Who coined the term 'psychiatry'?
Which of the following is considered a poor prognostic factor for schizophrenia?
Which of the following is considered a poor prognostic factor for schizophrenia?
In which socioeconomic strata is schizophrenia most commonly observed?
Which of the following is not considered a core diagnostic criterion for schizophrenia according to DSM-5?
In stupor catatonia, all are seen except -
Which of the following statements is NOT true about type 1 schizophrenia?
Ganser syndrome is classified under which of the following disorders?
Which neurotransmitter is believed to be increased in mania?
What is the core feature required for diagnosing a manic episode?
NEET-PG 2013 - Psychiatry NEET-PG Practice Questions and MCQs
Question 21: Who coined the term 'psychiatry'?
- A. Moral
- B. Bleuler
- C. Pinel
- D. Johann Reil (Correct Answer)
Explanation: ***Johann Reil*** - The term "**psychiatry**" (Psychiatrie) was coined by the German physician **Johann Christian Reil** in **1808**. - Reil introduced the term in his work to advocate for a more **humane and medical approach** to mental illness, moving away from purely custodial care. *Moral* - While Reil's efforts were part of a broader movement towards **moral treatment** of the mentally ill, "moral" itself is not the specific context in which the term was coined. - **Moral treatment** emphasized humane care, occupational therapy, and a therapeutic environment, contributing to the development of psychiatry but not coining the word. *Bleuler* - **Eugen Bleuler** is known for coining the term "**schizophrenia**" in the early 20th century. - He significantly contributed to the understanding of psychotic disorders but did not coin the broader term "psychiatry." *Pinel* - **Philippe Pinel** was a French physician who was an instrumental figure in the **humanitarian reform** of mental asylum care in the late 18th century. - He is famous for **unshackling patients** at Bicêtre and Salpêtrière asylums, but he did not coin the term "psychiatry."
Question 22: Which of the following is considered a poor prognostic factor for schizophrenia?
- A. Poor premorbid adjustment (Correct Answer)
- B. Male sex
- C. Presence of depression
- D. Blunted affect
Explanation: **Poor premorbid adjustment** - **Poor premorbid adjustment**, indicated by difficulties in social, academic, or occupational functioning before the onset of psychosis, is a consistent predictor of a worse outcome in schizophrenia. - This suggests a more pervasive and entrenched neurodevelopmental vulnerability impacting the individual's ability to cope and integrate socially. *Blunted affect (negative symptom)* - While **blunted affect** is a negative symptom often associated with poorer outcomes than positive symptoms, it is typically considered a *symptom* of the illness rather than a primary prognostic *factor* like premorbid adjustment. - Its presence contributes to disability, but it is not as strong an independent prognostic indicator as the life trajectory prior to illness onset. *Male sex (generally poorer prognosis)* - **Male sex** is generally associated with an **earlier age of onset** and often a **more severe course** of schizophrenia. - However, compared to significant functional impairment before disease onset, it is not as strong an individual predictor of overall long-term prognosis. *Presence of depression (often associated with better outcomes)* - The **presence of depressive symptoms** in schizophrenia is often associated with a **better prognosis**. - This is because depressive features can sometimes indicate a more preserved capacity for emotional experience and insight, which can align with higher functioning.
Question 23: Which of the following is considered a poor prognostic factor for schizophrenia?
- A. Presence of depression
- B. Presence of stressor
- C. Early onset (Correct Answer)
- D. Female sex
Explanation: ***Early onset*** - An **earlier age of onset** (e.g., childhood or early adolescence) for schizophrenia is consistently associated with a **worse long-term prognosis**, including more severe symptoms, greater functional impairment, and a lower likelihood of full recovery. - This is thought to be due to the greater developmental disruption caused by the illness when it begins at a younger age. *Presence of depression* - While depression is common in schizophrenia, it is generally considered to be a **treatable co-occurring condition** rather than a primary poor prognostic factor for the core psychotic disorder itself. - Effective treatment for depression can actually **improve overall quality of life** and adherence to antipsychotic medication. *Presence of stressor* - The presence of a significant psychosocial stressor at the onset of schizophrenia is often associated with a **better prognosis**, as it suggests a more reactive and potentially remitting course. - This indicates that the illness might be more environmentally triggered and less intrinsically severe. *Female sex* - **Female sex** is typically associated with a **somewhat better prognosis** in schizophrenia, with a later age of onset and potentially less severe symptoms compared to males. - This may be influenced by hormonal factors and differences in social support networks.
Question 24: In which socioeconomic strata is schizophrenia most commonly observed?
