Question 56#

To diagnose ‘double depression’ the patient must have a primary diagnosis of which of the following disorders?

A. Recurrent depressive disorder

C. Double depression refers to an episode of major depression in a patient with dysthymia. Dysthymic disorder is distinguished from major depressive disorder using both severity and duration criteria. Dysthymic patients complain that they have always been depressed since childhood or adolescence. A patient with dysthymia is prone to get recurrent depression, and major depression of various severities can occur on top of dysthymia, leading to double depression. It is estimated that nearly 40% of patients with major depression actually have a double depression. The prognosis may be poor in double depression.

Reference:

1. Sadock BJ and Sadock VA. Kaplan & Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry, 10th edn. Lippincott Williams & Wilkins, 2007, p. 565. 

Question 57#

Which of the following is a medical condition in which symptoms similar to OCD are found?

A. Sydenham’s chorea

A. Antineuronal antibodies are produced by group A beta haemolytic streptococci infection. This damages caudate nucleus resulting in Sydenham’s chorea. Also, patients with Sydenham’s chorea often have obsessive and compulsive symptoms, emotional lability, and hyperactivity. This is a spectrum of paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Guillain–Barré syndrome is an acute demyelinating disease of peripheral nerves.

Reference:

1. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 825. 

Question 58#

Strong risk factors for depression include all of the following EXCEPT:

A. Neuroticism

D. Among various risk factors attributed to the aetiology of depression, family history, neuroticism, recent life stressor, and past history of depression have most evidence. Brown and Harris in a landmark study established high risk of depression in urban-living women with early maternal loss, lack of a confiding relationship, greater than three children under the age of 14 at home, and unemployment.

References:

1. Patten SB. Are the Brown and Harris vulnerability factors risk factors for depression? Journal of Psychiatry and Neuroscience 1991; 16: 267–271.
2. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 698.

Question 59#

Which of the following is true regarding the clinical presentation of OCD?

A. Acute onset

C. Patients with obsessions usually harbour their difficulties for a long time (often 5 to 10 years) before they present to a doctor. The ego-dystonic nature of obsessions results in anxiety and reduces help seeking and sharing of their secret illness. OCD has its origin in adolescence or childhood. But most patients do not seek help until they are in their twenties or thirties. Often the onset of depression brings OCD to clinical attention.

Reference:

1. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 824.

Question 60#

A 17-year-old patient has recurrent intrusive thoughts which he perceives to be senseless and involuntary. He starts believing these thoughts are being inserted by his family members though these are his own thoughts.

Which of the following diagnoses must be considered apart from OCD?

A. Schizophrenia

A. Probable pointers in this vignette suggesting a diagnosis of schizophrenia are:

1. age of onset
2. ideas of ego alien thought insertion

Prodrome of psychosis may present with obsessional symptoms. Often it is diffi cult to differentiate OCD from schizophrenia in such presentations. But the useful pointers are:

1. ego-dystonic nature of obsessions may not be prominent in psychosis
2. insight that the thoughts are one’s own may not be seen in psychosis
3. resistance to the obsessions may be conspicuously absent
4. content of obsessions may be bizarre, instead of the usual themes of safety, contamination, sex, violence, religion, etc.

Reference:

1. Gelder MG et al., eds. New Oxford Textbook of Psychiatry. Oxford University Press, 2000, p. 824.