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A 24-Year-Old Woman Is Brought to the Office by Her

question 265

Multiple Choice

A 24-year-old woman is brought to the office by her mother for evaluation. Since dropping out of college 3 years ago, the patient has been unemployed and living at home. Over the past year, she has become increasingly isolated from her friends. She spends most of the day alone in her room on the computer and has no motivation to look for work. The patient won't go outside because she is convinced that people on the street are talking about her. She eats only food that she has prepared herself because she fears someone may be trying to poison her. The patient has no medical issues and takes no medication. Family history is significant for opioid use disorder in her brother and colon cancer in her father, who died 2 years ago after a long illness. The patient smokes marijuana twice a month and does not use alcohol.
Physical examination reveals a thin, disheveled woman. She refuses to change into an examination gown, makes poor eye contact, and gives very brief responses. Vital signs are normal and physical examination is unremarkable. A urine toxicology screen is positive for cannabinoids. A complete blood count and basic chemistry panel are normal.
Which of the following is the most likely diagnosis?

Definitions:

Advanced Directives

Legal documents that allow individuals to specify their preferences for medical treatment in case they become unable to communicate their wishes in the future.

Autonomy

stands for the right or condition of self-governance; the ability of an individual to make independent choices.

Nonmaleficence

A core ethical principle in healthcare that obligates healthcare providers to refrain from causing harm to patients.

Informed Consent

A process by which a patient or participant is fully informed about the procedures and risks involved in a medical treatment or research study and voluntarily agrees to participate.