Question 11: A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?
- A. Cotard syndrome
- B. Delusional disorder (Correct Answer)
- C. Illusions
- D. Hallucinations
Explanation: ***Delusional disorder***
- This diagnosis fits the scenario as the patient holds a **false, fixed belief** (daughter wanting to kill him) that is not amenable to change in light of conflicting evidence.
- The delusion is **non-bizarre** and relates to situations that can occur in real life, consistent with delusional disorder, and there are no other significant psychotic symptoms or impairment in functioning.
*Cotard syndrome*
- This is a rare syndrome characterized by **nihilistic delusions** (e.g., belief that one is dead, does not exist, or that organs have putrefied).
- The patient's delusion in the question is persecutory, not nihilistic.
*Illusions*
- **Illusions** are misinterpretations of real external stimuli (e.g., seeing a coat in the dark and believing it's a person).
- The patient's belief is a **false belief** without an external stimulus being misinterpreted.
*Hallucinations*
- **Hallucinations** are sensory experiences that occur in the absence of an external stimulus (e.g., hearing voices when no one is speaking).
- The patient's presentation is characterized by a **fixed false belief**, not primarily by sensory perceptions without external stimuli.
Question 12: A patient stopped alcohol consumption for 3 days and presented with irritability, disorientation, paranoid delusions, agitation, visual hallucinations, and altered sensorium. What is the likely diagnosis in this case?
- A. Wernicke's encephalopathy
- B. Alcohol withdrawal delirium (Correct Answer)
- C. Korsakoff's psychosis
- D. Alcohol intoxication
Explanation: ***Alcohol withdrawal delirium***
- The combination of **irritability, disorientation, paranoid delusions, agitation, visual hallucinations, and altered sensorium** developing 3 days after cessation of alcohol is classic for **delirium tremens**, the most severe form of alcohol withdrawal.
- This condition is a medical emergency that can lead to seizures, cardiovascular collapse, and death if not treated promptly.
*Wernicke's encephalopathy*
- Characterized by the triad of **ataxia, ophthalmoplegia, and confusion**, which is due to **thiamine deficiency** and is not fully consistent with the patient's presentation.
- While it can occur in chronic alcoholics, the rapid onset of severe agitation, hallucinations, and paranoia points more towards active withdrawal.
*Korsakoff's psychosis*
- This is a chronic neuropsychiatric syndrome that typically follows untreated Wernicke's encephalopathy, characterized by severe **anterograde and retrograde amnesia** and **confabulation**.
- It does not present with the acute delirium, agitation, and prominent hallucinations described.
*Alcohol intoxication*
- This occurs when a person has recently consumed a large amount of alcohol, leading to symptoms like **slurred speech, impaired coordination, mood changes, and reduced inhibition**.
- The patient's symptoms are occurring *after* stopping alcohol consumption for 3 days, indicating withdrawal, not active intoxication.