Which of the following is a supportive intervention during a clinical interview process?
B. Being empathetic and acknowledging a patient’s emotional state helps in facilitating progression of clinical interview. These are supportive interventions required in various degrees by patients. Summarization is not an intervention but a technique facilitating a clinician’s understanding of a patient’s story. Confrontation may be helpful in some situations, but it cannot be considered as a supportive intervention during clinical interview.
Which of the following statements is true when enquiring about suicidal ideation?
D. Thoughts of self harm should always be enquired about. Contemplation of suicide is very common among the mentally ill. There is no evidence that enquiring about suicidal ideations increases the risk of committing suicide. In fact many patients would welcome an opportunity to discuss any suicidal thoughts with a professional.
‘Do you ever hear voices commenting on what you are doing?’
This question is usually asked to ascertain the presence of which one of the following?
B. First rank symptoms (FRS), proposed by Kurt Schneider, suggest a diagnosis of schizophrenia. These symptoms are not specifi c for schizophrenia. The prevalence of FRS in schizophrenia ranges from 28% to 72%. First rank symptoms do not carry any prognostic signifi cance. The stated question in this case enquires for the presence of ‘running commentary’ hallucinations – voices commenting on patients’ thoughts or actions. Bleuler’s primary or fundamental symptoms consist of loosening of association, blunting of affect, ambivalence, and autism (the four A’s). All delusions and hallucinations were classed as secondary symptoms according to Bleuler. Negative symptoms include alogia, affective fl attening, avolition, apathy, anhedonia, asociality, and attentional impairment.
Regarding the Mini Mental State Examination (MMSE), which of the following statements is true?
A. While administering the MMSE, the subject is asked to guess the answer if he is unsure. This could possibly differentiate patients with pseudodementia who usually answer ‘I don’t know’ while truly demented patients often give wrong responses. On the attention subtest, initially the patient is asked to do the serial seven. If the score is less than 5, we do the WORLD backwards. The higher score among the two is taken. It is not enough for the patient to read the sentence out loud. It is a test of comprehension, so the patient needs to close his/her eyes after reading the command. Education affects the scores on the MMSE. Patients with higher educational status tend to score higher on the test. But education does not affect the rate of change of scores in both normal and dementia subject, and hence change in scores is a good index of worsening dementia. MMSE is not independent of socioeconomic status. This may be because socioeconomic status is indirectly linked to educational status.
Assessment of insight is an integral part of mental state examination in psychiatric practice. Regarding insight, which of the following statements is true?
E. The three dimensions of insight proposed by David include: the ability to label unusual experiences as pathological, to recognize that one has mental illness, and to comply with treatment. In a different approach to the concept of insight, emotional insight is considered the highest level of insight. This is the awareness and understanding of the illness which leads to a change in behaviour. Intellectual insight is the admission of illness and recognition of symptoms, without the ability to apply this knowledge to change or shape future behaviour. Patients with OCD may present with poor insight. DSM IV has a specifi er ‘with poor insight’ for OCD where poor insight is associated with poor prognosis. Patients with schizophrenia show variable levels of insight at various stages of their illness. Some exhibit a good level of insight when recovered, while at the worst phase of their illness they may deny having any mental illness.
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