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Clinical tasks on general psychiatry




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CLINICAL TASKS

ON GENERAL PSYCHIATRY

Below case descriptions are presented, and in each case 5 variants of syn-dromal diagnoses are suggested. Choose the right option. (Correct answers are given in the end).

1. A male patient, 37 years old, became too cheerful for no particular rea-son, he has a subjective feeling of high creative abilities, enthusiasm, elation and increased productivity, in spite of manifest disability to concentrate (im­paired attention); his speed of thinking processes is too high. He is uncritical to his state, and finds it normal.

Name the syndrome:

A. Manic (non-psychotic) syndrome

B. Syndrome of dysphoria

C. Hypomanic (non-psychotic) syndrome

D. Obsessive syndrome

E. Depersonalization syndrome

2. A male patient 22 years old, complained of the decrease of physical and mental productivity, as well as increased fatigue, weakness, increased need for rest after easy work. He became irritable, impatient and less toler­ate towards people, it is difficult for him to wait even for a short time; he often has headache, sweats easily, feels prickling sensations in the heart re-gion when worries.

^ Name the syndrome:

A. Depressive syndrome

B. Hypochondriac syndrome

C. Asthenic syndrome

D. Paranoia syndrome

E. Obsessive syndrome

3. After a head injury that the patient had 5 years ago he developed affec-tive disturbances: suddenly and for no serious reason he feels anger. His mood during these periods is characterised by tension, depression combined with anger or even rage, high irritability with a tendency to aggressive actions.

^ Name the syndrome:

A. Phobic syndrome

B. Dysphoric syndrome

C. Depressive syndrome

D. Manic syndrome

E. Asthenic syndrome

4. The patient's mother complains that at night he gets up from bed with open eyes and roams around the room aimlessly with a vacant expression on his face. He walks around the room, opening wardrobes and drawers of the writing table, goes through the things as though looking for something. One day being in this state, he opened the window, got onto the roof and walked near its edge with no signs of fear. All efforts to wake the patient up when he is in such a state are use­less. The patient doesn't remember anything about his night adventures.

^ Name the probable syndrome:

A. Fugue

B. Trance

C. Ambulatory automatism

D. Somnambulism

E. Motor automatism

5. A patient, while making repairs at home, suddenly stood quite still with the painting brush in his hand, then dropped it. This state lasted for a few seconds. After that the patent was rather confused, for some moments he couldn't understand what was happening. He totally forgot the state he was in and the events around him, occurring while he was in that state.

^ Name the syndrome:

A. Obnubilation

B. Trance

C. Fugue

D. Absence (petit mal)

E. Derealisation

6. A male patient 27 years old complained that suddenly and unintention­ally he found himself in a different city. He couldn't understand, how this could happen. During his travel, of which he was completely unaware, he made an impression of a person who was slightly confused and absentmind­ed, absorbed in his thoughts, but his behaviour was more or less normal.

^ Name the probable syndrome:

A. Fugue

B. Trance

C. Clerambault-Kandinsky syndrome

D. Somnambulism

E. Absence (petit mal)

7. At the hospital department the patient suddenly and unconsciously begins to turn round and round, then undresses quickly, throwing his clothes down. This state lasts for approximately one minute, then suddenly ends. The patient does not remember anything he was doing and what was happening during this period.

^ Name the probable syndrome:

A. Fugue

B. Trance

C. Clerambault-Kandinsky syndrome

D. Somnambulism

E. Absence (petit mal)

8. The patient complains that all the police forces in the country are after him, and there are many "spies" in the department. He states that certain persecutors aim at taking away his money and remove him from his position at work. His awareness is not disturbed. The orientation in space and time is normal. His insight is impaired, the patient is sure he is sane. The behavior corresponds to his thoughts and experiences; the patient demands justice, writes letters to different official bodies, asking to defend him from the ac-tions of the "spies."

^ Name the probable syndrome:

A. Paranoia syndrome

B. Paraphrenic syndrome

C. Paranoid syndrome

D. Clerambault-Kandinsky syndrome

E. Cotard's syndrome

9. The patient was brought to the reception department of a psychiatric hospital by policemen. At the reception department the patient is tense and angry. He states that his neighbor has established in his flat an apparatus, with which he records all the patient's thoughts and inserts his own thoughts into his head. Sometimes with the help of special equipment the neighbor broadcasts pro-grams, in which offends the patient in different ways. Recently the neighbor made the patient walk in the wrong direction, use obscene language in public, and produced artificial cheerfulness in him. The patient attacked his neighbor and tried to stab him with a knife.

