Assessment techniques for delusions US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Assessment techniques for delusions. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Assessment techniques for delusions US Medical PG Question 1: A 23-year-old man presents to the emergency department with a chief complaint of being assaulted on the street. The patient claims that he has been followed by the government for quite some time and that he was assaulted by a government agent but was able to escape. He often hears voices telling him to hide. The patient has an unknown past medical history and admits to smoking marijuana frequently. On physical exam, the patient has no signs of trauma. When interviewing the patient, he is seen conversing with an external party that is not apparent to you. The patient states that he is afraid for his life and that agents are currently pursuing him. What is the best initial response to this patient’s statement?
- A. I think you are safe from the agents here.
- B. You have a mental disorder but don’t worry we will help you.
- C. I don’t think any agents are pursuing you.
- D. What medications are you currently taking?
- E. It sounds like you have been going through some tough experiences lately. (Correct Answer)
Assessment techniques for delusions Explanation: ***It sounds like you have been going through some tough experiences lately.***
- This response **acknowledges the patient's distress** and experience without validating or refuting their delusional beliefs.
- It helps establish **rapport** and encourages the patient to share more about their symptoms, which is crucial for assessment in a psychiatric emergency.
*I think you are safe from the agents here.*
- While intended to reassure, directly addressing the delusion can be perceived as dismissive and may **escalate the patient's paranoia** or agitation.
- It does not validate their *feelings* of fear, which are real to them, even if the source is delusional.
*You have a mental disorder but don’t worry we will help you.*
- This statement is **confrontational** and judgmental, labeling the patient immediately with a diagnosis.
- This approach can cause the patient to become defensive, shut down, or feel stigmatized, making further assessment and trust-building very difficult in the **initial interaction**.
*I don’t think any agents are pursuing you.*
- Directly **challenging a patient's delusion** is generally unhelpful in acute settings and can lead to increased agitation.
- It invalidates their subjective reality and can make them feel misunderstood or distrustful of the healthcare provider.
*What medications are you currently taking?*
- While important information, asking about medications is too premature as an *initial response* to a patient expressing severe paranoia and fear.
- This question comes across as dismissive of their current emotional state and **prioritizes medical history over emotional support** and rapport-building.
Assessment techniques for delusions US Medical PG Question 2: A 35-year-old woman is brought to the inpatient psychiatric unit by the police after she was found violating the conditions of her restraining order by parking on the side street of her "lover’s" home every night for the past week. Her "lover", a famous hometown celebrity, has adamantly denied any relationship with the patient over the past 6 months. The patient insists that ever since he signed a copy of his album at a local signing, she knew they were in love. Despite him having his own wife and children, the patient insists that he is in love with her and goes to his house to meet in secret. Physical examination of the patient is unremarkable. Urine toxicology is negative. Which of the following statements best describes this patient’s condition?
- A. The patient will have concurrent psychotic disorders.
- B. The disorder must meet 2 out of the 5 core criteria.
- C. Symptoms must be present for at least 4 weeks. (Correct Answer)
- D. This disorder has a high prevalence rate.
- E. Patients may have a contributing medical condition.
Assessment techniques for delusions Explanation: ***Symptoms must be present for at least 4 weeks.***
- This patient presents with symptoms highly suggestive of **delusional disorder, erotomanic type**, where the primary delusion is that another person, usually of higher status, is in love with them. For a diagnosis of delusional disorder, the DSM-5 criteria state that the presence of one or more delusions must persist for **at least 1 month**.
- The patient's unwavering belief in a secret relationship with a celebrity, despite clear evidence to the contrary and the celebrity's denial, aligns with the characteristics of a **fixed, nonbizarre delusion**, which is the hallmark of delusional disorder.
*The patient will have concurrent psychotic disorders.*
- In **delusional disorder**, by definition, the patient typically does **not experience other psychotic symptoms** like prominent hallucinations, disorganized speech, or grossly disorganized/catatonic behavior.
- If other psychotic symptoms are prominent, the diagnosis would likely shift to **schizophrenia** or **schizoaffective disorder**, not delusional disorder.
*The disorder must meet 2 out of the 5 core criteria.*
- This statement refers to the diagnostic criteria for **schizophrenia**, which requires two or more of the five core symptoms (delusions, hallucinations, disorganized speech, grossly disorganized/catatonic behavior, negative symptoms).
- Delusional disorder is characterized primarily by the presence of **nonbizarre delusions** without meeting the full criteria for schizophrenia.
*This disorder has a high prevalence rate.*
- **Delusional disorder** is relatively **uncommon**, with an estimated lifetime prevalence of about 0.2%.
