Delusional disorder in special populations US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Delusional disorder in special populations. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Delusional disorder in special populations US Medical PG Question 1: A 26-year-old man is brought to the emergency department by his wife because of bizarre and agitated behavior for the last 6 weeks. He thinks that the NSA is spying on him and controlling his mind. His wife reports that the patient has become withdrawn and at times depressed for the past 3 months. He lost his job because he stopped going to work 4 weeks ago. Since then, he has been working on an invention that will block people from being able to control his mind. 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. Brief psychotic disorder
- B. Schizophreniform disorder (Correct Answer)
- C. Schizotypal personality disorder
- D. Schizophrenia
- E. Delusional disorder
Delusional disorder in special populations Explanation: ***Schizophreniform disorder***
- The patient's symptoms, including **delusions** (fixed false beliefs that the NSA is spying and controlling his mind), **disorganized speech**, and **agitated behavior**, are consistent with a psychotic disorder.
- The duration of active psychotic symptoms (6 weeks), which is more than 1 month but less than 6 months, fits the diagnostic criteria for **schizophreniform disorder**.
- The prodromal phase (withdrawn and depressed for 3 months) plus the active phase does not yet meet the 6-month requirement for schizophrenia.
*Brief psychotic disorder*
- This disorder is characterized by a sudden onset of psychotic symptoms lasting less than 1 month, followed by a full return to premorbid functioning.
- The patient's active psychotic symptoms have persisted for 6 weeks, exceeding the maximum duration for brief psychotic disorder.
*Schizotypal personality disorder*
- This disorder primarily involves a pervasive pattern of social and interpersonal deficits marked by acute discomfort with close relationships, as well as cognitive or perceptual distortions and eccentricities.
- While there might be odd beliefs or magical thinking, it does not typically involve the persistent and severe delusions and disorganized speech seen in this case.
- This is a personality disorder, not a psychotic disorder.
*Schizophrenia*
- Schizophrenia requires continuous signs of disturbance for at least 6 months, which includes at least 1 month of active-phase symptoms (delusions, hallucinations, disorganized speech).
- The patient's total duration of illness (3 months of prodromal symptoms plus 6 weeks of active symptoms) totals approximately 4.5 months, which is less than the 6-month minimum duration required for a diagnosis of schizophrenia.
*Delusional disorder*
- The primary feature of delusional disorder is the presence of one or more delusions for at least 1 month, without other prominent psychotic symptoms such as disorganized speech or behavior.
- This patient exhibits prominent **disorganized speech**, **labile affect**, and **disorganized behavior** (bizarre invention work), which are not characteristic of delusional disorder.
- Functioning is more impaired than typically seen in delusional disorder.
Delusional disorder in special populations US Medical PG Question 2: A 26-year-old woman is brought to the emergency department by her husband due to her disturbing behavior over the past 24 hours. Her husband says that he has noticed his wife talking to herself and staying in a corner of a room throughout the day without eating or drinking anything. She gave birth to their son 2 weeks ago but has not seen or even acknowledged her baby’s presence ever since he was born. He says that he didn’t think much of it because she seemed overwhelmed during her pregnancy and he considered that she was probably unable to cope with being a new mother; however, last night, he says, his wife told him that their child was the son of the devil and they ought to get rid of him as soon as possible. Which of the following describes this patient’s abnormal reaction to her child?
- A. Brief psychotic disorder
- B. Schizoaffective disorder
- C. Postpartum psychosis (Correct Answer)
- D. Major depressive disorder
- E. Postpartum blues
Delusional disorder in special populations Explanation: **Postpartum psychosis**
- This patient exhibits **psychotic symptoms** (delusions about the child, hallucinations like talking to herself) and **severe disorganization** (staying in a corner, not eating/drinking, neglecting her baby) within two weeks postpartum.
- This severe and acute onset of psychosis in the **postpartum period** is characteristic of postpartum psychosis, which is a medical emergency requiring immediate intervention.
*Brief psychotic disorder*
- While it involves psychotic symptoms of acute onset and short duration (less than one month), this diagnosis typically applies when symptoms are not directly attributable to a specific precipitating factor like childbirth.
