Marcus is a 22-year-old junior who was referred to the university counseling center by an academic advisor because of a significant decline in academic performance.
During his first two years of college, Marcus earned mostly Bs and occasionally As. He participated in intramural sports and maintained several close friendships.
Over approximately the past five months, Marcus has become increasingly isolated. He stopped participating in intramural sports and rarely leaves his residence hall room.
His roommate reports that Marcus sometimes sits alone and appears to be listening to someone who is not present. Marcus has stated that he hears a man’s voice criticizing him and telling him that people on campus are “plotting against” him.
Marcus recently told his professor that the university’s security cameras were specifically installed to monitor him.
His personal hygiene has declined considerably. He has missed multiple classes and has stopped completing assignments.
When asked about these changes, Marcus states:
“Nothing is wrong with me. You need to ask yourself why everyone seems to be following me.”
Marcus denies having a mental health problem.
CLINICAL OBSERVATION
Identify at least six clinically significant observations from your assigned case.
For each observation, explain why it is clinically relevant.
PSYCHOTIC SYMPTOM ANALYSIS
Identify examples of the following, if present:
Hallucinations
Delusions
Disorganized thinking or speech
Negative symptoms
Cognitive or functional changes
DIAGNOSTIC REASONING
Use the Seven Steps for Psychiatric Diagnosis to confirm the patients diagnosis/diagnoses. The Seven Steps for Psychiatric Diagnosis begins on page 161-165, include ALL of the steps. This assignment should be written in APA format. All Assignments should be uploaded into CANVAS.
Collecting Data: Performed during the assessment
Identifying Psychopathology: Performed during the assessment
Evaluating the Reliability of the Data
Determining the overall distinctive feature
Arriving at a diagnosis
Checking Diagnostic Criteria
Resolving Diagnostic Uncertainty
This clinical case asks you to identify at least six clinically significant observations in Marcus’s presentation and explain why each matters — the first step toward a diagnostic impression. Work systematically from the case facts to the clinical meaning; let the evidence drive the reasoning.
Key takeaways
- Pull observations straight from the case and explain the clinical significance of each.
- Marcus shows hallmark positive symptoms (auditory hallucinations, persecutory delusions) and negative symptoms (withdrawal, decline in self-care).
- Note the timeline (~5 months) and functional decline — key to the differential.
- Lack of insight (‘nothing is wrong with me’) is itself clinically significant.
- Map findings to DSM-5-TR criteria without over-diagnosing from a single detail.
Identify the six-plus observations
Go through the vignette and name the significant findings, with the ‘why’ for each:
- Auditory hallucinations — hearing a man’s voice criticizing him: a positive psychotic symptom.
- Persecutory delusions — believing people are ‘plotting’ and cameras monitor him: fixed false beliefs.
- Social withdrawal — stopped sports, rarely leaves his room: a negative symptom and functional decline.
- Decline in self-care/hygiene — reduced functioning typical of psychosis.
- Academic/functional deterioration — missed classes, incomplete work: marked drop from prior baseline (previously Bs and As).
- Lack of insight — denies any problem, projects onto others: affects engagement and treatment.
- Duration (~5 months) — relevant to distinguishing schizophrenia from shorter-course disorders.
Explain why each matters
For every observation, connect it to clinical meaning — which symptom cluster it belongs to and what it signals. This is what the assignment grades, not just a list.
Point toward the differential
The picture (positive + negative symptoms, functional decline, ~5+ months) raises schizophrenia-spectrum concerns, but note what you’d rule out — substance-induced psychosis, mood disorder with psychotic features, or a medical cause — using history and labs. Reference DSM-5-TR criteria.
Format
Organize by observation, keep the tone clinical and respectful, and cite the DSM-5-TR and course sources. Our guide to assessing psychotic disorders covers the full differential.