An IQ in the 40-54 range would be categorized by which one of the following labels?
Correct Answer C:
Moderate intellectual disability is the correct answer. The IQ is a standardized score of the Wechsler Adult Intelligence Scale (WAIS) with a population mean of 100 and a standard deviation score of 15. A score less than 25 is labeled profound intellectual disability; 25-39, severe intellectual disability; 55-70, mild intellectual disability; and 70-80, borderline intellectual disability. The WAIS is designed for people 16 years and older. The Wechsler Intelligence Scale for Children and a Wechsler Preschool and Primary Scale of Intelligence are used for younger individuals.
A 9-year-old girl is brought in by her parents, who state that she has been having terrible nightmares recently. Several nights in the last few months, she has woken up the whole family with her bloodcurdling screams. When this occurs, she seems inconsolable and disoriented, crying and hyperventilating for some time, refusing to acknowledge her parents’ presence, and crying until she falls back asleep. The girl admits she is concerned about this, but can’t remember what the nightmares were about. On further history, she says that she is generally happy. She admits that her dog dying last year was stressful for her, but denies that it bothers her much now.
What is the diagnosis?
Correct Answer D:
Sleep terror disorder is characterized by episodes of awakening from sleep with a scream, accompanied by intense fear and autonomic arousal, with unresponsiveness to others during the episode, and subsequent amnesia for the episode.
A. In PTSD, the traumatic event remains a focus of the person’s symptoms; for example, with persistent intrusive recollections of the event, avoidance of reminders of it, and persistent symptoms of increased arousal.
B. In nightmare disorder, the patient rapidly becomes oriented and responsive on wakening, and remembers the nightmares.
C. Panic attacks may wake patients from sleep, but there is rarely a history of screaming or disorientation.
E. Fear is sometimes a feature of the aura of temporal lobe seizures, and post-ictal confusion is the rule, but most such seizures start with motionless staring, followed by lip smacking. Screaming and crying during a seizure would be quite unusual.
A 40-year-old obese black male presents with a history of excessive daytime drowsiness. He readily falls asleep when reading or watching television. He admits to nearly crashing his car twice in the past month because he briefly fell asleep behind the wheel. Most frightening to the patient have been episodes characterized by sudden loss of muscle tone, lasting about 1 minute, associated with laughing. An overnight sleep study shows decreased sleep latency and no evidence of obstructive sleep apnea.
Appropriate treatment includes which one of the following?
Correct Answer A:
The clinical history and laboratory findings presented are consistent with a diagnosis of narcolepsy. Methylphenidate and other stimulant drugs remain the pharmacologic agents of choice in managing this disorder. Since there is no evidence of obstructive sleep apnea, weight reduction would not be expected to address his sleep problem. In general, sedatives, hypnotics, and alcohol should be avoided. Periodic daytime naps may help to reduce symptoms.
Erotomania is a psychiatric syndrome which includes each of the following features, except:
Correct Answer B:
The central theme of erotomania is a delusional belief that another person is in love with them in an idealized, romantic way rather than a pure sexual attraction. Most mental health experts believe erotomania is underdiagnosed because people with this condition do not seek psychiatric treatment. Stalking behavior can occur in erotomania. Violence is more common in males with erotomania and occurs more frequently when there are multiple objects of the delusional fixation and a history of antisocial behavior. The erotomaniac stalks to gain the idealized relationship and can react violently when the delusional beliefs are threatened.
A 32-year-old female singer in a rock group is evaluated for “mood swings”. She says that her mood has gone from the “depths of blackness” to “floating on air with happiness” and back several times a day every day for the past twenty years. She also complains of constant anxiety, which is relieved only when she is performing on stage. She denies any history of substance abuse. She has had an extensive number of relationships with men, none lasting more than a few months. She brags about her ability to get men to buy her whatever she wants. On examination, she is wearing heavy make-up and a low-cut shirt, and refers to the doctor as “honey”. Her affect is labile, shifting rapidly from tears to laughter and back.
What is the most likely diagnosis?
The attention-seeking behavior of patients with histrionic personality disorder manifests in a number of ways: through exaggerated displays of emotion, use of dramatic expressions in speech, use of their physical appearance to draw attention to themselves, and inappropriate familiarity and seductiveness. Because they are uncomfortable in situations where they are not the center of attention, they sometimes gravitate toward the entertainment industry.
B. Patients with narcissistic personality disorder share histrionic patients’ need for admiration, but their presentation is dominated by a grandiose sense of self-importance.
C. Borderline personality disorder is also notable for affective instability and dramatic, unstable relationships, but identity disturbance is a key feature and the characteristic affect displayed is one of inappropriate anger.
D. Many psychiatrists would consider this patient to have a bipolar spectrum illness because of her mood lability. However, the bipolar I diagnosis rests on the presence of a history of a full-blown manic episode, a seven-day period of elevated or irritable mood, along with symptoms of neurovegetative disturbance.
E. Substance abuse is possible despite her denial. However, the history overall is characteristic for histrionic personality disorder, so that remains the most likely diagnosis.
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