Question 1#

A 54-year-old man presents with a variety of physical symptoms that have been present for the past 9 years. Numerous investigations and review by a variety of specialties have indicated no organic basis for his symptoms.

This is an example of:

A. Munchausen's syndrome

Correct Answer D: Somatization disorder is the correct answer as the patient is concerned about persistent, unexplained symptoms rather than an underlying diagnosis such as cancer (hypochondrial disorder). Munchausen's syndrome describes the intentional production of symptoms, for example self poisoning.

Unexplained symptoms:

There are a wide variety of psychiatric terms for patients who have symptoms for which no organic cause can be found:

1- Somatization disorder:

• Multiple physical SYMPTOMS present for at least 2 years
• Patient refuses to accept reassurance or negative test results

2- Hypochondrial disorder:

• Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
• Patient again refuses to accept reassurance or negative test results

3- Conversion disorder:

• Typically involves loss of motor or sensory function
• The patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
• Patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

4- Dissociative disorder:

• Dissociation is a process of 'separating off' certain memories from normal consciousness
• In contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
• Dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

5- Munchausen's syndrome:

• Also known as factitious disorder
• The intentional production of physical or psychological symptoms

6- Malingering:

• Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain

 

 

Question 2#

Which one of the following is not a recognized feature of anorexia nervosa?

A. Hypokalaemia

Correct Answer E: 

Anorexia features:

• Most things low
• G's and C's raised: Growth hormone, Glucose, Salivary glands, Cortisol, Cholesterol, Carotinaemia

Anorexia nervosa: features:

Anorexia nervosa is associated with a number of characteristic clinical signs and physiological abnormalities which are summarized below:

• Reduced body mass index
• Bradycardia
• Hypotension
• Enlarged salivary glands

Physiological abnormalities:

• Hypokalaemia
• Low FSH, LH, Oestrogens and Testosterone
• Raised Cortisol and Growth hormone
• Impaired glucose tolerance
• Hypercholesterolaemia
• Hypercarotinaemia
• Low T3

Question 3#

Which one of the following symptoms may indicate mania rather than hypomania?

A. Predominately elevated mood

Correct Answer B: The presence of psychotic symptoms differentiates mania from hypomania.

Psychotic symptoms:

• Delusions of grandeur
• Auditory hallucinations 

The following symptoms are common to both hypomania and mania:

Mood:

• Predominately elevated
• Irritable

Speech and thought:

• Pressured
• Flight of ideas
• Poor attention

Behaviour:

• Insomnia
• Loss of inhibitions: sexual promiscuity, overspending, risk-taking
• Increased appetite 

Question 4#

A 45-year-old man who takes chlorpromazine for schizophrenia presents with severe restlessness.

What side effect of antipsychotic medication is this an example of?

A. Akathisia

Correct Answer A: Antipsychotics act as dopamine D2 receptor antagonists, blocking dopaminergic transmission in the mesolimbic pathways. Conventional antipsychotics are associated with problematic extrapyramidal side-effects which has led to the development of atypical antipsychotics such as clozapine.

Extrapyramidal side-effects:

• Parkinsonism
• Acute dystonia (e.g. torticollis, oculogyric crisis)
• Akathisia (severe restlessness)
• Tardive dyskinesia (late onset of choreoathetoid movements, abnormal, involuntary, may occur in 40% of patients, may be irreversible, most common is chewing and pouting of jaw)

The Medicines and Healthcare products Regulatory Agency has issued specific warnings when antipsychotics are used in elderly patients:

• Increased risk of stroke
• Increased risk of venous thromboembolism

Other side-effects:

• Antimuscarinic: dry mouth, blurred vision, urinary retention, constipation
• Sedation, weight gain
• Raised Prolactin:Galactorrhoea
• Neuroleptic Malignant syndrome: pyrexia, muscle stiffness
• Reduced seizure threshold (greater with atypicals)
•  

 

Question 5#

A 25-year-old man demands a CT scan of his abdomen in clinic. He states it is 'obvious' he has cancer despite previous negative investigations.

This is an example of a:

A. Hypochondrial disorder

Correct Answer A: 

Unexplained symptoms:

There are a wide variety of psychiatric terms for patients who have symptoms for which no organic cause can be found:

1- Somatization disorder:

• Multiple physical SYMPTOMS present for at least 2 years
• Patient refuses to accept reassurance or negative test results

2- Hypochondrial disorder:

• Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer
• Patient again refuses to accept reassurance or negative test results

3- Conversion disorder:

• Typically involves loss of motor or sensory function
• The patient doesn't consciously feign the symptoms (factitious disorder) or seek material gain (malingering)
• Patients may be indifferent to their apparent disorder - la belle indifference - although this has not been backed up by some studies

4- Dissociative disorder:

• Dissociation is a process of 'separating off' certain memories from normal consciousness
• In contrast to conversion disorder involves psychiatric symptoms e.g. Amnesia, fugue, stupor
• Dissociative identity disorder (DID) is the new term for multiple personality disorder as is the most severe form of dissociative disorder

5- Munchausen's syndrome:

• Also known as factitious disorder
• The intentional production of physical or psychological symptoms

6- Malingering:

• Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain