A 22-year-old college student is referred to the university psychiatric clinic by his academic advisor due to social isolation and eccentric behavior. For the past three years, the patient has had no close friends and spends most of his weekends extensively researching clairvoyance, telepathy, and astral projection. He tells the physician that he can frequently "feel the vibrational energy" of other people in the room, which makes him highly uncomfortable in crowds. He wears a heavy trench coat adorned with multiple mismatched scarves, regardless of the weather. His speech is vague and highly circumstantial, often drifting into tangential discussions about "cosmic alignments," but his thought process remains goal-directed without frank disorganization. He explicitly denies auditory or visual hallucinations, and there is no evidence of major depressive or manic episodes. He occasionally takes citalopram, which was prescribed by his primary care physician for mild generalized anxiety. Which of the following statements regarding the diagnosis and management of this patient's condition are accurate? (Select 2)
- The clinical presentation represents a pervasive pattern of social and interpersonal deficits, marked by eccentricities of behavior and cognitive distortions.Answer
- BThe patient's presentation is most consistent with schizophreniform disorder because his unusual beliefs and odd behavior have been present for more than 6 months.
- CIf the patient experiences treatment-resistant anxiety, combining his citalopram with a monoamine oxidase inhibitor (MAOI) such as phenelzine is a safe and evidence-based next step.
- Off-label use of a low-dose second-generation antipsychotic may be considered to help attenuate his perceptual distortions and eccentric thinking.Answer
- EThe patient is likely experiencing a prolonged bipolar depressive episode with psychotic features, and his citalopram dosage should be maximized as monotherapy.