A 60-year-old man whose wife passed away 3 months back now believes his intestines have rotten away and that he is responsible for the death of his wife and should be sent to prison. Likely diagnosis is
**Core Concept**
The patient is experiencing delusions of parasitic infestation, a type of delusional disorder, and also exhibits feelings of guilt and responsibility for his wife's death, which is a characteristic of major depressive disorder with psychotic features.
**Why the Correct Answer is Right**
Delusional disorder, specifically the somatic type, involves fixed, false beliefs about one's own body or health, often involving infestation or disease. In this case, the patient's belief that his intestines have rotten away is a delusion of parasitic infestation. The patient's feelings of guilt and responsibility for his wife's death are typical of major depressive disorder with psychotic features, which often involves delusions of guilt or worthlessness. These symptoms are a result of the patient's grief and depression following the loss of his wife.
**Why Each Wrong Option is Incorrect**
**Option A:** This option is incorrect because it does not accurately describe the patient's symptoms. While the patient is experiencing delusional thoughts, they are focused on his own body and health, rather than being grandiose or exhibiting a sense of superiority.
**Option B:** This option is incorrect because it does not account for the patient's feelings of guilt and responsibility for his wife's death. While the patient is experiencing delusional thoughts, they are not solely related to his own health or appearance.
**Option C:** This option is incorrect because it does not accurately describe the patient's symptoms. While the patient is experiencing delusional thoughts, they are not related to a perceived defect in his appearance or a fear of being observed by others.
**Option D:** This option is incorrect because it does not account for the patient's feelings of guilt and responsibility for his wife's death. While the patient is experiencing delusional thoughts, they are not solely related to his own actions or behavior.
**Clinical Pearl / High-Yield Fact**
Delusional disorder is a type of psychotic disorder characterized by the presence of one or more delusions for at least one month. Delusions can be somatic (involving one's own body or health), persecutory (involving a perceived threat from others), grandiose (involving a sense of superiority), or jealous (involving a perceived threat from a romantic partner).
**Correct Answer: C. Delusional disorder, somatic type.**