Case 6: A student who left university, laughing and murmuring to herself
A 21-year-old student, until now doing well, who has left university and during the interview laughs for no reason and murmurs to herself.
- 2 min read
- Checked 01 Nov 2026
The case
A 21-year-old student, who has always done well at her studies, has dropped out of university. While she is being assessed she laughs several times at moments that have nothing to do with what is being said, and with her head turned away she murmurs quietly to herself. Some questions have to be put to her twice.
Her mother says she gave up her studies because lately she could hardly concentrate and could not make even simple decisions. Her daughter has also told her, in confidence, that the neighbour has started building work next door "to hint something to her".
Summary
Diagnosis
What points to it
- Probable auditory verbal hallucinations: she murmurs with her head turned aside, laughs out of context and has to have questions repeated, as if she were listening to something else. She has not said she hears voices, so this is inferred from her behaviour: ask her directly.
- A delusion of reference: the neighbour's building work carries a message meant for her.
- How severe it is shows in what it does to her: she cannot concentrate or make simple decisions, behaves oddly in company and has lost her place at university after a good record.
What else it could be
The diagnosis needs symptoms for at least a month; if the history is shorter, it is an acute psychotic episode for now. A first psychosis calls for a search for a drug or a physical cause (drug screen, blood tests, a physical and neurological examination, and brain imaging if anything suggests it). A mood disorder with psychotic features is less likely with no manic or depressive syndrome described.
Management
- An antipsychotic, at a low starting dose in a first episode, begun in hospital and continued as an outpatient, with weight, glucose and lipids checked at the start and during treatment.
- Referral to an early intervention in psychosis team where one exists.
- Psychoeducation for her and her family, and family intervention.
- A lasting therapeutic relationship, with one person (a case manager) coordinating her medical and social care, including a phased return to study.
- Cognitive behavioural therapy for psychosis alongside the medication.
Outlook
Guarded. Her good record before the illness counts in her favour. Against her are the gradual loss of function and the trouble concentrating and deciding, which suggest the cognitive symptoms of schizophrenia, and which respond less to antipsychotics than hallucinations and delusions do.