Psychotic Disorders Practice Questions

Q: A patient is getting irritated, having fluctuation of emotions. He reports of hearing voices talking about his actions. He has poor eye contact with the people and wants to stay alone. These symptoms are there for more than two months. Which of the foll owing is pointing towards the diagnosis of schizophrenia and not delusional disorder?

Second person, third person auditory hallucinations. ***Second person, third person auditory hallucinations*** - **Auditory hallucinations** are a hallmark symptom of **schizophrenia**, specifically often described as voices talking about or to the patient in the third person or commenting on their actions. - These hallucinations help differentiate schizophrenia from **delusional disorder**, which is primarily characterized by non-bizarre delusions without significant hallucinations or other prominent **negative symptoms**. *Emotional problem/depression* - While **mood symptoms** can occur in schizophrenia, they are not diagnostic of the disorder itself and are often considered a comorbid feature or part of a schizoaffective presentation. - Emotional flattening and social withdrawal are considered **negative symptoms** that support a diagnosis of schizophrenia, but depression alone is nonspecific and does not confirm psychosis. *Delusion of persecution* - This is a common type of **delusional content** seen in delusional disorder, where fixed, false beliefs are the primary feature of the illness. - In schizophrenia, delusions are often present, but they are typically accompanied by other **psychotic symptoms** like hallucinations, disorganized speech, or catatonia, which are not required for a diagnosis of delusional disorder. *Symptoms are there for more than 2 months* - The duration criterion for schizophrenia requires signs of the disturbance to persist for at least **six months**, including at least one month of symptoms that meet the full diagnostic criteria. - While the duration of greater than one month is necessary for both, the presence of symptoms for two months is insufficient on its own to confirm schizophrenia versus other psychotic disorders without assessing the **nature of the symptoms**.

Q: A patient presents with as shown in the image (rabbit -like perioral movements) on long-term treatment. It is caused by which of the following drugs?

Risperidone. ***Risperidone*** - The patient exhibits **tardive dyskinesia**, an involuntary movement disorder characterized by **orofacial dyskinesias** such as "rabbit-like" perioral movements, commonly associated with long-term **antipsychotic** usage. - While atypical antipsychotics carry a lower risk than typical ones, **Risperidone** has a higher risk for **extrapyramidal symptoms** and tardive dyskinesia compared to other second-generation antipsychotics. *Clozapine* - Known as the antipsychotic with the **lowest risk** of inducing tardive dyskinesia, making it the preferred choice for patients who develop these movements on other agents. - Its primary side effect profile is dominated by risks of **agranulocytosis** and **metabolic syndrome**, rather than movement disorders. *Ziprasidone* - Associated with a **low risk** of inducing tardive dyskinesia, similar to other newer atypical antipsychotics. - It is more clinically noted for potential **QT interval prolongation** rather than the development of persistent orofacial involuntary movements. *Fluoxetine* - This is an **SSRI** (Selective Serotonin Reuptake Inhibitor) used for depression and anxiety, not an antipsychotic medication. - While movement disorders like tremor can occasionally occur with SSRIs, classic **tardive dyskinesia** is specifically linked to the blockade of **dopamine D2 receptors** found in antipsychotic therapy.

Q: A person thinks someone wants to kill him. He cannot be convinced or explained. What is the likely phenomenon?

Delusion. ***Delusion*** - A **delusion** is a fixed, false belief that is resistant to reason or confrontation with actual fact and is not consistent with the person's cultural or educational background. - The specific type described here is a **persecutory delusion**, where the individual believes they are being conspired against or threatened with harm. *Hallucination* - **Hallucinations** are sensory perceptions that occur in the absence of an external stimulus (e.g., hearing voices or seeing things that aren't there). - Unlike delusions, which are disorders of **thought content**, hallucinations are disorders of **perception**. *Illusion* - An **illusion** is a misinterpretation of a real sensory stimulus (e.g., seeing a rope and misinterpreting it as a snake). - This differs from a delusion because it relies on an existing, tangible, external **sensory input**, whereas a delusion is an internally generated false belief. *Obsession* - An **obsession** is an intrusive, unwanted, and recurrent thought, impulse, or image that causes significant anxiety or distress. - The key difference is that the individual with an obsession typically recognizes that the thought is a product of their own mind and is **ego-dystonic**, whereas the deluded individual firmly believes their thought is ** realidade** (reality).

Q: Who coined the term "Dementia precox"?

