Differential Diagnosis for Hearing Voices

Single Most Likely Diagnosis

• Schizophrenia: The patient's symptoms of hearing voices for 8 months, with the voices becoming more frequent and critical, are consistent with schizophrenia. The duration of symptoms and the nature of the hallucinations (hearing voices that comment on the patient) support this diagnosis.

Other Likely Diagnoses

• Schizoaffective Disorder: This diagnosis is considered because the patient's symptoms of hearing voices could be accompanied by a mood disorder, which is not explicitly mentioned but could be present.
• Major Depressive Disorder with Psychotic Features: The critical nature of the voices, telling the patient she is a terrible person, could indicate a depressive episode with psychotic features.
• Post-Traumatic Stress Disorder (PTSD) with Psychotic Symptoms: If the patient has a history of trauma, PTSD with psychotic symptoms could be a consideration, although this would be less likely without additional information about trauma.

Do Not Miss Diagnoses

• Neurosyphilis: Although rare, neurosyphilis can cause psychiatric symptoms, including hallucinations. Missing this diagnosis could lead to severe consequences, including progression to dementia or death if not treated.
• Temporal Lobe Seizures: Seizure activity in the temporal lobe can cause auditory hallucinations. This diagnosis is critical to consider because untreated seizures can lead to status epilepticus, a life-threatening condition.
• Brain Tumor or Cyst: A space-occupying lesion in the brain could cause hallucinations due to pressure on or damage to areas involved in auditory processing. Missing this diagnosis could lead to increased intracranial pressure, herniation, and death.

Rare Diagnoses

• Charles Bonnet Syndrome: Typically associated with visual hallucinations in visually impaired individuals, but in rare cases, it could present with auditory hallucinations.
• Hearing Loss with Psychotic Symptoms: In some cases, significant hearing loss can lead to hallucinations, possibly due to the brain's attempt to fill in the absence of sound.
• Wilson's Disease: A genetic disorder that leads to copper accumulation in the brain and can cause psychiatric symptoms, including hallucinations. It's rare but important to consider in young patients with psychiatric symptoms and movement disorders.