50 Psychopathology
| T | F | |
|---|---|---|
| 1. Passivity phenomena occur in persistent delusional disorder. |  |
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| 2. Dreams are abnormal perceptions. |  |
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| 3. Sensitiver Beziehungswahn is typically associated with hallucinations. |  |
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| 4. Depersonalization is common in agoraphobia. |  |
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| 5. Paraphasias include substitution of words. |  |
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| 6. Weight loss is seen in uncomplicated grief. |  |
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| 7. Repeated suggestion can induce false memories. |  |
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| 8. Waxy flexibility includes resisting passive movements. |  |
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| 9. Morbid jealousy differs from normal jealousy in the quality of evidence for infidelity. |  |
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| 10. Double orientation generally causes little distress to the patient. |  |
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| 11. Grandiose delusions occur in hypomania. |  |
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| 12. Hallucinations are always perceived as emanating from the surrounding environment. |  |
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| 13. Lilliputian hallucinations are often pleasurable. |  |
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| 14. Perceptual disturbances occur in derealization. |  |
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| 15. Pseudohallucinations are sensory deceptions. |  |
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| 16. Pseudohallucinations in the bereaved are indicative of morbid grief. |  |
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| 17. Schneider’s first rank symptoms have their emphasis on form rather than content. |  |
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| 18. Intermetamorphosis is a misidentification syndrome. |  |
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| 19. Dereistic thinking is usually goal directed. |  |
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| 20. Circumstantiality is a disorder of reasoning. |  |
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| 21. Overinclusive thinking can be assessed by object sorting tests. |  |
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| 22. Hypochondriacal delusions are found in most patients with dysmorphophobia. |  |
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| 23. Paranoid literally means ‘beside the mind’. |  |
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| 24. Out of body experiences may occur in normal people. |  |
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| 25. Thought broadcasting involves the patient believing that his thoughts are being read by others. |  |
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ANSWERS
False: Non-bizarre delusions constitute the most conspicuous or the only clinical characteristic in persistent delusional disorder. Passivity phenomena are sensations, feelings, impulses or volitional acts that are experienced by the patient as made or influenced by others in some way. They are bizarre delusions suggesting a diagnosis of schizophrenia. ICD-10 specifically excludes ‘delusion of control’ which is synonymous with passivity experiences from the description of persistent delusional disorder (DSM-IV 1994, 297.1; ICD-10 1992, F22.0; Wright et al 2005, p. 264).
False: Dreams are highly complex experiences that occur during REM sleep. They are described by the patient in the way they remember them when they are awake. Daydreams are different and involve fantasy (Johnstone et al 2004, p. 773; Sims 2004, p. 59).
False: These are sensitive delusions of reference first described by Kretschmer in 1927. He described a sensitive premorbid personality characterized by shyness and distrust. Such a person would be predisposed to form sensitive ideas of reference, which, following a key experience, would develop into a delusion that is understandable in this context (McKenna 2006, p. 270; Sims 2004, p. 129).
True: Depersonalization is common in agoraphobia. Roth, in 1959, suggested that depersonalization signified a special subgroup of agoraphobia, the phobic-anxiety-depersonalization syndrome that typically occurs in young married women (DSM-IV 1994; Gelder et al 2006, p. 189; ICD-10 1992, F40.0; Sims 2004, p. 334).
True: Paraphasia is defined as ‘substitutions within a language’.
Literal paraphasia is the misuse of the meanings of words so that the sentence does not make sense.
Phonemic paraphasias involve similar sounding words, e.g. murder for merger.
Verbal paraphasias involve the loss of a word but the substitute still makes sense, e.g. ‘four-legged sit-up’ for chair (Hodges 1994, p. 95; Lishman 1997, p. 102; Sims 2004, p. 183).
True: Sadness, tearfulness, irritability, anhedonia, early morning wakening, and loss of appetite, weight and libido may all occur in normal grief. One-third of the bereaved meet the criteria for a depressive episode at some point during their grieving. Morbid guilt, suicidal ideation, functional impairment, psychomotor retardation, global loss of self-esteem, worthlessness and persistent hallucinations are more indicative of depression (Gelder et al 2006, p. 169; Puri & Hall 2004, p. 82; Sadock & Sadock 2002, p. 61).
True: Loftus in 1979 showed that people can be misled into remembering things that have never occurred by asking leading questions. In further studies experimenters have falsely suggested to an individual that they experienced a traumatic event as a child. Some of these individuals have subsequently gone on to recall the event in great detail. For example, by repeated suggestion, childhood memories of having been lost in a crowd can be induced in up to 30% of those who had no such memory. However, some think that in order to be ‘misled’ the false event must in some way be compatible with their personal history (Gross 2001, p. 616).
