Question

A patient has depressive symptoms for 6 months and, in the last 2 weeks, auditory hallucinations. What is the probable diagnosis?

• A. Psychotic depression
• B. Schizoaffective disorder
• C. Manic depressive illness
• D. Schizophrenia

Hint:

The mood disturbance came first and dominates; the voices appear only within it.

Answer 1

The Correct Option is A

Step 1: The dominant and longstanding feature is a depressive episode lasting 6 months. The psychotic symptom, auditory hallucinations, has appeared only recently and within that depressive episode.
Step 2: Major depression with psychotic features (hallucinations or delusions arising during the depressive episode) is psychotic depression. The mood disorder drives the picture and the psychosis is mood-congruent and time-locked to it.
Why not the others: Schizoaffective disorder needs psychotic symptoms (such as hallucinations or delusions) to be present for at least 2 weeks in the ABSENCE of a prominent mood episode; here the psychosis appears only within depression, so it does not qualify. Manic depressive illness (bipolar) requires a manic episode, which is absent. Schizophrenia requires the full schizophrenia syndrome with prominent psychosis as the primary illness, not a 6-month mood disorder with brief late hallucinations.
Ref: Arvind Arora Review of Psychiatry p.103.