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Flashcards in Psychiatry Deck (11):

A 30-year-old man presents to his doctor as he has been feeling generally 'out of sorts' for the past few weeks. He is accompanied by his girlfriend who says he has 'not been himself'. She is worried and feels he may need to see a psychiatrist. There is no history of past mental health problems. Which one of the following symptoms would be most suggestive of depression?


Nausea before certain situations e.g. getting on a bus.

Early morning waking.

Excessive gambling.

Flash-backs to childhood problems.

Early morning waking.

Early morning waking is a classic somatic symptom of depression and often develops earlier than general insomnia.

Palpitations and nausea and more common with anxiety. Excessive gambling may suggest either a simple gambling addiction or be part of a hypomanic/manic disorder.

Flash-backs are common in post-traumatic stress disorder.


A 35-year-old male is seen by a mental health specialist after being adamant that the government had invaded his body. He is started on an antipsychotic medication. Which of these is a possible side effect of this type of medication?


Metabolic Syndrome.


Renal Failure.


Metabolic Syndrome.

Antipsychotics have a wide side effect profile due to their blockade of dopamine receptors. These include dystonia, dyskinesia, antiemetic effects, and hyperprolactinaemia. Another common side effect is the metabolic syndrome. Care must be taken with antipsychotics as they can also cause a prolonged QT interval. The remaining options do not represent antipsychotic side effects.


A 54-year-old man presents with a variety of physical symptoms that have been present for the past 9 years. Numerous investigations and review by a variety of specialties have indicated no organic basis for his symptoms. This is an example of:

Munchanusen's Syndrome.

Hypochondrial disorder.

Dissociative disorder.

Somatisation disorder.

Conversion Disorder.

Somatisation Disorder.

Somatisation disorder is the correct answer as the patient is concerned about persistent, unexplained symptoms rather than an underlying diagnosis such as cancer (hypochondrial disorder). Munchausen's syndrome describes the intentional production of symptoms, for example self poisoning


What are the key aspects of somatisation disorder? (2)

Multiple physical SYMPTOMS present for at least 2 years.
Patient refuses to accept reassurance or negative test results.


What are the key aspects of Hypochondrial disorder? (2)

Persistent belief in the presence of an underlying serious DISEASE, e.g. cancer.
Patient refuses to accept reassurance or negative test results.


What are the key aspects of Conversion disorder? (3)

Typically involves loss of motor or sensory function.
The patient doesn't consciously feign the symptoms (Factitious disorder) or seek material gain (malingering).
The patient may be indifferent to their apparent disorder - la belle indifference - although this has not been backs up by some studies.


What are the key aspects of dissociative disorder? (3)

Dissociation is a process of 'separating off' certain memories from normal consciousness.
It involves psychiatric symptoms (e.g. amnesia, fugue, stupor).
Dissociative identity disorder (DID) is the new term for multiple personality disorder as it is the most severe form of dissociative disorder.


What is Munchausen's syndrome also known as?

Factitious disorder.


What is the key feature of Munchausen's syndrome?

Intentional production of physical or psychological symptoms.


What is malingering?

Fraudulent simulation or exaggeration of symptoms with the intention of financial or other gain.


Which one of the following is not a first-rank symptom of schizophrenia?

Thought broadcasting.

Visual hallucinations.

Thought withdrawal.

Delusional perceptions.

Auditory hallucinations.

Visual hallucinations.