An old patient was brought to the hospital with the history of auditory hallucinations. He states that, some unknown peoples are conspiring against him. He hears them talking on his every actions continuously. What could be the most likely diagnosis:
Ans. (c) SchizophreniaRef.: Harrison 19th ed. / 2720* Hallucinatory voice commenting (keeping up a running commentary) on ones behavior, thought or action in the third person (third person hallucination) is a classical presentation of schizophrenia.* The patient presented here with 3rd party auditory hallucination, which is a very characteristic finding of Schizophrenia.Diagnostic criteria for schizophrenia according to DSM-IV and ICD 10 DSM-IVICD-10>1 criteria for 1 month* Bizzare delusions* Hallucinations consist of:# Hallucinatory voice commenting (keeping up a running commentary) on one's behavior, thought or action in the third person (third person hallucination)# Voices discussing or arguing i.e. hallucinations of two or more voices discussing or conversing with each other* Thought echo/ insertion/ withdrawal/ broadcasting* Delusion of control* Hallucinatory voices* Persistent delusionsOr> 2 Criteria* Delusions* Hallucinations* Negative symptoms i.e. affective flattening, alogia or avolition* Grossly disorganized or catatonic behavior* Disorganized speech (eg frequent incoherence or derailment)* Thought block/ disorder* Persistent hallucinations* Negative symptoms* CatatoniaTime course* Symptom for 1 month + 6 months social / occupational disturbance* 1 month (most of the time)Exclusions* Brief mood disturbance or schizoaffective disorder* Direct effect of drug abuse/ medication / medical condition* Schizoaffective disorder or extensive depressive/ manic symptoms* Drug intoxication/ withdrawal, overt brain disease.* Negative symptoms respond poor to treatment (poor prognosis) while positive symptoms are well responsive to treatment (better prognosis).Positive SymptomsNegative Symptoms* Hallucination* Delusion* Anhedonia: loss of interest in things which were interesting before.* Avolition: lack of desire to achieve goal* Alogia: poverty of speech* Attention deficit* Social withdrawal
Dementia
Delusional disorders
Schizophrenia
Acute psychosis
Schizophreniform Disorder