^ Name the probable syndrome:

A. Fregoly syndrome

B. Da Casta's syndrome

C. Cotard's syndrome

D. Syndrome of intermetamorphose

E. Clerambault-Kandinsky syndrome

10. A young female patient writes a letter: " Mummy! I am at a psychiatric hospital, they told me that I had a nervous breakdown and need proper treatment. Some strange things are happening here. Yesterday some visi­tors came to see me and tried to persuade me that they were my husband, son and daughter. Well, they really had some resemblance with the mem­bers of my family, but I understood at once, that they pretended, and really were some absolutely strange people. Why was this done? Please come here as soon as possible and help me to sort things out and understand what's happening."

^ Name the probable syndrome:

A. Kanner's syndrome

B. Clerambault-Kandinsky syndrome

C. Cotard's syndrome

D. Ganser's syndrome

E. Syndrome of "the third person"

11. At the inpatient department of a psychiatric hospital a female patient is passive, inert and is never involved in any activities on her own accord. Does some primitive work (makes cardboard boxes), but constantly needs induce­ment and activation. She is completely indifferent to the situation in the de­partment, to the members of her family and her own situation, does not care about being discharged from the hospital or left at the department for a longer time.

^ Name the probable syndrome:

A. Asthenic syndrome

B. Apathetic and abulic syndrome

C. Organic brain syndrome

D. Encephalopathic syndrome

E. Depressive syndrome

12. In a month after having flu the patient began to complain of persistent headaches, sleep and eating disorders; other complaints were irritability for no serious reason and emotional instability. Gets exhausted quickly, feels tired even after 20 or 30 minutes of conversation with the psychiatrist. Practically isn't able to read books, because can not concentrate, is easily distracted to other subjects. Is critical to the state of his health, understands that is ill and needs treatment.

^ Name the probable syndrome:

A. Apathetic syndrome

B. Neurotic syndrome

C. Hysterical syndrome

D. Asthenic syndrome

E. Organic syndrome

13. The parents of a 5-year-old child noticed the strange nature of his games. The boy seemed to transform persistently and for long periods of time into different characters, and this was associated with behavioral disorders. For example, pretending to be a dog, the boy asked for a bone, barked and refused to speak with his parents, explaining later, that "dogs don't speak The intelligence level is normal.

^ Name the probable syndrome

A. Overvalued ideas

B. Delusion-like fantasies

C. Delusions of imagination

D. Paranoia syndrome

E. Depersonalisation syndrome

14. The female patient, 34 years old, a school teacher, 4 months ago had to do much additional work: an inspector's check-up was expected. The teacher was very worried, she was afraid that the assessment of her work might be negative and prepared to her classes more thoroughly. She began to suffer sleep disorders, she couldn't go to sleep in the evening and felt jaded in the morning. She became irritable, shouted at the children for practically no reason, and then began to cry and ran away to the teachers' room. Neurological investigation showed finger and eye-lid tremor. She was unstable in the Romberg's posture, her knee reflexes were increased, and increased perspiration of palms and feet was found. No physical disorders were found on investigation.

^ Name the possible syndrome.

A. Hysterical syndrome

B. Hypochondriac syndrome

C. Asthenic syndrome

D. Depressive syndrome

E. Dysphoric syndrome

15. The observed patient's movements are retarded, she doesn't react to the attempts to contact her, answers no questions. Sometimes she spontane­ously stays in strange postures. It is possible to set (form) her body and limbs into different positions artificially. For instance, if the psychiatrist lifts her arm or leg, so that she remains standing on the other leg, the patient can stay in such an inconvenient position for quite a long time.

^ Name the probable syndrome:

A. Depressive stupor

B. Apathetic stupor

C. Psychogenic stupor

D. Catatonic stupor

E. Neurotic stupor

16. At the psychiatric department the patient monotonously walks along a corridor wall, doing a certain number of paces. Then he stops, makes a decisive gesture with his hand, calls out a senseless phrase and sharply turning round walks the same number of paces along the corridor and again re­peats the same gesture and phrase. He repeats this type of behavior several times, and it is impossible to stop him because he shows resistance. Name the probable syndrome:

A. Catatonic syndrome

B. Manic syndrome

C. Hebephrenic syndrome

D. Heboid syndrome

E. Hysterical syndrome

17. The patient has disturbed orientation in the environment and time, but orients well in his own personality. He takes the hospital for a railway station, and the other people — for passengers. Has visual hallucinations: sees white mice, cats and dogs, tries to shake off spiders, that seem to crawl over his body, feels disgust and fear. Tries to run away without explaining his intentions.

