Cognitive theories of delusion formation US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Cognitive theories of delusion formation. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Cognitive theories of delusion formation US Medical PG Question 1: A 29-year-old woman is brought to the physician by her father because of a change in her behavior over the past 8 months. The father says that his daughter has become increasingly withdrawn; she has not answered any phone calls or visited her family and friends. The patient says that she has to stay at home because a foreign intelligence service is monitoring her. She thinks that they are using a magnetic field to read her mind. Mental status exam shows disjointed and perseverative thinking. She is anxious and has a flat affect. Which of the following is the most likely diagnosis?
- A. Delusional disorder
- B. Schizophrenia (Correct Answer)
- C. Paranoid personality disorder
- D. Schizophreniform disorder
- E. Schizoid personality disorder
Cognitive theories of delusion formation Explanation: ***Schizophrenia***
- The patient's presentation with **delusions of persecution and thought broadcasting**, accompanied by **disjointed, perseverative thinking**, and **flat affect** for 8 months, is highly indicative of schizophrenia.
- Schizophrenia is characterized by a combination of positive symptoms (delusions, hallucinations, disorganized speech), negative symptoms (flat affect, social withdrawal), and cognitive symptoms (disorganized thinking) lasting for at least 6 months.
*Delusional disorder*
- Delusional disorder is characterized by the presence of **non-bizarre delusions for at least 1 month** without other significant psychotic symptoms or marked impairment in functioning.
- The patient's symptoms include **disorganized thinking and flat affect**, which are not typical of delusional disorder and suggest a broader psychotic illness.
*Paranoid personality disorder*
- Characterized by a pervasive distrust and suspicion of others, where their motives are interpreted as malevolent, but **without the presence of frank delusions or other psychotic symptoms**.
- The patient is experiencing **fixed, false beliefs (delusions)** involving mind reading and foreign intelligence, which goes beyond the pervasive distrust seen in paranoid personality disorder.
*Schizophreniform disorder*
- Schizophreniform disorder presents with symptoms identical to schizophrenia, but the **duration is between 1 and 6 months**.
- Since the patient's symptoms have been present for **8 months**, it exceeds the diagnostic criteria for schizophreniform disorder, making schizophrenia a more likely diagnosis.
*Schizoid personality disorder*
- Characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of expression of emotions in interpersonal settings.
- While the patient exhibits social withdrawal, this condition does **not involve delusions, disorganized thinking, or other psychotic features**.
Cognitive theories of delusion formation US Medical PG Question 2: A 23-year-old man is brought to the emergency department by his girlfriend because of acute agitation and bizarre behavior. The girlfriend reports that, over the past 3 months, the patient has become withdrawn and stopped pursuing hobbies that he used to enjoy. One month ago, he lost his job because he stopped going to work. During this time, he has barely left his apartment because he believes that the FBI is spying on him and controlling his mind. He used to smoke marijuana occasionally in high school but quit 5 years ago. Physical and neurologic examinations show no abnormalities. On mental status examination, he is confused and suspicious with marked psychomotor agitation. His speech is disorganized and his affect is labile. Which of the following is the most likely diagnosis?
- A. Schizophreniform disorder (Correct Answer)
- B. Schizoid personality disorder
- C. Delusional disorder
- D. Schizoaffective disorder
- E. Brief psychotic disorder
Cognitive theories of delusion formation Explanation: **Correct: Schizophreniform disorder**
- This patient presents with ***psychotic symptoms*** (delusions, disorganized speech, agitation) and ***negative symptoms*** (withdrawal, anhedonia, loss of job), which have been present for approximately ***3 months***.
- The ***duration of symptoms (1-6 months)*** is the key differentiating factor for schizophreniform disorder compared to brief psychotic disorder (<1 month) or schizophrenia (>6 months).
- Meets DSM-5 criteria: psychotic symptoms with functional impairment lasting between 1 and 6 months.
*Incorrect: Schizoid personality disorder*
- Characterized by a pervasive pattern of ***detachment from social relationships*** and a restricted range of emotional expression, which are ***ego-syntonic*** and typically stable over time.
