An elderly patient in a stroke ward laughs all of a sudden inappropriately, and within a few minutes becomes tearful and cries for no reason. She exhibits an abnormality in which of the following aspects of mental state examination?
A. Stability of affect refers to maintaining a particular affective state for a reasonable period of time. Unstable or labile affect – when extreme – presents as emotional incontinence seen in stroke. Severe lability of affect seen in stroke, especially in pseudobulbar palsy, is also called the PLAC (pathological laughter and crying) syndrome. Labile affect is also a feature of mania and delirium.
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Which of the following is the major difference between mood and affect in mental state examination?
E. Various schools of thought exist in distinguishing mood from affect. It is generally accepted that mood refers to a more pervasive emotional state than affect. (Climate = mood vs. weather = affect!) Both mood and affect can have objective and subjective components though one school maintains that mood is subjective while affect is objective.
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Nihilistic delusions will be congruent with which of the following fi ndings of mental state examination?
A. Nihilism is similar to pessimism with self reference of an extreme belief, for example ‘My brain is rotten’. Congruence refers to ‘in keeping with’ a particular state of mind – nihilism is usually congruent with depression. Nihilism with delusional intensity is seen in psychotic depression.
When eliciting suicide risk, which of the following questions should be avoided if possible?
E. Direct questioning about suicidality does not increase risk of suicide, so evasive questioning is not recommended. A step-wise approach, starting from enquiry about mood state, hopelessness and thoughts of death, passive wishes to die, and active suicidal plans, is often useful in assessment of suicidal thoughts.
Which of the following is not a manifestation of hypothyroidism?
B. Features suggestive of hypothyroidism include, slowing of EEG, excessive daytime sleepiness, hypothermia, cerebellar ataxia, dementia, psychosis. The peripheral neuropathy in hypothyroidism is a sensorimotor polyneuropathy with loss of refl exes, diminution in vibratory, joint position, and touch–pressure sensations, and weakness in the distal parts of the limbs. Myopathy may also be present. Nerve conduction studies typically show a slowing of nerve conduction velocities. Hypothyroidism is observed to be common in patients with Down’s syndrome.
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