Which one of the following statements regarding anorexia nervosa is correct?
Correct Answer C:
Anorexia nervosa:
Anorexia nervosa is the most common cause of admissions to child and adolescent psychiatric wards.
Epidemiology:
Diagnosis (based on the DSM-IV criteria):
The prognosis of patients with anorexia nervosa remains poor. Up to 10% of patients will eventually die because of the disorder.
A 24-year-old male is admitted to the Emergency Department complaining of severe abdominal pain. On examination he is shivering and rolling around the trolley. He has previously been investigated for abdominal pain and no cause has been found. He states that unless he is given morphine for the pain he will kill himself.
This is an example of:
Correct Answer C: This is difficult as the patient may well be an opiate abuser who is withdrawing. However, given the above options the most appropriate term to use is malingering as the patient is reporting symptoms with the deliberate intention of getting morphine.
Unexplained symptoms:
There are a wide variety of psychiatric terms for patients who have symptoms for which no organic cause can be found:
Somatization disorder:
Hypochondrial disorder:
Conversion disorder:
Dissociative disorder:
Munchausen's syndrome:
Malingering:
A 14-year-old boy is brought for review. He is normally fit and well and hasn't seen a doctor for over five years. His mother has been increasingly concerned about his behaviour in the past few weeks. She describes him staying up late at night, talking quickly and being very irritable. Yesterday he told his mother he was planning to 'take-over' the school assembly and give 'constructive criticism' to his teachers in front of the other pupils. He feels many of his teachers are 'underperforming' and need to be 'retaught' their subjects by him. He admits to trying cannabis once around six months ago and has drank alcohol 'a few times' in the past year, the last time being two weeks ago. Prior to his deterioration a few weeks ago his mother describes him as a happy, well adjusted, sociable young man.
Which one of the following is the most likely diagnosis?
Correct Answer C: Cannnabis and alcohol related problems are very unlikely given how long ago he used those substances. The delusions of grandeur imply this is mania rather than hypomania.
Hypomania vs. mania: The presence of psychotic symptoms differentiates mania from hypomania.
Psychotic symptoms:
The following symptoms are common to both hypomania and mania.
Mood:
Speech and thought:
Behaviour:
A 27-year-old woman is brought in by her husband. She has been refusing to go outside for the past 3 months, telling her husband she is afraid of catching avian flu. On exploring this further she is concerned due to the high number of migrating birds she can see in her garden. She reports that the presence of her husbands socks on the washing line in the garden alerted her to this.
What is the most likely diagnosis?
Correct Answer E: The washing line comment is an example of a delusional perception.
Schizophrenia: features:
Schneider's first rank symptoms may be divided into auditory hallucinations, thought disorders, passivity phenomena and delusional perceptions:
Auditory hallucinations of a specific type:
Thought disorder:
Passivity phenomena:
Delusional perceptions:
Other features of schizophrenia include:
*Occasionally referred to as thought alienation.
A 29-year-old fireman presents following a recent traumatic incident where a child died in a house fire. He describes recurrent nightmares and flashbacks which have been present for the past 3 months. A diagnosis of post-traumatic stress disorder is suspected.
What is the most appropriate first-line treatment?
Correct Answer B:
Post-traumatic stress disorder:
Post-traumatic stress disorder (PTSD) can develop in people of any age following a traumatic event, for example a major disaster or childhood sexual abuse. It encompasses what became known as 'shell shock' following the first world war. One of the DSM-IV diagnostic criteria is that symptoms have been present for more than one month.
Features:
from other people:
Management:
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