Kraepelin. **Explanation:** The term **"Dementia Praecox"** was coined by **Emil Kraepelin** (the father of modern scientific psychiatry). He used this term to describe a specific group of mental disorders characterized by an early onset (praecox) and a progressive intellectual deterioration (dementia). Kraepelin’s major contribution was the **"Kraepelinian Dichotomy,"** where he distinguished between Dementia Praecox (now Schizophrenia) and Manic-Depressive Psychosis (now Bipolar Disorder) based on their course and prognosis. **Analysis of Incorrect Options:** * **A. Freud:** Known as the father of Psychoanalysis; he focused on the unconscious mind and psychosexual development rather than the classification of psychoses. * **B. Bleuler:** Eugen Bleuler replaced the term "Dementia Praecox" with **"Schizophrenia"** in 1911. He argued that the condition did not always lead to dementia and emphasized the "splitting" of mental functions. He is famous for the **4 As** (Association, Affect, Ambivalence, Autism). * **D. Schneider:** Kurt Schneider is known for defining the **First Rank Symptoms (FRS)** of schizophrenia, which were used for decades as the primary diagnostic criteria to differentiate schizophrenia from other psychotic disorders. **NEET-PG High-Yield Pearls:** * **Emil Kraepelin:** Coined "Dementia Praecox" and "Paranoia." * **Eugen Bleuler:** Coined "Schizophrenia," "Schizoid," and "Ambivalence." * **Bénédict Morel:** First used the French term *"démence précoce"* (which Kraepelin later Latinized). * **Kurt Schneider:** Identified First Rank Symptoms (e.g., auditory hallucinations, thought withdrawal/insertion).

Q: A 17-year-old boy is diagnosed with schizophrenia. What is the risk that one of his siblings will develop the disease?

9%. **Explanation:** The risk of developing schizophrenia is heavily influenced by genetic proximity. In the field of psychiatric genetics, the risk increases as the percentage of shared genes with an affected individual increases. **1. Why 9% is Correct:** For a sibling of an affected individual (who shares approximately 50% of their genes), the lifetime risk of developing schizophrenia is approximately **8–10%** (standardized at **9%** for examination purposes). This is nearly 10 times higher than the risk in the general population. **2. Analysis of Incorrect Options:** * **A (2%):** This is too low for a first-degree relative. However, the risk for a **second-degree relative** (uncles, aunts, nephews, nieces) is approximately **2–3%**. * **B (5%):** This is an intermediate value but does not align with established epidemiological data for siblings. It is closer to the risk for a parent (approx. 6%). * **D (20%):** This is too high for a single sibling. This value is more representative of the risk when **both parents** have schizophrenia (approx. 40%) or for a **dizygotic (fraternal) twin** of an affected individual (approx. 12–17%). **Clinical Pearls & High-Yield Facts for NEET-PG:** * **General Population Risk:** 1% (Baseline). * **Monozygotic (Identical) Twin:** ~47–50% (Highest risk; proves it is not 100% genetic). * **Dizygotic (Fraternal) Twin:** ~12–17%. * **Child of one affected parent:** ~12–13%. * **Child of two affected parents:** ~40–46%. * **Sibling of affected individual:** ~8–10% (9%). **Key Concept:** Schizophrenia is a **polygenic** disorder. The more closely related a person is to a patient, the higher the risk, with the highest concordance seen in monozygotic twins.

Q: Schneiderian first-rank symptoms are characteristic of which condition?

All of the above. ### Explanation **The Underlying Concept:** Schneiderian First-Rank Symptoms (FRS), described by Kurt Schneider in 1959, were historically considered pathognomonic for **Schizophrenia**. However, modern psychiatry recognizes that these symptoms are **not exclusive** to schizophrenia. They represent a loss of ego boundaries and can occur in various psychotic states, including organic conditions and mood disorders with psychotic features. **Why "All of the Above" is Correct:** 1. **Schizophrenia (Option A):** FRS are a hallmark of schizophrenia (found in approximately 70-80% of cases). They include phenomena like thought insertion, withdrawal, broadcast, and third-person hallucinations. 2. **Organic Delusional Disorder (Option B):** Psychotic symptoms identical to FRS can be triggered by medical conditions (e.g., temporal lobe epilepsy, neurosyphilis) or substance use (e.g., amphetamines, alcoholic hallucinosis). 3. **Schizoaffective Disorder (Option C):** Since this disorder bridges the gap between schizophrenia and mood disorders, FRS are frequently present during the psychotic episodes. **NEET-PG High-Yield Pearls:** * **The 11 FRS include:** * *Auditory Hallucinations:* Thought echo (Gedankenlautwerden), third-person voices, and running commentary. * *Thought Interference:* Insertion, withdrawal, and broadcasting. * *Delusional Perception:* A normal perception followed by a private, highly significant, and illogical delusional conclusion. * *Made Phenomena (Passivity):* Made feelings (affect), made impulses, and made acts (volition). * *Somatic Passivity:* The belief that bodily sensations are being imposed by an external agency. * **Key Distinction:** FRS are used for **diagnosis** (clinical utility) but do not correlate with the **prognosis** of the disease. * **ICD-10 vs. DSM-5:** While ICD-10 gave high priority to FRS, **DSM-5 has de-emphasized them** because they lack specificity for schizophrenia.

