MEDizzy - A 22-year-old man presents with a 2-month history of

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Psychotic Disorders

A 22-year-old man presents with a 2-month history of third-person auditory hallucinations, thought broadcasting and persecutory delusions. No other symptoms are described. He has a history of depression, for which he received antidepressant therapy at the age of 20. He used cannabinoids on a weekly basis from the age of 17 to 21, but hasn’t used them for the past 4 months. What is the most likely diagnosis?

ExplanationThis patient meets the ICD-10 diagnostic criteria for paranoid schizophrenia, presenting with psychotic symptoms of > 1 month’s duration. The duration of symptoms rules out an acute psychotic disorder. The nature of the symptoms and the lack of recent drug use exclude drug-induced psychosis. Although individuals with delusional disorder can experience transient auditory hallucinations, the presence of third-person auditory hallucinations and thought broadcasting – first-rank symptoms – are strongly suggestive of paranoid schizophrenia. Illness duration must be > 3 months for delusional disorder to be diagnosed using ICD-10 diagnostic criteria. The patient has had one prior episode of depression and there is no history of psychotic symptoms occurring concurrent to mood disturbance, making a diagnosis of schizoaffective disorder unlikely at this stage. See WHO (1992).