Case Study: Khalid J. Renner (DSM-5-TR: Brief Psychotic Disorder)

(With stressor specifier)

Demographics

• Name: Khalid Renner

• Age: 24

• Occupation: Graduate student in mechanical engineering

• Background: Lives with a roommate; no personal or family psychiatric history; previously high-functioning and academically strong

Clinical Presentation

Onset

Khalid was brought to the emergency department by campus security after being found wandering the engineering building at 3 a.m., speaking rapidly about “hidden messages” in the ventilation system. His symptoms began suddenly approximately 36 hours earlier, following a devastating academic setback: his thesis advisor informed him that several years of project data were invalid due to a calibration error. Khalid described this moment as “like the world cracked open.”

Positive Symptoms

• Delusions:
  He believed the engineering faculty were part of a covert research organization using ultrasonic frequencies to recruit him for a secret mission.

• Hallucinations:
  Reported hearing “coded messages” transmitted through air vents, whispering instructions only he could understand.

• Disorganized speech:
  His speech was tangential and occasionally incoherent, rapidly shifting topics (“They need me—sound waves—frequencies—my project was the key”).

• Disorganized behavior:
  He attempted to “decode” messages by dismantling a dormitory smoke detector; tried to barricade his apartment door “to block the transmissions.”

Duration

Symptoms have persisted for two days.
Roommate describes completely typical behavior up until the abrupt onset.
No substance use, head trauma, or medical conditions identified.

Emotional Presentation

Khalid oscillates between agitation and tearfulness but does not display the negative symptoms characteristic of schizophrenia (e.g., flat affect, alogia, avolition).

DSM-5-TR Diagnostic Features Demonstrated

Key requirement: Presence of one or more (at least one must be delusions, hallucinations, or disorganized speech), lasting at least 1 day but <1 month, with eventual return to baseline.

Khalid shows:

1. Delusions

   • Firm conviction that faculty are part of a secret ultrasonic organization.

2. Hallucinations

   • Auditory hallucinations perceived as encoded messages.

3. Disorganized speech

   • Tangential, loosely connected statements.

4. Grossly disorganized behavior

   • Dismantling electronics, wandering campus at night.

Duration: ~48 hours (meets minimum 1-day requirement; well below 1-month threshold).
Return to baseline expected: Prior functioning was excellent, and early response to support in ED suggests likely rapid stabilization.
No mood episode, substance use, or medical condition better explains symptoms.

Specifier: With Marked Stressor(s) (“brief reactive psychosis”) due to the sudden loss of his thesis work and academic future.

Differential Diagnosis

• Schizophreniform Disorder / Schizophrenia:
  Duration too short; no negative symptoms; no prodromal decline.

• Substance-Induced Psychotic Disorder:
  Tox screen negative; peers confirm no recent substance use.

• Mood Disorder with Psychotic Features:
  Psychosis is not mood-congruent; no manic or depressive episode.

• Delusional Disorder:
  Presence of hallucinations, disorganized speech, and rapid onset inconsistent with delusional disorder.

• Culturally normative beliefs:
  Symptoms exceed cultural norms and impair functioning.

Functional Impairment

• Academic trajectory disrupted; unable to continue work safely.

• Roommate frightened; campus safety involved.

• Anxiety and insomnia since onset; high levels of psychological distress.

Precipitating Factors

• Acute stressor: Sudden academic collapse and fear of failing program.

• Perfectionistic traits: Rigid academic expectations, chronic self-criticism.

• Sleep deprivation: Had slept only 4 hours in the previous 48.

• Social isolation: Limited support system outside roommate.

Course and Prognosis

• With treatment, prognosis is excellent—most individuals return to full functioning within days or weeks.

• Recurrence risk increases if future stressors occur without coping supports.

Treatment Considerations

Immediate Care

• Short-term antipsychotic medication (low-dose atypical antipsychotic).

• Ensuring safety, sleep stabilization, and reduction of environmental stress.

Psychotherapy (after stabilization)

• Stress management training

• Psychoeducation on early warning signs and relapse prevention

• Cognitive-behavioral therapy to address catastrophic thinking around academic identity

• Supportive therapy linked with campus mental health services

Supportive Interventions

• Reduced academic load temporarily

• Contact with advisor to address academic remediation

• Encouraging structured social support through peers or student groups