IGNOU PB Bsc Nsg Entrance-2017
Mental Health Nursing
Medium
Delusion is not present in?
Appeared in: IGNOU PB Bsc Nsg Entrance-2017
Explanation
- Compulsive disorder (OCD) is defined by obsessions (intrusive thoughts) and compulsions (repetitive actions), not delusions.
- A key feature of OCD is that the individual typically retains insight, recognizing that their obsessive thoughts are irrational and a product of their own mind (ego-dystonic).
- Delusions are fixed, false beliefs that are held with conviction despite contrary evidence, and the person lacks insight into their irrationality.
Why Other Options Were Wrong
- Option A: Delusions are a common feature of manic episodes, often presenting as grandiose delusions (e.g., believing one has exceptional abilities or wealth) or persecutory delusions.
- Option B: Delirium, an acute confusional state, frequently involves transient, fluctuating, and often persecutory delusions as a core symptom alongside disturbances in consciousness and cognition.
- Option C: Severe or psychotic depression can present with mood-congruent delusions, such as delusions of guilt, poverty, or nihilism (belief of being dead or non-existent).
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differential diagnosis of psychiatric symptoms, specifically the presence of delusions as background academic context rather than a clinical decision trigger.
- Accurately differentiating between an obsession and a delusion is critical for correct diagnosis and treatment planning. Misdiagnosing OCD as a psychotic disorder can lead to inappropriate antipsychotic medication and delayed effective therapy (like SSRIs and CBT).
- A nurse's assessment should probe the patient's level of insight. Asking "What do you make of these thoughts?" or "Do you think these thoughts are unusual?" can help distinguish an ego-dystonic obsession from an ego-syntonic delusion.
- What if? If a patient with OCD has very poor insight and is almost convinced their obsession is real (obsessional delusion), the condition is specified as 'OCD with absent insight/delusional beliefs.' This is still classified under OCD, but it acknowledges the severity and may require a more intensive treatment approach, sometimes including antipsychotics alongside SSRIs.
How to Approach the Question
- First, identify the core concept: 'delusion'. A delusion is a fixed, false belief held despite evidence to the contrary.
- The question asks where this symptom is 'not' present. This is a negative-framing question, requiring you to eliminate the options where delusions are a known feature.
- Evaluate each option: Recall the key symptoms of Mania. You'll find grandiose or persecutory delusions are common.
- Next, recall the symptoms of Delirium. You'll find fluctuating, persecutory delusions are a hallmark.
- Then, recall the symptoms of severe Depression. You'll find mood-congruent delusions can occur.
- Finally, evaluate Compulsive Disorder (OCD). Its core features are obsessions and compulsions, with the patient usually having insight that the thoughts are irrational. This makes it the correct answer as delusions are not a defining feature.
Concept Tested & Keywords
- Concept Tested: Differential diagnosis of psychiatric symptoms, specifically the presence of delusions.
- Stem keywords: Delusion, present
- Lead-in keywords: not
- Negative lead-in flag: Question asks where a symptom is NOT present.
Question ID
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Reference Book
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 5269-5271, 13421-13423
Practise the full IGNOU PB Bsc Nsg Entrance-2017
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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