Which of the following is considered to be the most important difference between primary and secondary delusions?
A. Primary delusions do not carry any prognostic significance in schizophrenia, though they have diagnostic relevance. Primary delusions can occur in epileptic psychoses too. Primary delusional experiences occur more in acute stages of schizophrenia, and are rarely seen in chronic schizophrenia. In the chronic phase, original primary delusions are replaced largely by secondary delusions. The term secondary delusions refers to delusions that follow a primary delusion or follow other mental phenomena such as hallucinations, affective disturbances, etc.
Reference:
A 65-year-old housewife is admitted to a hospital in Durham following a head injury. She claims that the same hospital has an extension that runs into Dundee, and she could be in Dundee at the same time as she is in Durham.
Which of the following entities should be considered in her presentation?
C. Reduplicative paramnesia is the delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been ‘relocated’ to another site. It is one of the delusional misidentification syndromes and, although rare, is most commonly associated with acquired brain injury, particularly simultaneous damage to the right cerebral hemisphere and to both frontal lobes. It is also noted in patients with delirium.
Disorientation of age seen in schizophrenia is more common in which of the following patient groups?
D. Among inpatients with schizophrenia, 25% have age disorientation. Age-disoriented patients are younger at first admission and have had a longer duration of stay than patients with a diagnosis of schizophrenia without age disorientation. Age disorientation may be a feature of a type of schizophrenic illness of early onset and poor prognosis.
Double orientation is a phenomenon seen in chronic schizophrenia. It refers to which of the following?
C. Bleuler argued that a cardinal feature of schizophrenic deterioration involved ‘double registration’ or ‘double orientation’. According to him, in schizophrenic patients a delusional world exists where misinterpretations and threatening events are common. This is in addition to the existence of a ‘real’ world wherein life is near normal. These two orientations often get clearly separated in a long-standing, chronic schizophrenia patient.
Your pharmacist has asked you to reduce or change antipsychotic prescriptions to an inpatient as he has developed akathisia. Akathisia refers to which of the following descriptions?
C. Akathisia is a subjective feeling of restlessness, with or without objective signs of restlessness. It can present with a sense of anxiety, inability to relax, jitteriness, pacing, rocking motions while sitting, and rapid alternation of sitting and standing. It can be measured using Barnes akathisia scale.
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