Schizophrenia — MCQs

A 21-year-old man presents to the emergency room requesting surgery to remove "microchips," which he believes were implanted in his brain by "Russian spies" 6 months ago to control his thoughts. He also reports hearing the "spies" talk to each other through embedded "microspeakers." You notice that his hair appears unwashed and some of his clothes are on backward. Urine toxicology is negative for illicit drugs. Which of the following additional findings are you most likely to see in this patient during the course of his illness?

A 40-year-old male accountant is brought to the physician by his wife. She complains of her husband talking strangely for the past 6 months. She has taken him to multiple physicians during this time, but her husband did not comply with their treatment. She says he keeps things to himself, stays alone, and rarely spends time with her or the kids. When asked how he was doing, he responds in a clear manner with "I am fine, pine, dine doc." When further questioned about what brought him in today, he continues “nope, pope, dope doc.” Physical examination reveals no sensorimotor loss or visual field defects. Which of the following best describes the patient's condition?

A 23-year-old male presents to the emergency department. He was brought in by police for shouting on a subway. The patient claims that little people were trying to kill him, and he was acting within his rights to defend himself. The patient has a past medical history of marijuana and IV drug use as well as multiple suicide attempts. He is currently homeless. While in the ED, the patient is combative and refuses a physical exam. He is given IM haloperidol and diphenhydramine. The patient is transferred to the inpatient psychiatric unit and is continued on haloperidol throughout the next week. Though he is no longer aggressive, he is seen making "armor" out of paper plates and plastic silverware to defend himself. The patient is switched onto risperidone. The following week the patient is still seen gathering utensils, and muttering about people trying to harm him. The patient's risperidone is discontinued. Which of the following is the best next step in management?

A 25-year-old woman is brought to the physician by her husband because she has appeared increasingly agitated over the last week. She feels restless, has not been able to sleep well, and has been pacing around her house continuously in an attempt to relieve her symptoms. Two weeks ago, she was diagnosed with schizophrenia and treatment with fluphenazine was initiated. Today, physical examination is interrupted multiple times because she is unable to sit or stand still for more than a couple minutes. Which of the following is the most likely diagnosis?

An 18-year-old man is brought to the emergency department after his mother found him locked in his room stammering about a government conspiracy to brainwash him in subterranean tunnels. His mother says that he has never done this before, but 6 months ago he stopped going to classes and was subsequently suspended from college. She reports that he has become increasingly taciturn over the course of the past month. He drinks one to two beers daily and has smoked one pack of cigarettes daily for 3 years. He occasionally smokes marijuana. His father was diagnosed with schizophrenia at the age of 25 years. The patient has had no friends or social contacts other than his mother since he was suspended. He appears unkempt and aloof. On mental status examination, he is disorganized and shows poverty of speech. He says his mood is "good." He does not hear voices and has no visual or tactile hallucinations. Toxicology screening is negative. Which of the following is an unfavorable prognostic factor for this patient's condition?

A 31-year-old man is brought in to the clinic by his sister because she is concerned about his behavior since the death of their mother 2 months ago. The patient’s sister states that he has always been a ‘loner’ and preferred being by himself than socializing with others. His social isolation resulted in him being ‘socially awkward’, as described by his family. However, 2 months ago, when he found out about the death of their mother, he showed little emotion and attended her funeral in jeans and a dirty T-shirt which upset the rest of their family. When asked about it, he shrugged and said he was in a hurry to get to the funeral and “just left the house with what I had on.” He does not speak much during the interview, allowing his sister to speak on his behalf. His sister insists that he has ‘always been like this’, quiet and a complacent child who had no interest in playing with other children. The patient currently lives alone and spends his time repairing and building electrical appliances, and his sister is worried that his self-imposed isolation is making it ‘impossible for him to interact with other people normally’. Which of the following is the most likely diagnosis in this patient?

A 13-year-old boy with recently diagnosed schizophrenia presents with feelings of anxiety. The patient says that he has been having feelings of dread, especially since a friend of his has been getting bullied at school. He feels troubled by these feelings almost every day, making it difficult for him to get ready to go to school. He also has been hallucinating worse lately. Past medical history is significant for schizophrenia diagnosed 1 year ago. Current medications are fluphenazine. The patient is afebrile and vital signs are within normal limits. Physical examination is unremarkable. Which of the following medications would most likely be a better course of treatment for this patient?

A 20-year-old man is brought to the behavioral health clinic by his roommate. The patient’s roommate says that the patient has been looking for cameras that aliens planted in their apartment for the past 2 weeks. Approximately 3 months prior to the onset of this episode, the roommate says the patient stopped playing basketball daily because the sport no longer interested him. He stayed in his bedroom most of the day and was often tearful. The roommate recalls the patient talking about death frequently. The patient states he has been skipping many meals and has lost a significant amount of weight as a result. At the time his delusions about the aliens began, the depressive-related symptoms were no longer present. He has no other medical conditions. He does not drink but smokes 2 packs of cigarettes daily for the past 5 years. His vitals include: blood pressure 130/88 mm Hg, pulse 92/min, respiratory rate 16/min, temperature 37.3°C (99.1°F). On physical examination, the patient seems apathetic and uses an obscure word that appears to be ‘chinterfittle’. His affect is flat throughout the entire interaction. He is experiencing bizarre delusions but no hallucinations. The patient does not express suicidal or homicidal ideations. Urine drug screen results are provided below: Amphetamine negative Benzodiazepine negative Cocaine negative GHB negative Ketamine negative LSD negative Marijuana positive Opioids negative PCP negative Which of the following is the correct diagnosis?

A 50-year-old woman with a history of schizophrenia is being admitted to a locked inpatient psychiatry unit after discontinuing her medication. She was found wandering the streets, screaming in the air. According to her medical records, she was diagnosed with schizophrenia in her early 20s. She was initially living with her family but because of issues with medication compliance, substance abuse, and interpersonal problems, she has been homeless for the past 10 years. In addition to schizophrenia, her complicated medical history includes hypertension, diabetes, hypothyroidism, hyperlipidemia, morbid obesity, and substance abuse. She is not taking any medications at this time. At the hospital, her heart rate is 90/min, respiratory rate is 17/min, blood pressure is 110/65 mm Hg, and temperature is 37.0°C (98.6°F). She appears nervous and dirty. The clothes she was wearing are tattered and smell of urine and feces. She is too agitated and disruptive to perform a proper physical exam. Which of the following medications would be the most appropriate treatment for schizophrenia in this patient?

A 23-year-old woman is brought to the physician by her father because of strange behavior for the past 6 months. The father reports that his daughter has increasingly isolated herself in college and received poor grades. She has told her father that aliens are trying to infiltrate her mind and that she has to continuously listen to the radio to monitor these activities. She appears anxious. Her vital signs are within normal limits. Physical examination shows no abnormalities. Neurologic examination shows no focal findings. Mental status examination shows psychomotor agitation. She says: “I can describe how the aliens chase me except for my car which is parked in the garage. You know, the sky is beautiful today. Why does my mother have a cat?” Which of the following best describes this patient's thought process?