A 24-year-old male shows disorganized speech and delusions about the FBI listening to him. What is the most likely diagnosis?

The most likely diagnosis in this scenario is schizophrenia. The presence of disorganized speech and delusions, particularly of a paranoid nature—like the belief that the FBI is listening—are hallmark symptoms of schizophrenia.

Schizophrenia is characterized by a range of symptoms that can include delusions, hallucinations, disorganized thinking (evidenced by disorganized speech), and functioning impairment. This individual's symptoms suggest a significant disruption in their thought processes and perception of reality, aligning closely with the criteria for schizophrenia as outlined in diagnostic manuals.

Schizophreniform disorder refers to similar symptoms but lasts for at least one month and less than six months. Given the context implies persistent delusions and disorganized speech, this may suggest that the symptoms have been present for a longer duration than the minimum required for this diagnosis.

Delusional disorder is characterized primarily by the presence of one or more delusions that persist for at least one month, but typically does not include disorganized speech or major functional impairment seen here.

Psychoactive substance use disorder involves substance use leading to significant clinical impairment or distress, but the symptoms presented do not align with substance-induced psychotic disorder, since the question does not mention substance use.

In summary, the symptoms described