Q: In catatonic schizophrenia, all are seen except?

Flight of ideas. **Explanation:** The correct answer is **Flight of ideas**. **1. Why "Flight of ideas" is the correct answer:** Flight of ideas is a formal thought disorder characterized by rapid shifting from one topic to another, usually based on understandable associations or wordplay (clanging). This is a hallmark feature of **Mania** (Bipolar Disorder), not Schizophrenia. In Catatonic Schizophrenia, the primary pathology lies in **psychomotor disturbances** rather than the rapid pressure of thought seen in mood disorders. **2. Why the other options are incorrect:** Catatonia is a psychomotor syndrome that can occur in schizophrenia. The following are classic features: * **Mannerism (A):** These are habitual, exaggerated, or stilted movements that are goal-directed (e.g., a bizarre way of saluting). * **Negativism (B):** This refers to a motiveless resistance to all instructions or attempts to be moved. It can be passive (ignoring) or active (doing the opposite). * **Echolalia (C):** This is the automatic, parrot-like repetition of another person's words. Along with **Echopraxia** (mimicking movements), it forms part of the "automatic obedience" spectrum in catatonia. **3. Clinical Pearls for NEET-PG:** * **Waxy Flexibility (Cerea Flexibilitas):** A key catatonic sign where the patient maintains a posture imposed by the examiner for a long period. * **Ambitendence:** The patient makes a series of tentative, incomplete movements when asked to perform a task (e.g., reaching for a hand to shake but withdrawing). * **Treatment of Choice:** **Benzodiazepines (Lorazepam)** are the first-line treatment for catatonia. If unresponsive, **Electroconvulsive Therapy (ECT)** is the most effective definitive treatment. * **Note:** In ICD-11 and DSM-5, Catatonia is now treated as a specifier that can be associated with various mental disorders (most commonly Mood Disorders, though historically linked to Schizophrenia).

Q: All of the following are true about paranoid schizophrenia except?

Rapid deterioration of personality. **Explanation:** Paranoid Schizophrenia is characterized primarily by stable, systematized delusions and hallucinations, with a relatively preserved cognitive function and affect. **Why Option D is the Correct Answer:** Unlike other subtypes (such as Hebephrenic/Disorganized schizophrenia), Paranoid Schizophrenia is known for having a **better prognosis** and **minimal deterioration of personality**. Patients often maintain their social skills, grooming, and cognitive abilities for a longer duration. Rapid deterioration and significant emotional blunting are hallmarks of Disorganized Schizophrenia, not the paranoid type. **Analysis of Incorrect Options:** * **Option A:** It is statistically the **most common** clinical subtype of schizophrenia worldwide. * **Option B:** It typically has a **later onset** compared to other types, usually appearing in the late 20s or 30s (3rd or 4th decade). Earlier onset is more characteristic of Hebephrenic schizophrenia. * **Option C:** **Delusions of persecution** are most common, but **delusions of grandeur**, jealousy, or religiosity are also frequently present in this subtype. **Clinical Pearls for NEET-PG:** * **Best Prognosis:** Paranoid Schizophrenia (due to late onset and preserved personality). * **Worst Prognosis:** Hebephrenic (Disorganized) Schizophrenia. * **Key Feature:** Absence of prominent disorganized speech, disorganized behavior, or flat affect. * **ICD-11/DSM-5 Update:** Note that modern classification systems have moved away from these subtypes, but they remain high-yield for competitive exams based on traditional clinical descriptions.