- The clear temporal association with childbirth in this case makes postpartum psychosis a more specific and accurate diagnosis.
*Schizoaffective disorder*
- This disorder typically involves a combination of **mood symptoms** (depressive or manic) and **psychotic symptoms**, where psychotic symptoms are present for at least two weeks in the absence of a major mood episode.
- The sudden onset and direct link to the postpartum period distinguish this case from schizoaffective disorder, which usually has a more chronic or episodic course.
*Major depressive disorder*
- Although the patient shows signs of severe withdrawal and neglect, the presence of **frank psychotic symptoms** (delusions about the child being the "son of the devil") goes beyond the typical presentation of major depressive disorder, even with psychotic features.
- While depression can coexist, the predominant and acute psychotic features point more directly to postpartum psychosis.
*Postpartum blues*
- Postpartum blues are **mild and transient mood disturbances** (tearfulness, irritability, anxiety) occurring in the first few days to two weeks postpartum, typically resolving on their own.
- The patient's symptoms are far more severe, involving **psychotic delusions and severe functional impairment**, making postpartum blues an inadequate diagnosis.
Delusional disorder in special populations US Medical PG Question 3: Two dizygotic twins present to the university clinic because they believe they are being poisoned through the school's cafeteria food. They have brought these concerns up in the past, but no other students or cafeteria staff support this belief. Both of them are average students with strong and weak subject areas as demonstrated by their course grade-books. They have no known medical conditions and are not known to abuse illicit substances. Which statement best describes the condition these patients have?
- A. A trial separation is likely to worsen symptoms.
- B. The disorder is its own disease entity in DSM-5.
- C. Antipsychotic medications are rarely beneficial.
- D. Can affect two or more closely related individuals. (Correct Answer)
- E. Cognitive behavioral therapy is a good first-line.
Delusional disorder in special populations Explanation: ***Can affect two or more closely related individuals.***
- The shared delusional belief in **folie à deux**, also known as **shared psychotic disorder**, typically occurs in two or more people who are closely associated.
- In this case, the **dizygotic twins** sharing the same delusional belief about being poisoned from cafeteria food fits this pattern.
*A trial separation is likely to worsen symptoms.*
- **Separating the individuals** involved in **folie à deux** is often a crucial step in treatment, as it can help break the cycle of shared delusion and allow for individual therapy.
- Separation typically IMPROVES rather than worsens symptoms by removing the reinforcement of the shared delusion.
*The disorder is its own disease entity in DSM-5.*
- In the **DSM-5**, **folie à deux** is no longer considered a separate diagnostic category.
- Instead, it is classified under **Other Specified Schizophrenia Spectrum and Other Psychotic Disorder** or **Unspecified Schizophrenia Spectrum and Other Psychotic Disorder**, with the specific context of shared delusion noted.
*Antipsychotic medications are rarely beneficial.*
- **Antipsychotics** are actually commonly used in treating folie à deux, particularly for the **primary individual** who initially developed the delusion.
- They can be an important component of treatment, often combined with separation and psychotherapy.
*Cognitive behavioral therapy is a good first-line.*
- **Cognitive Behavioral Therapy (CBT)** can be beneficial, particularly after separation, to help individuals challenge and reframe their delusional beliefs.
- However, the **first-line intervention** for shared psychotic disorder is **separation of the involved individuals**, followed by individual therapy (which may include CBT) and medication as needed.
Delusional disorder in special populations US Medical PG Question 4: A 22-year-old man is brought to the emergency department by his father because he is having bizarre thoughts. The patient says that he is being haunted by aliens from outer space. The father is worried as his son has had these symptoms for the past 7 months and lately, it seems to be getting worse. He has become more self-obsessed and does not seem to have any interest in his favorite activities. He has no plans to harm himself or others but spends a lot of time and energy building ‘defenses’ in and around his room as he is absolutely sure that aliens will come to get him soon. His blood pressure is 121/79 mm Hg, pulse 86/min, respiratory rate 15/min, temperature 36.8°C (98.2°F). Which of the following is correct regarding the patient’s symptoms?
