Frequent Derailment in Medicine / Internal Medicine — 40yo Man | Psychiatry | SMLE Q#1451
SMLE Question #1451
Medicine / Internal Medicine
Psychiatry
Last updated: February 2026
A 40-year-old man is brought by his brother for 3 months of worsening social withdrawal, irritability, and episodes of incoherent speech with frequent derailment. He reports hearing voices commenting on him and has a fixed belief that coworkers are spying on him. He has no prior psychiatric history, no substance use, and no prominent mood episodes. His work performance has declined. What is the most likely diagnosis?
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