Question 91#

Which of the following is a feature of chronic fatigue syndrome?

A. Disproportionate fatigue compared to exertion

E. In chronic fatigue syndrome (also called myalgic encephalomyelitis or postviral fatigue; described as neurasthenia in ICD-10) the central feature is severe fatigue which is not related to level of exertion and unrelieved by rest. This is accompanied by aching muscles, insomnia, aching joints, and irritability. Patient may complain of sore throat, fever, and tender lymph nodes, especially, retrospectively, around the time of onset.

Reference:

1. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 1113.

Question 92#

Which of the following best differentiates hypochondriasis from somatoform disorder?

A. Patients with hypochondriasis are concerned about symptoms rather than diagnosis

D. There are important conceptual differences between somatization disorder and hypochondriasis. In hypochondriasis the patient dreads the presence of an undiagnosed disorder. He seeks diagnosis more than treatment. The patient asks for various unwarranted diagnostic tests but will not be satisfied by any negative results. A patient with somatization is not concerned about diagnosis as much as she is concerned about symptom relief and intervention. Various sophisticated diagnostic measures are not sought usually. Instead, various treatments may be tried by both patients and health-care professionals.

Reference:

1. World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders; Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization, 1992, pp. 162, 164.

Question 93#

A young lady develops transient bladder incontinence coinciding with a recent job loss. A few months later she presents to her GP with weakness of the right leg.

Which of the following medical disorder is often confused with conversion disorder?

A. Myasthenia gravis

E. Multiple sclerosis can present with discrete neurological dysfunctions separated in both time and bodily location. These symptoms often resolve on their own (relapsing–remitting course). For example, as in this case, bladder dysfunction and limb weakness. Conversion disorder also presents with neurological dysfunction (often ‘loss of function’ as opposed to somatoform disorder where there is a ‘positive’ symptom such as pain) which can resolve on its own, on resolution of a conflict.

Reference:

1. World Health Organization. The ICD-10 Classification of Mental and Behavioral Disorders; Clinical Descriptions and Diagnostic Guidelines. Geneva: World Health Organization, 1992, p. 158.

Question 94#

Which of the following is the single most important factor predicting suicide risk?

A. Recent life event

C. Past history of suicidal attempt is the most important predictor of risk. Other risk factors include family history of suicide, history of a major mental illness, low socioeconomic status, postdischarge period, severe physical illness, and easy access to lethal methods.

Reference:

1. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 1035.

Question 95#

You are bleeped to assess five patients at the same time at A & E. Which one of the following has highest risk of suicide compared to the others?

A. 32-year-old woman with obsessional symptoms

B. This is a difficult question; questions of this type are best answered at their face value, with only the given information and without making any further assumptions . Patient A has obsessional symptoms with no other pathology highlighted. As such, the risk of suicide is low in OCD without depression. Patient C has the risk factor of alcohol use, but the rest of the history (female, young, sought help, impulsive) suggests low risk. Patients D and E seem to have no suicidal intention. Patient B has various risk factors – middle aged, male, had a violent attempt, and a widower.

Reference:

1. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 1035.