Question

A 45-year-old woman presents with a long-standing history of “feeling tensed” along with an upset stomach, diarrhea, and heartburn. She mentions that her family members also experience similar symptoms. Which of the following symptoms is most likely to be observed in this patient?

• A. Neologisms
• B. Tingling at extremities
• C. Hallucinations
• D. Idea of reference

Hint:

In somatic symptom disorders or anxiety, look for physical manifestations like tingling or other somatic complaints without a clear medical cause.

Answer 1

The Correct Option is B

Step 1: Identify the underlying disorder.
A long history of feeling tense with gut complaints (upset stomach, diarrhoea, heartburn) and a familial pattern fits a chronic anxiety disorder rather than a psychotic illness. The clue to the expected sign is the physiology that anxiety triggers.

Step 2: Trace the physiological chain.
Anxious patients tend to hyperventilate. Excessive breathing blows off $CO_2$, lowering arterial $PaCO_2$ and producing respiratory alkalosis (a rise in blood pH). Alkalosis increases binding of calcium to albumin, dropping the ionised calcium and raising neuromuscular excitability.

Step 3: Predict the clinical sign.
This functional hypocalcaemia/alkalosis classically causes paraesthesias - tingling and numbness of the fingertips, toes, and around the mouth (perioral), sometimes with carpopedal spasm. So the symptom expected here is tingling at the extremities.

Step 4: Discard the psychotic options.
Neologisms (invented words), hallucinations, and ideas of reference are features of psychotic spectrum disorders such as schizophrenia, not of an anxiety disorder with somatic and hyperventilation symptoms. They do not fit this clinical picture.

Conclusion: Anxiety-driven hyperventilation, respiratory alkalosis, and a fall in ionised calcium explain the tingling.

Final Answer: Option 2 - Tingling at extremities.