Which of the following is not a catatonic symptom?
D. A gait disturbance seen in conversion disorder is called as astasia–abasia. It is a wildly ataxic, staggering gait accompanied by gross, irregular, jerky truncal movements, and thrashing and waving arm movements. Patients with the symptoms rarely experience a fall; even if they do, they do not get seriously injured. Posturing is maintaining an uncomfortable posture for a long time. Negativism is motiveless resistance to all movements; catatonia can also present itself as mitgehen – patient bends his limb even with a gentle finger push from the examiner like an ‘angle poise lamp’. Ambitendence is tested by asking the patient to show his tongue – the patient will keep moving it in and out similar to a ‘jack in the box’.
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Which of the following statements accurately differentiates catatonic rigidity from neurological spasticity?
A. In neurological spasticity the tone is increased irrespective of passive or active movements. A patient with catatonia can use the affected limb or muscle group when needed with completely normal tone – for example running out when there is a fi re. Negativistic phenomena, for example gegenhalten and mitgehen, are often distinguishing features of catatonia. Gegenhalten refers to the phenomenon where the patient resists movement of his or her extremities by the examiner. Mitgehen is said to be present when the patient moves in the direction of a slight push from the examiner in spite of the command to remain still. Catatonia persists in sleep and can continue for weeks without improvement. Catatonia is mostly seen in advanced primary mood or psychotic illnesses. Among inpatients with catatonic presentation, 25 to 50% are related to mood disorders and approximately 10% are associated with schizophrenia.
Which of the following differentiates the anhedonia seen in depression versus anhedonia seen in chronic schizophrenia? Anhedonia differs in:
A. Some differences are reported in the quality of anhedonia experienced by patients who are depressed compared to patients with schizophrenia. In depression anhedonia is more physical – not able to enjoy listening to music, not able to enjoy going for walks, etc. In schizophrenia it is thought to be more social – that is not able to enjoy other’s company, not feeling warm in personal relationships, etc. A longitudinal study by Blanchard et al. (2001) compared depressed patients and schizophrenia patients on a measure of social anhedonia; recovered depressed patients showed significantly less social anhedonia than schizophrenia patients on follow-up after 1 year. This suggests that anhedonia in depression is more of a state than a trait characteristic while it may be a trait characteristic in schizophrenia.
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Folie a deux is characterized by which of the following clinical descriptions?
C. Folie a deux is a shared delusion in which a psychotic person transfers his delusions to one or more people close to him. The non-psychotic ‘victim’ usually exhibits dependent traits on the primary patient. Separation of the pair can result in remission. The pair is usually a married couple or sisters/ brothers. Folie a deux can develop in any two persons with a close association with each other, irrespective of their actual relationship.
Which of the following pair is correctly matched?
A. Obsessions by definition are ego dystonic – against ones values or ideals. Delusions often arrive as judgements or explanations, relieving a puzzled atmosphere that precedes them. In view of such ‘relieving effect’, delusions can be termed as ego syntonic. Overvalued ideas are adhered to and acted upon by the patient, making them ego syntonic.
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