- This is a personality disorder with chronic traits, not an acute psychotic disorder.
- Does not include acute psychotic symptoms like delusions or disorganized speech.
*Incorrect: Delusional disorder*
- Defined by the presence of ***non-bizarre delusions*** for at least one month, without other significant psychotic symptoms or major functional impairment.
- This patient has ***bizarre delusions*** (FBI controlling his mind), ***disorganized speech***, ***psychomotor agitation***, and ***marked functional impairment***, which exceed the criteria for delusional disorder.
*Incorrect: Schizoaffective disorder*
- Requires the presence of a ***major mood episode*** (depressive or manic) concurrent with symptoms of schizophrenia, AND ***delusions or hallucinations for at least 2 weeks*** in the absence of a major mood episode.
- While the patient exhibits labile affect, there is no evidence of a distinct, prolonged major mood episode (major depression or mania) as required for schizoaffective disorder.
*Incorrect: Brief psychotic disorder*
- Characterized by the sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech or behavior) that last for ***at least one day but less than one month***, followed by full return to premorbid functioning.
- The patient's symptoms have been ongoing for approximately ***3 months***, which exceeds the duration criteria for brief psychotic disorder.
Cognitive theories of delusion formation US Medical PG Question 3: A 23-year-old woman is brought to the physician by her father because of strange behavior for the past 6 months. The father reports that his daughter has increasingly isolated herself in college and received poor grades. She has told her father that aliens are trying to infiltrate her mind and that she has to continuously listen to the radio to monitor these activities. She appears anxious. Her vital signs are within normal limits. Physical examination shows no abnormalities. Neurologic examination shows no focal findings. Mental status examination shows psychomotor agitation. She says: “I can describe how the aliens chase me except for my car which is parked in the garage. You know, the sky is beautiful today. Why does my mother have a cat?” Which of the following best describes this patient's thought process?
- A. Circumstantial speech
- B. Clang associations
- C. Flight of ideas
- D. Thought-blocking
- E. Loose associations (Correct Answer)
Cognitive theories of delusion formation Explanation: ***Loose associations***
- This is characterized by a **lack of logical connection** between thoughts or ideas, leading to a disorganized and incoherent flow of speech. The patient's statements about aliens, her car, the sky, and her mother's cat are **unrelated and lack a clear thematic thread**.
- It is a key feature of **thought disorganization** and is commonly seen in psychotic disorders like **schizophrenia**.
*Circumstantial speech*
- This involves including a **multitude of unnecessary details** before finally arriving at the point or answering the question.
- While the patient's speech is disorganized, it does not demonstrate the characteristic meandering yet goal-directed nature of circumstantiality.
*Clang associations*
- This refers to the **association of words based on their sound** rather than their meaning, often involving rhyming or alliteration.
- The patient's statements do not exhibit a pattern of rhyming or sound-based word choices.
*Flight of ideas*
- This is a rapid, continuous progression from one thought to another, with thoughts often **connected by tangential associations** but still having some discernable link.
- Although the patient's thoughts shift rapidly, the connections are not simply tangential; they are largely absent, suggesting a more severe form of disorganization than flight of ideas typically entails.
*Thought-blocking*
- This is an **abrupt cessation of thought or speech** in the middle of a sentence, often followed by a new and unrelated thought.
- The patient's speech flows continuously, albeit incoherently, without sudden stops or breaks.
Cognitive theories of delusion formation US Medical PG Question 4: A 52-year-old man comes to the physician because of a 3-week history of a cough and hoarseness. He reports that the cough is worse when he lies down after lunch. His temperature is 37.5°C (99.5°F); the remainder of his vital signs are within normal limits. Because the physician has recently been seeing several patients with the common cold, the diagnosis of a viral upper respiratory tract infection readily comes to mind. The physician fails to consider the diagnosis of gastroesophageal reflux disease, which the patient is later found to have. Which of the following most accurately describes the cognitive bias that the physician had?
