B Acute stress disorder
• C Brief psychotic disorder with marked stressor ✓
• D Dissociative identity disorder

Explanation

Brief psychotic disorder is defined by the sudden onset of at least one positive psychotic symptom lasting more than 1 day but less than 1 month, with full return to premorbid functioning. When symptoms occur shortly after an obvious significant stressor, the specifier 'with marked stressor' (formerly reactive psychosis) is applied. Schizophreniform disorder requires a duration of 1–6 months. Acute stress disorder involves trauma exposure and dissociative, re-experiencing, and avoidance symptoms rather than frank psychosis.

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

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