DSM-IV-TR Casebook Diagnosis of "Oberrealschul Student"
In the absence of any known general medical condition that
could account for the disturbance, the combination of disorganized
speech and catatonic behavior (stupor and excitement) clearly indicates
the diagnosis of Schizophrenia (see DSM-IV-TR). The diagnosis
is further confirmed by the history of onset of symptoms 7 months
previously, with a clear deterioration in functioning. Although
the hyperactivity, confused speech, and irritability might suggest
a Manic Episode, there is no description of a period with a persistent
elevated, expansive, or irritable mood. Although the patient often
is irritable and even violent, his mood seems to fluctuate unpredictably. In
contrast, when irritability is seen in mania, it usually is a response
to frustration of grandiosity or hyperactivity.