Psychotic Disorders — MCQs
On this page
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?
Who coined the term "Dementia precox"?
The term "Dementia praecox" was coined by whom?
Schneiderian first-rank symptoms are characteristic of which condition?
In catatonic schizophrenia, all are seen except?
All of the following are true about paranoid schizophrenia except?
Objects are seen reduced in size in which of the following?
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?
What is the term for a delusional belief that one is dead?
Endophenotypic markers of schizophrenia include all of the following except?
Psychotic Disorders Indian Medical PG Practice Questions and MCQs
Question 1: 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?
- A. Delusional disorder
- B. Depression
- C. Schizophrenia (Correct Answer)
- D. Anxiety disorder
Explanation: ### Explanation The clinical presentation described is a classic case of **Schizophrenia**. The diagnosis is based on the presence of positive symptoms, negative symptoms, and cognitive impairment lasting for a significant duration (typically >6 months per DSM-5 or >1 month per ICD-11). **Why Schizophrenia is Correct:** The patient exhibits several "Schneiderian First Rank Symptoms" (SFRS) and core features of schizophrenia: * **Thought Insertion:** A pathognomonic feature where the patient believes thoughts are being put into their mind by an external agency. * **Muttering and Smiling (Inappropriate Affect/Hallucinations):** Suggests auditory hallucinations and disorganized behavior. * **Negative Symptoms:** Blunt affect and decreased socialization (asociality) are hallmark negative features. * **Impaired Insight and Judgment:** Common in psychotic disorders, distinguishing them from neuroses. **Why Other Options are Incorrect:** * **Delusional Disorder:** Characterized by non-bizarre delusions (e.g., being followed) without prominent hallucinations, thought disorder, or negative symptoms like blunt affect. * **Depression:** While it can cause social withdrawal, it is primarily a mood disorder. It does not typically feature thought insertion or inappropriate smiling/muttering unless it is "Depression with Psychotic Features," which would require a predominant low mood. * **Anxiety Disorder:** Patients maintain intact reality testing and insight. They do not experience delusions, hallucinations, or thought alienation (like thought insertion). **NEET-PG High-Yield Pearls:** * **Schneiderian First Rank Symptoms (SFRS):** Includes thought insertion, withdrawal, broadcasting; third-person auditory hallucinations; and delusional perception. * **Bleuler’s 4 A’s of Schizophrenia:** **A**ffective flattening, **A**utism (social withdrawal), **A**mbivalence, and **A**ssociation looseness. * **Prognosis:** Good prognostic factors include late onset, female sex, presence of mood symptoms, and a clear precipitating factor. * **Treatment:** Atypical antipsychotics (e.g., Risperidone, Olanzapine) are first-line. Clozapine is the gold standard for treatment-resistant schizophrenia.
Question 2: Who coined the term "Dementia precox"?
- A. Freud
- B. Bleuler
- C. Kraepelin (Correct Answer)
- D. Schneider
Explanation: **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).
Question 3: The term "Dementia praecox" was coined by whom?
- A. Freud
- B. Bleuler
- C. Kraepelin (Correct Answer)
- D. Schneider
Explanation: **Explanation:** The term **"Dementia Praecox"** was coined by **Emil Kraepelin** (often referred to as the father of modern scientific psychiatry). He used this term to describe a specific group of psychotic illnesses 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 outcome. **Analysis of Incorrect Options:** * **Eugen Bleuler:** He renamed "Dementia Praecox" as **"Schizophrenia"** in 1911. He argued that the disease did not always lead to dementia and was characterized by a "splitting" of mental functions. He is famous for the **4 A’s** of schizophrenia. * **Kurt Schneider:** He focused on the symptomatology rather than the course of the illness. He described the **"First Rank Symptoms" (FRS)**, which were historically used to diagnose schizophrenia. * **Sigmund Freud:** The founder of psychoanalysis; he focused on the unconscious mind and psychosexual development rather than the classification of psychotic disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Emil Kraepelin:** Coined "Dementia Praecox"; focused on **prognosis/course**. * **Eugen Bleuler:** Coined "Schizophrenia"; described the **4 A's** (Affective flattening, Ambivalence, Autism, Loose Associations). * **Kurt Schneider:** Defined **First Rank Symptoms** (e.g., auditory hallucinations, thought withdrawal/insertion/broadcast). * **B.A. Morel:** Actually used the French term *"démence précoce"* earlier, but Kraepelin popularized and formalized the clinical entity in his textbooks.
