Chapter·PsychiatryDelusional disorder

Neurobiological basis of delusionsDownloads

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1

Two dizygotic twins present to the university clinic because they believe they are being poisoned through the school's cafeteria food. They have brought these concerns up in the past, but no other students or cafeteria staff support this belief. Both of them are average students with strong and weak subject areas as demonstrated by their course grade-books. They have no known medical conditions and are not known to abuse illicit substances. Which statement best describes the condition these patients have?

AA trial separation is likely to worsen symptoms.

BThe disorder is its own disease entity in DSM-5.

CAntipsychotic medications are rarely beneficial.

DCan affect two or more closely related individuals.

ECognitive behavioral therapy is a good first-line.

2

A 23-year-old woman is brought to the emergency department by her friend because of strange behavior. Two hours ago, she was at a night club where she got involved in a fight with the bartender. Her friend says that she was smoking a cigarette before she became irritable and combative. She repeatedly asked “Why are you pouring blood in my drink?” before hitting the bartender. She has no history of psychiatric illness. Her temperature is 38°C (100.4°F), pulse is 100/min, respirations are 19/min, and blood pressure is 158/95 mm Hg. Examination shows muscle rigidity. She has a reduced degree of facial expression. She has no recollection of her confrontation with the bartender. Which of the following is the most likely primary mechanism responsible for this patient's symptoms?

AStimulation of cannabinoid receptors

BInhibition of NMDA receptors

CInhibition of norepinephrine, serotonin, and dopamine reuptake

DStimulation of 5HT2A and dopamine D2 receptors

EInhibition of dopamine D2 receptors

3

A 31-year-old woman is brought to the physician because of increasing restlessness over the past 2 weeks. She reports that she continuously paces around the house and is unable to sit still for more than 10 minutes at a time. During this period, she has had multiple episodes of anxiety with chest tightness and shortness of breath. She was diagnosed with a psychotic illness 2 months ago. Her current medications include haloperidol and a multivitamin. She appears agitated. Vital signs are within normal limits. Physical examination shows no abnormalities. The examination was interrupted multiple times when she became restless and began to walk around the room. To reduce the likelihood of the patient developing her current symptoms, a drug with which of the following mechanisms of action should have been prescribed instead of her current medication?

AH2 receptor antagonism

B5-HT2A receptor antagonism

Cα2 receptor antagonism

DNMDA receptor antagonism

EGABA receptor antagonism

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