On an inpatient unit, a 31-year-old single woman reports experiencing auditory and visual hallucinations for 1 month, followed by a full major depressive episode for 2 months. The psychotic symptoms and depressive symptoms occurred concurrently for 3 months, until the depressive symptoms resolved with pharmacotherapy and psychotherapy. The psychotic symptoms persisted for 2 more weeks, at which time the patient checked herself into the hospital. Which diagnosis best fits this clinical picture?

Choice A reason: Schizoaffective disorder is diagnosed when psychotic symptoms occur both during and outside of mood episodes. In this case, the patient had psychosis before, during, and after a major depressive episode, fulfilling the criteria for schizoaffective disorder, depressive type. Choice B reason: Bipolar disorder with psychotic features requires the presence of manic or mixed episodes, which are not described here. The absence of mania excludes bipolar disorder from consideration. Choice C reason: Major depressive disorder with psychotic features involves psychosis that occurs exclusively during depressive episodes. Since the patient’s psychotic symptoms persisted beyond the resolution of depression, this diagnosis is not appropriate. Choice D reason: Schizophrenia requires at least 6 months of continuous symptoms, including 1 month of active-phase symptoms. The timeline here is insufficient for schizophrenia, and the depressive symptoms are not “unspecified”—they meet criteria for a major depressive episode.