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Personality Disorders, Human Sexuality, and Miscellaneous Syndromes

A 7-year-old girl is brought to the physician because her parents note that she gets up at night and, still asleep, walks around the house for a few minutes before returning to bed. When she is forced to awaken during one of these episodes, she is confused and disoriented. Her parents are afraid that she will accidentally hurt herself during one of these episodes. Which of the following is the most appropriate intervention the physician should recommend?

a. Tell the parents to maintain a safe environment and monitor the patient's symptoms.

b. Start the patient on a low dose of benzodiazepines at night.

c. Start the patient on a low dose of a tricyclic antidepressant.

d. Tell the parents that the child would benefit from cognitive psychotherapy.

e. Admit the child to the hospital and obtain an electroencephalogram (EEG).

The answer is a. (Kaplan and Sadock, p 555.) Non-rapid eye movement sleep arousal disorder is a parasomnia associated with slow-wave sleep. The patient is usually difficult to awaken, confused, and amnesic for the episode. Common in children, sleepwalking peaks between the ages of 4 and 8 years and usually disappears after adolescence. The person attempting to awaken the sleepwalker may be violently attacked. The severity of the disorder ranges from less than one episode per month without any problem to nightly episodes complicated by physical injury to the patient and others. There is no treatment recommended—rather, the goal is to continue to monitor the patient's symptoms and to maintain a safe environment until the disorder remits.

A 65-year-old woman lives alone in a dilapidated house, although her family members have tried in vain to move her to a better dwelling. She wears odd and out-of-fashion clothes and rummages in the garbage cans of her neighbors to look for redeemable cans and bottles. She is very suspicious of her neighbors. She was convinced that her neighbors were plotting against her life for a brief time after she was mugged and thrown onto the pavement by a teenager, but now thinks that this is not the case. She believes in the “power of crystals to protect me” and has them strewn haphazardly throughout her house. Which of the following is the most likely diagnosis?

a. Autism spectrum disorder

b. Schizophrenia

c. Schizotypal personality disorder

d. Avoidant personality disorder

e. Schizoid personality disorder

The answer is c. (Kaplan ...

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