Rosh Psychiatry Board Practice Exam

A woman is convinced that the police are surveilling her. What is the most likely diagnosis?

1. Brief psychotic disorder

2. Delusional disorder

3. Schizoaffective disorder

4. Schizophrenia

The correct answer is: Delusional disorder

The scenario describes a woman who firmly believes that the police are surveilling her. This belief aligns with the characteristics of delusions, which are fixed, false beliefs that are resistant to reasoning or contrary evidence. In the case of delusional disorder, the individual typically experiences non-bizarre delusions, meaning the beliefs are plausible but not grounded in reality. This type of disorder specifically encompasses situations where a person has significant beliefs that are not reflective of actual events, such as feeling persecuted or watched. Delusional disorder can present with a variety of themes, including persecution, which is what is evident in this woman's belief about the police. It is important to note that individuals with delusional disorder may not exhibit the broad spectrum of symptoms associated with disorders like schizophrenia, such as hallucinations, disorganized thought processes, or negative symptoms. Instead, they primarily maintain their delusion without other major psychotic features. By contrast, other options involve conditions that either require more pervasive symptoms (e.g., schizophrenia), or time-limited episodes (e.g., brief psychotic disorder), making them less representative of the scenario described. Schizoaffective disorder involves mood disorder symptoms in addition to psychotic symptoms, which is also not indicated in this scenario.