Kaplan USMLE Step 1: Woman found wandering and talking to herself

If you’re preparing for the United States Medical Licensing Examination® (USMLE®) Step 1 exam, you might want to know which questions are most often missed by test-prep takers. Check out this example from Kaplan Medical, and read an expert explanation of the answer. Also check out all posts in this series.

A 22-year-old woman who is a college student is brought to the emergency department by police because she was found talking to herself while walking back and forth across a busy street. She appears to be oriented to person, place and time. Her sister comes to the hospital and says that the patient dropped out of school three months ago and has been living on the streets. A review of her records shows a hospital admission two months ago for a similar condition. Psychiatric examination shows difficulty concentrating and talking to unheard voices. Urine toxicology is negative. Which of the following is the most likely diagnosis?

A. Brief psychotic disorder

B. Schizoaffective disorder

C. Schizoid personality disorder

D. Schizophrenia

E. Schizophreniform disorder

F. Schizotypal personality disorder

The correct answer is E.

This patient is suffering from schizophreniform disorder. There has been a marked decline in her level of functioning and she was endangering herself by walking in the middle of the street. Schizophreniform disorder is characterized by schizophrenia-like symptoms, but the duration of symptoms is less than six months (but more than one month). Fully developed psychotic symptoms are typical.

Choice A. Brief psychotic disorder is characterized by the presence of delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and one of the symptoms must be one of the first three symptoms listed. The duration of an episode of the disturbance is at least one day but less than one month. The patient in this question has an episode lasting between one and six months.