- A. Middle
- B. Upper
- C. Low (Correct Answer)
- D. Upper middle
Explanation: ***Low*** - Epidemiological studies consistently show a **higher prevalence of schizophrenia** in individuals from **lower socioeconomic strata**. - This association is explained by the "**social drift**" hypothesis, where individuals with schizophrenia experience a decline in social class due to the chronic and disabling nature of the illness, or the "**social causation**" hypothesis, which posits that adverse social conditions contribute to the development of the disorder. *Middle* - While individuals from all socioeconomic backgrounds can develop schizophrenia, it is **less common** compared to the lowest strata. - The middle socioeconomic group generally experiences **better access to resources** and support systems, which may mitigate some risk factors. *Upper* - Schizophrenia is **least common** in the upper socioeconomic strata. - Individuals in this group typically have **greater financial stability**, better living conditions, and access to high-quality healthcare, which might protect against environmental stressors. *Upper middle* - Similar to the middle and upper strata, the upper-middle class experiences a **lower prevalence of schizophrenia** compared to the low socioeconomic group. - This group often benefits from **good educational opportunities** and stable employment, reducing some of the psychosocial stressors associated with the disorder.
Question 25: Which of the following is not considered a core diagnostic criterion for schizophrenia according to DSM-5?
- A. Catatonia
- B. Hallucinations
- C. Disorganized speech
- D. Social withdrawal (Correct Answer)
Explanation: ***Social withdrawal*** - While **social withdrawal** is a common clinical feature and often reflects negative symptoms in schizophrenia, it is **not specifically listed** as one of the **five core diagnostic criteria (Criterion A)** in DSM-5. - The five core symptom domains are: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (diminished emotional expression or avolition). - Social withdrawal may be a manifestation of negative symptoms or part of **social/occupational dysfunction (Criterion B)**, but it is not itself a distinct core diagnostic criterion. *Catatonia* - **Catatonic behavior** (such as stupor, catalepsy, waxy flexibility, posturing, or mutism) is explicitly included as part of the **fourth core diagnostic criterion**: "Grossly disorganized or catatonic behavior." - This makes it one of the five primary symptom domains in **Criterion A** of DSM-5. - Note: "Catatonia" as a **specifier** (requiring 3+ out of 12 symptoms) is different from catatonic behavior as a core symptom. *Hallucinations* - **Hallucinations** (most commonly auditory, but can be visual, tactile, olfactory, or gustatory) are the **second core diagnostic criterion** in DSM-5. - At least **two of the five core symptoms** must be present, and hallucinations fulfill this requirement as a key **positive symptom**. *Disorganized speech* - **Disorganized speech** (formal thought disorder) is the **third core diagnostic criterion** for schizophrenia. - Characterized by **derailment, tangentiality, incoherence, or loose associations**, it reflects significant disruption in organized thinking and communication.
Question 26: In stupor catatonia, all are seen except -
- A. Mutism
- B. Akinesia
- C. Catalepsy
- D. Agitation (Correct Answer)
Explanation: ***Agitation*** - **Stuporous catatonia** is characterized by a significant reduction or absence of motor activity and responsiveness, making **agitation**—increased motor activity—an unlikely feature. - In such a state, the patient is typically rigid, immobile, and unresponsive to external stimuli, which is the antithesis of agitation. *Catalepsy* - **Catalepsy** refers to a trance-like state with a loss of voluntary motion and active posturing, where the limbs maintain any position in which they are placed (waxy flexibility). - This is a hallmark feature of **catatonic stupor**, indicating a profound disturbance in motor control. *Mutism* - **Mutism** is the absence or profound reduction of speech, which is a common and defining feature of **catatonic stupor**. - Patients in a stuporous state typically do not speak or respond verbally to questions or commands. *Akinesia* - **Akinesia** is the absence of movement, or pronounced difficulty in initiating voluntary movements, which is a key component of **catatonic stupor**. - Patients exhibit severe motor retardation, often appearing frozen or rigid.
Question 27: Which of the following statements is NOT true about type 1 schizophrenia?
- A. It has a poor prognosis. (Correct Answer)
- B. Intellect is usually maintained.
- C. It is an acute illness.
- D. It is characterized by negative symptoms.
Explanation: ***It has a poor prognosis.*** - This statement is **NOT true** about type 1 schizophrenia, making it the correct answer to this question. - Type 1 schizophrenia is generally associated with a **better prognosis** and good response to antipsychotic medication. - It is characterized by the prominence of **positive symptoms**, which tend to be more responsive to treatment. *It is an acute illness.* - This statement is **TRUE** about type 1 schizophrenia, so it is not the answer. - Type 1 schizophrenia is often characterized by an **acute onset** of symptoms, particularly positive symptoms. - This acute presentation differentiates it from type 2, which typically has a more insidious onset. *Intellect is usually maintained.* - This statement is **TRUE** about type 1 schizophrenia, so it is not the answer. - In type 1 schizophrenia, **cognitive function**, including intellect, is usually better preserved compared to type 2 schizophrenia. - While some cognitive deficits may occur, they are generally less severe and less pervasive than in type 2. *It is characterized by negative symptoms.* - This statement is **FALSE** about type 1 schizophrenia, but it is not the best answer because the prognosis statement is more definitively incorrect. - Type 1 schizophrenia is primarily characterized by the predominance of **positive symptoms**, such as hallucinations, delusions, and disorganized thought. - **Negative symptoms** (e.g., apathy, anhedonia, alogia, blunted affect) are the hallmark of type 2 schizophrenia.
