WBR0363

Author	[[PageAuthor::Gonzalo A. Romero, M.D. [1]]]
Exam Type	ExamType::USMLE Step 2 CK
Main Category	MainCategory::Psychiatry
Sub Category	SubCategory::Psychiatry
Prompt	[[Prompt::A 55-year-old woman comes to the Clinic for a routine Check up. She is an actress and is wearing a very tight red dress. Her hair is long and has highlights. She complaints she likes a man at work who he does not pay enough attention to her. The physician perceives that she is staring at him in a non-professional manner. She says to the doctor “you are very handsome, are you married?” and touches his tie. The physician steps back a feet away from her and continues interviewing her. She then says: “you don’t want me either, you are just like all other men, I thought you were my special doctor”. She then bursts into tears complaining that people should recognize her more when she walks in the streets because she is on television. She has been married 4 times, and has had 3 boyfriends over the last year. Upon her first divorce she cut her wrists trying to commit suicide. Which of the following is the most appropriate statement about her diagnosis?]]
Answer A	AnswerA::Personality disorders are commonly treated with pharmacotherapy during 6 months
Answer A Explanation	[[AnswerAExp::Incorrect. Personality disorders are life-long and pervasive, and their treatment involves long-standing psychotherapy and sometimes pharmacotherapy may benefit in individual cases. Because of the lack of research support for work on personality disorders and long-term treatment with psychotherapy, the empirical findings on the treatment of these disorders remain based on the case report method and not on clinical trials. On the basis of case presentations, the treatment of choice is psychotherapy aimed at self-development through resolution of conflict and advancement of inhibited developmental lines. Group therapy is not recommended for those with HPD because it often perpetuates histrionic behavior because the person then has an audience to play off of]]
Answer B	AnswerB::Her disorder was triggered by her divorce a life stressful event
Answer B Explanation	[[AnswerBExp::Incorrect. The causes of HDP are not well understood; although childhood events and genetics may be involved.]]
Answer C	AnswerC::Presents with the same manifestations in both genders
Answer C Explanation	[[AnswerCExp::Incorrect. The literature differentiates HPD according to gender: Women are described as self-centered, self-indulgent, and intensely dependent on others, emotionally shallow and have difficulty understanding others or themselves in any depth. Selection of marital or sexual partners is often highly inappropriate. Most all partners chosen will have symptoms of personality diseases far worse than their own. Tend to enter into abusive relationships. Males present problems of identity crisis, disturbed relationships, lack of impulse control, antisocial tendencies and are inclined to exploit physical symptoms. They are emotionally immature, dramatic, and shallow.]]
Answer D	AnswerD::This type of disorder requires psychotherapy for a long time, along with pharmacotherapy
Answer D Explanation	[[AnswerDExp::Correct. This disorder requires both long-term psychotherapy as it is a pervasive chronic disorder, in conjunction with pharmacotherapy.]]
Answer E	AnswerE::It commonly presents with splitting as a coping method
Answer E Explanation	[[AnswerEExp::Incorrect. Splitting is a defense mechanism commonly presents among persons with Borderline Personality Disorder. This mechanism makes the individual perceive facts or relationship as black or white, love or hate, the “split” from one end to the opposite to cope with stressful events.]]
Right Answer	RightAnswer::D
Explanation	[[Explanation::This patient typically presents with a Histrionic Personality Disorder (HDP), which is characterized by a pattern of excessive emotionality and attention seeking, excessive need for approval, inappropriate seductiveness, and usually beginning in early adulthood. These individuals are lively, dramatic, enthusiastic, and flirtatious. They may be inappropriately sexually provocative, express strong emotions with an impressionistic style, and be easily influenced by others. Educational Objective: a Wiki-mnemonic that can be used to remember the criteria for histrionic personality disorder is PRAISE ME: P - provocative (or seductive) behavior R - relationships, considered more intimate than they are A - attention, must be at center of I - influenced easily S - speech (style) - wants to impress, lacks detail E - emotional lability, shallowness M - make-up - physical appearance used to draw attention to self E - exaggerated emotions – theatrical Educational Objective: References: ]]
Approved	Approved::Yes
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