^ Name the probable syndrome:

A. Somnolent syndrome

B. Soporouse syndrome

C. Oneiroid syndrome

D. Delirious syndrome

E. Amentive syndrome

18. A 15-year-old teenager girl during last 4 or 5 months began to pay excessive attention to her appearance. For hours she looks at herself in the mirror, finds some defects in her face, which make it look "horrible" (states that her nose is crooked and her ears are too protruding). Thinks that every­body laughs at her. It is impossible to persuade her that she isn't right. She consulted a cosmetologist and asked him to make a plastic operation on her face.

^ Name the probable syndrome:

A. Hypochondriac syndrome

B. Cotard's syndrome

C. Dysmorphomanic syndrome

D. Fregoly

E. Metamorphopsia

19. Once the patient left home for work, but instead senselessly wondered around the city, travelled on different kinds of public traffic. The acquaint­ances, who met her found her looking gloomy, tired and rather confused. She could answer simple questions and didn't impress others as having any psy­chiatric problems. As the patient told later, she suddenly found herself in an unknown street and it was almost lunch-time, but she could not remember where she was all the time since morning and how she spent it.


^ Name the probable syndrome:

A. Fugue

B. Syndrome of twilight state of consciousness

C. Oneiroid syndrome

D. Somnolent syndrome

E. Derealisation

20. A patient with a head injury was brought to the admittance depart­ment. He is lying on a couch and does not react to the environment. Keeps silent, doesn't react to other people. The eye pupil reaction to light, corneal, conjunctiva, and tendon reflexes are weakened. No pathological reflexes arc registered. Demonstrates short-term reaction to pain stimuli (pulls away his hand, grimace of pain). After the termination of this state — total amnesia.

^ Name the probable syndrome:

A. Somnolent syndrome

B. Obnubilation syndrome

C. Soporouse syndrome

D. Comatose syndrome

E. Amentive syndrome

21. At the psychiatric department the patient has no motivation, no incen­tive, and no wishes. She doesn't speak to anybody, spends all her time in bed, fencing herself from others with a blanket. Eats only if she is led to the table under compulsion and fed with a spoon. Often urinates in bed and has no initiative to ask someone to change her bedclothes.

^ Name the probable syndrome:

A. Organic syndrome

B. Apathetic-abulic syndrome

C. Asthenic syndrome

D. Depressive syndrome

E. Catatonic syndrome

22. A male teenager (15 years old) with a normal level of intelligence and no conduct disorders before the age of 14, is characterized by rudeness, neg­ativism, perverted emotional reactions and drives with antisocial tendencies. His attitude to others, especially members of his family, is often cruel, he seems to enjoy hurting people. At school he sometimes bites or pinches girls painfully, and says that he does this because he "likes them." He often of­fends and beats his grandmother and mother, when they "irritate" him.

^ Name the probable syndrome:

A. Hebephrenic syndrome

B. Hyperkinetic syndrome

C. "Wildness"

D. Alienation

E. Heboid syndrome

23. A male patient, 51 years old, is sure that he has a serious incurable illness. He presents several physical complaints (unpleasant feelings in his chest and stomach, constipation, etc.) and regularly consults all the medical specialists in the outpatient department. He doesn't believe them, when they assure him that the results of investigations are normal. The patient is sure that a horrible diagnosis is being concealed from him. Demands more addi­tional investigations and a professor's consultation.

^ Name the probable syndrome:

A. Hysterical syndrome

B. Hypochondriac syndrome

C. Depressive syndrome

D. Paranoia

E. Overvalued ideas

24. The female patient, 23 years old, preferred to be alone, didn't com­municate with anybody, spent most of her time in bed, lying with open eyes and with a vacant expression on her face. Didn't answer any questions, when people insisted, covered her face with her hands. This state lasted for two weeks. When her state improved, she said that she had lived "in a world of fairy-tail dreams." She found herself on the sea beach, and the waves turned into snakes. Some fantastic creatures roamed around her. She saw a big col­umn made of human skulls, but was not frightened, only interested. During all this time she didn't see most of her real environment, everything was changed and seemed unreal.

^ Name the probable syndrome:

A. Delirious syndrome

B. Oneiroid syndrome

C. Amentive syndrome

D. Twilight state of consciousness

E. Somnolent syndrome

25. On the examination the patient's movements were very slow, he was disoriented in the environment and time. Answered questions with difficulty, after a pause. His answers were very short, sometimes wrong, often he an­swered with gestures. He could follow easy instructions. He explained to the doctor that he heard and saw everything, "as though through a layer of cot­ton wool." After this state terminated, the patient partly forgot the events hap­pened during the illness.

^ Name the probable syndrome:

A. Obnubilation

B. Somnolent syndrome

C. Twilight state

D. Soporose syndrome

E. Comatose syndrome

26. The patient, a young woman, impressible and capricious since child­hood, was accustomed to being the centre of attention, but was quarrelsome in the family. The onset of the disorder was acute, soon after the delivery of her first child. The birth was hard, with complications. The patient stated that she was ill with cancer. Vividly imagines a tumour inside "that grows, enveloping all her internal organs." After the doctor's examination and as­surance, that she had no tumour, the patient became calm for some time, but in a month the anxiety reappeared. Demands additional consultations and analyses.

^ What is the probable syndromal diagnosis?

A. Depressive syndrome

B. Asthenic syndrome

C. Paranoiac syndrome

D. Obsessional syndrome

E. Hypochondriac syndrome

27. The patient consulted a psychiatrist with a complaint of being what he called "too pedantic." He told the doctor that he simply couldn't begin doing any work without putting all his instruments symmetrically. "Recently I had to repair my car, but was putting the wrenches and screw drivers sym metrically instead." Conflicts often occurred in the family about trifles: the patient insisted that all the things had to lie symmetrically. Otherwise he felt discomfort and nervous tension.

^ What is the probable syndromal diagnosis?

A. Depressive syndrome

B. Obsessive-compulsive syndrome

C. Asthenic syndrome

D. Cotard's syndrome

E. Dysmorphomanic syndrome

28. A 17-year-old girl, after her mother's serious illness became anxious and irritable. Waited impatiently for the classes to be over, then ran home as fast as possible, imagining the horrible picture of her mother's death. Her heart palpitated, she felt heaviness in the stomach and trembled all over. The girl got calm again only when she saw that her mother was well.

^ What is the syndromal diagnosis?

A. Cotard's syndrome

B. Asthenic syndrome

C. Depressive syndrome

D. Obsessive-phobic syndrome

E. Syndrome of overvalued ideas

30. The patient had consulted the psychiatrist several times. During this visit the complaints were as follows: the state occurred acutely, she felt that her body had changed "as if it was not hers", her voice became "somehow different." As she stood at night near the window, she suddenly saw her body as if from aside, and "felt the experiences and sensations of both bodies si­multaneously." The patient told the psychiatrist that all night she seamed to "live double life."

^ What is the syndromal diagnosis?

A. Apathetic syndrome

B. Derealisation syndrome

C. Depersonalisation syndrome

D. Paraphrenic syndrome

E. Visual hallucinosis syndrome

30. The patient, who was treated at a psychiatric hospital several times, insists, that he is "The Sovereign of the Cosmos." He stated that now he is living his third life on Earth and the ninth life (in general) in the universe, that yesterday he had "travelled in time", and last night he had "possessed the USA President's brain and ordered him to stop the war." The experienc­es are emotionally coloured and the patient can't be dissuaded.

^ What is the syndromal diagnosis?

A. Obsessive ideas syndrome

B. Overvalued ideas syndrome

C. Paranoiac syndrome

D. Paranoid syndrome

E. Paraphrenic syndrome

31. At the psychiatric department the patient is lively and cheerful, her eyes shine, and her mood is elevated almost all the time. Her clothes look rather extraordinary: the slippers are decorated with bows and a lot of cot­ton wool balls are sewn all over her jersey. Her hair is made into a strange coiffure, her lips are painted with bright lipstick. The patient is excessively energetic and restless, she intrudes into every activity going on at the depart­ment, dances, sings, makes sexually advances to male visitors of the depart­ment. Seems never to get tired, sleeps only for 3 or 4 hours at night, her appe­tite is increased. Speaks very quickly, with no pauses, can't keep one line of conversation, and constantly "skips" from one topic to another.

^ Name the syndromal diagnosis.

A. Catatonic excitation

B. Manic syndrome

C. Hebephrenic excitation

D. Hyperbulic syndrome

E. Hysterical syndrome

32. The patient is excited and restless, incessantly walks around the room, wrings her hands, weeps and groans. There is an expression of fear on her face. Asks the people around her to save her family, which is sure to be in great danger. Promises to give the people much money for rescuing her rela­tions. The personnel can't dissuade her: the patient stays extremely anxious. Couldn't sleep for two nights, and hasn't eaten any food for three days, say­ing, "How can I eat, when my dear ones are dying?" Tried to commit sui­cide.

^ Name the syndromal diagnosis.

A. Hypochondriac syndrome

B. Anxiety and depressive syndrome

C. Agitated depression syndrome

D. Masked depression syndrome

E. Catatonic syndrome

33. The patient complains that he was unjustly transferred to a lower posi­tion at work with smaller salary. He thinks that this happened because his boss overheard his conversation with his colleague, in which the patient criticised the boss. In his new position he behaves extremely carefully, in the actions of his colleagues he "sees" bad attitude towards him. The patient is full of thoughts about "persecution" and "overhearing of conversations." Thinks that in this way the administration is getting rid of disagreeable employees.

^ What is the syndromal diagnosis?

A. Paranoiac syndrome

B. Paranoid syndrome

C. Paraphrenic syndrome

D. Clerambault-Kandinsky syndrome

E. Overvalued ideas syndrome

34. A patient with higher technical education formulated a hypothesis that it was possible to get drinking water in the given area at the depth of 34 me­tres. He made appropriate drafts, carried out geodesic investigations and went to his chief with the results. But the patient got the chiefs written refusal, saying that the water in this region didn't answer hygienic standards, so it was inexpedient to continue further work on this issue. The patient, though, was deeply dissatisfied with this answer and directed his report and drafts to higher institutions, trying to prove his ideas in spite of the circumstances. He spent much of his time exchanging letters with different authorities, and mean­while his work wasn't done properly, and his relations with his family wors­ened.

^ What is the syndromal diagnosis?

A. Obsessional ideas syndrome

B. Overvalued ideas syndrome

C. Hyperbulic syndrome

D. Paranoid syndrome

E. Hebephrenic syndrome

35. Patient B., 51 years old, during the last 5 months didn't work, and had consulted a number of different doctors. Complained of weakness, sleeplessness, and bad appetite. Has a lot of unpleasant sensations in dif­ferent parts of his body, which are difficult to describe: "my heart is as if peppered," "blood makes noises in my veins," "I feel emptiness in my chest," etc. In spite of satisfactory results of medical investigations, the patient remains anxious and thinks that doctors conceal the diagnosis from him.

^ What is the syndromal diagnosis?

A. Depressive syndrome

B. Hypochondriac syndrome

C. Senesthopathic hypochondria

D. Asthenic syndrome

E. Paranoiac syndrome

36. Patient B., 35 years old, told his psychiatrist that during the opera­tion of cholecystectomy (which he had 2 months ago) the surgeon intention­ally implanted in his body an apparatus, that enables to watch the patient. He can precisely localise the apparatus in his abdomen, feels its warmth, hears signals issued from it, that transmit the patient's co-ordinates. States that he has become a participant of important scientific investigations, demands pay­ment for that. In the course of conversation sometimes stops speaking and listens attentively to something.

^ What is the syndromal diagnosis?

A. Paranoiac syndrome

B. Clerambault-Kandinsky syndrome

C. Paranoid syndrome

D. Overvalued ideas syndrome E. Obsessive ideas syndrome

37. From Salvador Daly's diary: "The grasshopper! When it's mentioned I shake with terror. I have only to begin thinking — and it is here. The heavy clumsy jumping of this green creature freezes me with horror and disgust. What a loathsome creature! All my life it persecutes me, tortures me and drives me crazy. The age-long torture of Salvador Daly is the grasshopper! I am already 37 years old, but the terror produced in me by this creature still grows. If I'll be standing on the edge of a precipice and a grasshopper hops at me — I am sure to jump down only to stop this torture."

^ What is the syndromal diagnosis?

A. Obsessive phobic syndrome

B. Overvalued ideas syndrome

C. Paranoiac syndrome

D. Paranoid syndrome

E. Clerambault-Kandinsky syndrome

38. A female patient, 42 years old, is disabled (invalid of 2-nd group) owing to her mental disorder. At the inpatient department of a psychiatric hospital spends most of her time in bed, talking to herself. The patient ex­plained, that she was hearing "voices" of a big group of people, who "at­tached" themselves to her head with the help of complicated equipment. These people's brains were joined with her brain into a kind of system, so she is able to exchange thoughts with them and follow their instructions. These phenomena change her mood, suppress her will and "turn her into a robot." The patient is sure that other people know her thoughts.

^ What is the syndromal diagnosis?

A. Cotard's syndrome

B. Verbal hallucinosis syndrome

C. Overvalued ideas syndrome

D. Clerambault-Kandinsky syndrome

E. Paraphrenic syndrome

39. A male patient 22 years old, a bank clerk, two weeks ago had flu, but didn't stay in bed and continued to work. Complains of constant pain in his throat, supposes that he "is ill with the larynx tuberculosis", that his throat "has decomposed", all his teeth have fallen out, and the brain "has dissolved." Refuses to walk, because all his organs were "pasted together." Assured eve­rybody around that he has died, remaining "a living corps." His mood is gloomy and depressed. Refuses to communicate with people, because his "mouth is full of dangerous germs."

^ What is the syndromal diagnosis?

A. Cotard's syndrome

B. Paranoiac syndrome

C. Depressive-paranoid syndrome

D. Hypochondriac syndrome

E. Paranoid syndrome

40. Patient Yu., male, 20 years old, for 1 year has systematically used synthetic opioid narcotic drugs. Decided to stop using them "with an effort of his will power." In two days he felt so bad, that had to consult a psychia­trist. On examination: the patient's skin and visible mucous membranes pale and damp. He is restless and worried, depressed and feels hopelessness. Some­times he sneezes, periodically has chills. Complains of pains in his abdomen and in the heart area, breathlessness, anorexia and sleeplessness. The pa­tient's blood pressure is 80/60 mm hg, pulse rate is 58 a minute.

^ What is the syndromal diagnosis?

A. Syndrome of physical dependence

B. Syndrome of psychological dependence

C. Syndrome of changed reactivity

D. Abstinent syndrome

E. Delirious syndrome

41. Patient P., male 48 years old, was admitted to a psychiatric hospital on the request of his wife, who told the psychiatrist that during the last year her husband behaved very strangely. Having abandoned all the other activi­ties, he was trying to invent an apparatus, which he called "Silodar" ("The Power-giver"). The patient expected this apparatus to give new powers and energy to all the mankind. During the consultation the patient showed the psychiatrist his "manuscript" — a thin copybook, covered with simple math­ematical equations and formulas, illustrated with human figures. When he noticed the psychiatrist's sceptical glance, he explained that this was a kind of "cipher", and the main variant "was stolen by American spies." The pa­tient had no hallucinations, his memory and attention were normal.

^ Name the syndromal diagnosis:

A. Overvalued ideas syndrome

B. Obsessive ideas syndrome

C. Paranoiac syndrome

D. Paranoid syndrome

E. Paraphrenic syndrome

42. Patient O., male, 52 years old is disabled (2-nd group invalid) owing to mental illness. At the psychiatric department the patient is often angry and some­times aggressive. Calls himself "The Sovereign of the World", says that he can freely move from planet to planet. Often feels the smell of gasoline and acetone and thinks that someone makes him feel these smells on purpose. When he closes his eyes he can see different animals and insects. States that his grandfather, who was a millionaire, was onboard the "Titanic", and next year the patient is going to organize an expedition to lift the treasures from the bottom of the ocean. There are a lot of neologisms in his speech, such as "temperometer" or "polyplanetary", etc.

^ Name the probable syndrome:

A. Hebephrenic syndrome

B. Paranoiac syndrome

C. Paranoid syndrome

D. Paraphrenic syndrome

E. Organic brain syndrome

43. Patient K., 22 years old, was hospitalized to a mental health hospital for the first time. In the third day after his admission, the following state de­veloped: the patient often froze in strange and inconvenient postures, his face was expressionless, his lips protruding (as if he was going to whistle); the skin on his face was greasy, and increased salivation was observed. His hands and feet were cyanotic. It was impossible to communicate with the patient, and he doesn't eat on his own. When the nurse tried to open his mouth, the chewing muscles were hypertonic. Waxy flexibility of the muscles was ob­served. Needs to be taken care of constantly.

^ Name the syndromal diagnosis:

A. Apathetic syndrome

B. Asthenic syndrome

C. Hypobulic syndrome

D. Catatonic syndrome

E. Depressive syndrome

44. Patient S., male, 52 years old, an actor by profession, during a re­hearsal suddenly began to bite others and fool about: he ran around the stage, made faces, laughed loudly, tore the decorations, recited senseless rhymes, which he made up himself, then jumped down into the orchestra pit. Didn't let anyone come near him, was aggressive and used dirty language when peo­ple tried to stop or catch him. Before anyone could stop him, the patient sud­denly ran out into the street shouting, "Art for the masses!"

^ Name the probable syndrome:

A. Maniacal excitation

B. Catatonic excitation

C. Hysterical excitation

D. Agitated depression

E. Hebephrenic excitation

45. Patient A., female, 22 years old was admitted to the inpatient depart­ment of a psychiatric hospital in the state of psychomotor excitation. Jumps up from her bed, shouts, spits, and tries to attack other patients. When in bed, constantly roles about, takes off her clothes, and tears the bedclothes. Doesn't answer any questions, but sometimes pronounces senseless mono­logues, like the following one, "Take away the aminazine... you can smoke in bed when you are hungry ... you are crooked and I am square... it is dirty here, and I'm like a fly" and so on. It's almost impossible to draw the pa­tient's attention.

^ What is the probable syndromal diagnosis?

A. Hebephrenic syndrome

B. Hyperbulic syndrome

C. Catatonic syndrome

D. Syndrome of agitated depression E.. Maniac syndrome

46. Patient K., male 39 years old was brought to the psychiatric hospital by an ambulance. Two days ago became anxious and restless. It seamed to him that his room was full of people, different voices shouted from outside through the wall that they were going to kill him, threatened him, suggested to go and have a drink. At night he couldn't sleep, saw mice with their tails cut off, then a goblin appeared and ordered the patient to gather gold from the floor. He saw all these creatures and objects as if they were real, picked

up golden coins and felt them in his hands. At the inpatient department the patient is excited, his state worsens in the evening and at night. The contact with him is formal. Knows his name and age, but doesn't understand where he is.

^ Name the probable syndromal diagnosis:

A. Delirious syndrome

B. Oneiroid syndrome

C. Syndrome of twilight state of consciousness

D. Somnolent syndrome

E. Amentive syndrome

47. Patient 0.,72 years old, a cobbler, has no complaints. The patient is polite in communication with others. Greets the doctor several times a day, whenever he meets him. Can't name the date, month or year. Says, "I've come here today and drove my car, it is parked outside in the yard", (really the patient has spent a month at the psychiatric hospital). In a few minutes after the interview with his psychiatrist, completely forgot the content of their con­versation, and told his son: "the doctor showed me the photo of his wife and gave me some wine." The patient remembers well most of the events that oc­curred when he was young, can tell the dates if important historical events, but forgets recent events. The professional skills are intact.

^ Name the syndromal diagnosis:

A. Asthenic syndrome

B. Total dementia syndrome

C. Partial dementia syndrome

D. Organic brain syndrome

E. Amnestic syndrome

48. Patient V., male, 13 years old, is short, has dysplastic body frame. The occipital part of his head is flat, eye slits are narrow and slanted. Mimic movements are poor, the mouth half open. Tries to keep near the nurse. Is capable of doing simple errands (sweep and wash the floor, make beds, bring meals to other patients). Speech and language skills are underdeveloped, uses phrases consisting of 2 or 3 words, articulation is disturbed. Can't read or write. Is incapable of acquiring academic skills.

