A 22 year-old medical student is brought to your office by his friends and his dad who is concerned about his mental status. His dad found him in a very dirty room. There are pizza boxes strewn all over the apartment. There is spoiled food in the refrigerator. He looks disheveled and unkempt as if he did not take a shower for many days. His friends report that for over a year, the patient has lost interest in things he used to take lots of pleasure like going on hiking and playing sports. He is staying in his room by himself staring at a Van Gogh’s the Starry Night painting on his wall. He feels a sense of emptiness and hopelessness in his life. On your questioning, the patient describes he is ‘feeling down’ most of the time. But when his energy levels are normal, he hears voices informing him that an alien race is planning to abduct all doctors from this nation. He affirms that ‘the White House already knew about this but kept the American people in the dark’. When he hears these voices, his friends report, he becomes completely disorganized and loses his focus on his studies and even on personal hygiene and sleep. He voiced a desire to mutilate his ear like Van Gogh, his favorite painter. He was seen urinating in a local public park when lots of other people were around him. He hears these voices for five to six weeks in a row and then for many months he feels just down. His dad informs that for many years, his son looked mostly ‘depressed’ except for these bouts of ‘alien nonsense’ which would come unexpectedly when he was doing just fine. What is the most likely diagnosis in this patient?
