In which socioeconomic strata is schizophrenia most commonly observed?
What is the most likely neurochemical change associated with schizophrenia?
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?
Cyclothymia is classified as which type of mood disorder?
All are required to diagnose major depression except?
What does the term 'Folie-à-deux' refer to?
NEET-PG 2013 - Psychiatry NEET-PG Practice Questions and MCQs
Question 51: 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 52: What is the most likely neurochemical change associated with schizophrenia?
- A. Increased GABA activity
- B. Increased dopaminergic activity (Correct Answer)
- C. Decreased dopaminergic activity
- D. Decreased norepinephrine activity
Explanation: ***Increased dopaminergic activity*** - The **dopamine hypothesis** of schizophrenia posits that the positive symptoms (hallucinations, delusions) are mainly due to **hyperactivity of dopamine D2 receptors** in the mesolimbic pathway. - Most **antipsychotic medications** work by blocking these D2 receptors, reducing dopaminergic transmission and alleviating symptoms. *Increased GABA activity* - **GABA (gamma-aminobutyric acid)** is the primary inhibitory neurotransmitter in the brain; *decreased* GABAergic activity has been implicated in schizophrenia, not increased. - A reduction in GABAergic interneurons can lead to **disinhibition** and contribute to cognitive deficits and positive symptoms. *Decreased dopaminergic activity* - While *decreased* dopamine activity in the **mesocortical pathway** (leading to the prefrontal cortex) is associated with the negative symptoms (e.g., avolition, anhedonia) and cognitive deficits of schizophrenia, the *primary* neurochemical change linked to the characteristic psychotic symptoms is an *increase* in mesolimbic dopamine. - Therefore, considering the overall presentation, **increased dopamine** is the most likely and direct answer. *Decreased norepinephrine activity* - Although **norepinephrine dysregulation** has been observed in schizophrenia, it is not considered the primary neurochemical change. - Changes in norepinephrine are often secondary or contribute to specific symptom clusters like **attention deficits** or mood disturbances rather than the core psychotic features.
Question 53: 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 54: 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 55: 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 56: 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 57: 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.
Question 58: Cyclothymia is classified as which type of mood disorder?
- A. Major depression
- B. Dysthymia
- C. Persistent mood disorder
- D. Bipolar mood disorder (Correct Answer)
Explanation: ***Bipolar mood disorder*** - **Cyclothymia (Cyclothymic Disorder)** is classified under **Bipolar and Related Disorders** in both DSM-5 and ICD-11, making it part of the bipolar spectrum. - It is characterized by **chronic, fluctuating mood disturbances** lasting at least 2 years (1 year in children/adolescents) with numerous periods of hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes. - The alternating, less severe mood swings share the fundamental **bipolar pattern** of mood elevation and depression, hence its classification under bipolar mood disorders. *Major depression* - **Major depressive disorder** is a unipolar mood disorder involving persistent feelings of sadness, loss of interest, and other depressive symptoms that significantly impair daily functioning, **without any episodes of mania or hypomania**. - Cyclothymia involves **mood instability with both elevated and depressed periods**, which distinguishes it from unipolar major depression. *Dysthymia* - **Dysthymia** (now termed **Persistent Depressive Disorder** in DSM-5) is characterized by chronic, low-grade depressive symptoms lasting at least 2 years, **without manic or hypomanic episodes**. - While both involve sub-threshold symptoms, cyclothymia includes periods of **hypomanic symptoms** (elevated mood, increased energy), which are absent in dysthymia. *Persistent mood disorder* - This is a broad, non-specific descriptive term rather than a formal diagnostic category in DSM-5 or ICD-11. - While cyclothymia is indeed a persistent condition, it is **specifically categorized under Bipolar and Related Disorders** due to the presence of both elevated (hypomanic) and depressed mood states.
Question 59: All are required to diagnose major depression except?
- A. Depressed mood
- B. Decreased concentration
- C. Nihilistic ideas (Correct Answer)
- D. Insomnia
Explanation: ***Nihilistic ideas*** - While nihilistic ideas (e.g., belief that life is meaningless or that nothing matters) can occur in severe depression, they are **not a mandatory diagnostic criterion** for major depressive disorder (MDD). - The diagnosis of MDD requires a specific number of core symptoms, and nihilistic ideation is not listed as one of them in diagnostic manuals like the DSM-5. *Depressed mood* - A **depressed mood** for most of the day, nearly every day, is one of the two **cardinal symptoms** required for a diagnosis of major depressive disorder. - The other cardinal symptom is anhedonia (loss of interest or pleasure). *Insomnia* - **Insomnia** (difficulty falling or staying asleep) or hypersomnia (sleeping excessively) is a common neurovegetative symptom of major depressive disorder and is one of the **nine diagnostic criteria**. - At least 5 of these 9 criteria must be present for a diagnosis, including at least one of the two cardinal symptoms. *Decreased concentration* - **Diminished ability to think or concentrate**, or indecisiveness, is another of the **nine diagnostic criteria** for major depressive disorder. - This cognitive symptom highlights the impact of depression on mental function beyond mood.
Question 60: What does the term 'Folie-à-deux' refer to?
- A. Delusion of persecution
- B. Sharing of delusion (Correct Answer)
- C. Delusion of double
- D. None of the options
Explanation: ***Sharing of delusion*** - **Folie-à-deux**, also known as **shared psychotic disorder**, describes a rare psychiatric syndrome in which a **delusional belief** is transmitted from one individual to another. - It typically occurs between two people in a close relationship, where one individual (the primary case) develops a delusion and the other person (the secondary case) subsequently adopts the same delusion. *Delusion of persecution* - A **delusion of persecution** is a specific type of delusion where an individual believes they are being harmed, harassed, or conspired against by others. - While it can be the content of a shared delusion in folie-à-deux, the term itself refers to the *type* of delusion, not the *sharing* mechanism. *Delusion of double* - "Delusion of double" is not a standard term for folie-à-deux. - This phrase might be confused with **delusional misidentification syndromes** (like Capgras syndrome where a person believes someone has been replaced by an identical impostor), but this is a different concept from shared psychotic disorder. *None of the options* - This option is incorrect because "sharing of delusion" accurately defines folie-à-deux.