A 45-year-old man presents to a psychiatrist by his wife with recent behavioral and emotional changes. The patient’s wife says that her husband’s personality has completely changed over the last year. She also says that he often complains of unpleasant odors when actually there is no discernible odor present. The patient mentions that he is depressed at times while on other occasions, he feels like he is ‘the most powerful man in the world.’ The psychiatrist takes a detailed history from this patient and concludes that he is most likely suffering from a psychotic disorder. However, before prescribing an antipsychotic medication, he recommends that the patient undergoes brain imaging to rule out a brain neoplasm. Based on the presence of which of the following clinical signs or symptoms in this patient is the psychiatrist most likely recommending this imaging test?
AOlfactory hallucinations
BEcholalia
CAnhedonia
DDelusions of grandeur
EThought broadcasting
A 24-year-old man is brought to your emergency department under arrest by the local police. The patient was found naked at a busy intersection jumping up and down on top of a car. Interviewing the patient, you discover that he has not slept in 2 days because he does not feel tired. He reports hearing voices. The patient was previously hospitalized 1 year ago with auditory hallucinations, paranoia, and a normal mood. What is the most likely diagnosis?
ASchizophrenia
BBipolar disorder
CBrief psychotic disorder
DSchizotypal disorder
ESchizoaffective disorder
A 25-year-old woman presents to the psychiatric emergency department in restraints. She was found trying to break into a deli at midnight. The patient claims that she has an idea that will revolutionize the shipping industry. The patient is not violent but seems highly agitated and is speaking very rapidly about her ideas. She is easily distractible and tells you about many of her other ideas. She has a past medical history of depression and hypertension refractory to treatment. Her current medications include captopril, ibuprofen, and melatonin. A neurological exam is deferred due to the patient's current status. Her pulmonary and cardiovascular exams are within normal limits and mild bilateral bruits are heard over her abdomen. The patient is given haloperidol and diphenhydramine and spends the night in the psychiatric inpatient unit. The patient is started on long-term therapy and is discharged 3 days later. At a follow up visit at her primary care physician, the patient is noted to have a blood pressure of 150/100 mmHg. She is started on chlorthalidone and instructed to return in 3 days. When the patient returns her blood pressure is 135/90 mmHg. She exhibits a fine tremor, and complains of increased urinary frequency. Her pulse is 47/minute, and she is afebrile. Which of the following is the best next step in management?
AUltrasound of the renal arteries
BMaintain current medication regimen
CIncrease captopril dose
DChange diuretics
EIncrease chlorthalidone dose
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