Question 28: Ganser syndrome is classified under which of the following disorders?
- A. OCD
- B. Conversion disorder
- C. Dissociative disorder (Correct Answer)
- D. Schizoid personality disorder
Explanation: ***Dissociative disorder*** - Ganser syndrome is characterized by a "passing-off" behavior, where the individual gives **approximate or nonsensical answers** to simple questions, often associated with other dissociative symptoms. - While historically difficult to classify, contemporary understanding places it within the spectrum of dissociative disorders due to its features of an altered state of consciousness and a detachment from reality. *OCD* - **Obsessive-compulsive disorder (OCD)** involves recurrent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). - Ganser syndrome does not typically present with the classic symptom profile of obsessions and compulsions. *Conversion disorder* - **Conversion disorder** involves neurological symptoms (e.g., paralysis, blindness, seizures) that are not consistent with neurological disease and are often preceded by psychological stress. - While both involve psychological factors, Ganser syndrome is distinct in its presentation of "answers" that are close but incorrect, rather than physical symptoms. *Schizoid personality disorder* - **Schizoid personality disorder** is characterized by a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. - This disorder primarily affects social functioning and emotional expression, which is different from the specific cognitive and behavioral pattern seen in Ganser syndrome.
Question 29: Which neurotransmitter is believed to be increased in mania?
- A. Decreased dopamine
- B. Increased dopamine (Correct Answer)
- C. Increased norepinephrine
- D. Decreased norepinephrine
Explanation: ***Increased dopamine*** - **Dopamine** is the primary neurotransmitter implicated in the pathophysiology of mania according to the **dopaminergic hypothesis** of mood disorders. - Increased dopaminergic activity in the **mesolimbic and mesocortical pathways** contributes to the core symptoms of mania including **euphoria**, **increased goal-directed activity**, **reduced need for sleep**, **psychosis**, and **impulsivity**. - Evidence includes: response to dopamine antagonists (antipsychotics) in treating mania, and dopamine agonists can precipitate manic episodes. - Studies using neuroimaging and CSF analysis support elevated dopamine activity during manic episodes. *Increased norepinephrine* - While norepinephrine is also increased in mania and contributes to **arousal**, **attention**, and **energy levels**, it is considered a secondary or contributory mechanism rather than the primary pathophysiological change. - The **catecholamine hypothesis** suggests both dopamine and norepinephrine are elevated, but dopamine plays the more central role in the characteristic manic symptoms. *Decreased dopamine* - Decreased dopamine is associated with **depression**, **Parkinson's disease**, and **negative symptoms of schizophrenia**, not mania. - Low dopamine leads to reduced motivation, anhedonia, psychomotor retardation, and lack of energy—the opposite of manic presentation. *Decreased norepinephrine* - Decreased norepinephrine is linked to **depressive states**, characterized by low energy, poor concentration, and reduced arousal. - This is directly contrary to the hyperarousal, excessive energy, and heightened activity seen in mania.
Question 30: What is the core feature required for diagnosing a manic episode?
- A. Decreased appetite
- B. Increased sleep
- C. Grandiosity
- D. Elevated mood (Correct Answer)
Explanation: ***Elevated mood*** - The **DSM-5 criteria** for a manic episode explicitly state that an abnormally and persistently **elevated, expansive, or irritable mood** must be present for at least one week. - This core mood disturbance is what differentiates mania from other psychiatric conditions and is a prerequisite for diagnosis. *Grandiosity* - While **grandiosity** (inflated self-esteem or sense of importance) is a common associated symptom of a manic episode, it is not the sole diagnostic requirement. - It is one of several symptom criteria that must be present in addition to the mood disturbance for a diagnosis of mania. *Decreased appetite* - **Decreased appetite** is generally not a feature of a manic episode; in fact, individuals in a manic state often have an **increased appetite** or engage in impulsive eating due to lack of inhibition. - A decreased appetite is more commonly associated with depressive episodes. *Increased sleep* - **Increased sleep** is contrary to the typical presentation of a manic episode, where individuals often experience a **decreased need for sleep** and can function on very little sleep, feeling energized. - A significant reduction in the need for sleep is a characteristic symptom of mania, not an increase.