The presentation of the patient after periods of medication
discontinuation with third person auditory hallucination, self
absorbed behaviours, and decline in socio-occupational
functioning lasting for more than four weeks met the ICD-10
criteria for schizophrenia. One might be tempted to think that
the initial presentation was part of the second diagnosis, the
former occurring in the prodromal phase of the later. This is
unlikely because the ICD-10 clearly describes the prodromal
phase of schizophrenia as a phase in which symptoms and
behaviour, such as loss of interest in work, social activities, and
personal appearance and hygiene, together with generalized
anxiety and mild degrees of depression and preoccupation,
preceded the onset of psychotic symptoms by weeks or even
months. This ICD description is quite different from the
patient’s morbid conviction of a perceived abnormality of an
otherwise normal thumb and probably a normal tooth that was
inadvertently removed. The preoccupation in this case report
was marked (to a delusional intensity) without loss of interest,
social activities, and personal hygiene.
Conclusion
It is therefore proposed that the reported case describes one
of schizophrenia preceded by a somatic delusional disorder.