**Summarize the Relevant Historical Information:**
**Presenting Problem:**
- **Demographic Description:** Jane is a 22-year-old, single Caucasian college freshman.
- **Self-Description of Problem:** Jane might describe her problem as being bothered by her professors and roommate, feeling paranoid about being talked about, and hearing voices that disturb her sleep. She mentions drinking to drown out these voices.
**History of the Presenting Problem:**
Jane has been experiencing auditory hallucinations for the past six months, which have made her feel paranoid and suspicious of others. This paranoia has caused her to socially isolate herself, negatively impacting her academic performance. She began binge drinking over the past two weeks to help manage these auditory hallucinations.
**DSM-IV TR Diagnosis:**
- **Axis I:** Schizophrenia or Schizoaffective Disorder (primary diagnosis)
- **Axis II:** No Diagnosis
- **Axis III:** Severe chronic asthma
- **Axis IV:** Moderate psychosocial stressors due to academic and social pressures
- **Axis V:** GAF Score: 40-50 (significant impairment in functioning)
**DSM-5 Diagnosis:**
Schizophrenia with auditory hallucinations, characterized by paranoia and social withdrawal. Note: Stressors include academic and social pressures. Note: Functional impairment includes a decline in academic performance and social isolation.
**Justification of Diagnoses:**
- **DSM-IV:** Symptoms include auditory hallucinations, paranoia, and social withdrawal, aligning with criteria for schizophrenia. Other potential diagnoses, such as mood disorders, were ruled out due to the primary presence of psychotic symptoms.
- **DSM-5:** Symptoms remain consistent with schizophrenia, with additional note of functional impairments due to academic decline and social issues.
**Case Formulation:**
Jane's problems may be understood through the cognitive-behavioral theory, which suggests that her maladaptive thoughts (e.g., paranoia) contribute to her distress and isolation. The onset of auditory hallucinations and paranoia led to maladaptive coping strategies, such as alcohol use, further affecting her academic and social life.
