Psychotherapeutic approaches — MCQs

A 23-year-old man presents to an outpatient psychiatrist complaining of anxiety and a persistent feeling that “something terrible will happen to my family.” He describes 1 year of vague, disturbing thoughts about his family members contracting a “horrible disease” or dying in an accident. He believes that he can prevent these outcomes by washing his hands of “the contaminants” any time that he touches something and by performing praying and counting rituals each time that he has unwanted, disturbing thoughts. The thoughts and rituals have become more frequent recently, making it impossible for him to work, and he expresses feeling deeply embarrassed by them. Which of the following is the most effective treatment for this patient's disorder?

A 20-year-old male is involuntarily admitted to the county psychiatric unit for psychotic behavior over the past three months. The patient's mother explained to the psychiatrist that her son had withdrawn from family and friends, appeared to have no emotions, and had delusions that he was working for the CIA. When he spoke, his sentences did not always seem to have any connection with each other. The mother finally decided to admit her son after he began stating that he "revealed too much information to her and was going to be eliminated by the CIA." Which of the following diagnoses best fits this patient's presentation?

A 10-year-old child is sent to the school psychologist in May because he refuses to comply with the class rules. His teacher says this has been going on since school started back in August. He gets upset at the teacher regularly when he is told to complete a homework assignment in class. Sometimes he refuses to complete them altogether. Several of his teachers have reported that he intentionally creates noises in class to interrupt the class. He tells the psychologist that the teacher and his classmates are at fault. What is the most appropriate treatment?

A 15-year-old girl is brought to the physician by her mother for an annual well-child examination. Her mother complains that the patient has a poor diet and spends most of the evening at home texting her friends instead of doing homework. She has been caught smoking cigarettes in the school bathroom several times and appears indifferent to the dean's threats of suspension. Two weeks ago, the patient allowed a friend to pierce her ears with unsterilized safety pins. The mother appeals to the physician to lecture the patient about her behavior and “set her straight.” The patient appears aloof and does not make eye contact. Her grooming is poor. Upon questioning the daughter about her mood, the mother responds “She acts like a rebel. I can't wait until puberty is over.” Which of the following is the most appropriate response?

A 19-year-old male is brought to the emergency department by his roommate for 'strange' behavior over the last 48 hours. The patient states that he is hearing voices speak to him, giving him secret messages and instructions to carry out. He believes that the FBI is following him and spying on his conversations. The patient is concerned that they are listening to these messages and will find out his secrets. The patient's friend does not believe the patient ingested any substance or used any recreational drugs prior to this episode. A negative drug screen is obtained and confirms this. Physical examination does not reveal any abnormalities. Which of the following treatments might best target this patient's symptoms?

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 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 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 24-year-old woman presents with her husband to a physician with the complaints of fever, cough, and cold for the past 5 days. When the physician asks her if she has taken any medication for her symptoms, she answers, “My husband and I possess great powers to heal sickness. So I tried to cure my symptoms with my power. However, due to some divine cause, it did not work this time, so I thought I should seek medical advice”. Upon asking her husband about this, he says, "I have always had an immense ability to heal others through my powerful thoughts. It is only after I married her that she came to realize the powers within herself.” The physician examines her and prescribes appropriate medications for her symptoms. A year later, the woman presents again to the same physician with a cough and cold for 2 days. The physician asks her why did she not use her ‘power’ this time. She replies, “I separated from my husband 6 months ago, and I no longer believe that I nor my husband had any special power.” The woman denies any hallucinations, mood disturbances, and socio-occupational impairment to date. Which of the following conditions was this patient most likely suffering from?

A 44-year-old man is brought to the clinic by his wife insisting that her husband has been acting strange lately. He is a dentist by profession and has no known medical conditions. For the past 6 weeks, he has insisted on listening to the 6 PM news on the radio. He is adamant that the news anchor is referencing his life during the broadcasts. Apart from this, his wife states that her husband is fine. He and his wife deny the use of any prescribed medications or illicit drugs. He is a non-smoker and drinks alcohol only on social occasions. Physical examination and routine laboratory investigations are normal. What is the most likely diagnosis?