- A. It would benefit from psychosurgery.
- B. He has a fixed false belief. (Correct Answer)
- C. It is best treated with cognitive behavioral therapy alone.
- D. It is a negative symptom.
- E. It falls under the disorganized thinking domain.
Delusional disorder in special populations Explanation: ***He has a fixed false belief.***
- The patient's conviction that he is being haunted by aliens, despite evidence to the contrary and the distress it causes, constitutes a **delusion**.
- A delusion is by definition a **fixed, false belief** that is not in keeping with the individual's cultural background.
*It would benefit from psychosurgery.*
- Psychosurgery, such as lobotomy, is an extreme and rarely used intervention for **severe, refractory mental disorders**, typically only after all other treatments have failed and with significant ethical considerations.
- While the patient's symptoms are impairing, **first-line treatments** for psychotic disorders involve antipsychotic medications and psychotherapy, not psychosurgery.
*It is best treated with cognitive behavioral therapy alone.*
- While CBT for psychosis (CBTp) can be a useful **adjunct** in managing delusions and reducing distress, it is **not sufficient as monotherapy** for active, severe psychotic symptoms.
- The primary intervention for profound delusions like those described is **antipsychotic medication**, with CBT added as an adjunctive treatment to help improve functioning and coping.
- CBT alone would be inadequate for someone with such fixed, impairing delusions actively building defenses against perceived threats.
*It is a negative symptom.*
- Negative symptoms of psychosis include features like **anhedonia** (lack of pleasure), **alogia** (poverty of speech), **avolition** (lack of motivation), and affective flattening.
- The patient's bizarre belief in aliens is a **positive symptom** as it represents an *addition* to normal experience, rather than a *reduction* or *absence* of normal functions.
- Note: The patient's decreased interest in activities suggests negative symptoms are also present, but the question asks about "the patient's symptoms" in context of the delusion described.
*It falls under the disorganized thinking domain.*
- Disorganized thinking or speech involves patterns like **loose associations, tangentiality, incoherence**, or word salad, where the logical connections between thoughts are lost.
- While the content of the patient's thoughts is bizarre, the core issue described is the *belief itself* (a delusion, which is a **positive symptom**), rather than disordered *thought processes* or the way he expresses them.
Delusional disorder in special populations US Medical PG Question 5: A 24-year-old woman with no past medical history is post operative day 2 from a cesarean section that resulted in the birth of her first child. She begins to cry when she's told that today's lunch will be gluten-free. Although the patient feels "exhausted" and has had trouble sleeping, she deeply desires to return home and take care of her newborn. The patient denies any changes in concentration or suicidal thoughts now or during the pregnancy. What is the diagnosis and likely outcome?
- A. Major depressive episode; this patient is at high risk of recurrence
- B. Postpartum depression; the patient will likely remain depressed for at least six more months
- C. Postpartum psychosis; symptoms will resolve in time, but she needs treatment with antipsychotics, lithium, and/or antidepressants
- D. Postpartum bipolar disorder; this patient will likely have future bipolar episodes
- E. Postpartum "blues"; her symptoms are likely self-limited (Correct Answer)
Delusional disorder in special populations Explanation: ***Postpartum "blues"; her symptoms are likely self-limited***
- The patient exhibits mild, transient mood lability (crying over gluten-free lunch) and fatigue, which are characteristic of **postpartum blues**.
- Symptoms typically begin within 2-3 days postpartum and resolve spontaneously within **two weeks**, without significant impairment in functioning, making them self-limited.
*Major depressive episode; this patient is at high risk of recurrence*
- While she has some symptoms like fatigue and sleep disturbance, she denies changes in concentration or suicidal ideation, and expresses a desire to care for her child, which argues against a **major depressive episode**.
- A diagnosis of major depressive episode requires five or more symptoms for at least two weeks, including either **depressed mood** or **anhedonia**, which are not fully met here.
*Postpartum depression; the patient will likely remain depressed for at least six more months*
- This patient's symptoms are mild and have only been present for two days, making **postpartum depression** (which typically lasts longer and is more severe) less likely.