- A. Framing
- B. Anchoring
- C. Visceral
- D. Confirmation
- E. Availability (Correct Answer)
Cognitive theories of delusion formation Explanation: ***Availability***
- The physician recently seeing several patients with the common cold led to this diagnosis readily coming to mind, demonstrating how easily recalled examples can disproportionately influence diagnosis.
- This bias occurs when easily recalled instances or information (like recent cases of common cold) are used to estimate the likelihood or frequency of an event, even if other more relevant data exist.
*Framing*
- This bias occurs when the way information is presented (e.g., as a gain or a loss) influences a decision, rather than the intrinsic characteristics of the options themselves.
- The scenario does not involve the presentation of information in different ways to sway the physician's judgment.
*Anchoring*
- This bias involves relying too heavily on an initial piece of information (the "anchor") when making subsequent judgments, often leading to insufficient adjustment away from that anchor.
- While the physician initially considered a viral URI, the setup is more about the ease of recall influencing the decision rather than being stuck on an initial data point.
*Visceral*
- This is not a commonly recognized cognitive bias in the context of medical decision-making; "visceral" largely refers to emotional or intuitive feelings rather than a structured cognitive bias.
- Cognitive biases describe systematic patterns of deviation from norm or rationality in judgment, not merely emotional responses.
*Confirmation*
- This bias involves seeking, interpreting, favoring, and recalling information in a way that confirms one's pre-existing beliefs or hypotheses.
- The physician did not actively seek information to confirm the common cold diagnosis; rather, the diagnosis came to mind due to recent encounters, which aligns with availability bias.
Cognitive theories of delusion formation US Medical PG Question 5: A group of gastroenterologists is concerned about low colonoscopy screening rates. They decide to implement a free patient navigation program to assist local residents and encourage them to obtain colonoscopies in accordance with U.S. Preventive Services Task Force (USPSTF) guidelines. Local residents were recruited at community centers. Participants attended monthly meetings with patient navigators and were regularly reminded that their adherence to screening guidelines was being evaluated. Colonoscopy screening rates were assessed via chart review, which showed that 90% of participants adhered to screening guidelines. Data collected via chart review for local residents recruited at community centers who did not participate in the free patient navigation system found that 34% of that population adhered to USPSTF guidelines. Which of the following has most likely contributed to the observed disparity in colonoscopy screening rates?
- A. Recall bias
- B. Confirmation bias
- C. Reporting bias
- D. Hawthorne effect (Correct Answer)
- E. Sampling bias
Cognitive theories of delusion formation Explanation: ***Hawthorne effect***
- The **Hawthorne effect** is a type of reactivity in which individuals modify an aspect of their behavior in response to their awareness of being observed.
- In this study, participants were aware that their adherence to screening guidelines was being evaluated, likely leading to increased compliance simply due to this awareness rather than the efficacy of the patient navigation program alone.
*Recall bias*
- **Recall bias** occurs when participants disproportionately remember or inaccurately recall past events, often due to their current health status or beliefs.
- This bias is less likely here as colonoscopy screening rates were assessed via **chart review**, an objective measure, rather than participant self-report.
*Confirmation bias*
- **Confirmation bias** is the tendency to search for, interpret, favor, and recall information in a way that confirms one's preexisting beliefs or hypotheses.
- This bias typically affects the researchers or observers, not the participants' behavior in the observed manner, as the question focuses on the participants' increased screening rates.
*Reporting bias*
- **Reporting bias** refers to selective revealing or suppression of information during the reporting of research findings, and can occur when study participants selectively report symptoms or behaviors.
- While participants might selectively report, the data here was gathered through **chart review**, which is a more objective measure of actual behavior, making reporting bias less likely to explain the disparity in screening rates.
*Sampling bias*
- **Sampling bias** occurs when a sample is not representative of the population from which it is drawn, leading to skewed results.
- While there might be some sampling bias in who chose to participate in the free program, the observed disparity is specifically about behavior change in those *being observed*, pointing more strongly to the Hawthorne effect.
