Loss of insight is a common feature in schizophrenia. Which of the following neurological symptoms is comparable to loss of insight?
C. Insight is a multidimensional concept; it is not useful to restrict oneself to the assessment of ‘presence’ or ‘absence’ of insight. Though traditionally insight was considered to be present in those with neurosis and absent in those with psychosis, this is now regarded as too simplistic. Insight is now recognized to exist in a spectrum of varying degrees. David (1990) has considered insight to be composed of an awareness of one’s own mental experiences, ability to recognize abnormal experiences as pathological, and compliance with treatment interventions. Insight is closely related to the neurological symptom of anosognosia. A patient who is suffering from a hemiplegia refuses to accept that he has lost the function of his limb. (‘A’–absence, ‘noso’–ill health or disease, ‘gnosis’–awareness).
References:
Patients that complain of unusual symptoms, using the words ‘as if’, are most likely to have which of the following phenomena?
C. Depersonalization is the third most common symptom that is seen in patients attending psychiatric clinics. It is defined as a change in self awareness where the individual feels as if he is unreal. The ‘as if’ quality differentiates it from psychotic states. When a similar feeling occurs for objects and environment around an individual, it is termed as derealization (Mapother). It is always subjective, unpleasant, and invariably associated with affective change but preserved insight. Emotional numbing, loss of feelings of agency and self esteem, disturbed body image, altered perception of time, and disturbed sensory experiences of all modalities are reported.
Reference:
A 43-year-old widow presents to the clinic with vague complaints. She is unable to express her emotions verbally. Difficulty in differentiating bodily sensation from emotional state is characteristic of patients with which of the following?
D. The patient described here most probably suffers from depression with difficulty in expressing here feelings to others. Inability to verbally express emotional states (alexithymia) can partially explain symptoms of somatization occurring secondary to depression. In somatization disorder, recurrent, multiple, frequently changing somatic complaints are present for several years; this is not the case with the patient described in this question. Pathological changes in right cerebral hemisphere projections and failed thalamic feedback are also suggested but not proved as possible explanations for somatizing. It is suggested that the patients with first-rank symptoms of psychosis have difficulties in differentiating the ‘source’ of their experiences. They might misattribute internal mood state or self generated motor impulses to external sources, leading to a delusional elaboration.
Pathological gambling is considered as a part of which of the following cluster of symptoms?
C. Pathological gambling is defined as persistent, recurrent and problematic gambling behaviour associated with a preoccupation to gamble and spending increasing amounts of money in gambling. Patients often show a loss of control over gambling and pursue gambling at considerable expense of other activities of daily living. It is best regarded as an impulse control disorder together with kleptomania, intermittent explosive disorder and pyromania, etc. The gambling behaviour must not be directly due to manic episodes in order to be diagnosed as pathological gambling. It is not an overvalued idea; it is an abnormal behaviour and not merely an aberration of thought content. Pathological gambling is not an essential feature of antisocial personality.
A 43-year-old widow presents to the clinic with vague complaints. She is unable to express her emotions verbally.
Which of the following symptoms is LEAST likely to be seen in this lady?
E. Alexithymia is often accompanied by diminution of fantasy, reduced symbolic thinking, literal thinking concerned with details, difficulties in recognizing one’s own feelings, difficulties in differentiating body sensations and emotional states, and complaints of robot-like existence. Amnesia is not a feature of alexithymia.
Click to expand