Rosh Psychiatry Board Practice Exam

A 21-year-old man presents with symptoms of a "mental breakdown" lasting six weeks. What is the most likely diagnosis?

1. Schizoaffective disorder

2. Schizophrenia, first episode, currently in full remission

3. Schizoid personality disorder

4. Schizophreniform disorder

The correct answer is: Schizophreniform disorder

The most likely diagnosis in this case is the one that aligns with the duration and nature of the symptoms described. The symptoms of a "mental breakdown" lasting for six weeks suggests a significant period of disturbance but has not yet reached the threshold for a diagnosis of schizophrenia, which requires that symptoms persist for six months. Schizophreniform disorder is characterized by symptoms that are similar to those of schizophrenia but with a shorter duration—specifically, lasting from one to six months. This particular timeframe fits well with the six-week duration presented in the scenario. In addition to the timeframe, symptoms of schizophreniform disorder include hallucinations, delusions, disorganized speech, and negative symptoms, which align with the notion of experiencing a "mental breakdown." In contrast, schizoaffective disorder requires the presence of mood symptoms in conjunction with psychotic symptoms over an extended period, which is not indicated here. Schizophrenia in full remission also involves a longer history of psychotic symptoms followed by a period of remission, which does not match the acute onset described. Lastly, schizoid personality disorder is a chronic pattern of detachment from social relationships and does not account for acute psychiatric symptoms such as those described. Thus, the presentation strongly supports a diagnosis