MRCP2-3800
You are asked to evaluate a 68-year-old woman’s condition by psychiatry. Her husband has become increasingly worried about her behavior over the past three weeks. She has accused him of stealing my true husband and has become suspicious of him. Initially, she avoided her husband and refused to eat food he had prepared. However, today she threatened him with a knife, and the police had to be called.
The psychiatry doctor is concerned because she was admitted to the hospital five weeks ago and treated for a suspected urinary tract infection with intravenous antibiotics. Subsequent testing showed the pathogen to be an extended-spectrum beta-lactamase producing bacteria. She currently has a temperature of 38.7 degrees, heart rate 105 bpm regular, RR 18, and Sats 99% on room air. Her husband notes that she has been spending more time in the toilet over the past three weeks but is unsure if this is due to her paranoia.
Her husband describes an episode 30 years ago where she required antidepressants, antipsychotics, and ECT after a close family bereavement. She is otherwise healthy and has no history of cognitive problems. Her husband states that there is a strong history of mental health problems in her family, but he is unable to be more specific.
When you speak to her, she appears to be confused and scores 19/30 on the Mini Mental State Examination. She can point to, name, and recognize her husband and can also pick him out from pictures. However, she tells you that the man standing next to her is not her husband but a lookalike who has replaced him. Despite all your best efforts to show evidence to the contrary, she cannot be persuaded to change her opinion.
What is the best way to describe her presentation?