Comorbidity with Axis I disorders — MCQs

A 29-year-old woman is brought to the physician by her father because of a change in her behavior over the past 8 months. The father says that his daughter has become increasingly withdrawn; she has not answered any phone calls or visited her family and friends. The patient says that she has to stay at home because a foreign intelligence service is monitoring her. She thinks that they are using a magnetic field to read her mind. Mental status exam shows disjointed and perseverative thinking. She is anxious and has a flat affect. Which of the following is the most likely diagnosis?

A 21-year-old female was brought to the emergency room after losing large amounts of blood from slicing her wrists longitudinally. A few days later, she was interviewed by the psychiatrist and discussed with him why she had tried to kill herself. "My evil boyfriend of 2 months left me because I never let him leave my side for fear that he would cheat on me and leave me...now I feel so empty without him." Which of the following personality disorders does this female most likely have?

A 25-year-old woman is brought to the emergency department by her boyfriend after she cut her forearms with a knife. She has had multiple visits to the emergency department in the past few months for self-inflicted wounds. She claims that her boyfriend is the worst person in the world. She and her boyfriend have broken up 20 times in the past 6 months. She says she cut herself not because she wants to kill herself; she feels alone and empty and wants her boyfriend to take care of her. Her boyfriend claims that she is prone to outbursts of physical aggression as well as mood swings. He says that these mood swings last a few hours and vary from states of exuberance and self-confidence to states of self-doubt and melancholy. On examination, the patient appears well-dressed and calm. She has normal speech, thought processes, and thought content. Which of the following is the most likely diagnosis?

A 23-year-old woman is brought to the emergency department by her boyfriend 10 minutes after ingesting at least 15 acetaminophen tablets. She has been admitted to the hospital several times in the past few months after attempted self-harm. She claims that her boyfriend is “extremely selfish” and “does not care for her.” She says she feels lonely and wants her boyfriend to pay attention to her. Her boyfriend says that they have broken up 10 times in the past year because she is prone to outbursts of physical aggression as well as mood swings. He says that these mood swings last a few hours and can vary from states of “exuberance and affection” to states of “depression.” On examination, the patient appears well-dressed and calm. She has normal speech, thought processes, and thought content. Which of the following is the most likely diagnosis?

A 27-year-old man is brought to a psychiatrist by his mother who is concerned that he has become increasingly distant. When asked, he says that he is no longer going out because he is afraid of going outside by himself. He says that ever since he was a teenager, he was uncomfortable in large crowds and on public transportation. He now works from home and rarely leaves his house except on mandatory business. Which of the following personality disorders is most likely genetically associated with this patient's disorder?

A 23-year-old female college senior comes to the physician with a 1-year history of recurrent palpitations accompanied by sweating, facial blushing, and sometimes nausea. The symptoms are worse during class when she is occasionally called out to speak, which causes her to feel embarrassed. She has been skipping class on discussion days because she is concerned that her classmates may notice her symptoms. The patient does not enjoy jogging in the park anymore and has gained 2 kg (4 lbs 7 oz) over the past 2 months. Her appetite is unchanged. She has no history of serious illness. She does not smoke or drink alcohol. She has experimented with marijuana but does not use it currently. She appears nervous and does not make eye contact with the physician. Her vitals show a pulse of 85/min, her blood pressure is 125/70 mmHg, and her temperature is 36.8°C. Mental status examination reveals full range of affect. Neurological exam shows no abnormalities. Which of the following is the most likely diagnosis for this patient's symptoms?

A 35-year-old woman presents to clinic in emotional distress. She states she has been unhappy for the past couple of months and is having problems with her sleep and appetite. Additionally, she reports significant anxiety regarding thoughts of dirtiness around the house. She states that she cleans all of the doorknobs 5-10 times per day and that, despite her actions, the stress related to cleaning is becoming worse. What is this patient's diagnosis?

A 52-year-old man presents with a 1-month history of a depressed mood. He says that he has been “feeling low” on most days of the week. He also says he has been having difficulty sleeping, feelings of being worthless, difficulty performing at work, and decreased interest in reading books (his hobby). He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. A review of systems is significant for a 7% unintentional weight gain over the past month. The patient is afebrile and his vital signs are within normal limits. A physical examination is unremarkable. The patient is prescribed sertraline 50 mg daily. On follow-up 4 weeks later, the patient says he is slightly improved but is still not feeling 100%. Which of the following is the best next step in the management of this patient?

A 22-year-old man comes to the physician because of generalized fatigue for the past 3 months. During this time, his grades have declined in his college courses because he has had difficulty focusing on assignments and sometimes sleeps in class. He no longer plays the drums for his band and has stopped attending family events. His temperature is 37°C (98.6°F), pulse is 60/min, and blood pressure is 130/80 mm Hg. Physical examination shows no abnormalities. On mental status examination, he describes his mood as “ok.” He has a flat affect. There is no evidence of suicidal ideation. His speech is slow in rate and monotone in rhythm, and his thought process is organized. He has no delusions or hallucinations. Which of the following is the most appropriate next step in treatment?

A 32-year-old man comes to the physician because of a 2 month history of difficulty sleeping and worsening fatigue. During this time, he has also had difficulty concentrating and remembering tasks at work as well as diminished interest in his hobbies. He has no suicidal or homicidal ideation. He does not have auditory or visual hallucinations. Vital signs are normal. Physical examination shows no abnormalities. Mental status examination shows a depressed mood and flat affect with slowed thinking and speech. The physician prescribes sertraline. Three weeks later, the patient comes to the physician again with only minor improvements in his symptoms. Which of the following is the most appropriate next step in management?