AIIMS MAY 2017 (PSYCHIATRY : recall based) Q1) A 12 year old girl presented to the OPD with abdominal colic, nausea, diarrhoea and lethargy and headache for last 1 year. Her irritability and anger increased since last few months and she presented to emergency with weakness of lower limbs. What is the diagnosis? A. Conversion disorder B. Acute intermittent porphyria C. Lower Limb paralysis D. AIDP with migraine Ans B. Acute Intermittent Porphyria. (Ref : Kaplan and sadock synopsis chapter 21, 11th edition) The porphyrias are disorders of heme biosynthesis that result in excessive accumulation of porphyrins. The triad of symptoms is acute, colicky abdominal pain; motor polyneuropathy; and psychosis. Acute intermittent porphyria is an autosomal dominant disorder that affects more women than men and has its onset between ages 20 and 50 years. The psychiatric symptoms include anxiety, insomnia, lability of mood, depression, and psychosis. Symptoms of this disease also predominately include psychosis, apathy, or depression, along with intermittent abdominal pain, neuropathy, and autonomic dysfunction. Elevated levels of porphobilinogen are found in the urine of symptomatic patients with acute intermittent porphyria. (There is no evidence of presence of acute precipitating stress factor, nor is there any ascending weakness) Q2) A 24y old female with epilepsy gets repeated thoughts to cut off her fingers with a knife. She goes onto into detailed planning as to how do the same. These thoughts are distressing but do not urge her to do the action nor does it cause anxiety. The thoughts stay for 5-10 minutes after which she gets a seizure and the thoughts disappear and don’t come back again and she feels better. Diagnosis? A. Obsession B. Thought crowding C. Forced thinking D. Thought insertion Ans C : FORCED THINKING (Ref : Lishman's organic psychiatry pg 310) In partial seizures, patients may experience distortions of thought such as forced thinking, which describes a feeling of being compelled to think about a specific topic or word; or crowding of thoughts, which describes a feeling of racing, disorganised thoughts. Q3) Mutism and akinesis in a patient who appears awake and even alert is best described as: A. Stupor B. Oneroid C. Twilight D. Delirium Ans A. Stupor Ref: Kaplan synopsis appendix glossary of terms stupor: (1) State of decreased reactivity to stimuli and less than full awareness of one’s surroundings; as a disturbance of consciousness, it indicates a condition of partial coma or semicoma. (2) In psychiatry, used synonymously with mutism and does not necessarily imply a disturbance of consciousness; in catatonic stupor, patients are ordinarily aware of their surroundings. ------------------ Follow “Dams Psychiatry” page----------------Dr. Sachin Arora (psychiqueries@gmail.com)
