Rosh Psychiatry Board Practice Exam

In a case of a man having a seizure and displaying strange behavior, which detail confirms a diagnosis?

1. Prior history of untreated schizophrenia

2. Recent overconsumption of alcohol

3. Recent history of alcohol cessation

4. Recent cessation of seizure medication

The correct answer is: Recent history of alcohol cessation

When assessing a case of seizure with unusual behavior, confirming the diagnosis often hinges on understanding recent changes in the individual's health or lifestyle. The detail regarding recent cessation of alcohol consumption is particularly significant because it can indicate the possibility of alcohol withdrawal seizures, a common occurrence in individuals who have been consuming alcohol heavily and then suddenly stop. Withdrawal seizures typically arise 6 to 48 hours after the last drink and can present with abnormal behavior or altered mental status, which aligns with the symptoms described. This detail also connects to the underlying neurophysiological changes associated with alcohol dependence and withdrawal. The body becomes reliant on alcohol to maintain normal neuronal function, and its abrupt absence can lead to hyperexcitability of the nervous system, resulting in seizures. In contrast, other details, such as a prior history of schizophrenia or recent overconsumption of alcohol, can provide context but do not directly confirm the diagnosis of the seizure's cause. The recent cessation of seizure medication is important for evaluating seizure activity but is less relevant in this context compared to the impact of alcohol cessation on seizure risk.