- It is one of the **less common psychotic disorders**, especially when compared to schizophrenia or mood disorders with psychotic features.
*Patients may have a contributing medical condition.*
- While medical conditions can sometimes cause psychotic symptoms (e.g., **substance-induced psychosis** or psychosis due to another medical condition), this is typically excluded in the diagnosis of **primary delusional disorder**.
- The patient's urine toxicology is negative, and her physical examination is unremarkable, suggesting that her symptoms are not due to a medical condition or substance use.
Assessment techniques for delusions US Medical PG Question 3: A 24-year-old man is brought to your emergency department under arrest by the local police. The patient was found naked at a busy intersection jumping up and down on top of a car. Interviewing the patient, you discover that he has not slept in 2 days because he does not feel tired. He reports hearing voices. The patient was previously hospitalized 1 year ago with auditory hallucinations, paranoia, and a normal mood. What is the most likely diagnosis?
- A. Schizophrenia
- B. Bipolar disorder
- C. Brief psychotic disorder
- D. Schizotypal disorder
- E. Schizoaffective disorder (Correct Answer)
Assessment techniques for delusions Explanation: ***Schizoaffective disorder***
- This patient demonstrates the **hallmark feature** of schizoaffective disorder: **psychotic symptoms occurring both during AND independent of mood episodes**.
- **Current presentation**: Clear **manic episode** (decreased need for sleep, grandiose/disinhibited behavior, psychomotor agitation) with psychotic features (auditory hallucinations).
- **Previous hospitalization**: **Psychotic symptoms (hallucinations, paranoia) in the absence of a mood episode** ("normal mood"), requiring hospitalization for at least 2 weeks - this is the **key diagnostic criterion** for schizoaffective disorder.
- The diagnosis requires an **uninterrupted period of illness** with both psychotic symptoms (meeting Criterion A for schizophrenia) and a major mood episode, PLUS psychotic symptoms for **≥2 weeks without prominent mood symptoms**.
*Bipolar disorder*
- In bipolar disorder with psychotic features, psychotic symptoms occur **exclusively during mood episodes** (manic, hypomanic, or depressive).
- This patient's previous hospitalization with psychosis but **"normal mood"** indicates psychotic symptoms independent of mood episodes, which **rules out** bipolar disorder and points to schizoaffective disorder.
- While the current presentation shows mania with psychosis, the longitudinal course is critical for diagnosis.
*Schizophrenia*
- Schizophrenia involves **continuous psychotic symptoms** without prominent mood episodes dominating the clinical picture.
- This patient has **prominent manic symptoms** (decreased sleep, grandiose behavior, agitation) that are central to the current presentation, making schizophrenia less likely.
- The presence of full mood episodes that occupy a **substantial portion** of the illness duration favors schizoaffective disorder over schizophrenia.
*Brief psychotic disorder*
- Brief psychotic disorder involves psychotic symptoms lasting **<1 month** with full return to baseline functioning.
- This patient has a **recurrent course** with hospitalization 1 year ago, indicating a chronic/recurring condition rather than a brief, self-limited episode.
*Schizotypal disorder*
- This is a **personality disorder** characterized by social deficits, cognitive/perceptual distortions, and eccentric behavior, but **NOT overt psychotic episodes**.
- Does not involve acute psychotic breaks with severe symptoms like hallucinations requiring hospitalization or manic episodes.
Assessment techniques for delusions US Medical PG Question 4: A 23-year-old man is brought to the emergency department by his girlfriend because of acute agitation and bizarre behavior. The girlfriend reports that, over the past 3 months, the patient has become withdrawn and stopped pursuing hobbies that he used to enjoy. One month ago, he lost his job because he stopped going to work. During this time, he has barely left his apartment because he believes that the FBI is spying on him and controlling his mind. He used to smoke marijuana occasionally in high school but quit 5 years ago. Physical and neurologic examinations show no abnormalities. On mental status examination, he is confused and suspicious with marked psychomotor agitation. His speech is disorganized and his affect is labile. Which of the following is the most likely diagnosis?
- A. Schizophreniform disorder (Correct Answer)
- B. Schizoid personality disorder
- C. Delusional disorder
- D. Schizoaffective disorder
- E. Brief psychotic disorder
Assessment techniques for delusions Explanation: **Correct: Schizophreniform disorder**
- This patient presents with ***psychotic symptoms*** (delusions, disorganized speech, agitation) and ***negative symptoms*** (withdrawal, anhedonia, loss of job), which have been present for approximately ***3 months***.
- The ***duration of symptoms (1-6 months)*** is the key differentiating factor for schizophreniform disorder compared to brief psychotic disorder (<1 month) or schizophrenia (>6 months).
