If mood symptoms are brief, the diagnosis is schizophrenia.

• A. Schizoaffective Disorder
• B. Diagnosis of Schizophrenia
• C. Delusional Disorder
• D. Bipolar Disorder

Answer: (B)

Mood symptoms that are brief compared with the psychotic symptoms point to schizophrenia. In schizophrenia, the psychotic features (delusions, hallucinations, disorganized thinking) are the dominant illness features, and any mood symptoms are transient and do not account for most of the illness duration. The diagnostic criteria emphasize a long course of illness with prominent psychosis (at least 1 month of active symptoms and at least 6 months of disturbance overall), with mood symptoms not a sustained or primary driver.

If mood symptoms were a substantial part of the illness, you’d consider schizoaffective disorder, which requires mood symptoms to be present for a large portion of the illness and a period of psychosis without mood symptoms. Delusional disorder involves fixed delusions without the full spectrum of schizophrenia symptoms and without mood symptoms playing a central role. Bipolar disorder with psychotic features requires the psychotic symptoms to occur during mood episodes; if mood symptoms are brief and psychosis persists outside mood episodes, schizophrenia is more likely.