Questions Flashcards
A 21 year old male without any previous medical problems presents to clinic. A mental state examination is undertaken. His appearance and behaviour includes lots of bright colourful clothes, featuring wellington boots despite it being dry and sunny. He is socially disinhibited, asking the clinician personal questions. His mood appears low and he is agitated. His speech is fast when answering questions, but there is no spontaneous speech. Concerning thoughts, these include the belief that the government are using drones to put thoughts into his head. He is experiencing auditory hallucinations, specifically third person commentary on his actions. He has poor concentration and is easily distractible whilst he is not aware that he has any problem. From the mental state examination, what is the most likely diagnosis? A) Bipolar Disorder B) Mania C) Schizophrenia D) Paranoid Personality Disorder
Answer is C.
The correct answer is schizophrenia. With auditory hallucinations, delusions and thought insertion schizophrenia is the most likely diagnosis. While fast speech with poor concentration can be seen in mania the low mood makes this unlikely. While low mood and perceptual abnormalities can occur in severe depression the thought insertion and auditory hallucinations are more related to schizophrenia. Paranoid personality disorder may partly fit with belief in conspiracy type theories and being suspicious but there is no evidence of grudges and sensitiveness. Furthermore, the description matches schizophrenia more with typical thought insertion and external auditory hallucinations with third person commentary, which would be absent in paranoid personality disorder.
