A 32-year-old man presents to a dermatologist with circumscribed areas of alopecia. He admits to recurrent pulling of his hair, especially at times of stress. He feels a sense of relief after the act. He has a normal IQ and no other stereotyped behaviour.
Which of the following is the most appropriate diagnosis?
C. Stereotyped and recurrent pulling of hair with exacerbations during times of stress is characteristic of an impulse control disorder called trichotillomania. Similar to other impulse control disorders such as kleptomania, there is a sense of relief associated with the act. This commonly involves the scalp, facial hair, or axillary hair. The prognosis in children is better than adults; the latter often show a chronic fluctuating course. Some patients may bite the pulled hair, and complications such as intestinal obstruction can occur, especially in children. Differential diagnoses for compulsive hair pulling include OCD, Tourette’s syndrome, and pervasive developmental disorders.
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Risk of developing schizophrenia is increased in which of the following populations?
A. There is a strong correlation between low IQ and incidence of schizophrenia. Traditionally, male and female incidences were thought to be equal but this has been recently challenged. McGrath undertook an exhaustive review of the literature on incidence rates and concluded that distribution of rates was significantly higher in males compared to females; the median male/female rate ratio was 1.40 in this analysis. Another meta-analysis, looking at 20 year’s data on patients under 64, concluded similarly. Note that prevalence of schizophrenia does not differ between sexes. This may be because mortality is higher in males with schizophrenia.
Which of the following is an important difference between male and female schizophrenia?
D. Though schizophrenia is equally prevalent in men and women, differences exist in the onset and course of illness. Onset and age at first hospitalization are earlier in men; women display a bimodal age distribution, with a second peak occurring in middle age. It is observed that men are more likely to be impaired by negative symptoms and women are more likely to have better premorbid adjustment. The outcome for female schizophrenia patients is better than that for male schizophrenia patients; currently it is unclear whether this could be attributed to later age of onset in females.
What is the risk of developing schizophrenia in a concordant monozygotic twin?
B. The prevalence of schizophrenia in general population is around 1%. The prevalence rate increases when considering non-twin siblings of schizophrenia patients (8%). The risk is further elevated to 12% for a child born to a mother or father with schizophrenia. The risk shoots to 40% if both parents have schizophrenia, while having a monozygotic twin with schizophrenia increases the risk to 47% for the second twin. In dizygotic twins the risk is similar to that for a non-twin sibling, that is 12%.
Which is a chromosomal deletion syndrome closely related to schizophrenia phenotype?
C. Velo–cardio–facial or di George syndrome (VCFS) is a genetic, autosomal dominant condition defined by Shprintzen in 1978. It occurs in 1 per 4000 live births; spontaneous deletion of chromosome 22q11.2 is responsible in most cases. It is characterised by mental retardation, facial dysmorphic features, cardiac anomalies, and neuroendocrine abnormalities, such as absent parathyroid, maldeveloped thymus, etc. It is thought to be related to problems in neural crest cell migration. Interestingly, the recent discovery of COMT polymorphism to be located at the same chromosomal loci adds to the speculation that psychosis is linked to this chromosome.
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