- Meets DSM-5 criteria: psychotic symptoms with functional impairment lasting between 1 and 6 months.
*Incorrect: Schizoid personality disorder*
- Characterized by a pervasive pattern of ***detachment from social relationships*** and a restricted range of emotional expression, which are ***ego-syntonic*** and typically stable over time.
- This is a personality disorder with chronic traits, not an acute psychotic disorder.
- Does not include acute psychotic symptoms like delusions or disorganized speech.
*Incorrect: Delusional disorder*
- Defined by the presence of ***non-bizarre delusions*** for at least one month, without other significant psychotic symptoms or major functional impairment.
- This patient has ***bizarre delusions*** (FBI controlling his mind), ***disorganized speech***, ***psychomotor agitation***, and ***marked functional impairment***, which exceed the criteria for delusional disorder.
*Incorrect: Schizoaffective disorder*
- Requires the presence of a ***major mood episode*** (depressive or manic) concurrent with symptoms of schizophrenia, AND ***delusions or hallucinations for at least 2 weeks*** in the absence of a major mood episode.
- While the patient exhibits labile affect, there is no evidence of a distinct, prolonged major mood episode (major depression or mania) as required for schizoaffective disorder.
*Incorrect: Brief psychotic disorder*
- Characterized by the sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech or behavior) that last for ***at least one day but less than one month***, followed by full return to premorbid functioning.
- The patient's symptoms have been ongoing for approximately ***3 months***, which exceeds the duration criteria for brief psychotic disorder.
Assessment techniques for delusions US Medical PG Question 5: A 24-year-old woman is brought to the hospital by her mother because she has "not been herself" for the past 3 months. The patient says she hears voices in her head. The mother said that when she is talking to her daughter she can’t seem to make out what she is saying; it is as if her thoughts are disorganized. When talking with the patient, you notice a lack of energy and an apathetic affect. Which of the following is the most likely diagnosis for this patient?
- A. Major depressive disorder
- B. Schizophrenia
- C. Brief psychotic disorder
- D. Schizotypal disorder
- E. Schizophreniform disorder (Correct Answer)
Assessment techniques for delusions Explanation: ***Schizophreniform disorder***
- The patient exhibits core **psychotic symptoms** (hearing voices, disorganized thoughts) for a duration of **3 months**, which is characteristic of schizophreniform disorder (symptoms lasting **1 to 6 months**).
- Her **lack of energy** and **apathetic affect** align with the negative symptoms commonly seen in psychotic disorders.
*Major depressive disorder*
- While **lack of energy** and **apathetic affect** can be present, the prominent **hallucinations** (hearing voices) and **disorganized thoughts** are not primary features of major depressive disorder.
- A diagnosis of depression alone would not fully account for her psychotic symptoms.
*Schizophrenia*
- Schizophrenia requires symptoms to be present for **at least 6 months**, including at least one month of **active phase symptoms**. This patient's symptoms have only been present for 3 months.
- While the symptoms are consistent with schizophrenia, the **duration criterion** has not yet been met.
*Brief psychotic disorder*
- Brief psychotic disorder is characterized by psychotic symptoms lasting **less than 1 month**. This patient's symptoms have been ongoing for 3 months.
- The chronicity of symptoms makes this diagnosis unlikely.
*Schizotypal disorder*
- Schizotypal disorder is a **personality disorder** characterized by peculiar thoughts and behaviors, but typically **without overt psychotic episodes** or pronounced disorganized speech/hallucinations as described.
- While there may be odd beliefs or ideas of reference, the clear **auditory hallucinations** and **thought disorder** in this case point to a more severe psychotic condition.
Assessment techniques for delusions US Medical PG Question 6: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?
- A. "Does the diarrhea typically precede the constipation, or vice-versa?"
- B. "Is the diarrhea foul-smelling?"
- C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
- D. "Are the symptoms worse in the morning or at night?"
- E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)
Assessment techniques for delusions Explanation: ***Can you tell me more about the symptoms you have been experiencing?***
- This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis.
- In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions.
*Does the diarrhea typically precede the constipation, or vice-versa?*
- While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience.
- It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture.
*Is the diarrhea foul-smelling?*
- Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions.
- However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed.
*Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life*
- Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time.
- However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially.
*Are the symptoms worse in the morning or at night?*
- Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related.
- This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.
