Case Formulation for Nina
Today, I would like to present the case formulation for Nina, a 28-year-old Nigerian
immigrant who works as a financial analyst and lives alone. Nina has a limited support
system and a history of stress related to cultural adjustment. Recently, she has been
using cannabis and amphetamines, which has led to acute psychotic symptoms.
II. Presenting Problem
Nina's symptoms include auditory hallucinations, persecutory delusions, disorganized
thinking, and erratic behavior, significantly impairing her functioning. She has poor
insight and judgment, cognitive deficits, and worsening self-care. These symptoms
began after she started using cannabis and amphetamines, raising concerns about
substance-induced psychosis versus a primary psychotic disorder like schizophrenia.
III. DSM-5-TR Diagnosis
Primary Diagnosis:
F15.259 – Stimulant-Induced Psychotic Disorder, with Delusions, with Hallucinations, with Onset
During Intoxication (Provisional)
F20.9 – Schizophrenia (Rule Out)
F32.3 – Major Depressive Disorder (MDD) with Psychotic Features (Rule Out)
F31.2 – Bipolar I Disorder with Psychotic Features (Rule Out)
The DSM-5-TR criteria for Stimulant-Induced Psychotic Disorder (SIPD) require that the
psychotic symptoms (hallucinations and/or delusions) arise in the context of substance use and
are not better explained by a primary psychotic disorder.
As for the Presence of hallucinations and/or delusions.
✅ We know thatNina has auditory hallucinations (threatening voices telling her she is being
watched) and persecutory delusions (believing people are plotting against her).
B. There is evidence that the symptoms developed during or soon after substance intoxication,
withdrawal, or exposure to a medication.
, ✅ Nina recently started using amphetamines and cannabis.
✅ Her psychotic symptoms emerged after her stimulant use.
✅ Amphetamines are known to cause paranoia, hallucinations, and delusions, supporting a
causal link.
C. As part of the criteria The disturbance is not better explained by a primary psychotic disorder
(e.g., schizophrenia, schizoaffective disorder).
✅ Nina has no prior history of psychosis or prodromal symptoms.
✅ No family history of schizophrenia or primary psychotic disorders has been noted.
✅ The sudden onset of psychosis after stimulant use strongly suggests a substance-induced
etiology.
⛔ Schizophrenia cannot be ruled out yet, but substance-induced psychosis is the more likely
cause at this stage.
D. The disturbance does not occur exclusively during the course of a delirium.
✅ Nina is alert and oriented (except for disorientation to time) and does not exhibit fluctuating
consciousness, ruling out delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or
other areas of functioning.
✅ Nina has impaired judgment, disorganized thoughts, cognitive deficits, and declining self-
care.
✅ She has difficulty working, maintaining hygiene, and interacting appropriately with others.
Since Nina’s symptoms began after recent stimulant use and there is no prior history of
psychosis, Stimulant-Induced Psychotic Disorder is the most likely primary diagnosis at this
time.Since substance-induced psychosis can sometimes unmask an underlying primary
psychotic disorder, this diagnosis is provisional. If Nina’s symptoms persist for more than a week
after stopping stimulants, schizophrenia or another primary disorder must be reconsidered.
Today, I would like to present the case formulation for Nina, a 28-year-old Nigerian
immigrant who works as a financial analyst and lives alone. Nina has a limited support
system and a history of stress related to cultural adjustment. Recently, she has been
using cannabis and amphetamines, which has led to acute psychotic symptoms.
II. Presenting Problem
Nina's symptoms include auditory hallucinations, persecutory delusions, disorganized
thinking, and erratic behavior, significantly impairing her functioning. She has poor
insight and judgment, cognitive deficits, and worsening self-care. These symptoms
began after she started using cannabis and amphetamines, raising concerns about
substance-induced psychosis versus a primary psychotic disorder like schizophrenia.
III. DSM-5-TR Diagnosis
Primary Diagnosis:
F15.259 – Stimulant-Induced Psychotic Disorder, with Delusions, with Hallucinations, with Onset
During Intoxication (Provisional)
F20.9 – Schizophrenia (Rule Out)
F32.3 – Major Depressive Disorder (MDD) with Psychotic Features (Rule Out)
F31.2 – Bipolar I Disorder with Psychotic Features (Rule Out)
The DSM-5-TR criteria for Stimulant-Induced Psychotic Disorder (SIPD) require that the
psychotic symptoms (hallucinations and/or delusions) arise in the context of substance use and
are not better explained by a primary psychotic disorder.
As for the Presence of hallucinations and/or delusions.
✅ We know thatNina has auditory hallucinations (threatening voices telling her she is being
watched) and persecutory delusions (believing people are plotting against her).
B. There is evidence that the symptoms developed during or soon after substance intoxication,
withdrawal, or exposure to a medication.
, ✅ Nina recently started using amphetamines and cannabis.
✅ Her psychotic symptoms emerged after her stimulant use.
✅ Amphetamines are known to cause paranoia, hallucinations, and delusions, supporting a
causal link.
C. As part of the criteria The disturbance is not better explained by a primary psychotic disorder
(e.g., schizophrenia, schizoaffective disorder).
✅ Nina has no prior history of psychosis or prodromal symptoms.
✅ No family history of schizophrenia or primary psychotic disorders has been noted.
✅ The sudden onset of psychosis after stimulant use strongly suggests a substance-induced
etiology.
⛔ Schizophrenia cannot be ruled out yet, but substance-induced psychosis is the more likely
cause at this stage.
D. The disturbance does not occur exclusively during the course of a delirium.
✅ Nina is alert and oriented (except for disorientation to time) and does not exhibit fluctuating
consciousness, ruling out delirium.
E. The disturbance causes clinically significant distress or impairment in social, occupational, or
other areas of functioning.
✅ Nina has impaired judgment, disorganized thoughts, cognitive deficits, and declining self-
care.
✅ She has difficulty working, maintaining hygiene, and interacting appropriately with others.
Since Nina’s symptoms began after recent stimulant use and there is no prior history of
psychosis, Stimulant-Induced Psychotic Disorder is the most likely primary diagnosis at this
time.Since substance-induced psychosis can sometimes unmask an underlying primary
psychotic disorder, this diagnosis is provisional. If Nina’s symptoms persist for more than a week
after stopping stimulants, schizophrenia or another primary disorder must be reconsidered.