Cognitive theories of delusion formation US Medical PG Question 6: A 29-year-old woman presents to the clinic regularly with her young daughter and complains that ever since her last delivery 5 years ago, she has been having intermittent light vaginal bleeding. She has seen several doctors so far and even some ‘specialist doctors.’ Her menstrual history also appears to be variable. Physical examination is within normal limits. Her urine analysis always seems to have > 10 RBCs/hpf. Which of the following is the most likely diagnosis?
- A. Somatic symptom disorder
- B. Malingering
- C. Illness anxiety disorder
- D. Factitious disorder imposed on another
- E. Factitious disorder (Correct Answer)
Cognitive theories of delusion formation Explanation: ***Factitious disorder***
- This is characterized by the **intentional falsification of physical or psychological symptoms** with the primary motivation being to assume the sick role, without obvious external rewards. The patient in the vignette consistently presents with ambiguous symptoms (intermittent light vaginal bleeding, variable menstrual history, unexplained hematuria) that are not substantiated by objective findings, and seeks multiple consultations (doctor shopping).
- The patient's presentation with her daughter, the history of multiple doctor visits, and the lack of clear medical explanation despite persistent symptoms are all consistent with a desire to maintain the **"sick role"**, which is the defining feature of factitious disorder.
- Key features include: normal physical exam, persistent symptom reporting, healthcare utilization pattern, and absence of external incentives.
*Somatic symptom disorder*
- In **somatic symptom disorder**, patients experience genuine distress and anxiety about their symptoms and truly believe they are ill, rather than consciously fabricating or inducing symptoms.
- While these patients may also seek multiple medical opinions, they are not intentionally producing symptoms—they genuinely perceive their symptoms as real medical problems.
*Malingering*
- **Malingering** involves the intentional production of false or grossly exaggerated physical or psychological symptoms, but the motivation is explicitly for **external incentives** (e.g., avoiding work or military duty, obtaining financial compensation, evading criminal prosecution, or acquiring drugs).
- The vignette does not suggest any tangible external benefits that the patient is trying to obtain, making malingering less likely.
- Malingering is not considered a psychiatric disorder but rather a V-code/Z-code condition.
*Factitious disorder imposed on another*
- **Factitious disorder imposed on another** (formerly Munchausen syndrome by proxy) involves a caregiver (usually a parent) fabricating or inducing illness in another person (typically a child) to indirectly assume the sick role or gain attention for themselves.
- In this case, the patient is fabricating her own illness, not the illness of her daughter, so this diagnosis is incorrect.
*Illness anxiety disorder*
- In **illness anxiety disorder** (formerly hypochondriasis), patients have excessive worry about having or acquiring a serious illness, with minimal or no somatic symptoms present.
- These patients are not intentionally producing symptoms; rather, they misinterpret normal bodily sensations as signs of serious disease.
- The presence of fabricated physical findings (hematuria) and the pattern of doctor shopping without genuine anxiety about disease make this diagnosis less likely.
Cognitive theories of delusion formation US Medical PG Question 7: A 35-year-old computer programmer presents to the psychiatrist at the request of his mother for his oddities. He explains that he wears an aluminum foil cap while he works because he does not want extraterrestrial life to steal his thoughts. He spends his free time building a radio transmitter to contact distant planets. He denies any delusions or hallucinations. He claims that nothing is wrong with his eccentricities and is happy the way his life is. Which of the following personality disorders does this male most likely have?
- A. Schizotypal (Correct Answer)
- B. Schizoid
- C. Narcissistic
- D. Borderline
- E. Paranoid
Cognitive theories of delusion formation Explanation: ***Schizotypal***
- This patient exhibits **eccentric behavior**, **odd beliefs** (aliens stealing thoughts), and **magical thinking** (radio transmitter for distant planets) without reaching the level of frank delusions or hallucinations.
- The patient's lack of concern about his "eccentricities" and satisfaction with his life are consistent with the **ego-syntonic nature** often seen in personality disorders.
*Schizoid*
- Characterized by a **detachment from social relationships** and a restricted range of emotional expression, often preferring solitary activities.
- While they may display some oddities, their primary feature is a **lack of interest in social interaction**, which is not the prominent feature described here.
*Narcissistic*
- Individuals with narcissistic personality disorder display a **pervasive pattern of grandiosity**, a need for admiration, and a lack of empathy.
- Their behaviors are typically driven by a need for **external validation** and a sense of superiority, which are absent in this case.
*Borderline*
- Marked by **instability in interpersonal relationships**, self-image, affects, and impulsivity; traits like fear of abandonment, unstable identity, and self-harm are common.
- The patient's presentation does not align with the **emotional dysregulation and interpersonal chaos** characteristic of borderline personality disorder.
*Paranoid*
- Characterized by a **pervasive distrust and suspiciousness of others**, interpreting their motives as malevolent.
- While the patient has unusual beliefs, his primary concern is about alien intervention, not **suspicion of human intentions** or behaviors.
Cognitive theories of delusion formation US Medical PG Question 8: A 20-year-old male is brought to a psychiatrist by his parents for bizarre behavior. His parents report that over the past two semesters in school, his personality and behavior have changed noticeably. He refuses to leave his room because he believes people are spying on him. He hears voices that are persecutory and is convinced that people at school have chips implanted in their brains to spy on him. Screenings for depression and mania are negative. His past medical history is unremarkable. His family history is notable for a maternal uncle with bipolar disorder. He does not drink alcohol or smoke. His temperature is 98.8°F (37.1°C), blood pressure is 115/70 mmHg, pulse is 85/min, and respirations are 18/min. On examination, he appears to be responding to internal stimuli. Which of the following pathways is primarily responsible for these symptoms?
- A. Papez circuit
- B. Mesocortical pathway
- C. Nigrostriatal pathway
- D. Tuberoinfundibular pathway
- E. Mesolimbic pathway (Correct Answer)
Cognitive theories of delusion formation Explanation: ***Mesolimbic pathway***
- The **mesolimbic pathway** is primarily associated with the **positive symptoms of psychosis**, such as **hallucinations and delusions**, due to **dopamine hyperactivity**.
- The patient's **persecutory delusions, auditory hallucinations, and paranoia** are hallmark positive symptoms seen in conditions like schizophrenia, which are mediated by this pathway.
*Papez circuit*
- The **Papez circuit** is involved in **emotion and memory**, connecting structures like the hippocampus and cingulate gyrus.
- Dysregulation of this circuit would more likely manifest as deficits in memory or emotional regulation rather than the prominent psychotic features described.
*Mesocortical pathway*
- The **mesocortical pathway** projects to the **prefrontal cortex** and is implicated in **negative symptoms** (e.g., apathy, flat affect) and **cognitive deficits** (e.g., executive dysfunction) of psychosis, often due to **dopamine hypoactivity**.
- While cognitive and negative symptoms can co-occur in psychotic disorders, they are not the primary, most striking symptoms described here.
*Nigrostriatal pathway*
- The **nigrostriatal pathway** is crucial for **motor control**, connecting the substantia nigra to the striatum.
- Dysfunction in this pathway leads to **extrapyramidal symptoms** (e.g., tremors, rigidity, dyskinesia), which are not present in this patient's presentation.
*Tuberoinfundibular pathway*
- The **tuberoinfundibular pathway** connects the hypothalamus to the pituitary gland and regulates **prolactin secretion**.
- Its primary role is in neuroendocrine function, and its dysfunction would lead to **hyperprolactinemia** and related symptoms, not the psychotic features described.
Cognitive theories of delusion formation US Medical PG Question 9: Two days after undergoing hemicolectomy for colon cancer, a 78-year-old man is found agitated and confused in his room. He says that a burglar broke in. The patient points at one corner of the room and says “There he is, doctor!” Closer inspection reveals that the patient is pointing to his bathrobe, which is hanging on the wall. The patient has type 2 diabetes mellitus and arterial hypertension. Current medications include insulin and hydrochlorothiazide. His temperature is 36.9°C (98.4°F), pulse is 89/min, respirations are 15/min, and blood pressure is 145/98 mm Hg. Physical examination shows a nontender, nonerythematous midline abdominal wound. On mental status examination, the patient is agitated and oriented only to person. Which of the following best describes this patient's perception?
