A 19-year-old female college student is brought into the emergency department by her boyfriend. The boyfriend reports that the patient got caught stealing from the company she works for and subsequently got fired. The boyfriend received a text that evening saying “I’ll miss you.” When he arrived at her dorm room, the patient was slumped in the shower covered in blood. The patient agreed to be driven to the emergency room. When asked about what happened, the patient replies “I just want out of this life.” The patient has bipolar disorder, and takes lithium as prescribed. She has a psychiatrist she sees every week, which the boyfriend confirms. She has never had a prior suicide attempt nor has she ever been hospitalized for a psychiatric disorder. The patient’s vitals are stable. Upon physical examination, a 4 centimeter vertical incision is noted on the patient’s left forearm. During the patient’s laceration repair, she asks if she will be admitted. She states, “these ups and downs are common for me, but I feel better now.” She verbalizes that she understands that she overreacted. She asks to go home, and her boyfriend insists that he will stay with her. They both confirm that neither of them have guns or know any peers with access to guns. Which of the following is the most appropriate management for the patient?
AHave the patient sign a suicide contract before discharge
BSet up a next-day appointment with the patient’s psychiatrist
CInvoluntarily admit the patient
DCall the patient’s parents
EDiscontinue lithium and start valproate
A patient with documented paranoid schizophrenia commits a violent crime. During trial, the defense argues that the patient should not be held responsible due to their mental illness. Under the M'Naghten Rule, which of the following criteria must be met for an insanity defense?
AHistory of psychiatric treatment
BUnable to control impulses
CPresence of any mental illness
DUnable to distinguish right from wrong
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 The patient's mother explained to the psychiatrist that her son had withdrawn from family and friends, appeared to have no emotions, and had delusions that he was working for the CIA.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
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