A 67 year old woman comes to the clinic because she is havin…

A 67 year old woman comes to the clinic because she is having difficulty “controlling her movements”. The patient explains that her symptoms have become worse with emotional stress and fatigue. Her past medical history is notable for hypertension, hyperlipidemia, osteoarthritis, and schizophrenia. During the exam the PMHNP notices that she exhibits facial grimacing, smacking of the lips, and twisting movements of her fingers. The patient feels self conscious going to the store because she feels others stare at her. She lives alone and feels isolated. She denies having any delusions or hallucinations. What is the most likely diagnosis?