Catatonia across disorders US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Catatonia across disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Catatonia across disorders US Medical PG Question 1: A 45-year-old woman presents with recent onset movement abnormalities. She says that she noticeably blinks, which is out of her control. She also has spasms of her neck muscles and frequent leg cramps. Past medical history is significant for ovarian cancer, currently being treated with an antineoplastic agent that disrupts microtubule function and an alkylating agent, as well as metoclopramide for nausea. Her blood pressure is 110/65 mm Hg, the respiratory rate is 17/min, the heart rate is 78/min, and the temperature is 36.7°C (98.1°F). Physical examination is within normal limits. Which of the following drugs would be the best treatment for this patient?
- A. Physostigmine
- B. Bethanechol
- C. Benztropine (Correct Answer)
- D. Diazepam
- E. Clozapine
Catatonia across disorders Explanation: ***Benztropine***
- This patient presents with symptoms of **drug-induced parkinsonism** or **extrapyramidal symptoms (EPS)**, likely caused by **metoclopramide**, a dopamine receptor antagonist. Benztropine, an **anticholinergic agent**, is effective in blocking cholinergic overactivity in the basal ganglia, which is characteristic of EPS.
- Its mechanism of action helps to restore the balance between **dopamine** and **acetylcholine** in the striatum, thereby alleviating symptoms like dystonia, akathisia, and parkinsonism.
*Physostigmine*
- Physostigmine is an **acetylcholinesterase inhibitor** that increases acetylcholine levels. It is used to reverse anticholinergic toxicity, which is the opposite of the current clinical need.
- Administering physostigmine would worsen the patient's EPS symptoms as it would further imbalance the dopamine-acetylcholine ratio towards cholinergic dominance.
*Bethanechol*
- Bethanechol is a **direct cholinergic agonist** that primarily acts on muscarinic receptors in the bladder and gastrointestinal tract. It is used for urinary retention and gastrointestinal hypomotility.
- This drug would not address the underlying pathophysiology of EPS and could potentially exacerbate cholinergic side effects, rather than resolving movement disorders.
*Diazepam*
- Diazepam is a **benzodiazepine** that enhances the effect of GABA, a major inhibitory neurotransmitter. It is used for anxiety, seizures, and muscle spasms, but it is not a primary treatment for EPS.
- While it might offer some symptomatic relief for muscle spasms, it does not directly target the dopaminergic-cholinergic imbalance responsible for EPS, and it is associated with sedation and dependence.
*Clozapine*
- Clozapine is an **atypical antipsychotic** with potent D4 and serotonin 5-HT2A receptor antagonism, known for its low risk of EPS. It is primarily used for treatment-resistant schizophrenia.
- As an antipsychotic, clozapine is not indicated for the treatment of drug-induced EPS and could potentially introduce new side effects, including agranulocytosis and myocarditis, making it an inappropriate choice for this presentation.
Catatonia across disorders US Medical PG Question 2: A 24-year-old graduate student is brought to the emergency department by her boyfriend because of chest pain that started 90 minutes ago. Her boyfriend says she has been taking medication to help her study for an important exam and has not slept in several days. On examination, she is diaphoretic, agitated, and attempts to remove her IV lines and ECG leads. Her temperature is 37.6°C (99.7°F), pulse is 128/min, and blood pressure is 163/97 mmHg. Her pupils are dilated. The most appropriate next step in management is the administration of which of the following?
- A. Lorazepam (Correct Answer)
- B. Ketamine
- C. Haloperidol
- D. Activated charcoal
- E. Dantrolene
Catatonia across disorders Explanation: ***Lorazepam***
- This patient presents with symptoms highly suggestive of **sympathomimetic toxicity** (agitation, tachycardia, hypertension, dilated pupils, diaphoresis) likely due to stimulant abuse for studying. **Benzodiazepines** like lorazepam are the first-line treatment to manage agitation, tachycardia, and hypertension in this setting.
- Lorazepam helps by **calming the central nervous system** and reducing the sympathetic overdrive, thereby mitigating the cardiovascular and neurological effects of stimulant toxicity.
