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A 42-year-old woman is seen in the emergency room after she was brought in for starting a fight in a bar. During the interview, she answers questions with a nearly continuous flow of accelerated speech that jumps from topic to topic. For example, one run-on sentence began, “I am fine, are you fine?…does the sun shine?…it is nice outside today…the today show is a very interesting place to be, I will have to run it.” Which of the following psychiatric findings best describes this style of train of thought?
A 23-year-old man comes to the psychiatrist with a chief complaint of a depressed mood. He is very anxious and obviously uncomfortable in the physician’s office. Which of the following actions should be used to help develop rapport with this patient?
A 23-year-old woman is seen by a psychiatrist in the emergency room. During the history, the patient is asked to describe her mood. She answers the following, “I am fine, like great wine, right off the vine. Do you like to climb? I need a glass of gin with lime.” She notes that she believes that she is the missing princess of Slovenia and needs someone to call that country to tell them she has been found. Which of the following findings would be listed on a report of this patient’s mental status examination?
A 56-year-old man has been hospitalized for a myocardial infarction. One day after admission, he becomes tremulous, anxious, and tachycardic. Several hours later, he begins laughing and pointing to the butterflies that he sees flying around the room. When the nurse enters the room, she sees no butterflies. This misperception of reality is best described by which of the following psychiatric terms?
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A 22-year-old woman is seen by a psychiatrist in the emergency room after she is found walking in the middle of a busy street with no shoes on. During her interview she is asked to tell the physician what the following statement means: “Those in glass houses should not throw stones.” Which of the following best describes the cognitive functions being tested by this request?
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A 28-year-old woman is admitted to the hospital secondary to a bacterial pneumonia. Her white blood cell count is extremely low because she has been receiving chemotherapy for lymphoma. The second night in the hospital, she begins crying inconsolably, though she is unable to tell the nurse why. Forty minutes later, she pulls out her IV and begins screaming that people are trying to hurt her. Several hours later she is found to be difficult to arouse and is disoriented. Which of the following is the most likely diagnosis?
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A 52-year-old man is sent to see a psychiatrist after he is disciplined at his job because he consistently turns in his assignments late. He insists that he is not about to turn in anything until it is “perfect, unlike all of my colleagues.” He has few friends because he annoys them with his demands for “precise timeliness” and because of his lack of emotional warmth. This has been a lifelong pattern for the patient, though he refuses to believe the problems have anything to do with his personal behavior. Which of the following is the most likely diagnosis for this patient?
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A 23-year-old woman comes to the psychiatrist because she “cannot get out of the shower.” She tells the psychiatrist that she has been unable to go to her job as a secretary for the past 3 weeks because it takes her at least 4 hours to shower. She describes an elaborate ritual in which she must make sure that each part of her body has been scrubbed three times, in exactly the same order each time. She notes that her hands are raw and bloody from all the scrubbing. She states that she hates what she is doing to herself but becomes unbearably anxious each time she tries to stop. She notes that she has always taken long showers, but the problem has been worsening steadily for the past 5 months. She denies problems with friends or at work, other than the problems that currently are keeping her from going to work. Which of the following is the most likely diagnosis?
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A 37-year-old man with chronic schizophrenia is brought to see a new psychiatrist for treatment. While taking the history, the psychiatrist finds that the patient functions with a flat affect and circumstantial speech all the time. He has few friends. He is able to hold a menial job at the halfway house where he lives, and his behavior is not influenced by delusions or hallucinations currently. In DSM-IV, the old multiaxial system of rating a patient’s global assessment of functioning, this element would have been documented on Axis V. In DSM-5, how is it suggested that an assessment of functioning be documented?
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A 28-year-old man comes to the psychiatrist because his employer required it. The patient says that he does not know why the employer required it—that his job is good and that he likes it because it requires him to sit in front of a computer screen all day. He notes he has one friend whom he has had for more than 20 years and “doesn’t need anyone else.” The friend lives in another state and the patient has not seen him for at least a year. The patient denies any psychotic symptoms. His eye contact is poor and his affect is almost flat.
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Study Notes
Psychiatric Assessment and Diagnostic Considerations
- The woman in the emergency room exhibits rapid, continuous speech with shifting topics, indicative of flight of ideas, a common feature of mania.
- The male patient with a depressed mood requires building rapport; showing empathy and active listening can help alleviate his anxiety.
- The young woman believes she is a missing princess and exhibits loosening of associations in her speech patterns, suggesting a thought disorder or potential delusions.
- The 56-year-old man experiences visual hallucinations (seeing butterflies) in the context of altered mental status, common after acute medical stressors.
- The inquiry about the proverb "Those in glass houses should not throw stones" tests abstract thinking, revealing cognitive function and comprehension ability.
- The pneumonia patient shows signs of potential delirium or severe emotional distress, likely linked to the stress of illness and hospitalization.
- The man with perfectionist tendencies and lack of emotional warmth exhibits traits suggestive of Obsessive-Compulsive Personality Disorder (OCPD), focusing on control and perfectionism.
- The 23-year-old woman presents with compulsive behaviors regarding her showering, supporting a diagnosis of Obsessive-Compulsive Disorder (OCD), characterized by intrusive thoughts and ritualistic behaviors.
- The 37-year-old man with chronic schizophrenia exhibits stable yet impaired functioning with a flat affect; under DSM-5, functioning is now assessed with the World Health Organization Disability Assessment Schedule (WHODAS 2.0) rather than the previous multiaxial system.
- The 28-year-old man exhibits signs of social withdrawal and a flat affect, potentially indicating a Personality Disorder or Schizoid Personality Disorder, given his lack of desire for social connections.
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Description
A woman exhibiting accelerated speech patterns is evaluated in an emergency room setting. Which psychiatric finding is most likely to describe her communication style?