- Postpartum depression involves persistent symptoms that significantly impair functioning and often require intervention; these symptoms are not yet severe or prolonged enough.
*Postpartum psychosis; symptoms will resolve in time, but she needs treatment with antipsychotics, lithium, and/or antidepressants*
- There is no mention of **hallucinations, delusions, severe confusion, or disorganized behavior**, which are hallmarks of postpartum psychosis.
- Postpartum psychosis is a severe psychiatric emergency requiring immediate inpatient treatment and does not resolve simply with time without significant intervention.
*Postpartum bipolar disorder; this patient will likely have future bipolar episodes*
- While **sleep disturbance** is present, there are no classic manic or hypomanic symptoms such as **euphoria, grandiosity, increased goal-directed activity, or racing thoughts**.
- A single, acute presentation like this, without a history of bipolar disorder or clear manic symptoms, does not typically lead to a diagnosis of postpartum bipolar disorder.
Delusional disorder in special populations US Medical PG Question 6: A 24-year-old man is brought to the doctor's office by his mother because the patient believes aliens have begun to read his mind and will soon have him performing missions for them. The patient's mother says that the delusions have been intermittently present for periods of at least 1-month over the past year. When he is not having delusions, she says he still lacks expression and has no interest in socializing with his friends or going out. He has no past medical history and takes no prescription medications. The patient has smoked 1 pack of cigarettes daily for the past 10 years. Since the disturbance, he has not been able to maintain employment and lives at home with his mother. His vitals include: blood pressure 124/82 mm Hg, pulse 68/min, respiratory rate 14/min, temperature 37.3°C (99.1°F). On physical examination, the patient exhibits poor eye contact with a flat affect. His speech is circumferential, and he is currently experiencing bizarre delusions. The results from a urine drug screen are shown below:
Amphetamine negative
Benzodiazepine negative
Cocaine negative
GHB negative
Ketamine negative
LSD negative
Marijuana negative
Opioids negative
PCP negative
Which of the following is the correct diagnosis?
- A. Schizophrenia (Correct Answer)
- B. Schizoaffective disorder
- C. Schizotypal personality disorder
- D. Schizoid personality disorder
- E. Schizophreniform disorder
Delusional disorder in special populations Explanation: ***Correct: Schizophrenia***
- The patient presents with **bizarre delusions** (positive symptom), **flat affect**, **lack of interest in socializing**, and **social withdrawal** (negative symptoms), characteristic of schizophrenia.
- The symptoms have been present **intermittently over the past year**, with the mother noting that even when delusions are absent, the patient continues to exhibit negative symptoms (flat affect, social withdrawal).
- This indicates **continuous signs of illness for at least 6 months** with **at least 1 month of active psychotic symptoms**, fulfilling **DSM-5 criteria** for schizophrenia.
- The patient demonstrates **significant functional impairment** (unable to maintain employment), which is required for diagnosis.
- **Substance-induced psychosis** is ruled out by negative urine drug screen.
*Incorrect: Schizoaffective disorder*
- Requires the presence of a **major mood episode (depressive or manic)** concurrent with psychotic symptoms for a substantial portion of the illness.
- Psychotic symptoms must also persist for **at least 2 weeks in the absence of a major mood episode**.
- This patient shows **no evidence of major mood symptoms** (no depression or mania described).
*Incorrect: Schizotypal personality disorder*
- Involves **cognitive or perceptual distortions** (odd beliefs, magical thinking) and eccentric behavior, but symptoms are typically **less severe** than frank psychosis.
- Patients usually maintain **better baseline functioning** than those with schizophrenia.
- This patient's **severe delusions, significant functional impairment**, and chronic deterioration are more consistent with schizophrenia than a personality disorder.
*Incorrect: Schizoid personality disorder*
- Characterized by **detachment from social relationships** and restricted emotional expression.
- **Does not include psychotic symptoms** such as delusions or hallucinations.
- This patient's bizarre delusions rule out this purely personality-based diagnosis.
*Incorrect: Schizophreniform disorder*
- Diagnosed when symptoms of schizophrenia are present for **1 to 6 months** (more than 1 month but less than 6 months).