Assessment techniques for delusions US Medical PG Question 7: A 16-year-old boy is brought in to a psychiatrist's office by his mother for increasingly concerning erratic behavior. Her son has recently entered a new relationship, and he constantly voices beliefs that his girlfriend is cheating on him. He ended his last relationship after voicing the same beliefs about his last partner. During the visit, the patient reports that these beliefs are justified, since everyone at school is “out to get him.” He says that even his teachers are against him, based on their criticism of his schoolwork. His mother adds that her son has always held grudges against people and has always taken comments very personally. The patient has no psychiatric history and is in otherwise good health. What condition is this patient genetically predisposed for?
- A. Antisocial personality disorder
- B. Major depressive disorder
- C. Narcolepsy
- D. Substance use disorder
- E. Schizophrenia (Correct Answer)
Assessment techniques for delusions Explanation: ***Schizophrenia***
- The patient's symptoms of **pervasive distrust**, **suspiciousness**, beliefs that others are "out to get him," and taking comments personally are characteristic of **paranoid personality disorder**.
- **Paranoid personality disorder (PPD)** is considered part of the **schizotypal spectrum** or **cluster A personality disorders**, and individuals with PPD have a higher genetic predisposition to develop **schizophrenia** and other psychotic disorders.
*Antisocial personality disorder*
- This disorder is characterized by **disregard for and violation of the rights of others**, impulsivity, and lack of remorse, which are not the primary features described here.
- While individuals with this disorder may exhibit manipulative behavior, their core issue is not paranoid ideation but rather a pattern of social irresponsibility and law-breaking.
*Major depressive disorder*
- This condition is characterized by **persistent sadness**, loss of interest or pleasure, and other vegetative symptoms, which are not present in this patient's presentation.
- The patient's primary symptoms revolve around **paranoia and suspiciousness**, not mood disturbances.
*Narcolepsy*
- Narcolepsy is a **neurological condition** characterized by overwhelming daytime sleepiness and sudden attacks of sleep.
- This diagnosis is entirely unrelated to the patient's psychological symptoms of paranoia and distrust.
*Substance use disorder*
- While substance use can sometimes induce paranoid thinking, the patient's long-standing history of **grudges** and taking comments personally, even prior to potential substance exposure (implied by no psychiatric history mentioned for substance abuse), suggests a more ingrained personality trait rather than solely substance-induced paranoia.
- There is **no information provided about substance use**, making this a less likely primary condition or genetic predisposition.
Assessment techniques for delusions US Medical PG Question 8: Two days after undergoing hemicolectomy for colon cancer, a 78-year-old man is found agitated and confused in his room. He says that a burglar broke in. The patient points at one corner of the room and says “There he is, doctor!” Closer inspection reveals that the patient is pointing to his bathrobe, which is hanging on the wall. The patient has type 2 diabetes mellitus and arterial hypertension. Current medications include insulin and hydrochlorothiazide. His temperature is 36.9°C (98.4°F), pulse is 89/min, respirations are 15/min, and blood pressure is 145/98 mm Hg. Physical examination shows a nontender, nonerythematous midline abdominal wound. On mental status examination, the patient is agitated and oriented only to person. Which of the following best describes this patient's perception?
- A. Hallucination
- B. Illusion (Correct Answer)
- C. Loose association
- D. Delusion
- E. External attribution
Assessment techniques for delusions Explanation: ***Illusion***
- An **illusion** is a **misinterpretation of an actual external stimulus**, as seen when the patient perceives his bathrobe as a burglar.
- This symptom, combined with **agitation**, **confusion**, and **recent surgery**, is highly suggestive of **delirium**.
*Hallucination*
- A **hallucination** is a **perception in the absence of an external stimulus**, meaning the patient would see or hear something that is not there at all.
- The patient here is clearly reacting to an existing object (the bathrobe), albeit misinterpreting it.
*Loose association*
- **Loose association** refers to a **thought disorder** where ideas shift from one subject to another in a way that is unrelated or minimally related, making the speech difficult to follow.
- This describes a pattern of thought, not a perceptual disturbance involving an external object.
*Delusion*
- A **delusion** is a **fixed, false belief** that is not amenable to change in light of conflicting evidence and is not in keeping with the individual's cultural background.
- While the patient believes a burglar is present, this belief arises from a direct misinterpretation of an object rather than a fixed, unfounded belief.
*External attribution*
- **External attribution** is a psychological concept where individuals ascribe responsibility for events or outcomes to **external factors** rather than internal ones.
- This term describes a cognitive bias in explaining causality, not a perceptual disturbance.
