Schizophrenia spectrum disorders Quiz: Ace Your Exams

A 24-year-old man is brought to the physician by his partner. The partner tells the physician that for the last six months, the patient has been acting like he is responding to voices, and they often hear him muttering as if to someone in the room, even if no one else is present. The patient tells the physician that he hears people talking to him and commanding him to harm himself. However, he has never attempted to do so. Additionally, the patient’s partner notes that he has been accusing the landscaper of “working with the government,” claiming the landscaper is trying to harm him. The partner adds that the patient has become increasingly withdrawn from his friends for the last year. He also stopped visiting family and, five months ago, quit his job for no specific reason. Past medical history is insignificant. The patient has a past history of alcohol use disorder. He used intranasal cocaine on several occasions during college. However, he no longer drinks alcohol and stopped using cocaine three years ago. Urine toxicology is negative. Which of the following is the most likely diagnosis of this patient?