A 37-year-old man repos that after a sudden financial loss, he had a bout of illness in which he felt sad and nervous and fearful, could not sleep or eat properly. He also began to hear voices telling him that he was useless and should kill himself. His symptoms stopped after approximately one week. He has had no similar episodes. Medical history includes no psychiatric conditions. Physical examination shows no abnormalities, and results of laboratory studies are within normal limits. Which of the following is the most likely diagnosis?

**Core Concept**
A psychotic episode can be triggered by significant life stressors, resulting in a sudden onset of psychotic symptoms such as hallucinations, delusions, and disorganized thinking. This condition is often referred to as a brief psychotic disorder.

**Why the Correct Answer is Right**
The patient's symptoms, including hallucinations and delusions, developed in response to a significant life stressor and resolved on their own within a week. This pattern is consistent with a brief psychotic disorder, which is characterized by a sudden onset of psychotic symptoms that last for a short period, typically less than one month. The patient's lack of prior psychiatric history and physical examination findings within normal limits also support this diagnosis.

**Why Each Wrong Option is Incorrect**
**Option A:** This diagnosis would be incorrect because a major depressive episode typically involves persistent mood disturbances, such as depressed mood or loss of interest in activities, for at least two weeks, which is not the case in this patient.

**Option B:** This diagnosis would be incorrect because a bipolar disorder typically involves a history of manic or hypomanic episodes, which is not present in this patient.

**Option C:** This diagnosis would be incorrect because a schizophrenia spectrum disorder typically involves a longer duration of psychotic symptoms, often with a gradual onset and a more chronic course.

**Clinical Pearl / High-Yield Fact**
A brief psychotic disorder can be a "rule out" diagnosis in patients presenting with psychotic symptoms, as it can mimic other psychiatric conditions. However, a thorough assessment of the patient's mental status, medical history, and laboratory studies is essential to rule out other potential causes of psychotic symptoms.

**Correct Answer:** C. Schizophrenia spectrum disorder

✓ Correct Answer: B. Brief psychotic disorder