False: Waxy flexibility or flexibilitas cerea is when the patient allows himself to be moulded into an awkward posture which he will then hold for several minutes. This is a catatonic symptom. The phenomenon of resisting passive movements is called opposition (McKenna 2006, p. 19; Sims 2004, p. 364).
True: The essential feature of morbid or pathological jealousy is an abnormal belief that the marital partner is being unfaithful. The term should be used only when the jealousy is based on unsound evidence and reasoning (Gelder et al 2006, p. 314; Sims 2004, p. 132).
True: Double orientation occurs when patients with chronic schizophrenia behave in a manner incompatible with their firmly held delusions. This delusional belief is thus separate from and therefore does not influence their feelings and behaviour. For example, the patient may believe he is a member of the Royal Family but at the same time lives happily in a hostel (Gelder et al 2006, p. 9; Sims 2004, p. 215).
False: According to ICD-10, delusions and hallucinations do not occur in hypomania. The presence of grandiose delusions would change the diagnosis to mania with psychotic symptoms (ICD-10 1992, F30.0; Johnstone et al 2004, p. 427).
False: Hallucinations are usually perceived as emanating from the surrounding environment or the outer objective space. However, they can be perceived as arising from within the body or from remote locations as in extracampine hallucinations (Sims 2004, pp. 98, 112).
True: Lilliputian hallucinations are abnormal perceptions often of little creatures or humans. Here micropsia affects the visual hallucinations. They are accompanied by strong affect, usually a strange mixture of terror and humour. Many patients do enjoy them and are able to watch them with interest and delight. They occur in organic states such as delirium tremens (Lishman 1997, p. 12; Sims 2004, p. 105).
True: Derealization is an unpleasant feeling of unreality relating to the environment. There can be distortion of time sense, emotional numbing and perceptual changes whilst insight is preserved. The outside world may be experienced as flat, dull and unreal. People can appear as lifeless, two-dimensional ‘cardboard’ figures. It is often accompanied by depersonalization. It can occur as a transient phenomenon in healthy adults and children, especially when tired (Gelder et al 2006, p. 16; Sims 2004, p. 231).
True: Pseudohallucinations are sensory deceptions. They are false perceptions that are experienced in full consciousness. They are different from normal perception, imagery, illusions, dreams and hallucinations. They are clear, vivid and involuntary but are figurative and occur in inner subjective space (McKenna 2006, p. 10; Sims 2004, p. 108).
False: Pseudohallucinations can occur in people free of mental illness at times of crisis, e.g. bereavement. Pseudohallucinations in the bereaved are called hallucinations of widowhood. They occur in up to 50% of the widowed. They do not indicate pathological grief (Gelder et al 2006, p. 169; Sims 2004, p. 111).
True: Schneider suggested that the presence of any one of the first rank symptoms, in the absence of organic disease, was positive evidence for schizophrenia. It is now recognized that first rank symptoms, whilst highly suggestive of schizophrenia, are not pathognomonic (McKenna 2006, pp. 26, 89; Sims 2004, p. 166).
True: Capgras, Fregoli, subjective doubles and intermetamorphosis are the four misidentification syndromes. In intermetamorphosis the patient believes to a delusional level that a familiar person and a misidentified stranger share physical and psychological similarities (Gelder et al 2000, p. 668; Sims 2004, p. 134).
False: Bleuler coined the term dereistic thinking. It is also known as autistic or undirected fantasy thinking. It refers to preference for an inner personalized idiosyncratic reality rather than external reality (Sims 2004, p. 149).
False: Circumstantiality is a disorder of thinking. It is a pattern of speech which is indirect, delayed at reaching the end goal and frequently includes unnecessary detail. It occurs in schizophrenia, learning disability and epilepsy. It is not uncommon in normal subjects (McKenna 2006, p. 16; Sims 2004, p. 154).
False: Overvalued ideas are usually found in dysmorphophobia. Delusions do not occur in dysmorphophobia. Hypochondriacal delusions are found in depression, schizophrenia and are most commonly in persistent delusional disorder (Sims 2004, pp. 138, 258).
True: In Greek, paranoia means beside the mind. Paranoid is a derivative of this term and translates as ‘like paranoia’. The actual meaning and usage of these words in practice is still debated (McKenna 2006, p. 238).
True: Out of body experience is the illusion of being separated from one’s own body. Out of body experiences are often accompanied by autoscopy where one sees and feels the presence of one’s double. This experience can occur in normal people when deprived of sensory stimuli and also in near death experiences, e.g. after a myocardial infarction (Gelder et al 2006, p. 7; Lishman 1997, p. 73; Sims 2004, p. 215).
False: In thought broadcasting the patient experiences his thoughts as leaving his head and being projected over a wide area and hence others are aware of them. It is a first rank symptom of schizophrenia. It differs from delusions of thoughts being read (McKenna 2006, p. 29; Sims 2004, p. 165).
