An 18-year-old man is brought to the emergency department after his mother found him locked in his room stammering about a government conspiracy to brainwash him in subterranean tunnels. His mother says that he has never done this before, but 6 months ago he stopped going to classes and was subsequently suspended from college. She reports that he has become increasingly taciturn over the course of the past month. He drinks one to two beers daily and has smoked one pack of cigarettes daily for 3 years. He occasionally smokes marijuana. His father was diagnosed with schizophrenia at the age of 25 years. The patient has had no friends or social contacts other than his mother since he was suspended. He appears unkempt and aloof. On mental status examination, he is disorganized and shows poverty of speech. He says his mood is "good." He does not hear voices and has no visual or tactile hallucinations. Toxicology screening is negative. Which of the following is an unfavorable prognostic factor for this patient's condition?
APoor premorbid functioning
BLate onset of illness
CPresence of mood symptoms
DGood insight into illness
EStrong family support
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 The patient's mother explained to the psychiatrist that her son had withdrawn from family and friends, appeared to have no emotions, and had delusions that he was working for the CIA.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?
ASchizophrenia
BBrief psychotic disorder
CSchizophreniform disorder
DSchizoid personality disorder
ESchizotypal personality disorder
A 34-year-old man presents to the behavioral health clinic for an evaluation after seeing animal-shaped clouds in the form of dogs, cats, and monkeys. The patient says that these symptoms have been present for more than 2 weeks. Past medical history is significant for simple partial seizures for which he takes valproate, but he has not had his medication adjusted in several years. His vital signs include: blood pressure of 124/76 mm Hg, heart rate of 98/min, respiratory rate of 12/min, and temperature of 37.1°C (98.8°F). On physical examination, the patient is alert and oriented to person, time, and place. Affect is not constricted or flat. Speech is of rapid rate and high volume. Pupils are equal and reactive bilaterally. The results of a urine drug screen are as follows: Alcohol positive Amphetamine negative Benzodiazepine negative Cocaine positive GHB negative Ketamine negative LSD negative Marijuana negative Opioids negative PCP negative Which of the following is the most likely diagnosis in this patient?
ADelusion
BAlcohol withdrawal
CVisual hallucination
DCocaine intoxication
EIllusion
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