- This patient's symptoms have been present **over the past year**, exceeding the 6-month maximum duration for schizophreniform disorder.
- The chronic nature and duration of symptoms establish the diagnosis of schizophrenia instead.
Delusional disorder in special populations US Medical PG Question 7: A 31-year-old woman comes to the physician because she thinks that her “right wrist is broken.” She says that she has severe pain and that “the bone is sticking out.” She has not had any trauma to the wrist. Her medical records indicate that she was diagnosed with schizophrenia 2 years ago and treated with olanzapine; she has not filled any prescriptions over the past 4 months. Three weeks ago, she stopped going to work because she “did not feel like getting up” in the morning. Vital signs are within normal limits. Physical examination of the right wrist shows no visible injury; there is no warmth, swelling, or erythema. Range of motion is limited by pain. On mental status examination, she has a flat affect. Her speech is pressured and she frequently changes the topic. She has short- and long-term memory deficits. Attention and concentration are poor. There is no evidence of suicidal ideation. Urine toxicology screening is negative. An x-ray of the wrist shows no abnormalities. Which of the following is the most appropriate response to this patient's concerns?
- A. “It seems as though you are having a schizophrenia relapse. If you don't follow my recommendations and take your medications, you will most likely have further and possibly more severe episodes.”
- B. “I cannot see any injury of your wrist and the physical exam as well as the x-ray don't show any injury. I imagine that feeling as if your wrist was broken may be very uncomfortable. Can you tell me more about what it feels like?” (Correct Answer)
- C. I understand your concerns; however, your symptoms seem to be psychological in nature. I would be happy to refer you to a mental health professional.
- D. You are clearly distressed. However, your tests do not suggest a physical problem that can be addressed with medications or surgery. I suggest that we meet and evaluate your symptoms on a regular basis.
- E. I can imagine that you are uncomfortable. That certainly looks painful. Let's take care of this injury first and then we should talk about your problems getting up in the morning.
Delusional disorder in special populations Explanation: ***“I cannot see any injury of your wrist and the physical exam as well as the x-ray don't show any injury. I imagine that feeling as if your wrist was broken may be very uncomfortable. Can you tell me more about what it feels like?”***
- This response **validates the patient's experience of pain and distress** while gently reorienting them to the objective findings (no physical injury).
- It opens a dialog to explore the **patient's subjective experience** and build trust, which is crucial for addressing underlying psychiatric issues in a patient with schizophrenia.
*“It seems as though you are having a schizophrenia relapse. If you don't follow my recommendations and take your medications, you will most likely have further and possibly more severe episodes.”*
- This statement is **confrontational and judgmental**, potentially alienating the patient and making them less likely to engage in treatment.
- Directly labeling a relapse and warning of future severity without first building rapport can trigger **defensiveness and non-compliance**.
*I understand your concerns; however, your symptoms seem to be psychological in nature. I would be happy to refer you to a mental health professional.*
- While accurate about the psychological nature of symptoms, this response **dismisses the patient's immediate physical complaint** and might make them feel unheard.
- It prematurely jumps to a referral without fully exploring the current presentation or establishing a therapeutic alliance, which can be perceived as the physician "passing the buck."
*I can imagine that you are uncomfortable. That certainly looks painful. Let's take care of this injury first and then we should talk about your problems getting up in the morning.*
- This response **validates a non-existent injury**, reinforcing the patient's delusion and potentially diverting attention from the underlying psychiatric condition.
- Prioritizing a non-existent injury would lead to inappropriate medical interventions and delay necessary psychiatric care.
*You are clearly distressed. However, your tests do not suggest a physical problem that can be addressed with medications or surgery. I suggest that we meet and evaluate your symptoms on a regular basis.*
- While acknowledging distress and the lack of physical pathology, this response is somewhat **vague and lacks a clear plan** for addressing the primary concern of perceived injury.
- "Regular evaluation" without specific intent to explore the psychological component or re-initiate psychiatric treatment may not be sufficient for a patient experiencing a schizophrenia relapse.
