A 12-year-old boy repeatedly wakes up in middle of night screaming, but could recall only fragments of any mental images. He appears to be disoriented for several minutes on waking.
Which of the following diagnoses is the most appropriate?
B. Night terror is a sleep disorder seen mostly in children. It is a disturbance of slow wave non-REM sleep. Generally in NREM sleep, dreams cannot be fully recollected. When a patient wakes up from NREM sleep, he is often confused. A night terror is a dramatic episode where the patient screams, has autonomic arousal, appears confused but goes back to sleep without clear memory of the arousal the next morning. Though this is fairly common in children around age 7, a new onset sleep terror in adults should prompt neurological investigations to rule out epilepsy or brain damage. About 1 to 6% of children have the disorder. It is more common in boys and tends to run in families.
Reference:
A 25-year-old man has had irrational fear for darkness since childhood. He is not distressed about this currently and does not take special measures to avoid being in the dark.
Which of the following is true?
C. Irrational fears are common in childhood but most of them disappear by adolescence. Any irrational fear of certain objects or situations associated with strong avoidance behaviour prompts a diagnosis of phobia. Phobia can develop against any object/ place though certain phobias, for example animals or spider phobia, seem common and more recurring than others; this might have an evolutionary explanation (stimulus preparedness).
Which one of the following specific phobias is strongly genetic?
C. Blood injury injection phobia is different from other phobias in two important aspects:
The affected persons may have inherited a particularly strong vasovagal reflex, which becomes associated with phobic emotions.
Which one of the following features during trauma has the capacity to predict future development of PTSD?
B. Emotional numbing when undergoing the trauma is associated with later risk of developing PTSD. PTSD occurs after exposure to stressful event of exceptionally threatening or catastrophic nature. But not everyone who is exposed to such situations develops PTSD. Predisposing factors may include pre-existing neuroticism, genetic predisposition (one-third of the variance is explained by genes), and hypocortisolaemia apart from an abnormal hippocampal response to stress.
Which of the following is NOT a feature of panic disorder?
E. Panic attacks have an autonomic arousal component with sweating, palpitation, trembling or shaking, shortness of breath or smothering, feeling of choking, nausea, and dizziness. A cognitive component is characterized by fear of going mad, losing control, fear of dying, derealization and depersonalization. The most characteristic type of panic attack is the spontaneous (out of the blue) episode. Situational panic attacks occur when exposed to or anticipating an exposure to a particular situations. Occasionally, some individuals have panic attacks in certain situations sometimes but not always – these are called situationally predisposed panic attacks. Nocturnal panic attacks are common in patients with panic disorder. They are similar to panic attacks that occur in daytime. Isolated, nocturnal panic attacks are rare and must prompt investigations to rule out medical causes. Especially in case of non-fearful panic attacks where cognitive components are absent, one should suspect medical causes. There is nothing called unilateral panic attack!
Click to expand