Differential Diagnosis
- Single most likely diagnosis
- Schizophrenia: The patient's symptoms of hearing voices, decline in academic performance, change in behavior, and diminished facial expressivity are consistent with a diagnosis of schizophrenia. The age of onset and the presence of both positive (hallucinations) and negative (diminished facial expressivity, soft voice) symptoms further support this diagnosis.
- Other Likely diagnoses
- Bipolar Disorder with Psychotic Features: The patient's irritability, mood swings, and hallucinations could be indicative of a bipolar disorder with psychotic features. However, the absence of a clear manic or hypomanic episode makes this diagnosis less likely.
- Major Depressive Disorder with Psychotic Features: The patient's decline in academic performance, irritability, and hallucinations could also be consistent with a major depressive disorder with psychotic features. However, the absence of reported depressive symptoms such as anhedonia or changes in appetite makes this diagnosis less likely.
- Autism Spectrum Disorder: The patient's history of being a straight A student and his recent decline in academic performance, combined with his diminished facial expressivity and minimal eye contact, could suggest an autism spectrum disorder. However, the presence of hallucinations is not typical of autism spectrum disorder.
- Do Not Miss diagnoses
- Neurosyphilis: This condition can present with psychiatric symptoms, including hallucinations and changes in behavior. Although it is less likely, it is a potentially treatable condition that should not be missed.
- Wilson's Disease: This genetic disorder can present with psychiatric symptoms, including hallucinations and changes in behavior, as well as neurological symptoms such as tremors. Although it is rare, it is a potentially treatable condition that should not be missed.
- Brain Tumor: A brain tumor can present with a variety of symptoms, including hallucinations, changes in behavior, and decline in academic performance. Although it is less likely, it is a potentially life-threatening condition that should not be missed.
- Rare diagnoses
- Temporal Lobe Epilepsy: This condition can present with hallucinations, changes in behavior, and decline in academic performance. Although it is rare, it is a potentially treatable condition that should be considered.
- Mitochondrial Disorders: These disorders can present with a variety of symptoms, including psychiatric symptoms, neurological symptoms, and decline in academic performance. Although they are rare, they should be considered in the differential diagnosis.