WBR0457
| Author | [[PageAuthor::Rim Halaby, M.D. [1]]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Behavioral Science/Psychiatry |
| Sub Category | SubCategory::Neurology |
| Prompt | [[Prompt::A 20 year old male patient is brought to the physician’s office by his parents because he is hearing voices in his head for the past 2 months. Upon further questioning, the parents explain that the patient has been staying in his room all by himself, avoiding contact with other people, and neglecting basic personal hygiene. They also report that the patient is always worried that the mob implanted a chip in his brain and want to kill him, despite the parents’ assurance of no one being around the house. The parents also report the patient has not had any 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 |
| 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. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Schizophrenia, WBRKeyword::Schizophreniform, WBRKeyword::Psychosis, WBRKeyword::Hallucination, WBRKeyword::Delusion |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |