INI-CET 2023 - Psychiatry PYQs Practice Questions

Q: La belle indifference is seen in?

Conversion disorder. ***Conversion disorder*** - **La belle indifference** refers to a patient's unconcerned attitude towards their symptoms, which are often dramatic, and is a classic but not pathognomonic feature of conversion disorder. - In **conversion disorder**, psychological stress is "converted" into physical symptoms affecting voluntary motor or sensory function, such as paralysis or blindness, without a neurological explanation. *Depression* - Patients with depression typically exhibit significant **distress** and concern over their symptoms, such as **sadness**, loss of interest, and functional impairment. - The emotional state in depression is characterized by dysphoria and often includes pronounced feelings of **helplessness** and **hopelessness**. *Cotard syndrome* - Is a rare psychiatric disorder characterized by a **nihilistic delusion**, where a person believes they are dead, do not exist, or have lost their organs or blood. - Patients with Cotard syndrome often show severe **anxiety**, **distress**, and sometimes withdrawal, rather than indifference to their bizarre symptoms. *Schizophrenia* - Patients with schizophrenia may display a range of emotional responses, including **flat affect** or **inappropriate affect**, but not typically "la belle indifference." - Their symptoms often include **hallucinations**, **delusions**, and disorganized thought, which usually cause significant impairment and distress, sometimes leading to significant isolation or perceived threats. [Practice more Psychiatry PYQs on OnCourse]

Q: A patient tells psychiatrist: "My brain is missing. What is the point of me eating anything. I am already dead". The patient has which type of delusion?

Nihilistic delusion. ***Nihilistic delusion*** - The patient's statements ("**My brain is missing**," "**I am already dead**," "What is the point of me eating anything") are characteristic of **nihilistic delusions**, specifically Cotard's syndrome. - This type of delusion involves a belief in the non-existence of oneself, parts of one's body, or the entire world. *Delusion of misidentification* - This involves a belief that familiar people or objects have been replaced by imposters, or that someone is a different person entirely. - The patient's statements do not describe the misidentification of another person or object. *Bizarre Delusion* - While the statements could be considered bizarre, **bizarre delusions** are defined as clearly implausible, not understandable, and not derived from ordinary life experiences (e.g., aliens implanted a chip in my brain). - Nihilistic delusions, especially in the context of Cotard's syndrome, are a specific subtype of delusion that can be bizarre, but "nihilistic delusion" is a more precise characterization here. *Hypochondriacal Delusion* - This involves a false belief of having a severe disease despite medical reassurance. - While there is a physical component to the delusion ("my brain is missing"), the overarching theme of non-existence and being dead goes beyond a simple preoccupation with illness. [Practice more Psychiatry PYQs on OnCourse]

Q: A patient of schizophrenia is being treated with clozapine. For which rare but serious side effects should he be monitored?

Agranulocytosis. ***Agranulocytosis*** - **Agranulocytosis** is a severe and potentially fatal reduction in white blood cells (specifically neutrophils) that can occur with clozapine use [2, 3]. - This is the **rare but serious side effect** that requires mandatory monitoring, occurring in **0.8-2%** of patients. - Patients on clozapine require routine **complete blood count (CBC)** monitoring: **weekly for the first 6 months**, then biweekly for months 6-12, then monthly thereafter . - This is the primary reason clozapine has restricted use despite being the most effective antipsychotic for treatment-resistant schizophrenia. *Seizures* - While clozapine can lower the **seizure threshold** (especially at higher doses), seizures occur in **1-2%** of patients and are **dose-dependent** . - Seizures are a known side effect that warrants dosage adjustment, but they are **not as rare** as agranulocytosis and do not require the same intensive blood monitoring protocol. - Management involves dose reduction or adding anticonvulsants. *Hepatomegaly* - **Hepatic dysfunction** can occur with clozapine, but **hepatomegaly** (enlarged liver) itself is not one of its rare, life-threatening side effects requiring specific monitoring above other, more severe issues. - Liver enzyme elevation may be monitored, but this is not the primary "rare but serious" concern. *Renal bleed* - **Renal complications** or **renal bleeding** are not recognized as significant or specifically monitored rare side effects of clozapine. - Clozapine's major concerns primarily involve hematologic (agranulocytosis), cardiovascular (myocarditis), and metabolic systems. [Practice more Psychiatry PYQs on OnCourse]

Question 1

La belle indifference is seen in?

Accepted Answer

Conversion disorder

Answer

Depression

Answer

Cotard syndrome

Answer

Schizophrenia

Question 2

A patient tells psychiatrist: "My brain is missing. What is the point of me eating anything. I am already dead".
The patient has which type of delusion?

Accepted Answer

Nihilistic delusion

Answer

Delusion of misidentification

Answer

Bizarre Delusion

Answer

Hypochondriacal Delusion

Question 3

A patient of schizophrenia is being treated with clozapine. For which rare but serious side effects should he be monitored?

Accepted Answer

Agranulocytosis

Answer

Seizures

Answer

Hepatomegaly

Answer

Renal bleed

INI-CET 2023 — Psychiatry