^ Name the syndromal diagnosis:

A. Mental retardation syndrome

B. Dementia syndrome

C. Amnestic syndrome

D. Organic brain syndrome

E. Apathetic syndrome

49. Patient A., male, 66 years old, is a chronic patient of a psychiatric hospital. Isn't oriented in the environment, can't find his bed and lies down on somebody else's, is untidy when he eats. His mood changes frequently, often is angry and scolds people and grumbles, and sometimes is complacent and promises to "load everyone with money." Doesn't remember his doctors name, doesn't recognize his relatives who come to see him. Sometimes becomes anxious, looks for something under his bed, ties up his things in a bundle and sits on it. Explains these actions, telling that "there are thieves and robbers" around him. Directly after having had lunch says, that he didn't eat anything for three days and is starving, asked for a piece of bread. Name the syndromal diagnosis:

A. Mental retardation syndrome

B. Amnestic syndrome

C. Organic brain syndrome

D. Dementia syndrome

E. Paranoid syndrome

50. Patient B., male, 18 years old, was sent to the psychiatric hospital for military psychiatric examination. The level of academic achievements is extremely low (doesn't know any names of countries, their capitals, is ignorant concerning the basic information about his own country). Grew up having no contacts with peers, spent almost all his childhood in an isolated house with his father, a forest guard. Attended school very irregularly, formally had six classes of education. At the psychological testing shows good abilities in the tasks on analysis and synthesis, and abstract thinking. Shows interest towards magazines and books at the department library.

^ What is the syndromal diagnosis?

A. Mental retardation syndrome

B. Dementia syndrome

C. Isolated family and insufficient schooling

D. Organic brain syndrome

E. Amnestic syndrome

51. Patient S., female, 38 years old was hospitalised to a tuberculosis hos­pital. Her somatic state was grave: she had fever, tachicardia, and breath­lessness. In bed she constantly moved, waved her arms, sometimes lay across the bed with the risk of falling down, stroke strange postures and froze in them for a short time. Didn't answer questions or react to any contact. Some­times smiled and seamed to listen to something, her speech was incoherent and senseless. On recovery the patient didn't remember anything about her experiences during the illness. She had pronounced asthenic syndrome after the described state.

^ Name the syndromal diagnosis:

A. Somnolent syndrome

B. Twilight state of consciousness

C. Delirious syndrome

D. Oneiroid syndrome

E. Amentive state of consciousness

52. Patient A., female, 30 years old, at the psychiatric inpatient department lies all the time in bed, without changing her posture. Manifests no reaction to the changes in the environment, presence of other people, and sounds. Is abso­lutely devoid of activity. Doesn't eat on her own, has to be fed from the spoon. When a doctor or some other person speaks to her, the patient doesn't answer, but seems to listen and sometimes tears appear in her eyes. Her facial expression is constantly sad. Her muscular tonus is somewhat increased.

^ Name the syndromal diagnosis:

A. Psychogenic stupor

B. Catatonic stupor

C. Asthenic stupor

D. Apathetic and abulic stupor

E. Depressive stupor

53. A patient wrote an official letter to the police bodies: "Please defend me against a group of bandits. They have secretly inserted a radio transmit­ter in my brain, and with it put bad thoughts into my head. They have cov­ered all my feelings with a glass lid. Intending to control me, the move my tongue and make me say rude and dirty words, fill my head with their con­versations. I have changed, and now feel myself like a robot." Can't be dis­suaded. Name the syndromal diagnosis:

A. Clerambault-Kandinsky syndrome

B. Paranoid syndrome

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D. Paranoiac syndrome

E. Cotard's syndrome

54. Patient P., female, 87 years old was brought to the mental health serv­ice by the police because she couldn't find her way home. Told the police officer who found her wondering in the street, that she lived with her two sis­ters, told him her address, first and family name. The police found out that the name she gave was her maiden's name, and she had really had the ad­dress she gave, but it was 40 years ago. She had her own family, a son and a daughter, but she didn't remember that they were grown-ups, and thought that they were small children. Couldn't remember what had happened to her in the morning, before she left home.

Name the syndromal diagnosis:

A. Capgra's syndrome

B. Ganzer's syndrome

C. Cotard's syndrome

D. Korsakoff's syndrome

E. Kanner's syndrome


^ CORRECT ANSWERS:

1 C;

15 D;

29 C;

43 D;

2 C;

16 A;

30 E;

44 E;

3 B;

17 D;

31B;

45 C;

4 D;

18 C;

32 C;

46 A;

5 D;

19 B;

33 A;

47 E;

6 B;

20 C;

34 B;

48A;

7 A;

21B;

35 C;

49 D;

8 C;

22 E;

36 C;

50 C;

9 E;

23 B;

37A;

51E;

10 E;

24 B;

38 D;

52 E;

11B

25 A

39 A;

53 A

12 D

26 E

40 D;

54 D

13 B

27 B

41C;




14 C

28 D

42 D;




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