Question 4: Schneiderian first-rank symptoms are characteristic of which condition?
- A. Schizophrenia
- B. Organic delusional disorder
- C. Schizoaffective disorder
- D. All of the above (Correct Answer)
Explanation: ### 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.
Question 5: In catatonic schizophrenia, all are seen except?
- A. Mannerism
- B. Negativism
- C. Echolalia
- D. Flight of ideas (Correct Answer)
Explanation: **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).
Question 6: All of the following are true about paranoid schizophrenia except?
- A. Most common type of schizophrenia
- B. Onset in 3rd or 4th decade
- C. Delusions of grandeur
- D. Rapid deterioration of personality (Correct Answer)
Explanation: **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.
Question 7: Objects are seen reduced in size in which of the following?
- A. Hypnagogic hallucinations
- B. Lilliputian hallucinations (Correct Answer)
- C. Psychomotor hallucinations
- D. Haptic hallucinations
Explanation: **Explanation:** The correct answer is **Lilliputian hallucinations (Option B)**. This term is derived from Jonathan Swift’s *Gulliver's Travels*, where the inhabitants of Lilliput were tiny. In psychiatry, these are a type of visual hallucination where objects, people, or animals are perceived as being much smaller than their actual size. Unlike macropsia (an illusion), these are true hallucinations where the tiny figures are perceived in the absence of an external stimulus. They are classically associated with **Organic Brain Syndromes**, specifically **Delirium Tremens** (alcohol withdrawal) and certain intoxications. **Analysis of Incorrect Options:** * **Hypnagogic hallucinations (Option A):** These are vivid, dream-like hallucinations that occur while **falling asleep**. They are a part of the classic tetrad of Narcolepsy but can occur in normal individuals. (Mnemonic: **GO**ing to sleep = Hypna**go**gic). * **Psychomotor hallucinations (Option C):** These involve a false sense of movement of body parts. The patient may feel as if their limbs are moving or their body is being twisted when it is actually stationary. * **Haptic hallucinations (Option D):** Also known as tactile hallucinations, these involve the sensation of touch or surface stimuli. A common subtype is **Formication** (the sensation of insects crawling under the skin), frequently seen in Cocaine use (Cocaine bugs) and Alcohol withdrawal. **High-Yield Pearls for NEET-PG:** * **Alice in Wonderland Syndrome:** A clinical condition involving distorted body image and size (micropsia/macropsia), often associated with Migraines, Epilepsy, or EBV infection. * **Charles Bonnet Syndrome:** Complex visual hallucinations occurring in elderly patients with significant visual impairment (e.g., macular degeneration), with preserved insight. * **Hypnopompic hallucinations:** Hallucinations occurring while **waking up** from sleep.
Question 8: 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?
- A. Voices commenting on the patient's actions or thoughts
- B. Thought broadcasting
- C. Somatic passivity (Correct Answer)
- D. Delusions of control
Explanation: **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 9: What is the term for a delusional belief that one is dead?
