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FMGE 2011 — Psychiatry

Q: All are true about delirium tremens, except:

Normal sleep-wake cycle. ***Normal sleep wake cycle*** - Delirium tremens is characterized by a **disrupted sleep-wake cycle**, often with **insomnia** and **nocturnal exacerbation** of symptoms, making a normal sleep-wake cycle an incorrect statement. - The brain's regulatory mechanisms for sleep are significantly impaired due to the withdrawal of alcohol's suppressive effects. *Clouding of consciousness* - **Clouding of consciousness** is a hallmark feature of delirium tremens, representing a reduced awareness of the environment and impaired attention. - Patients often present with **disorientation** regarding time, place, and person. *Visual hallucinations* - **Visual hallucinations** are very common in delirium tremens, often described as vivid, frightening, and involving small animals or insects. - These hallucinations contribute to the patient's **agitation** and fear. *Coarse tremors* - **Coarse tremors**, particularly of the hands and face, are a classic physical sign of alcohol withdrawal and an integral part of delirium tremens. - These tremors are due to the **overactivity of the sympathetic nervous system** as the inhibitory effects of alcohol wear off. [Practice more Psychiatry PYQs on OnCourse]

Q: Visual hallucinations are most commonly seen in:

Delirium. ***Delirium*** - **Visual hallucinations** are a hallmark symptom of **delirium**, often described as vivid and fluctuating. - Delirium presents with acute onset of **waxing and waning consciousness**, attention deficits, and cognitive impairment. *OCD* - **Obsessive-compulsive disorder** (OCD) is characterized by recurrent, intrusive thoughts (**obsessions**) and repetitive behaviors (**compulsions**). - It does not typically involve hallucinations; rather, individuals are usually aware of the irrationality of their obsessions and compulsions. *Delusional syndrome* - **Delusional disorders** primarily involve fixed, false beliefs (**delusions**) that are not bizarre and are not accompanied by prominent hallucinations. - While hallucinations can occur, they are generally not the most prominent or characteristic feature, unlike in delirium or psychotic disorders. *Mania* - **Mania**, a mood disorder, is characterized by an elevated, expansive, or irritable mood, increased activity, racing thoughts, and decreased need for sleep. - While psychotic features such as delusions (often grandiose) can occur in severe mania, **visual hallucinations** are less common than in delirium and audio hallucinations are more likely if present. [Practice more Psychiatry PYQs on OnCourse]

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All are true about delirium tremens, except:

Visual hallucinations are most commonly seen in: