Schizophrenia — MCQs

Question 1: A 24-year-old man and his mother arrive for a psychiatric evaluation. She is concerned about his health and behavior ever since he dropped out of graduate school and moved back home 8 months ago. He is always very anxious and preoccupied with thoughts of school and getting a job. He also seems to behave very oddly at times such as wearing his winter jacket in summer. He says that he hears voices but he can not understand what they are saying. When prompted he describes a plot to have him killed with poison seeping from the walls. Today, his heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 36.8°C (98.2°F). On physical exam, he appears gaunt and anxious. His heart has a regular rate and rhythm and his lungs are clear to auscultation bilaterally. CMP, CBC, and TSH are normal. A urine toxicology test is negative. What is the most likely diagnosis?

• A. Schizophrenia (Correct Answer)
• B. Substance-induced psychosis
• C. Schizophreniform disorder
• D. Schizoaffective disorder
• E. Brief psychotic disorder

Explanation: ***Schizophrenia*** - The patient presents with **delusions** ("plot to have him killed"), **hallucinations** ("hears voices"), **disorganized thinking** (preoccupied with school and job but no progress made, wearing winter jacket in summer can be a sign of disorganized behavior), and **negative symptoms** (appears gaunt and anxious, social withdrawal, drop out of school). These symptoms have been present since he dropped out of graduate school 8 months ago, indicating a **duration of at least 6 months**. - The combination of these symptoms persisting for over 6 months, impacting his functioning, and absence of other medical or substance-related causes, is diagnostic of **schizophrenia**. *Substance-induced psychosis* - The **urine toxicology test is negative**, ruling out recent substance use as the cause of his psychotic symptoms. - The **chronicity** of symptoms (8 months) is less typical for acute substance-induced psychosis, which generally resolves more quickly after the substance is cleared. *Schizophreniform disorder* - Schizophreniform disorder involves the same symptoms as schizophrenia but with a **duration of at least 1 month but less than 6 months**. - The patient's symptoms have been present for **8 months**, exceeding the criteria for schizophreniform disorder. *Schizoaffective disorder* - Schizoaffective disorder requires the presence of a **major mood episode** (depressive or manic) concurrent with criteria A of schizophrenia. Additionally, **delusions or hallucinations for at least 2 weeks** must occur in the absence of a major mood episode at some point during the illness. - While the patient appears anxious, there is **no clear evidence of a persistent major depressive or manic episode** that would qualify for schizoaffective disorder. *Brief psychotic disorder* - Brief psychotic disorder is characterized by psychotic symptoms lasting **more than 1 day but less than 1 month**. - The patient's symptoms have been ongoing for **8 months**, far exceeding the duration for brief psychotic disorder.