WBR0457

Author	[[PageAuthor::Serge Korjian M.D. (Reviewed by Serge Korjian)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Behavioral Science/Psychiatry
Sub Category	SubCategory::General Principles
Prompt	[[Prompt::A 19-year-old man is brought by his parents to the physician’s office for reporting voices in his head for the past 2 months. Upon further questioning, the parents explain that the patient has been isolating himself in his room, avoiding contact with other people, and neglecting basic personal hygiene. They also report that the patient is always concerned that an alien force is seeking to implant a chip in his brain and is plotting to kill him. Further questioning reveal no signs of depressive or manic episodes. What is the most likely diagnosis of this patient?]]
Answer A	AnswerA::Schizophrenia
Answer A Explanation	[[AnswerAExp::Schizophrenia is a psychiatric disorder characterized by positive and negative symptoms that persist for at least 6 months. Positive symptoms include hallucinations, commonly auditory, delusions, speech disorganization, neglect of personal hygiene, social withdrawal, and sense of being controlled. On the other hand, negative symptoms refer to loss of mental capacity to perform tasks. They are generally more difficult to identify in schizophrenia than positive symptoms.]]
Answer B	AnswerB::Schizophreniform disorder
Answer B Explanation	[[AnswerBExp::Schizophreniform disorder has symptoms that are similar to schizophrenia but have not yet passed the 6 month time span. Patients that have symptoms that are present between 1-6 months are diagnosed with schizophreniform disorder, which might persist into schizophrenia.]]
Answer C	AnswerC::Brief psychotic disorder
Answer C Explanation	AnswerCExp::Brief psychotic disorder has symptoms similar to schizophrenia but span from 1 day until 1 month. Brief psychotic disorder can persist into schizophreniform disorder and later into schizophrenia.
Answer D	AnswerD::Schizoaffective disorder
Answer D Explanation	[[AnswerDExp::Schizoaffective disorder is a psychiatric disease characterized by the combination of schizophrenia symptoms and those of bipolar disorder. The diagnosis requires that the patient has 2 weeks of psychotic features without any signs of mania or depression. In the vignette, however, the patient is described to have neither mania nor depression.]]
Answer E	AnswerE::Delusional disorder
Answer E Explanation	[[AnswerEExp::Delusional disorder is characterized by only delusions that are typically non-bizarre, i.e. people who are not familiar with the patient can believe what he is saying because even though they are delusions, they still make sense. However, the patient in the vignette believes he has a chip inserted by the mob; this is a bizarre delusion. Along with the other symptoms that patient has, the diagnosis of delusional disorder becomes unlikely.]]
Right Answer	RightAnswer::B
Explanation	[[Explanation::Schizophreniform disorder is characterized by symptoms of schizophrenia that are present for at least 1 month until 6 months. Before 1 month, the symptoms are still consistent with brief psychotic disorder; and after 6 months, the diagnosis of schizophrenia can be made. Despite chance of recovery, schizophreniform disorder is a serious mental condition because it commonly persists beyond 6 months; after which the diagnosis of schizophrenia can be made. Educational Objective: Schizophreniform disorder is a psychiatric disease that is characterized by the positive and negative symptoms of schizophrenia that persist from 1 month until 6 month. Schizophreniform disorder may persist to schizophrenia. References: American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author. First Aid 2014 page 512.]]
Approved	Approved::Yes
Keyword	WBRKeyword::Schizophrenia, WBRKeyword::Schizophreniform, WBRKeyword::Psychosis, WBRKeyword::Hallucination, WBRKeyword::Delusion
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::