Differential Diagnosis
- Single most likely diagnosis
- Schizophrenia: The patient's symptoms of paranoia, withdrawal, hearing voices, and delusions of being poisoned are classic symptoms of schizophrenia. The onset of symptoms at age 22 is also consistent with the typical age of onset for schizophrenia.
- Other Likely diagnoses
- Major Depressive Disorder with Psychotic Features: The patient's symptoms of diminished appetite, trouble sleeping, and poor self-care could be indicative of a depressive episode, and the presence of psychotic symptoms such as hearing voices and delusions could suggest a psychotic depression.
- Brief Psychotic Disorder: The patient's symptoms of hearing voices and delusions have been present for only two weeks, which could suggest a brief psychotic disorder.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Neurosyphilis: The presence of a painless ulcer on the hard palate could be a sign of syphilis, and neurosyphilis can cause psychiatric symptoms such as psychosis and personality changes.
- HIV-Associated Psychosis: The patient's symptoms of psychosis and poor self-care could be indicative of an HIV-associated psychosis, and the presence of a painless ulcer on the hard palate could be a sign of oral candidiasis, which is common in HIV-infected individuals.
- Rare diagnoses
- Temporal Lobe Epilepsy: Although the patient has no history of seizures, temporal lobe epilepsy can cause psychotic symptoms such as hearing voices and delusions, and the presence of a painless ulcer on the hard palate could be a sign of an underlying neurological condition.
- Systemic Lupus Erythematosus (SLE): SLE can cause psychiatric symptoms such as psychosis and personality changes, and the presence of a painless ulcer on the hard palate could be a sign of oral ulcers, which are common in SLE.