Schizophrenization Process in a Hyperactive-Bipolar Patient with Substance Use: A Clinical Case with Neologistic Delusions

This case report traces the evolution of a psychotic state in a physician with a history of hyperactivity, bipolar disorder, and substance use. Initially presenting with mood instability and impulsivity, the patient developed neologistic delusions, thought fragmentation, and a progressive withdrawal from reality—culminating in a schizophreniform state. The discussion focuses on the phenomenon of “schizophrenization” as a clinical process—not merely a categorical diagnosis. It examines how neurodevelopmental factors, symbolic overload, and failure of frontal inhibition may contribute to the emergence of psychotic structures, particularly in high-functioning individuals under stress. The case integrates neurobiological hypotheses with symbolic psychiatry, interpreting the delusional content as a failed attempt to stabilize the disintegrating self. The patient’s medical training and access to pharmacological substances are analyzed as both defenses and triggers in the breakdown process. This case illustrates the continuity between affective disorders, impulse control deficits, and psychotic collapse. It calls for a dimensional, process-based understanding of mental illness that captures transitions, not just endpoints.