Assessment techniques for delusions US Medical PG Question 9: A 34-year-old man presents to the behavioral health clinic for an evaluation after seeing animal-shaped clouds in the form of dogs, cats, and monkeys. The patient says that these symptoms have been present for more than 2 weeks. Past medical history is significant for simple partial seizures for which he takes valproate, but he has not had his medication adjusted in several years. His vital signs include: blood pressure of 124/76 mm Hg, heart rate of 98/min, respiratory rate of 12/min, and temperature of 37.1°C (98.8°F). On physical examination, the patient is alert and oriented to person, time, and place. Affect is not constricted or flat. Speech is of rapid rate and high volume. Pupils are equal and reactive bilaterally. The results of a urine drug screen are as follows:
Alcohol positive
Amphetamine negative
Benzodiazepine negative
Cocaine positive
GHB negative
Ketamine negative
LSD negative
Marijuana negative
Opioids negative
PCP negative
Which of the following is the most likely diagnosis in this patient?
- A. Delusion
- B. Alcohol withdrawal
- C. Visual hallucination
- D. Cocaine intoxication
- E. Illusion (Correct Answer)
Assessment techniques for delusions Explanation: ***Illusion***
- The patient is seeing **animal shapes in the clouds**, which is a misinterpretation of a real external stimulus. This is the definition of an **illusion**.
- Unlike hallucinations, illusions involve a distorted perception of an existing object, rather than perceiving something that is not present.
*Delusion*
- A **delusion** is a **fixed, false belief** that is not amenable to change in light of conflicting evidence, and it is not what is being described here.
- The patient is experiencing a perceptual distortion, not a false belief system.
*Alcohol withdrawal*
- While the patient tests positive for alcohol, the symptoms described are **perceptual distortions** (misinterpretation of clouds), not typical signs of alcohol withdrawal which include tremors, seizures, and delirium tremens.
- The timeline of "more than 2 weeks" also makes acute alcohol withdrawal less likely, as withdrawal symptoms typically peak within days.
*Visual hallucination*
- A **hallucination** is a perception in the absence of an external stimulus; the patient would be seeing animals when no clouds (or other visual stimuli) are present.
- The patient is seeing animal shapes *in the clouds*, indicating an existing external stimulus that is being misinterpreted.
*Cocaine intoxication*
- While cocaine intoxication can cause psychiatric symptoms like paranoia and hallucinations, the specific description of **seeing animal shapes in clouds** (misinterpretation of a real stimulus) points more directly to an illusion rather than a primary effect of cocaine use.
- The patient's presentation does not include other common symptoms of acute cocaine intoxication like severe agitation, dilated pupils, or hyperthermia beyond a rapid heart rate.
Assessment techniques for delusions US Medical PG Question 10: A 23-year-old woman is brought to the physician by her father because of strange behavior for the past 6 months. The father reports that his daughter has increasingly isolated herself in college and received poor grades. She has told her father that aliens are trying to infiltrate her mind and that she has to continuously listen to the radio to monitor these activities. She appears anxious. Her vital signs are within normal limits. Physical examination shows no abnormalities. Neurologic examination shows no focal findings. Mental status examination shows psychomotor agitation. She says: “I can describe how the aliens chase me except for my car which is parked in the garage. You know, the sky is beautiful today. Why does my mother have a cat?” Which of the following best describes this patient's thought process?
- A. Circumstantial speech
- B. Clang associations
- C. Flight of ideas
- D. Thought-blocking
- E. Loose associations (Correct Answer)
Assessment techniques for delusions Explanation: ***Loose associations***
- This is characterized by a **lack of logical connection** between thoughts or ideas, leading to a disorganized and incoherent flow of speech. The patient's statements about aliens, her car, the sky, and her mother's cat are **unrelated and lack a clear thematic thread**.
- It is a key feature of **thought disorganization** and is commonly seen in psychotic disorders like **schizophrenia**.
*Circumstantial speech*
- This involves including a **multitude of unnecessary details** before finally arriving at the point or answering the question.
- While the patient's speech is disorganized, it does not demonstrate the characteristic meandering yet goal-directed nature of circumstantiality.
*Clang associations*
- This refers to the **association of words based on their sound** rather than their meaning, often involving rhyming or alliteration.
- The patient's statements do not exhibit a pattern of rhyming or sound-based word choices.
*Flight of ideas*
- This is a rapid, continuous progression from one thought to another, with thoughts often **connected by tangential associations** but still having some discernable link.
- Although the patient's thoughts shift rapidly, the connections are not simply tangential; they are largely absent, suggesting a more severe form of disorganization than flight of ideas typically entails.
*Thought-blocking*
- This is an **abrupt cessation of thought or speech** in the middle of a sentence, often followed by a new and unrelated thought.
- The patient's speech flows continuously, albeit incoherently, without sudden stops or breaks.
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