Near death experiences are related to which of the following phenomenology?
C. Out of body experiences, autoscopy, depersonalization, and transcendental experiences together in various proportions constitute a near death experience. The temporal–parietal junction may be the seat of pathological change in near death experience. The experience of seeing oneself from an external space is a feature of autoscopy. The detached, ‘as if’ quality of near death is linked to depersonalization.
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Mutism is a catatonic sign. Which of the following with regard to mutism is true?
B. In catatonic mutism comprehension is preserved and the patient may obey commands. It can range from full mutism to partial states where the patient mumbles and makes non-verbal vocalizations. Patients can move their vocalizing muscles – hence they can cough and clear their throats. Other catatonic signs are ambitendency (patient appears stuck in indecisive, hesitant movements), automatic obedience (exaggerated cooperation with examiner’s request or incessant continuation of requested movement), and echopraxia/ echolalia (mimicking examiner’s movements/ speech) etc.
Astasia–abasia is associated with which one of the following disorders?
D. Astasia–abasia refers to the inability to either stand or balance oneself. Patients exhibit a dramatic gait disturbance, inconsistent with focal neurological deficits. They can walk more or less normally though they cannot stand balanced. It is a dissociative conversion reaction similar to other pseudoneurological problems seen in conversion.
Which one of the following patients CANNOT experience hallucinations?
E. Hallucinations are not always pathological. Any normal person can experience hallucinations, for example hypnagogic hallucinations and hallucinations during bereavement. Even patients with very low IQ can experience these perceptual disturbances, as perception requires a lower-level cognitive processing. Even congenitally deaf patients can experience hallucinations, emphasizing the role of higher brain centres not lower sensory organs in producing the phenomenon.
A 32-year-old carpenter starts believing that his new laptop is sending him infrared signals.
Which of the following processes CANNOT explain the development of the above belief?
E. An exaggeration of self-serving attribution bias is seen in psychosis. Patients excessively attribute hypothetical,positive events to internal causes (stable and global – grandiose) and hypothetical,negative events to external causes (stable and global – persecutory). When deluded patients were shown a sequence of black and white beads and were asked to decide which jar the sequence was probably drawn from (jar A had majority of black beads and B had majority of white), they came to a conclusion with far fewer beads in a given sequence than controls. They were also relatively overconfident about the accuracy of their judgement. This is hypothesized to be due to impaired probabilistic reasoning (the ability to generate hypothesis and test statistical probability). But later studies showed that when allowed to see as many beads as the controls, patients reached similar, correct conclusions – they were able to generate hypothesis and test the probability; the defect being deficient data gathering (less information before decision). This is called jumping-to-conclusion style of reasoning (JTC). Persecutory delusionsreflect false beliefs about the intentions and behaviour of others that could arise from theory of mind deficits.
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