Delusional disorder in special populations US Medical PG Question 8: Ten days after the vaginal delivery of a healthy infant girl, a 27-year-old woman is brought to the physician by her husband because of frequent mood changes. She has been tearful and anxious since she went home from the hospital 2 days after delivery. She says that she feels overwhelmed with her new responsibilities and has difficulties taking care of her newborn because she feels constantly tired. She only sleeps for 2 to 3 hours nightly because the baby “is keeping her awake.” Sometimes, the patient checks on her daughter because she thinks she heard her cry but finds her sleeping quietly. Her husband says that she is afraid that something could happen to the baby. She often gets angry at him and has yelled at him when he picks up the baby without using a hand sanitizer beforehand. She breastfeeds the baby without any problems. The patient's mother has bipolar disorder with psychotic features. The patient's vital signs are within normal limits. Physical examination shows an involuting uterus consistent in size with her postpartum date. Mental status examination shows a labile affect with no evidence of homicidal or suicidal ideation. Laboratory studies show a hemoglobin concentration of 13 g/dL and a thyroid-stimulating hormone level of 3.1 μU/mL. Which of the following is the most appropriate next step in management?
- A. Risperidone therapy
- B. Bupropion therapy
- C. Cognitive behavioral therapy
- D. Reassurance (Correct Answer)
- E. Sertraline therapy
Delusional disorder in special populations Explanation: ***Reassurance***
- The patient exhibits symptoms of **"baby blues"**, including tearfulness, anxiety, mood swings, and feeling overwhelmed, which are common within the first two weeks postpartum and typically resolve spontaneously.
- Given the transient nature of **baby blues** and the absence of more severe symptoms like psychosis or significant functional impairment, **reassurance** and supportive care are the most appropriate initial steps.
*Risperidone therapy*
- **Risperidone** is an **antipsychotic** medication used for conditions like psychosis or severe mood disorders, which are not present in this patient's mild, transient symptoms of baby blues.
- Initiating antipsychotic therapy for **self-limiting baby blues** is unnecessary and could lead to unwanted side effects.
*Bupropion therapy*
- **Bupropion** is an **antidepressant** primarily used for major depressive disorder and seasonal affective disorder, and is not indicated for the mild, transient symptoms of **baby blues**.
- Its mechanism of action involves dopamine and norepinephrine reuptake inhibition, differing from typical SSRIs often considered for postpartum depression.
*Cognitive behavioral therapy*
- While **CBT** is an effective treatment for **postpartum depression** and anxiety disorders, the patient's symptoms are consistent with **baby blues**, which are self-limiting and resolve with supportive care in most cases.
- CBT would be more appropriate if the symptoms were severe, persistent beyond two weeks, or indicative of a more significant mood disorder.
*Sertraline therapy*
- **Sertraline** is an **SSRI antidepressant** commonly used for **postpartum depression** and anxiety, but it is not indicated for the transient and mild symptoms of **baby blues**.
- Antidepressants are typically reserved for more severe and persistent symptoms characteristic of postpartum depression, which usually lasts longer than two weeks.
Delusional disorder in special populations US Medical PG Question 9: A 29-year-old woman presents with convulsions. The patient’s brother says that he found her like that an hour ago and immediately called an ambulance. He also says that she has been extremely distraught and receiving supportive care from a social worker following a sexual assault by a coworker a few days ago. He says that the patient has no history of seizures. She has no significant past medical history and takes no medications. The patient’s vital signs include: temperature 37.0°C (98.6°F), pulse 101/min, blood pressure 135/99 mm Hg, and respiratory rate 25/min. On physical examination, the patient is rolling from side to side, arrhythmically thrashing around, and muttering strangely. Her eyes are closed, and there is resistance to opening them. Which of the following is the most likely diagnosis in this patient?
- A. Body dysmorphic disorder
- B. Somatic symptom disorder
- C. Illness anxiety disorder
- D. Somatic symptom disorder with predominant pain
- E. Functional neurological symptom disorder (Conversion disorder) (Correct Answer)
Delusional disorder in special populations Explanation: ***Functional neurological symptom disorder (Conversion disorder)***
- This patient presents with **neurological symptoms (pseudoseizures)** inconsistent with known neurological conditions, following a significant **psychological stressor (sexual assault).**
- Key features like **resistance to eye opening**, **arrhythmic thrashing**, **eyes closed during episode**, and general atypical presentation for a true seizure strongly suggest functional neurological symptom disorder (conversion disorder), as these are classic features of *psychogenic non-epileptic seizures (PNES)*.
