A 27-year-old woman is brought to the emergency department by her employer due to increasingly paranoid and disorganized behavior over the past year. The patient works as a housekeeper and has had progressive difficulty performing her work responsibilities. She has become increasingly secretive over the past 6 months and recently started talking in a whisper because she believes that listening devices are planted in the walls. Over the past month, she started hiding food and personal possessions in closets and under beds. The patient does not use alcohol or illicit drugs. Vital signs are stable, and physical examination is unremarkable. During the interview, she changes topics frequently and rambles about voices harassing her. Which of the following additional mental status findings is most likely in this patient?

Question

A 27-year-old woman is brought to the emergency department by her employer due to increasingly paranoid and disorganized behavior over the past year.  The patient works as a housekeeper and has had progressive difficulty performing her work responsibilities.  She has become increasingly secretive over the past 6 months and recently started talking in a whisper because she believes that listening devices are planted in the walls.  Over the past month, she started hiding food and personal possessions in closets and under beds.  The patient does not use alcohol or illicit drugs.  Vital signs are stable, and physical examination is unremarkable.  During the interview, she changes topics frequently and rambles about voices harassing her.  Which of the following additional mental status findings is most likely in this patient?

Quizplus · Accepted Answer

11ec160b_363f_1d84_9249_6bc3106bca13_MD0001_00 This patient's paranoid delusions, disorganized speech and behavior, auditory hallucinations, and 1-year history of functional decline are consistent with schizophrenia. Symptom domains in schizophrenia include positive symptoms (eg, delusions, hallucinations, disorganization) and negative symptoms (eg, flat affect, apathy, poverty of speech, social withdrawal). On mental status examination, flat affect is manifested by a lack of facial expression and a monotone voice, typically accompanied by poor eye contact. Negative symptoms are less responsive to antipsychotic medication and typically persist between acute psychotic episodes. Although patients with schizophrenia commonly have cognitive impairments (eg, attention, processing speed, executive functioning), they are typically oriented and do not show a fluctuating level of consciousness that is associated with delirium (Choice C). (Choices B and E) Euphoric mood and rapid, pressured speech are characteristic findings of an acute manic episode in bipolar disorder. Patients with schizophrenia may have speech that is disorganized (eg, tangential speech, derailment), but it typically is not pressured. (Choices D and F) Although olfactory and tactile hallucinations can occur in schizophrenia, they are uncommon and more likely to be associated with substance use or neurological disorders. Auditory is the most common type of hallucination in schizophrenia. Educational objective: In addition to positive psychotic symptoms (eg, delusions, hallucinations, disorganization), patients with schizophrenia frequently exhibit negative symptoms such as flat affect (ie, lack of facial expression). Negative symptoms typically persist between acute psychotic episodes and are more resistant to treatment. __________ References: Emotional face processing and flat affect in schizophrenia: functional and structural neural correlates. (http://www.ncbi.nlm.nih.gov/pubmed/21284912) The current conceptualization of negative symptoms in schizophrenia. (http://www.ncbi.nlm.nih.gov/pubmed/28127915)

A 27-Year-Old Woman Is Brought to the Emergency Department by Her