Histrionic personality disorder — MCQs

A 34-year-old female presents to a counselor at the urging of her parents because they are concerned that she might be depressed. After recently breaking up with her long-term boyfriend, she moved back in with her parents because she could not handle making decisions alone. Soon after their breakup, she started going on 5–7 dates a week. She has been unemployed for 3 years, as her boyfriend took care of all the bills. In the past year, she thought of looking for a job but never felt confident enough to start the process. Her mom arranges her doctor's appointments and handles her car maintenance. She describes feeling uneasy when she is alone. She has hypothyroidism treated with levothyroxine. She does not smoke or drink alcohol. Vital signs are normal. Mental status exam shows a neutral affect. Neurologic examination shows no focal findings. Which of the following is the most likely diagnosis?

A 35-year-old computer programmer presents to the psychiatrist at the request of his mother for his oddities. He explains that he wears an aluminum foil cap while he works because he does not want extraterrestrial life to steal his thoughts. He spends his free time building a radio transmitter to contact distant planets. He denies any delusions or hallucinations. He claims that nothing is wrong with his eccentricities and is happy the way his life is. Which of the following personality disorders does this male most likely have?

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 25-year-old woman presents to her primary care physician with a chief complaint of diffuse muscle aches and pains. She states that she has trouble doing everyday tasks such as showering, cooking, and cleaning due to the pain. The patient has a past medical history of anxiety and bulimia nervosa and is currently not taking any medications. Upon further questioning, the patient states that her symptoms started last week when her boyfriend left her for another individual. The patient was quite upset, as she states she always had tended to all his needs and never argued with him. Since he has left, she has been unable to decide what she should do with herself during the day. The patient has been living with her mother for the past day and states that has helped greatly, as her mother helps her plan her days and gives her chores to do. Regardless, the patient states that her pain persists. The physician sets up a referral for the patient to work with a psychiatrist. Upon hearing this, the patient becomes visually bothered and questions if the physician is actually trying to help her. Which of the following personality disorder does this patient most likely suffer from?

A 12-year-old boy is brought in by his parents as they are concerned about his behavior. He is constantly arguing with his parents and blatantly defying their every request. In school, he is known for being intentionally tardy and for defying his teachers. Upon further questioning of the patient you learn about some of his recent behaviors such as beginning smoking to bother his parents. You also notice that he is disrespectful towards you. You then learn that he has also gotten into weekly fights with his peers at school with no apparent cause. In addition, last week he was seen hitting one of the local neighborhood cats with a baseball bat trying to kill it. The patient lives at home with his two parents in a pre-World War II house that was recently renovated. Physical exam is unremarkable. Laboratory values are as follows: Na: 140 mmol/L K: 4.5 mmol/L Cl: 100 mmol/L Glucose: 80 mg/dL Ca: 10 mmol/L Mg: 3 mEq/L Cr: 0.8 mg/dL BUN: 10 mg/dL Serum lead: < .01 µg/dL Hb: 15 g/dL Hct: 45% MCV: 95 Urine toxicology: negative As the patient leaves the office you notice him stealing all of the candy from the office candy bowl. The patient seems unconcerned about his behavior overall. Which of the following statements is most likely to be true in this patient?

A 10-year-old boy is brought to the physician by his parents because they are concerned about his “strange behavior”. The parents state that he has always been a lonely kid without many friends, but recently he has been having behavioral problems that seem to be unprovoked and are occurring more frequently. The child throws tantrums for no reason and does not respond to punishment or reward. He also has a “strange obsession” with collecting rocks that he finds on his way to and from school to the point where his room is filled with rocks. He plays alone in his room, lining the rocks up, organizing them by size, shape, or color, and he will randomly bark or make high-pitched noises without provocation. His teachers say he daydreams a lot and is very good at art, being able to recreate his favorite cartoon characters in great detail. On physical assessment, the patient does not make eye contact with the physician but talks incessantly about his rock collection. The child’s grammar and vocabulary seem normal but his speech is slightly labored, and he can’t seem to tell that the physician is not really interested in hearing about his rock collection. Which of the following is the most likely diagnosis?

The prison doctor sees a 25-year-old man for some minor injuries sustained during a recent lunchroom brawl. The patient has a long history of getting into trouble. During his interview, he seems very charming and carefully deflects all responsibility to others and gets irritable and hostile once probed on the issues. He is married and has 2 young children for whom he does not pay child support. Which of the following details is most critical for diagnosing this patient’s condition?

A 45-year-old woman repetitively visits the general surgery clinic worried that her inguinal hernia is incarcerated. 2 months ago, she was seen in the emergency department where she presented with a left lower abdominal swelling. The mass was easily reduced and the patient was referred to the general surgery clinic for elective surgical repair. Because her condition was deemed not urgent, she was informed that she was down on the surgical waiting list. Despite this, she continues to visit the clinic and the ED worried that her bowels are ‘trapped and dying.’ Each time she is reassured and any protrusion present is quickly reduced. She has previously frequently visited her primary care physician for complaints of abdominal pain and inconsistent bowel habits, but no etiology could be identified. She continues to intermittently have these symptoms and spends hours every day worrying about what may be going on. She has no other significant past medical history. Which of the following is the most appropriate diagnosis?

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 33-year-old man with documented antisocial personality disorder and substance use disorder is convicted of assault. The defense attorney requests psychiatric testimony that the defendant's personality disorder diminished his capacity to conform his conduct to the law. His history includes multiple prior convictions, repeated lying, failure to sustain employment, lack of remorse, and disregard for others' safety. However, he understood the wrongfulness of his actions and planned the assault in advance. Evaluate the relationship between antisocial personality disorder and criminal responsibility.