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corepsychiatry

lady building fire in the back garden...how to approach this station

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Please help us out with this station

lady building fire in the back garden.Assess her delusional beliefs...content.Find out if they are primary or secondary?do a risk assessement

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the lady will have delusion of poverty and no other symptom as such....royal college used to give a station with similar history but with nihilistic delusion in the past but this september it was about delusion of poverty.

history is - she is building fire outside the garden....as you ask her as to why she is doing it....she will say that she does not have money for funeral and hence she is building fire....you need to explore more about her belief of having no money and at the same time clarifying about any nihilistic delusion which she denies....when you ask if she thinks she is already dead, she denies this.

as for delusion of poverty.....you need to ask when did she first realise that she does not have any money.....to identify if it is primary or secondary....ask if she suddenly realised that she does not have any money or if something happened which made her to realise that.....she will say that nothing happened but she knows she is poor.....then you need to test the fixity and the truth of her belief....

for this you need to ask her a bit about her social situation, who does she live with (alone - so you are assessing risk as well), how long has she lived alone, does she work (no) , how much money she has in her bank (she says she has about 30000 or 40000 pounds in her bank) - this info will confirm that she is not poor and her belief is not real.....then test fixity of belief......ask her why she thinks she is poor in spite of having so much money in her bank, how sure she is that she is poor...could it be that she is unwell and she is thinking like this - she denies this.

then you need to assess risk - to her - risk of harm to self - selfharm/suicide thoughts, risk of fire, risk of self neglect, check her mood if depressed.

in the end summarise her belief.....that she thinks she is poor, which started suddenly a few weeks ago and inspite of having money in bank she thinks she is poor.

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That is interesting twist from College- nihilistic delusion to delusion of poverty!!!

Message to candidates- please go with an open mind and do the task following basics of eliciting psychopathology.

Thanks for sharing Umesh.

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That is interesting twist from College- nihilistic delusion to delusion of poverty!!!

Message to candidates- please go with an open mind and do the task following basics of eliciting psychopathology.

Thanks for sharing Umesh.

absolutely

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