A 49-year-old man with a known history of alcohol dependence and schizophrenia is brought to the psychiatric hospital because of frank delusions and visual hallucinations. Which of the following should be a diagnostic possibility for inclusion in the differential diagnosis?
Borderline personality disorder
Steroid-induced psychosis
Brief psychotic disorder
Substance/medication-induced psychotic disorder
The Correct Answer is D
Choice A reason: Borderline personality disorder may involve transient psychotic symptoms under stress, but it does not typically present with sustained delusions and visual hallucinations. It is not a primary differential diagnosis in this context.
Choice B reason: Steroid-induced psychosis is a valid diagnosis but requires a history of corticosteroid use. There is no mention of steroid exposure in this case, making it less likely.
Choice C reason: Brief psychotic disorder involves sudden onset of psychotic symptoms lasting less than one month, often triggered by stress. Given the patient’s chronic psychiatric and substance use history, this diagnosis is less appropriate.
Choice D reason: Substance/medication-induced psychotic disorder is highly relevant in this case. Alcohol dependence can lead to psychotic symptoms, especially during withdrawal or intoxication. This diagnosis accounts for both substance use and the presence of hallucinations and delusions.
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Correct Answer is B
Explanation
Choice A reason: Rational emotive behavioral therapy (REBT) focuses on challenging irrational beliefs and promoting rational thinking. While helpful for emotional regulation, it is not the primary evidence-based approach for relapse prevention in substance use.
Choice B reason: Cognitive behavioral therapy (CBT) is the most widely supported therapy for relapse prevention. It helps clients identify triggers, develop coping strategies, and restructure maladaptive thoughts that contribute to substance use. CBT is effective in maintaining sobriety and preventing relapse.
Choice C reason: Dialectical behavioral therapy (DBT) is beneficial for emotional regulation and is often used for borderline personality disorder. While it may help with co-occurring conditions, CBT is more targeted for relapse prevention.
Choice D reason: Solution-focused therapy emphasizes strengths and future goals but lacks the structured approach needed for relapse prevention. It is better suited for short-term problem-solving than long-term substance use management.
Correct Answer is B
Explanation
Choice A reason: This describes internal validity, which assesses whether the observed effect is due to the intervention and not confounding variables. It does not address generalizability.
Choice B reason: External validity refers to the extent to which study findings can be generalized beyond the specific sample used. If the sample accurately reflects the broader population, the results are more likely to apply in real-world settings, enhancing external validity.
Choice C reason: A p-value of 0.1 suggests that the results are not statistically significant at the conventional threshold of 0.05. It does not relate to external validity, which is about generalizability, not statistical significance.
Choice D reason: Peer-reviewed publication indicates that the research has undergone expert scrutiny, but it does not guarantee external validity. Generalizability depends on study design and sample characteristics, not publication status.
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