- A. Hallucination
- B. Illusion (Correct Answer)
- C. Loose association
- D. Delusion
- E. External attribution
Cognitive theories of delusion formation Explanation: ***Illusion***
- An **illusion** is a **misinterpretation of an actual external stimulus**, as seen when the patient perceives his bathrobe as a burglar.
- This symptom, combined with **agitation**, **confusion**, and **recent surgery**, is highly suggestive of **delirium**.
*Hallucination*
- A **hallucination** is a **perception in the absence of an external stimulus**, meaning the patient would see or hear something that is not there at all.
- The patient here is clearly reacting to an existing object (the bathrobe), albeit misinterpreting it.
*Loose association*
- **Loose association** refers to a **thought disorder** where ideas shift from one subject to another in a way that is unrelated or minimally related, making the speech difficult to follow.
- This describes a pattern of thought, not a perceptual disturbance involving an external object.
*Delusion*
- A **delusion** is a **fixed, false belief** that is not amenable to change in light of conflicting evidence and is not in keeping with the individual's cultural background.
- While the patient believes a burglar is present, this belief arises from a direct misinterpretation of an object rather than a fixed, unfounded belief.
*External attribution*
- **External attribution** is a psychological concept where individuals ascribe responsibility for events or outcomes to **external factors** rather than internal ones.
- This term describes a cognitive bias in explaining causality, not a perceptual disturbance.
Cognitive theories of delusion formation US Medical PG Question 10: A 34-year-old man presents to the behavioral health clinic for an evaluation after seeing animal-shaped clouds in the form of dogs, cats, and monkeys. The patient says that these symptoms have been present for more than 2 weeks. Past medical history is significant for simple partial seizures for which he takes valproate, but he has not had his medication adjusted in several years. His vital signs include: blood pressure of 124/76 mm Hg, heart rate of 98/min, respiratory rate of 12/min, and temperature of 37.1°C (98.8°F). On physical examination, the patient is alert and oriented to person, time, and place. Affect is not constricted or flat. Speech is of rapid rate and high volume. Pupils are equal and reactive bilaterally. The results of a urine drug screen are as follows:
Alcohol positive
Amphetamine negative
Benzodiazepine negative
Cocaine positive
GHB negative
Ketamine negative
LSD negative
Marijuana negative
Opioids negative
PCP negative
Which of the following is the most likely diagnosis in this patient?
- A. Delusion
- B. Alcohol withdrawal
- C. Visual hallucination
- D. Cocaine intoxication
- E. Illusion (Correct Answer)
Cognitive theories of delusion formation Explanation: ***Illusion***
- The patient is seeing **animal shapes in the clouds**, which is a misinterpretation of a real external stimulus. This is the definition of an **illusion**.
- Unlike hallucinations, illusions involve a distorted perception of an existing object, rather than perceiving something that is not present.
*Delusion*
- A **delusion** is a **fixed, false belief** that is not amenable to change in light of conflicting evidence, and it is not what is being described here.
- The patient is experiencing a perceptual distortion, not a false belief system.
*Alcohol withdrawal*
- While the patient tests positive for alcohol, the symptoms described are **perceptual distortions** (misinterpretation of clouds), not typical signs of alcohol withdrawal which include tremors, seizures, and delirium tremens.
- The timeline of "more than 2 weeks" also makes acute alcohol withdrawal less likely, as withdrawal symptoms typically peak within days.
*Visual hallucination*
- A **hallucination** is a perception in the absence of an external stimulus; the patient would be seeing animals when no clouds (or other visual stimuli) are present.
- The patient is seeing animal shapes *in the clouds*, indicating an existing external stimulus that is being misinterpreted.
*Cocaine intoxication*
- While cocaine intoxication can cause psychiatric symptoms like paranoia and hallucinations, the specific description of **seeing animal shapes in clouds** (misinterpretation of a real stimulus) points more directly to an illusion rather than a primary effect of cocaine use.
- The patient's presentation does not include other common symptoms of acute cocaine intoxication like severe agitation, dilated pupils, or hyperthermia beyond a rapid heart rate.
More Cognitive theories of delusion formation US Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