- A. Erotomania
- B. Cotard delusion (Correct Answer)
- C. Delusion of self-reproach
- D. Delusion of persecution
Explanation: **Explanation:** **Cotard Delusion** (also known as Cotard’s syndrome or "Walking Corpse Syndrome") is a rare neuropsychiatric condition characterized by nihilistic delusions. In its most severe form, patients believe they are dead, do not exist, are putrefying, or have lost their internal organs or blood. It is most commonly associated with severe psychotic depression, though it can occur in schizophrenia or organic brain lesions. **Analysis of Incorrect Options:** * **A. Erotomania (De Clérambault’s Syndrome):** A delusion where the patient believes that another person, usually of higher social status or a celebrity, is deeply in love with them. * **C. Delusion of self-reproach:** A common feature of depressive disorders where the patient feels excessive, irrational guilt or believes they have committed a unforgivable sin or crime. * **D. Delusion of persecution:** The most common type of delusion (seen frequently in Schizophrenia), where the individual believes they are being conspired against, spied on, or harmed by others. **High-Yield Clinical Pearls for NEET-PG:** * **Nihilism:** The core theme of Cotard’s is "nothingness." * **Triad of Cotard’s:** Depressive mood, nihilistic delusions, and hypochondriacal delusions. * **Associated Condition:** Classically linked to **Agitated Depression** in the elderly. * **Treatment:** Electroconvulsive Therapy (ECT) is often considered the gold standard for rapid symptom resolution in severe cases.
Question 10: Endophenotypic markers of schizophrenia include all of the following except?
- A. Smooth pursuit eye movement alterations
- B. Saccadic eye movement disinhibition
- C. Prepulse inhibition of startle response paradigm
- D. P50 auditory evoked potential (Correct Answer)
Explanation: **Explanation:** An **endophenotype** is a heritable, stable trait that bridges the gap between invisible genetic risk and the visible clinical syndrome. In Schizophrenia, these markers are found in both patients and their unaffected first-degree relatives. **Why Option D is the "Except":** The question is slightly controversial as **P50 auditory evoked potential suppression deficits** are actually a classic endophenotype of Schizophrenia. However, in the context of competitive exams like NEET-PG, if forced to choose an "except," it often relates to the specific nature of the deficit. Patients with schizophrenia show **reduced suppression** (failure to gate) of the P50 response to repeated stimuli. If an option implies the P50 potential itself is the marker rather than the *lack of gating/suppression*, it is technically the outlier compared to the more definitive oculomotor markers. *Note: In some versions of this question, "P300 amplitude" or "Sensory gating" are used; always look for the option that describes a physiological process rather than a clinical symptom.* **Analysis of Other Options:** * **A & B (Oculomotor Markers):** Smooth pursuit eye movement (SPEM) deficits (tracking a moving object) and saccadic eye movement disinhibition (failure to suppress reflexive eye movements) are the most robust endophenotypes, seen in ~80% of patients and ~40% of relatives. * **C (Prepulse Inhibition - PPI):** This measures **sensorimotor gating**. In schizophrenia, a weak leading stimulus (prepulse) fails to inhibit the startle response to a subsequent loud noise, indicating a failure in the brain's filtering mechanism. **High-Yield Clinical Pearls for NEET-PG:** * **Most common endophenotype:** SPEM (Smooth Pursuit Eye Movement) deficits. * **P50 Gating:** Relates to alpha-7 nicotinic receptor abnormalities. * **P300:** An event-related potential (ERP) that shows **decreased amplitude** and increased latency in schizophrenia. * **Wisconsin Card Sorting Test (WCST):** Used to assess executive function (DLPFC) and is also considered a cognitive endophenotype.
Practice by Chapter
Schizophrenia: Epidemiology and Etiology
Practice Questions
Schizophrenia: Clinical Features
Practice Questions
Schizophrenia: Treatment
Practice Questions
Schizoaffective Disorder
Practice Questions
Delusional Disorders
Practice Questions
Brief Psychotic Disorder
Practice Questions
Substance-Induced Psychotic Disorders
Practice Questions
Psychosis in Medical Conditions
Practice Questions
First Episode Psychosis
Practice Questions
Treatment-Resistant Psychosis
Practice Questions
Rehabilitation in Psychotic Disorders
Practice Questions
Outcome and Prognosis
Practice Questions
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free