Clinical Vignettes

A 27-year-old male presents to your clinic with a 4-year history of hallucinations and delusions for which he has been intermittently managed with antipsychotics. He is currently untreated. He also complains of 4 months of depressed mood, weight loss, insomnia, fatigue, and loss of interest in activities. He denies using any illicit substances or having any other medical conditions. What is the most likely diagnosis?

Schizoaffective Disorder. Note that there have been psychotic symptoms without affective symptoms present, but now also meets criteria for a depressive episode.

A 76-year-old man presents with 1 year of worsening depressive symptoms. He has trouble falling asleep, feels worthless, cannot concentrate, and has thoughts of death. Over 3 years ago his wife passed away from cancer. For 6 months now he has adamantly stated that the cancer was his fault and that he was the one that killed his wife, despite all evidence to the contrary. He also often hears her voice scolding him when no one is around. What is the most likely diagnosis?

Depression with Psychotic Features. Note the mood-congruent delusion in the setting of depression and psychotic symptoms that only appear during affective episode. Also remember schizophrenia rarely presents in this advanced age.

What is a delusional disorder?

What are some types of delusions that may occur in this disorder?

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