*Ketamine*
- Ketamine is a **dissociative anesthetic** that typically increases heart rate and blood pressure, which would exacerbate the patient's existing sympathetic hyperactivity and cardiovascular instability.
- It is not indicated for the management of stimulant-induced agitation or catecholamine surge.
*Haloperidol*
- Haloperidol is an **antipsychotic** that can prolong the **QT interval** and potentially lower the seizure threshold, effects that can be dangerous in stimulant toxicity.
- It does not directly address the underlying sympathetic overdrive and can worsen hyperthermia with its anticholinergic properties.
*Activated charcoal*
- Activated charcoal is used to **prevent absorption** of toxins from the gastrointestinal tract, but it is typically only effective if given within 1-2 hours of ingestion. This patient's symptoms started 90 minutes ago, implying some absorption has already occurred, and her agitated state makes oral administration risky if airway protection is not ensured.
- It is also contraindicated in patients with an unprotected airway due to the risk of aspiration, and benzodiazepines are needed first to control agitation and protect the airway.
*Dantrolene*
- Dantrolene is a **skeletal muscle relaxant** used primarily to treat **malignant hyperthermia** and **neuroleptic malignant syndrome**.
- While this patient has some signs of hyperthermia, dantrolene is not the first-line treatment for stimulant-induced hyperthermia, which is primarily managed by controlling agitation and sympathetic overdrive with benzodiazepines and external cooling.
Catatonia across disorders US Medical PG Question 3: A 38-year-old woman comes to the physician for a follow-up visit. She has a 2-year history of depressed mood and fatigue accompanied by early morning awakening. One week ago, she started feeling a decrease in her need for sleep and now feels rested after about 5 hours of sleep per night. She had two similar episodes that occurred 6 months ago and a year ago, respectively. She reports increased energy and libido. She has a 4-kg (8.8-lb) weight loss over the past month. She does not feel the need to eat and says she derives her energy ""from the universe"". She enjoys her work as a librarian. She started taking fluoxetine 3 months ago. On mental exam, she is alert and oriented to time and place; she is irritable. She does not have auditory or visual hallucinations. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?
- A. Delusional disorder
- B. Cyclothymic disorder
- C. Schizoaffective disorder
- D. Bipolar II disorder (Correct Answer)
- E. Medication-induced bipolar disorder
Catatonia across disorders Explanation: ***Bipolar II disorder***
- The patient meets criteria for **Bipolar II disorder**: at least one **hypomanic episode** (current presentation) and at least one **major depressive episode** (2-year history with recurrent episodes).
- Current hypomanic features include: **decreased need for sleep** (feels rested after 5 hours), **increased energy and libido**, **significant weight loss** (4 kg in one month), **irritability**, and grandiose thinking ("derives energy from the universe").
- She has had **recurrent depressive episodes** over 2 years (episodes 1 year ago and 6 months ago), fulfilling the major depressive episode requirement.
- While the hypomania emerged after starting **fluoxetine**, antidepressants commonly **unmask underlying bipolar disorder** rather than cause a separate medication-induced condition. The diagnosis remains **Bipolar II disorder** per DSM-5-TR when there is evidence of an underlying mood disorder pattern.
*Medication-induced bipolar disorder*
- Substance/medication-induced bipolar disorder requires that symptoms occur **exclusively during substance use** without evidence of an independent bipolar disorder.
- This patient's **recurrent pattern** of mood episodes (multiple depressive episodes over 2 years) suggests an **underlying bipolar disorder** that was unmasked by antidepressant treatment, not a purely medication-induced condition.
- The temporal relationship with fluoxetine is significant but represents **antidepressant-induced switching** in bipolar disorder, not a separate diagnostic entity.
*Delusional disorder*
- Requires **non-bizarre delusions** persisting for at least one month as the predominant feature, without prominent mood symptoms.
- This patient's primary presentation is a **mood episode** (hypomania) with the "universe" comment being part of her elevated/expansive mood rather than a fixed, systematized delusion.
- Functioning remains relatively intact (still enjoys her work).
*Cyclothymic disorder*
- Involves numerous periods of **hypomanic and depressive symptoms** for at least 2 years, but symptoms never meet full criteria for hypomanic or major depressive episodes.
