**Question:** All are seen in hysterical somatisation except -

A. Anxiety
B. Depression
C. Delirium
D. Acute myocardial infarction

**Core Concept:**
Hysterical somatisation is a psychiatric disorder characterized by the conversion of psychological conflicts into physical symptoms without any organic basis. In other words, the patient presents with non-existent or exaggerated organic symptoms due to psychological causes. The term "hysteria" has been replaced by the more appropriate term "conversion disorder" in the DSM-5.

**Why the Correct Answer is Right:**

Correct Answer: C. Delirium

Delirium is a temporary disturbance in consciousness and cognition that can be caused by various factors, such as medication side effects, infections, and neurological conditions. Unlike hysterical somatisation, delirium is an acute, fluctuating condition involving impaired attention, disorientation, and altered level of consciousness. It is a medical emergency and requires immediate medical attention, whereas hysterical somatisation is a psychological condition.

**Why Each Wrong Option is Incorrect:**

A. Anxiety: Anxiety is a common psychological condition that can manifest as various somatic symptoms in patients with hysterical somatisation. It is not a specific exclusion criterion for the disorder.

B. Depression: Depression is a mood disorder that can present with somatic symptoms like fatigue, anorexia, and sleep disturbances. However, depression is a distinct psychiatric disorder with clear diagnostic criteria and is not a specific exclusion criterion for hysterical somatisation.

D. Acute myocardial infarction: This is an acute cardiac emergency characterized by chest pain, ST-segment changes on electrocardiography, and elevated cardiac biomarkers. It is a life-threatening medical condition requiring urgent medical attention and cannot be confused with hysterical somatisation.

**Clinical Pearl:**

Hysterical somatisation and conversion disorder are often confused with organic somatic disorders. It is essential for clinicians to consider these psychological conditions when evaluating patients presenting with somatic symptoms that do not have a clear organic basis. A thorough psychiatric evaluation, including a history of onset, progression, and response to treatment, can help differentiate between organic and psychogenic somatic symptoms. In addition, a comprehensive physical examination, including neurological and psychiatric assessments, is crucial for accurate diagnosis and management of these patients.