Which of the following is the most important factor in increasing the risk of suicide in epilepsy?
A. Suicide is increased fivefold among patients with epilepsy. Among patients presenting with self-harm, epileptic subjects are over-represented from five- to sevenfold. Risk factors for suicide in epilepsy are ranked as follows:
Reference:
Andrew is a 30-year-old man who presented with frontal headaches and a history of complex partial seizures. Typically, his seizures begin with 20 seconds of orobuccal movements followed by 40 seconds of altered consciousness. At seizure onset, Andrew feels he must constantly think of the word ‘Supercalifragilisticexpialidocious’ and repeat this several times without him being able to control it.
What is this phenomenon called?
A. This type of psychic aura is called ‘forced thinking,’ characterized by recurrent intrusive thoughts, ideas, or crowding of thoughts. Forced thinking must be distinguished from obsessional thoughts and compulsive urges. Epileptic patients with forced thinking experience their thoughts as stereotypical, out-of-context, brief, and irrational, but not necessarily as ego dystonic. Periodic lateralizations are recurrent EEG complexes that may be associated with prolonged confusional behaviour and focal cognitive changes. Kaplan HI.
The phenomenon where the onset of peri-ictal psychosis occurs as a result of control of epileptic seizures is called:
A. Periictal psychotic symptoms more often worsen with increasing seizure activity. Rarely, psychotic symptoms alternate with seizure activity. In this ‘alternating psychosis’, as long as the patient’s seizures are not controlled, they are free of psychotic symptoms, but when they are seizure free and their EEG has ‘forced’ or ‘paradoxical normalization’, they manifest psychotic symptoms. This alternating pattern is much less common than the increased emergence of psychotic behaviour with increasing seizure activity. Twilight states are episodes of confusion that may be associated with the seizure (ictal) or after a seizure (post ictal). They may be associated with odd behaviours, and the patient is usually not conscious about the behaviour. Geschwind syndrome is otherwise called epileptic personality. It consists of a cluster of personality traits including hyposexuality, hypergraphia, hyperviscosity, hyperreligiosity seen in patients with long-standing epilepsy.
Which of the following is NOT considered a feature of irritable bowel syndrome (IBS)?
A. IBS is the prototypical functional gastrointestinal disorder characterized by abdominal pain and diarrhoea or constipation. The International Congress of Gastroenterology has developed a standardized set of criteria for IBS. They include either abdominal pain relieved by defaecation or associated with a change in frequency or consistency of stool; or disturbed defaecation involving two or more of the following: altered stool frequency; altered stool form hard or loose and watery; altered stool passage straining or urgency or feeling of incomplete evacuation; passage of mucus. IBS can be categorized into diarrhoea-predominant, constipation-predominant, and mixed subtypes. Medical treatment often targets the predominant symptom. IBS accounts for as much as 50% of all outpatient evaluations done by gastroenterologists.
Which of the following is NOT a model that has been proposed to explain the relationship between IBS and high rates of psychiatric comorbidity?
E. Studies of psychiatric comorbidity in IBS estimate rates of comorbidity at 42–64% of all IBS patients. The exact mechanism for high rates of psychiatric comorbidity in IBS is unknown. Four models have been proposed to explain the relationship between IBS and high rates of psychiatric comorbidity. The first model is the somatization disorder hypothesis. This model classifies IBS as one of a group of diagnoses that can be made from a primary somatization disorder or other somatoform disorder. The somatopsychic hypothesis states that psychological symptoms are the result of chronic gastrointestinal distress and the unsatisfactory interaction with healthcare providers who do not accurately diagnose and treat IBS. Psychogenic hypothesis states that specific psychiatric disorders cause IBS for a significant proportion of patients. Panic disorder, in particular, is proposed as a cause for secondary IBS. The self-selection model proposes that psychiatric comorbidity increases the rate of treatment seeking in patients who have IBS.
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