- This patient has **full hypomanic and major depressive episodes**, making Bipolar II disorder the more appropriate diagnosis.
- The severity of her current symptoms (significant sleep reduction, 4-kg weight loss, marked functional changes) exceeds cyclothymic disorder.
*Schizoaffective disorder*
- Requires a **major mood episode** concurrent with **criterion A symptoms of schizophrenia** (delusions, hallucinations) for at least 2 weeks, plus psychotic symptoms without mood symptoms for at least 2 weeks.
- This patient has **no hallucinations** and no clear psychotic symptoms independent of her mood state.
- Her elevated mood fully accounts for her presentation.
Catatonia across disorders US Medical PG Question 4: 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)
Catatonia across disorders 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.
Catatonia across disorders US Medical PG Question 5: A 20-year-old female presents to student health at her university for excessive daytime sleepiness. She states that her sleepiness has caused her to fall asleep in all of her classes for the last semester, and that her grades are suffering as a result. She states that she normally gets 7 hours of sleep per night, and notes that when she falls asleep during the day, she immediately starts having dreams. She denies any cataplexy. A polysomnogram and a multiple sleep latency test rule out obstructive sleep apnea and confirm her diagnosis. She is started on a daytime medication that acts both by direct neurotransmitter release and reuptake inhibition. What other condition can this medication be used to treat?
- A. Obsessive-compulsive disorder
- B. Bulimia
- C. Attention-deficit hyperactivity disorder (Correct Answer)
- D. Tourette syndrome
- E. Alcohol withdrawal
Catatonia across disorders Explanation: ***Attention-deficit hyperactivity disorder***
- The patient's presentation is consistent with **narcolepsy type 2 (without cataplexy)**, given the excessive daytime sleepiness, short latency to REM sleep (immediate dreaming), and exclusion of sleep apnea. The medication described, acting via **direct neurotransmitter release and reuptake inhibition**, is characteristic of a stimulant like **methylphenidate** or an amphetamine-based drug.
- These stimulants are commonly used as first-line treatment for **attention-deficit hyperactivity disorder (ADHD)** due to their effects on dopamine and norepinephrine in the brain, improving focus and reducing impulsivity.
*Obsessive-compulsive disorder*
- **Obsessive-compulsive disorder (OCD)** is typically treated with selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy.
- Stimulants are not indicated for OCD and may even worsen anxiety symptoms in some individuals.
*Bulimia*
- **Bulimia nervosa** is often managed with a combination of psychotherapy (e.g., cognitive behavioral therapy) and antidepressants like fluoxetine.
- Stimulants are not a primary treatment for bulimia and could potentially exacerbate some symptoms or risks due to their appetite-suppressing effects.
*Tourette syndrome*
- **Tourette syndrome** involves motor and vocal tics and is often treated with alpha-2 adrenergic agonists (e.g., guanfacine, clonidine) or dopamine receptor blocking agents.
- Stimulants generally are not used for Tourette syndrome as they can sometimes worsen tics.
*Alcohol withdrawal*
- **Alcohol withdrawal** is a medical emergency managed with benzodiazepines to prevent seizures and delirium tremens.
- Stimulants are contraindicated in alcohol withdrawal as they can increase seizure risk and cardiac complications.
Catatonia across disorders US Medical PG Question 6: A 31-year-old man is brought to the emergency department because of fever and increasing confusion for the past day. He has bipolar disorder with psychotic features and hypothyroidism. Current medications are lithium, haloperidol, and levothyroxine. He drinks one beer with dinner every night. His speech is confused and he is oriented to person only. His temperature is 40°C (104°F), pulse is 124/min, and blood pressure is 160/110 mm Hg. He appears acutely ill. Examination shows diaphoresis and muscle rigidity. Deep tendon reflexes are 1+ bilaterally. There is minor rigidity of the neck with full range of motion. His lungs are clear to auscultation. The abdomen is soft and nontender. His leukocyte count is 15,100/mm3 and serum creatine kinase activity is 1100 U/L. Which of the following is the most likely diagnosis?
