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Q

I regularly present cases to my SPR, and he thought I was not correct in labelling somatic passivity as a delusion. As somatic passivity is something you feel, he explains that it is a form of a  hallucination. Can I have a clarification on this? Dr AM

A

Unlike in somatic hallucinations, in somatic passivity a feeling of a sensation is not essential for the diagnosis. Your view that it is a delusional belief is correct. It is easy to get confused with this sort of concepts and you must be careful at the exam. Somatic passivity is in fact a delusion of control, ( another first rank symptom like delusions of thought possession.) KLW

Q

If you are asked to examine the mood in front of examiners, what is the best way of doing this? Dr SW

A

There is no best way of doing this, as any good enough way is good enough. I would refer you to the web page of part I or II clinicals.

In brief this would consist of

a.  What is the predominant mood?  high or low / subjective and objective

b.  Are there any other associated moods?  anxiety, anger, suspicion etc

c.  What about the affect?

d.  Are there any associated cognitions? (including suicidal ideation/DSH)

e.  Are there any associated somatic manifestations accompanying the mood?
(even though you will not ask about this, under examination of mood when you are doing your MSE, it is better to ask about somatic manifestations, when asked to examine the mood in front of examiners.)

f.  Any psychotic symptoms (delusions/hallucinations) which may be mood congruent? e.g. grandiose/ nihilistic. KLW

Q.

If the patient tells you that there is nothing wrong with him, what can you say to the examiners about the presenting complain? Dr SW

A.

If the patient is psychotic and has no insight I would start by saying that "the patient has no insight and therefore thinks that there is nothing wrong with him".

If the patient is very well currently and had been unwell in the past I would go back to the time he was unwell and find out the presenting complain at that time. I would present it for example by saying "my patient presented five months ago with a history of  feeling low and depressed  which has increasingly got worse over the preceding eight months".

In the history of the presenting complain I would explain how those symptoms developed and the sequence of events leading to the presentation. AS