Q: A 42-year-old female presents with a complaint of hearing instructions from other planets. Which of the following is NOT considered a first-rank symptom of schizophrenia?

Somatic passivity. **Explanation:** The concept of **First-Rank Symptoms (FRS)** was introduced by **Kurt Schneider** to differentiate schizophrenia from other psychotic disorders. These symptoms are considered highly suggestive of schizophrenia, though not pathognomonic. **Why the answer is Somatic Passivity (Note on Question Context):** In the context of standard NEET-PG patterns, there is often a misunderstanding regarding the list. However, **Somatic Passivity IS actually a First-Rank Symptom.** If the question asks which is NOT an FRS and lists these four, it is technically a "controversial" or "faulty" question because all four options provided (A, B, C, and D) are classic Schneiderian First-Rank Symptoms. * **Somatic Passivity:** The belief that external forces are influencing one’s body/sensations (e.g., "aliens are heating my internal organs"). * **Voices Commenting:** Auditory hallucinations where voices describe the patient's activities in the third person. * **Thought Broadcasting:** The belief that one's thoughts are being transmitted to others. * **Delusions of Control (Made Volition):** The belief that one's actions or movements are controlled by an external agency. **Clinical Pearls for NEET-PG:** * **Schneider’s 11 First-Rank Symptoms** include: 1. Audible thoughts (Thought echo) 2. Voices arguing 3. Voices commenting 4. Somatic passivity 5. Thought withdrawal 6. Thought insertion 7. Thought broadcasting 8. Made feelings (affect) 9. Made impulses 10. Made volitional acts 11. Delusional perception * **High-Yield Fact:** FRS are included in the **ICD-10** criteria for schizophrenia but have been **removed from the DSM-5** due to their lack of specificity and poor prognostic value. * **Memory Aid:** Remember the "3 Ts" (Thought withdrawal, insertion, broadcasting) and "3 Made" phenomena (Feelings, Impulses, Acts).

Question 1

A patient is getting irritated, having fluctuation of emotions. He reports of hearing voices talking about his actions. He has poor eye contact with the people and wants to stay alone. These symptoms are there for more than two months. Which of the foll owing is pointing towards the diagnosis of schizophrenia and not delusional disorder?

Accepted Answer

Second person, third person auditory hallucinations

Answer

Emotional problem/depression

Answer

Delusion of persecution

Answer

Symptoms are there for more than 2 months

Question 2

A patient presents with as shown in the image (rabbit -like perioral movements) on long-term treatment. It is caused by which of the following drugs?

Accepted Answer

Risperidone

Answer

Clozapine

Answer

Ziprasidone

Answer

Fluoxetine

Question 3

A person thinks someone wants to kill him. He cannot be convinced or explained. What is the likely phenomenon?

Accepted Answer

Delusion

Answer

Hallucination

Answer

Illusion

Answer

Obsession

Question 4

A 32-year-old female presents with gradual onset of suspiciousness, muttering and smiling without clear reason, decreased socialization, and violent outbursts. Mental status examination reveals a blunt affect, thought insertion, impaired judgment, and insight. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Delusional disorder

Answer

Depression

Answer

Anxiety disorder

Question 5

Who coined the term "Dementia precox"?

Accepted Answer

Kraepelin

Answer

Freud

Answer

Bleuler

Answer

Schneider

Question 6

A 17-year-old boy is diagnosed with schizophrenia. What is the risk that one of his siblings will develop the disease?

Accepted Answer

9%

Answer

2%

Answer

5%

Answer

20%

Question 7

Schneiderian first-rank symptoms are characteristic of which condition?

Accepted Answer

All of the above

Answer

Schizophrenia

Answer

Organic delusional disorder

Answer

Schizoaffective disorder

Question 8

In catatonic schizophrenia, all are seen except?

Accepted Answer

Flight of ideas

Answer

Mannerism

Answer

Negativism

Answer

Echolalia

Question 9

All of the following are true about paranoid schizophrenia except?

Accepted Answer

Rapid deterioration of personality

Answer

Most common type of schizophrenia

Answer

Onset in 3rd or 4th decade

Answer

Delusions of grandeur

Question 10

A 42-year-old female presents with a complaint of hearing instructions from other planets. Which of the following is NOT considered a first-rank symptom of schizophrenia?

Accepted Answer

Somatic passivity

Answer

Voices commenting on the patient's actions or thoughts

Answer

Thought broadcasting

Answer

Delusions of control

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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