- A. Delirium tremens
- B. Neuroleptic malignant syndrome (Correct Answer)
- C. Bacterial meningitis
- D. Herpes simplex encephalitis
- E. Lithium toxicity
Catatonia across disorders Explanation: ***Neuroleptic malignant syndrome***
- The patient presents with **fever (40°C)**, **muscle rigidity**, **altered mental status (confusion)**, **autonomic instability (tachycardia, hypertension, diaphoresis)**, and **elevated creatine kinase**, all classic features of **Neuroleptic Malignant Syndrome (NMS)**.
- The use of **haloperidol**, a high-potency antipsychotic, is a significant risk factor for NMS.
*Delirium tremens*
- While delirium tremens can cause altered mental status, autonomic instability, and fever, it is typically preceded by a history of **heavy chronic alcohol intake** followed by acute withdrawal, which is not indicated by "one beer with dinner every night."
- **Muscle rigidity** and **marked elevation of creatine kinase** are not typical features of delirium tremens.
*Bacterial meningitis*
- Although bacterial meningitis presents with fever and altered mental status, it would typically involve **nuchal rigidity** that limits range of motion, which is not fully present here, and **CSF findings** (e.g., pleocytosis, low glucose) would be diagnostic.
- **Profound muscle rigidity** and **markedly elevated creatine kinase** are not characteristic features of bacterial meningitis.
*Herpes simplex encephalitis*
- This condition presents with fever, altered mental status, and often **focal neurological deficits** or **seizures**, which are not described.
- Diagnosis relies on **characteristic MRI findings** and **CSF PCR for HSV DNA**, and it would not typically cause diffuse **muscle rigidity** or **elevated creatine kinase**.
*Lithium toxicity*
- **Lithium toxicity** typically presents with neurological symptoms like **tremors**, **ataxia**, **nystagmus**, and altered mental status, but it is less commonly associated with **severe muscle rigidity**, **very high fever (40°C)**, or **markedly elevated creatine kinase** unless complicated by severe dehydration or NMS-like features.
- A **high lithium level** would be expected, which is not mentioned as present.
Catatonia across disorders US Medical PG Question 7: A 28-year-old male presents to trauma surgery clinic after undergoing an exploratory laparotomy, femoral intramedullary nail, and femoral artery vascular repair 3 months ago. He suffered multiple gunshot wounds as a victim of a drive-by shooting. He is progressing well with well-healed surgical incisions on examination. He states during his clinic visit that he has been experiencing 6 weeks of nightmares where he "relives the day he was shot." The patient also endorses 6 weeks of flashbacks to "the shooter pointing the gun at him" during the daytime as well. He states that he has had difficulty sleeping and cannot concentrate when performing tasks. Which of the following is the most likely diagnosis?
- A. Schizophrenia
- B. Normal reaction to trauma
- C. Acute stress disorder
- D. Post-traumatic stress disorder (PTSD) (Correct Answer)
- E. Schizophreniform disorder
Catatonia across disorders Explanation: ***Post-traumatic stress disorder (PTSD)***
- The patient's symptoms of **nightmares**, **flashbacks** (re-experiencing the trauma), **difficulty sleeping**, and **impaired concentration** following severe trauma are characteristic of PTSD.
- The symptoms have persisted for **6 weeks** (more than 1 month), meeting the duration criterion for PTSD diagnosis.
*Schizophrenia*
- Schizophrenia is characterized by **psychotic symptoms** such as hallucinations, delusions, and disorganized thought/speech, which are not described in this patient.
- While stress can exacerbate schizophrenia, the patient's symptoms are directly tied to a specific traumatic event, not a chronic psychotic disorder.
*Normal reaction to trauma*
- While some distress is expected after trauma, the presence of **persistent re-experiencing symptoms** (nightmares, flashbacks), and hyperarousal symptoms lasting for **over a month** is beyond a normal, transient reaction.
- These symptoms significantly impair the patient's functioning and indicate a clinically significant disorder.
*Acute stress disorder*
- Acute stress disorder presents with similar symptoms to PTSD, including intrusive thoughts, negative mood, dissociation, avoidance, and arousal.