- The temporal relationship to trauma and absence of prior seizure history further support this diagnosis.
*Body dysmorphic disorder*
- This disorder involves a **preoccupation with perceived flaws in physical appearance**, which are often minor or not observable to others.
- The patient's symptoms of pseudoseizures and thrashing are **neurological manifestations** and do not align with concerns about physical appearance.
*Somatic symptom disorder*
- This diagnosis involves **one or more somatic symptoms that are distressing or result in significant disruption** of daily life, with **excessive thoughts, feelings, or behaviors** related to the somatic symptoms.
- While somatic symptom disorder can include neurological complaints, the acute presentation of pseudoseizures with specific neurological signs (eye closure resistance, arrhythmic movements) directly linked to recent severe trauma makes functional neurological symptom disorder the more precise diagnosis.
*Illness anxiety disorder*
- Characterized by a **preoccupation with having or acquiring a serious illness** based on misinterpretation of bodily symptoms, with minimal or no somatic symptoms present.
- The patient is experiencing active neurological symptoms (pseudoseizures), not health anxiety or unfounded fear of having an illness.
*Somatic symptom disorder with predominant pain*
- In this specifier, the primary symptom is **pain**, which is distressing and associated with excessive thoughts, feelings, or behaviors related to the pain.
- The patient's primary presentation is **pseudoseizures with motor symptoms**, not pain, making this diagnosis inconsistent with her clinical picture.
Delusional disorder in special populations US Medical PG Question 10: A 28-year-old woman is brought into the clinic by her husband with concerns that she might be depressed. She delivered a healthy newborn a week and a half ago without any complications. Since then, she has been having trouble sleeping, eating poorly, and has stopped playing with the baby. The patient says she feels like she is drained all the time and feels guilty for not doing more for the baby. Which of the following is the best course of treatment for this patient?
- A. Reassurance
- B. Fluoxetine (Correct Answer)
- C. Risperidone
- D. Amitriptyline
- E. No treatment
Delusional disorder in special populations Explanation: ***Fluoxetine***
- This patient's symptoms (trouble sleeping, poor appetite, guilt, and anhedonia towards the baby) occurring 10 days postpartum are highly suggestive of **postpartum depression**. **SSRIs** like fluoxetine are first-line pharmacological treatments for this condition.
- Fluoxetine is a **selective serotonin reuptake inhibitor (SSRI)** that helps regulate mood by increasing serotonin levels in the brain. It is generally considered safe during breastfeeding, with a relatively low infant exposure compared to other antidepressants.
*Reassurance*
- Reassurance alone may be appropriate for **postpartum blues**, which are milder and self-limiting, typically resolving within two weeks.
- This patient's symptoms are more severe and persistent, lasting beyond typical postpartum blues and significantly impacting her functioning, indicating a need for more substantial intervention.
*Risperidone*
- Risperidone is an **atypical antipsychotic** primarily used to treat conditions like schizophrenia or bipolar disorder, or as an adjunct for severe refractory depression with psychotic features.
- There is no indication of psychosis in this patient's presentation, and the use of an antipsychotic would be disproportionate and carry unnecessary side effects.
*Amitriptyline*
- Amitriptyline is a **tricyclic antidepressant (TCA)**. While effective for depression, TCAs are generally not first-line due to a less favorable side effect profile (e.g., anticholinergic effects, cardiac conductivity issues) compared to SSRIs.
- SSRIs like fluoxetine are preferred for initial treatment of postpartum depression due to their better tolerability and safety profile.
*No treatment*
- This patient exhibits clear symptoms of **postpartum depression**, which is a serious condition that can worsen without intervention and impact both the mother's and infant's well-being.
- Untreated depression can lead to significant functional impairment, chronic suffering, and in severe cases, harm to oneself or the baby.
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