An old man whose wife recently died is brought to you by his daughter. He is depressed, always crying and telling you that he's already dead and that his internal organs have been eaten by worms.
What is he likely having?
Correct Answer A:
A nihilistic delusion is a delusion that nothing exists, or that a significant aspect of the self (such as one's brain or the outside world) does not exist. Nihilistic delusions center on the nonexistence of self or parts of self, others, or the world. A person with this type of delusion may have the false belief that the world is ending.
→ Hallucination (choice B) is a perception of visual, auditory, tactile, olfactory, or gustatory experiences without an external stimulus and with a compelling sense of their reality, usually resulting from a mental disorder or as a response to a drug. Severe depression is sometimes accompanied by auditory hallucinations, which are usually transient and limited to single words or short phrases and, generally, saying things consistent with the patient's depressed mood.
→ Deja-vu (choice C) is the phenomenon of having the strong sensation that an event or experience currently being experienced has been experienced in the past, whether it has actually happened or not.
→ A delusion is a false belief which is firmly sustained and based on incorrect inference about reality. Hypnopompic delusions (choice d) occur when one is waking up.
→ Delirium (choice D) is an acutely disturbed state of mind that occurs in fever, intoxication, and other disorders and is characterized by restlessness, illusions, and incoherence of thought and speech. Given this patient's presentation, it's obvious that it does not fit the diagnosis of delirium.
A patient is convinced that an intravenous injection he received has made him immortal.
This is an example of which one of the following?
Correct Answer B: Delusion is a fixed false belief based on incorrect inference about external reality that persist despite the evidence to the contrary and these beliefs are not ordinarily accepted by other members of the person's culture or subculture .
→ Illusion is a misperception of a real external stimulus.
→ Hallucination is a sensory perception in the absence of external stimuli that is similar in quality to a true perception, auditory (most common), visual, gustatory, olfactory, tactile.
→ Perseveration - uncontrollable repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder.
→ Derealization - feeling that the world/outer environment is unreal.
A 28-year-old man with a drug addiction presents with rhinorrhea, tachycardia, dilated pupils and high blood pressure.
The most likely cause is:
Correct Answer D:
Organophosphate poisoning causes pinpoint pupils.
Of the answer choices, d) fits the question stem the best.
An 8-year-old boy is brought to your department by his parents because of concerns about his behavior. They report that they have noticed over the last 9 months he tends to blame his younger sister for mistakes he makes and poor performance and he seems to be resentful towards his sister. This has led him to make many negative reports to parents about his sister in order to “make her pay.” They don’t have physical aggression towards each other and he is not known to damage any properties. He often argues vigorously with his mother about the bedtime rules. Both parents agreed that it was appropriate that the children be in bed no later than 10 pm but he prefers staying awake playing electronic games. The child’s only past medical history is intermittent asthma, treated with albuterol inhaler on as per-needed-basis. His sister is 7 years old and according to his parents she doesn’t exhibit any abnormal behavior for a child of her age.
Which of the following is the most appropriate management to treat or prevent this boy’s behavior the parents described?
This child’s behavior as described by his parents fulfills the DSM-V criteria for oppositional defiant disorder (ODD). To fulfill this diagnosis, an individual must have 4 of the following:
This child blames his sister for his mistakes or poor performance, is resentful and spiteful towards her. He also often argues with his mother over bed-time hour rules. Treatment goal is to establish generational boundary through parent management training (PMT). This method consists of procedures in which parents are trained to change their own behaviors (choice D) and thereby alter their child's problem behavior. If the majority of interactions with the child are focused around correcting their negative behaviors, a cycle of negative interactions is created where the child expects attention after misbehaving. On the contrary, praise builds the child’s self-esteem and serves to strengthen the bond between a child and their caregiver.
→ Tutoring for homework to help the boy focus while studying (choice A) is recommended to manage attention deficit hyperactivity disorder (ADHD), which tends to occur in a large number of children diagnosed with ODD. Because of the high-comorbidity to adequately evaluate one disorder, it is also important to investigate the presence of others. This child only has ODD and treatment for ADHD is not necessary.
→ Recommend starting treatment with methylphenidate (choice B) should be done in a patient with ADHD.
→ In order to discourage his behavior, parents should tell him they don't take his opinion seriously (choice C) is considered negative reinforcement in children with ODD, which can only worsen the condition.
→ Start treatment with carbamazepine to prevent aggressiveness (choice E) should be considered in children with conduct disorder, which also is a common comorbid condition in children with ODD and especially found in half of those who have ODD for longer than 3 years. This child doesn’t have conduct disorder.
Key point:
Oppositional defiant disorder is diagnosed in children who are at least 8 years old and have repeated behaviors of annoying others including refusal to comply with parents or other authority figures request. An effective treatment for ODD is parent management training (PMT).
A 4-year-old boy, is found to be checking and playing with his genitals more often than before.
Which of the following stages of Freud’s psychosexual development is this child in?
Correct Answer C:
The concept of psychosexual development, developed by Sigmund Freud at the end of the nineteenth century, consists of five separate phases: oral, anal, phallic, latency, and genital. Here is an explanation of each phase:
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