- However, acute stress disorder is diagnosed when symptoms occur **3 days to 1 month** after trauma exposure; this patient's symptoms have lasted **6 weeks**, exceeding the 1-month threshold for ASD and meeting criteria for PTSD.
*Schizophreniform disorder*
- Schizophreniform disorder involves psychotic symptoms like **hallucinations, delusions, or disorganized speech**, lasting between 1 and 6 months.
- The patient's symptoms are primarily related to trauma re-experiencing and hyperarousal, not psychotic features.
Catatonia across disorders US Medical PG Question 8: A 33-year-old man presents to the emergency department acutely confused. The patient was found down at a local construction site by his coworkers. The patient has a past medical history of a seizure disorder and schizophrenia and is currently taking haloperidol. He had recent surgery 2 months ago to remove an inflamed appendix. His temperature is 105°F (40.6°C), blood pressure is 120/84 mmHg, pulse is 150/min, respirations are 19/min, and oxygen saturation is 99% on room air. Physical exam is notable for a confused man who cannot answer questions. His clothes are drenched in sweat. He is not making purposeful movements with his extremities although no focal neurological deficits are clearly apparent. Which of the following is the most likely diagnosis?
- A. Heat exhaustion
- B. Nonexertional heat stroke
- C. Neuroleptic malignant syndrome
- D. Malignant hyperthermia
- E. Exertional heat stroke (Correct Answer)
Catatonia across disorders Explanation: ***Exertional heat stroke***
- This diagnosis is supported by the patient's presentation of **hyperthermia** (105°F), **tachycardia**, **confusion**, and a history of working at a **construction site** (suggesting physical exertion in a hot environment).
- The patient's **drenched clothes from sweat** indicate the body's initial attempt to cool down, but the extremely high core temperature and confusion signify a failure of thermoregulation.
*Heat exhaustion*
- While heat exhaustion also involves **sweating** and can present with elevated body temperature, the core temperature is typically **below 104°F (40°C)**, and **marked altered mental status** (like severe confusion) is less common or less severe.
- The patient's temperature of 105°F (40.6°C) and profound confusion are more indicative of heat stroke.
*Nonexertional heat stroke*
- Nonexertional (or classic) heat stroke usually affects populations with **compromised thermoregulation** (e.g., elderly, very young, chronically ill) who are exposed to high environmental temperatures **without significant physical exertion**.
- The patient's age (33) and history of working at a construction site make exertional heat stroke more likely than nonexertional.
*Neuroleptic malignant syndrome*
- NMS is characterized by **fever, muscle rigidity** (often "lead pipe" rigidity), **altered mental status**, and **autonomic instability** (including tachycardia and diaphoresis), and is associated with **antipsychotic medications** like haloperidol.
- However, NMS typically develops **gradually over days to weeks**, not acutely. The key differentiator here is the **clear environmental and exertional context** (construction site work), **acute onset** after being found down, and the **absence of characteristic muscle rigidity** that would be prominent in NMS.
- Heat stroke is more probable given the immediate occupational exposure and clinical timeline.
*Malignant hyperthermia*
- Malignant hyperthermia is a rare, life-threatening condition associated with exposure to certain **anesthetic agents** (e.g., succinylcholine, volatile anesthetics) or, less commonly, severe exertion in susceptible individuals.
- The patient's recent surgery was two months prior, and there is no mention of current exposure to triggers, making it unlikely to be the immediate cause of his acute presentation.
Catatonia across disorders US Medical PG Question 9: A 25-year-old male presents to his primary care physician with a chief complaint of anxiety and fatigue. The patient states that during this past week he has had final exams and has been unable to properly study and prepare because he is so exhausted. He states that he has been going to bed early but has been unable to get a good night’s sleep. The patient admits to occasional cocaine and marijuana use. Otherwise, the patient has no significant past medical history and is not taking any medications. On physical exam you note a tired and anxious appearing young man. His neurological exam is within normal limits. The patient states that he fears he will fail his courses if he does not come up with a solution. Which of the following is the best initial step in management?
