Background:
Mr. Johnson, a 69-year-old retired man, with no history of a psychiatric disorder, presents to the clinic with a complaint of hearing voices. He reports hearing indistinct voices conversing with each other, commenting on his actions, and occasionally making derogatory remarks. Mr. Johnson denies any history of substance use or significant life stressors. His family members express concern about his increasing social withdrawal and changes in behavior over the past few months.
Multiple Choice Questions:
1. What psychiatric term is commonly used to describe the phenomenon of hearing voices in the absence of external stimuli?
A. Auditory hallucinations
B. Delusions
C. Obsessions
D. Derealization
2. Considering Mr. Johnson's age and the late onset of these symptoms, which of the following conditions is most likely associated with late-life psychosis?
A. Bipolar Disorder
B. Schizophrenia
C. Major Depressive Disorder
D. Dementia with psychotic features
3. What is the first-line treatment approach for late-life psychosis, especially when associated with conditions like dementia?
A. High-dose antipsychotic medications
B. Electroconvulsive therapy (ECT)
C. Cognitive-behavioral therapy (CBT)
D. Addressing underlying medical conditions and minimizing antipsychotic use
Answers:
1. A. Auditory hallucinations
Explanation: Auditory hallucinations refer to the perception of sounds, such as voices, without any external auditory stimuli. In Mr. Johnson's case, his complaint of hearing indistinct voices that converse, commenting on his actions, and occasionally making derogatory remarks aligns with the characteristic features of auditory hallucinations. This term is commonly used to describe such perceptual experiences in psychiatric assessments.
2. D. Dementia with psychotic features
Explanation: Late-life psychosis, especially in the context of auditory hallucinations, is often associated with conditions like dementia. Dementia with psychotic features involves cognitive decline along with the presence of psychotic symptoms, such as hallucinations or delusions. Given Mr. Johnson's age and the absence of a history of psychiatric disorders, dementia with psychotic features becomes a more likely consideration.
3. D. Addressing underlying medical conditions and minimizing antipsychotic use
Explanation: In the context of late-life psychosis, particularly when associated with conditions like dementia, the first-line approach involves addressing underlying medical conditions and minimizing the use of antipsychotic medications. Antipsychotics may have side effects that can be particularly problematic in older adults, and non-pharmacological approaches, such as addressing medical comorbidities and providing supportive care, are prioritized. This approach aims to balance symptom management with minimizing potential risks associated with medication use.