Question 16#

A patient looks dishevelled, with unkempt hair and dirty, unwashed clothes. Self neglect is commonly noted in all of the following EXCEPT:

A. Alcoholism

E. While self neglect can be seen in any severe mental illness, it is not very common in isolated anxiety disorders. In alcoholism self neglect indicates a higher risk of vitamin and nutritional deficiencies. In schizophrenia, this may be secondary to negative symptoms or depression.

Reference:

1. Garden G. Physical examination in psychiatric practice. Advances in Psychiatric Treatment 2005; 11: 142–149.

Question 17#

A 57-year-old lady with many previous hospitalizations is brought by police to casualty. She is wearing full make-up, green lipstick, shiny green nail polish, and green jewellery. She asks everyone at the admission unit to call her Ms Green.

Which of the following diagnoses is most consistent with the above presentation?

A. Mania

A. Exuberant dressing and makeup suggests elevated mood. It is possible that the lady described in this scenario has bipolar illness.

Reference:

1. Semple DM et al., eds. Oxford Handbook of Psychiatry, 1st edn. Oxford University Press, 2005, p. 38.

Question 18#

Which of the following domains of cognition is tested by administering Serial Sevens Test?  

A. Short-term memory

B. Serial sevens test is a part of Mini Mental State Examination. In this test, the subject is asked to subtract seven from 100 serially for fi ve times. One point is given for each correct subtraction. Though it has arithmetic properties, in MMSE this test is primarily administered to test attention. Alternatively, the subject may be asked to spell the word ‘WORLD’ backwards to test attention. The better of two scores is used to calculate final MMSE scores.

Reference:

1. Ridha B and Rossor M. The Mini Mental State Examination. Practical Neurology 2005; 5: 298–303.

Question 19#

A 33-year-old man attending an out-patient clinic turns towards his left and spits out, muttering unintelligibly. He does this act at least three times in half an hour and appears very guarded.

This gesture is suggestive of which of the following?

A. Depression

D. Hallucinatory behaviours, such as the one described in this example, are often noted in acutely psychotic patients with poor insight. Questioning the behaviour gently could elicit more information from the patient.

Reference:

1. Semple DM et al., eds. Oxford Handbook of Psychiatry, 1st edn. Oxford University Press, 2005, p. 38.

Question 20#

A depressed patient does not smile or laugh when a joke is shared by a fellow patient. She shows a defect in which of the following aspects of mental state examination?

A. Stability of affect

B. Reactivity of affect refers to change in affect in response to environmental cues. Lack of reactivity is common in depression. Congruity is the appropriateness of the person’s affect to the symptoms or the thought content. In this case, the affect is appropriate to the symptom of depression.

Reference:

1. Semple DM et al., eds. Oxford Handbook of Psychiatry, 1st edn. Oxford University Press, 2005, p. 81.