- A. Polysomnography
- B. Sleep hygiene education (Correct Answer)
- C. Alprazolam
- D. Melatonin
- E. Zolpidem
Catatonia across disorders Explanation: ***Sleep hygiene education***
- This is the **best initial step** because it addresses lifestyle factors that commonly contribute to **insomnia and fatigue**, especially during periods of stress like final exams.
- Helping the patient establish **regular sleep patterns**, avoid stimulants, and create a conducive sleep environment can significantly improve sleep quality without medication.
*Polysomnography*
- This is a diagnostic test typically reserved for when a **primary sleep disorder** like sleep apnea or restless legs syndrome is suspected.
- Given the patient's acute stressor (final exams) and **drug use**, lifestyle interventions should be tried first before pursuing expensive and invasive testing.
*Alprazolam*
- This is a **benzodiazepine** that can be used for acute anxiety or insomnia, but it carries a risk of **dependence, tolerance, and withdrawal**.
- It is not a first-line treatment for a patient experiencing sleep difficulties primarily due to stress and poor sleep habits, and its use should be avoided in those with a history of substance abuse.
*Melatonin*
- Melatonin can be helpful for **circadian rhythm disorders** or jet lag, but its efficacy for primary insomnia is limited and inconsistent.
- While it has fewer side effects than prescription hypnotics, **sleep hygiene education** is still a more fundamental and effective initial approach for this patient.
*Zolpidem*
- This is a **non-benzodiazepine hypnotic** often prescribed for short-term insomnia, but it has potential side effects like **next-day drowsiness** and can be abused, especially in individuals with a history of substance use.
- **Sleep hygiene** should always be optimized first, especially in a young patient whose sleep issues are clearly linked to stress and lifestyle.
Catatonia across disorders US Medical PG Question 10: A 23-year-old woman is brought to the physician by her father because of irritability, mood swings, and difficulty sleeping over the past 10 days. A few days ago, she quit her job and spent all of her savings on supplies for a “genius business plan.” She has been energetic despite sleeping only 1–2 hours each night. She was diagnosed with major depressive disorder 2 years ago. Mental status examination shows pressured speech, a labile affect, and flight of ideas. Throughout the examination, she repeatedly states “I feel great, I don't need to be here.” Urine toxicology screening is negative. Which of the following is the most likely diagnosis?
- A. Schizoaffective disorder
- B. Bipolar disorder type II
- C. Bipolar disorder type I (Correct Answer)
- D. Delusional disorder
- E. Attention-deficit hyperactivity disorder
Catatonia across disorders Explanation: ***Bipolar disorder type I***
- The patient's presentation of lasting **elevated mood**, decreased need for sleep, increased energy, pressured speech, flight of ideas, and impulsive behavior (quitting job, spending savings) are hallmark symptoms of a **manic episode**.
- A diagnosis of **Bipolar I Disorder** requires the occurrence of at least one manic episode, which is clearly evident here and distinguishes it from other mood disorders, especially given her prior history of major depressive disorder.
*Schizoaffective disorder*
- This disorder involves a period of illness during which there is an uninterrupted period of major mood episode (depressive or manic) concurrent with symptoms of **schizophrenia**, such as delusions or hallucinations, for at least 2 weeks in the absence of a major mood episode.
- The patient's symptoms are primarily mood-driven and do not include the characteristic psychotic features that persist independently of mood disturbances.
*Bipolar disorder type II*
- Bipolar II Disorder is characterized by at least one major depressive episode and at least one **hypomanic episode**.
- The patient's current symptoms, including significant impairment in social/occupational functioning, are indicative of a **manic episode**, not a hypomanic episode, which by definition does not cause marked impairment or require hospitalization.
*Delusional disorder*
- This disorder is characterized by the presence of **non-bizarre delusions** that last for at least one month, without other prominent psychotic symptoms or significant impairment in functioning.
- While the patient's "genius business plan" might seem delusional, her pervasive mood disturbance, flight of ideas, and significant functional impairment are not consistent with the primary features of delusional disorder.
*Attention-deficit hyperactivity disorder*
- ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, often presenting in childhood.
- While there is some overlap in symptoms like impulsivity and difficulty sleeping, the episodic nature, the extent of **mood disturbance**, grandiosity, and **pressured speech** are more characteristic of a manic episode than ADHD.
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