An 18-year-old man is brought to the physician by his mother after he has become increasingly withdrawn over the past year. The patient's mother says that he no longer likes to leave the house or hang out with friends, despite being a very social teenager prior to this year. She describes episodes where she hears him talking loudly and angrily in his room, but when she goes to check on him, he is not on the phone and there is no one else in the room with him. She also describes episodes where the patient refuses to leave his bed, saying he feels depressed and worthless. During these episodes, he refuses to eat, go to school, or take part in any activity, saying he is too tired and cannot focus. The patient's mother becomes tearful while explaining this to the doctor, but the patient appears unemotional and disinterested. The physician requests to speak to the patient alone.
Upon further questioning, the patient admits that he has been hearing voices for the past 9 months that tell him he is disgusting and useless. He feels that the government is trying to get into his head to manipulate him, but he doesn't want to tell his mother because he is afraid that they have already gotten to her. A few times in the last year, he admits to being so depressed that he is not able to leave his bed. However, he says that he has not felt depressed in the last several months. During the interview, the patient suddenly stops speaking to the doctor and looks around wildly, saying "Stop talking to me!" When the physician asks who he is speaking to, the patient says that the voice of an older male has been bothering him for several months.
Which of the following is the most likely diagnosis?
- A) Depression with psychotic features
- B) Major depressive disorder
- C) Schizoaffective disorder
- D) Schizophrenia
- E) Schizophreniform disorder