A 45-Year-Old Man Is Hospitalized Due to Suicidal Ideation

A 45-year-old man is hospitalized due to suicidal ideation.  Over the past month, the patient has become increasingly depressed, withdrawn, and physically restless.  He has had increasing difficulty concentrating at his job as a computer programmer.  The patient's appetite has been poor, and he has had difficulty falling and staying asleep.  He stopped going to work last week and refused to leave the house until his hospitalization.  The patient has no medical or psychiatric history.  Physical examination is unremarkable apart from a 4.5-kg (10-lb) weight loss.  On mental status examination, the patient appears depressed and anxious.  He reports that he is responsible for "all the evil in the world" and has heard a voice for the past week telling him that he does not deserve to live.  Which of the following is the most likely diagnosis in this patient?

A) Bipolar disorder with psychotic features
B) Delusional disorder
C) Major depressive disorder with psychotic features
D) Schizoaffective disorder
E) Schizophrenia
F) Schizophreniform disorder

Correct Answer:

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