Behavioral Science & Ethics USMLE Step 1 Practice Question
A 47-year-old man with a 20-year history of schizophrenia is brought to the emergency department by paramedics after being found rummaging through dumpsters in an alley. He reports that he stopped taking his antipsychotic medication 6 months ago because he "felt better" and thought he no longer needed it. He has been homeless for the past 3 months after losing his apartment. On examination, he is disheveled and malodorous. Vital signs are all within normal limits. Mental status examination reveals organized speech but tangential thinking with frequent loose associations. He reports auditory hallucinations of two voices having a conversation in his head, which he has been hearing for the past 4 months. He denies suicidal or homicidal ideation, and there is no evidence of acute medical illness. His last psychiatric hospitalization was 18 months ago. Which of the following is the most appropriate next step in management?
Answer choices
- AInvoluntary inpatient psychiatric admission with reinitiation of antipsychotic medicationCorrect answer
- BDischarge with a referral to outpatient psychiatry and social work for housing assistance
- CInitiate lorazepam for anxiety and arrange same-day outpatient psychiatric follow-up
- DRestart antipsychotic medication in the ED and observe for 4 hours before discharge with case management
- EOrder neuroimaging to rule out structural brain abnormality causing the psychotic symptoms
- FAdminister an SSRI to address negative symptoms and arrange outpatient follow-up within 2 weeks
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