MEDizzy - A 25-year-old man presents to the clinic with a 1-year

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Psychotic Disorders

A 25-year-old man presents to the clinic with a 1-year history of functional decline and psychotic symptoms. He presents with third-person auditory hallucinations that give a running commentary on his thoughts and actions, bizarre delusions, including believing that he is the father of the Queen of England, and describes thought withdrawal. He displays formal thought disorder, with derailment and neologisms prominent. He has experienced recurrent episodes of mood disturbance for extended periods over the past 2 years and currently displays features of mania. He intermittently uses cannabis and previously used amphetamines, but stopped 6 months ago. What is the probable diagnosis?

ExplanationSchizoaffective disorder is diagnosed when the patient has features of both schizophrenia and a mood disorder but does not strictly meet the diagnostic criteria for either illness alone. In this case, the patient is presenting with Schneiderian first-rank symptoms but also mood symptoms, which have occurred concurrent to the psychotic symptoms. In ICD-10, schizoaffective disorder is diagnosed by simultaneous and equally prominent mood and psychotic symptoms, particularly the occurrence of Schneiderian first-rank symptoms in the context of prominent mood disturbance. The term should not be applied to patients who exhibit schizophrenic symptoms and mood symptoms only in different episodes of illness. See WHO (1992)