Schizophrenia spectrum disorders Quiz: Ace Your Exams

A 40-year-old woman comes to the physician for an annual physical. She has been mostly healthy, though she had a fever and dry cough for about one week earlier this year. She tells the physician that her colleagues at work “jinxed me for my good health and wellbeing.” She adds that these colleagues are jealous of her success and wish her bad luck, but she does not believe they intend to cause physical harm. She says that she has a “special ability” to know if someone likes her or not, so she typically carries an array of crystals with her to “ward off evil thoughts.” She has not been hearing voices, and she describes her mood as “fair enough.” The patient has been living on her own for the past 20 years and rarely goes out to new places. She does not use alcohol or recreational drugs. Physical examination shows a middle-aged woman wearing undergarments outside of multiple layers of mismatched clothing. On mental status examination, the patient has a flat affect and avoids eye contact. Which of the following is the most likely diagnosis of this patient?