USMLE® Step 1 style questions USMLE
A 23-year-old man is brought to the physician by his parent due to concerns of abnormal behavior. The patient’s parent tells the physician that the patient has been acting in a strange manner lately. Eight months ago, he spontaneously left his job, which he previously enjoyed, without reason. The parent adds that he no longer spends time with his friends and has become increasingly withdrawn from his family. Last month, he started acting as if he was responding to a voice no one else could hear, and he has been heard talking to himself in his room. The patient tells the physician that someone is talking to him and telling him about plans related to people trying to harm him. The patient recreationally uses alcohol and cocaine. He has also smoked one pack of cigarettes per day for the last five years. He was diagnosed with migraines three years ago but has not experienced any headaches recently. According to the patient’s parent, there is no known history of mental health disorders in the family. The physician strongly suspects a diagnosis of schizophrenia. Which of the following is considered a risk factor for this patient’s condition?
Content Reviewers:Rishi Desai, MD, MPH
Contributors:Tanner Marshall, MS
Schizo means split, and phrenia, in this case refers to the mind.
Even though schizophrenia can be interpreted to mean “splitting of the mind”, it does not refer to a split personality, like some media sources might portray, but rather schizophrenia describes a scattered or fragmented pattern of thinking.
Schizophrenia’s actually a syndrome, meaning there’re all sorts of symptoms that might be associated with it and different patients might experience different symptoms, although the symptoms can be broadly categorized into three major areas: positive symptoms, negative symptoms, and cognitive symptoms.
Alright taking a step back, most human symptoms from any illness are extreme versions of a normal physiologic process (for example everyone has a heartbeat and tachycardia is a fast heartbeat, everyone has a normal body temperature, but during a fever that temperature is higher).
In schizophrenia, patients have positive symptoms which aren’t positive in the sense that they’re helpful, but positive in the sense that they’re some new feature that doesn’t have some “normal” or physiologic counterpart.
Delusions are false beliefs that the patient might feel very strongly about, so much so that they won’t change their mind, even if you give them evidence against it.
There are all sorts of different delusions, like, for example, a delusion of control, where somebody thinks that some outside force or person or thing is controlling their actions.
They could also be delusions of reference, where someone might think that insignificant remarks are directed at them, like a newscaster is speaking directly to them through the TV.
Hallucinations are a second type of positive symptom, and can be any kind of sensation that’s not actually there, including visual but also including auditory sensations, like hearing voices or commands.
A third type is disorganized speech An example being something like a “word salad”, which seems like just a random jumbling of words or phrases, like “pencil dog hat coffee blue”.
Disorganized behavior on the other hand could be like if they exhibit bizarre or silly behavior that’s out of context and doesn’t seem to have much of a purpose, like for example wearing multiple layers of jackets on a hot summer day.
Also sometimes the behavior is described as “catatonic”, which has to do with their movements, posture, and responsiveness.
So like they might be super resistant to moving, or be in an unresponsive stupor.
Negative symptoms, are like when there’s this reduction or removal of normal processes, and this is like a decrease in emotions they can express, or a loss of interest in things they once found interesting.
One type of a negative symptom is called flat affect, where they don’t respond with an emotion or reaction that would seem appropriate, like if they saw something very unexpected like a small monkey playing in their living room, they might simply sit and watch idly as if nothing was happening.
Another type is alogia, or poverty of speech, which is a lack of content in speech, so like if somebody asked them “do you have any children?”, they might respond with “yes”, instead of “yes, one boy and two girls”.
A third type of negative symptom is avolition, which is this decrease in motivation to complete certain goals, so someone might stay at home for long periods of time, without trying to reach out to friends or find work.
Cognitive symptoms include things like not being able to remember things, learn new things, or understand others easily.
These symptoms are more subtle though, and more difficult to notice and might only be detected if they have really specific tests performed.
An example might be somebody not being able to keep track of several things at once, like a phone number and an address.
People with schizophrenia seem to cycle through three phases, typically in order.