Brief Psychotic Disorder — MCQs
A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?
Which of the following is not a Cluster A personality disorder?
Which of the following is false about bipolar disorder?
Which of the following is not considered a core diagnostic criterion for schizophrenia according to DSM-5?
Schizophrenia with the worst prognosis is which of the following?
Prognosis of schizophrenia is best, if:
Which of the following statements is NOT true about type 1 schizophrenia?
Which of the following hallucinations is pathognomonic of schizophrenia?
Most reliable marker of conversion to psychosis in high-risk individuals:
A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?
Brief Psychotic Disorder Indian Medical PG Practice Questions and MCQs
Question 1: A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?
- A. Postpartum depression
- B. Postpartum blues (Correct Answer)
- C. Postpartum psychosis
- D. Postpartum anxiety
Explanation: ***Postpartum blues*** - This condition presents with mild, transient symptoms like **tearfulness**, **mood swings**, and **insomnia** typically peaking around **4-5 days postpartum** and resolving within two weeks. - It is a very common, self-limiting condition impacting up to 80% of new mothers, attributed to drastic **hormonal shifts** post-delivery. *Postpartum depression* - Symptoms are similar to postpartum blues but are more **severe**, last longer (typically **beyond two weeks**), and significantly impair functioning. - It often includes feelings of **hopelessness**, pervasive sadness, loss of pleasure, and sometimes thoughts of harming oneself or the baby. *Postpartum psychosis* - This is a severe psychiatric emergency characterized by **hallucinations**, delusions, disorganized thinking, and bizarre behavior, usually within the first 2-3 weeks postpartum. - It is a rare condition requiring **urgent medical intervention** due to the high risk of harm to mother and baby. *Postpartum anxiety* - While anxiety can co-occur with postpartum blues or depression, primary postpartum anxiety specifically involves excessive and **uncontrollable worry** or fear, often about the baby's health or safety. - It does not typically present with the prominent **tearfulness** and **mood swings** characteristic of blues or depression.
Question 2: Which of the following is not a Cluster A personality disorder?
- A. schizoid
- B. schizotypal
- C. paranoid
- D. anankastic (Correct Answer)
Explanation: ***Anankastic*** - **Anankastic personality disorder**, also known as **obsessive-compulsive personality disorder (OCPD)**, is classified under **Cluster C** personality disorders. - Cluster C disorders are characterized by anxious, fearful thinking or behavior, which differentiates them from the odd or eccentric behaviors of Cluster A. *Schizoid* - **Schizoid personality disorder** is a **Cluster A** personality disorder, characterized by a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings. - Individuals with schizoid personality disorder typically show no desire for close relationships, including those with family members. *Schizotypal* - **Schizotypal personality disorder** is a **Cluster A** personality disorder, characterized by pervasive patterns of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships, as well as by cognitive or perceptual distortions and eccentricities of behavior. - These individuals may have odd beliefs or magical thinking that is inconsistent with cultural norms. *Paranoid* - **Paranoid personality disorder** is a **Cluster A** personality disorder, characterized by a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent. - Individuals with this disorder often believe that others are exploiting, harming, or deceiving them, even without sufficient basis.
Question 3: Which of the following is false about bipolar disorder?
- A. Unipolar mania is more common than bipolar disorder (Correct Answer)
- B. Genetic factors play important role
- C. Rapid cycling is more common in females
- D. Age of onset is earlier than unipolar depression
Explanation: ***Unipolar mania is more common than bipolar disorder*** - This statement is **false** because **unipolar mania is extremely rare**, while **bipolar disorder (which includes both manic and depressive episodes)** is significantly more common. - **Unipolar mania** refers to recurrent manic episodes without any depressive episodes, a presentation that is seldom observed clinically. *Genetic factors play important role* - This statement is **true**, as **bipolar disorder has a strong genetic component**, with **heritability estimated between 60-80%**. - **First-degree relatives** of individuals with bipolar disorder are at a significantly higher risk of developing the condition. *Rapid cycling is more common in females* - This statement is **true**; **rapid cycling (4 or more mood episodes per year)** occurs more frequently in females with bipolar disorder. - **Women with bipolar disorder** are also more likely to experience **mixed features** and **more depressive episodes** compared to males. *Age of onset is earlier than unipolar depression* - This statement is **true** because the **typical age of onset for bipolar disorder is in early adulthood (late teens to early 20s)**, whereas **unipolar depression often has a later average onset**, though both can occur at any age. - An earlier age of onset in bipolar disorder is linked to poorer prognosis and more severe illness course.
Question 4: 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 5: Schizophrenia with the worst prognosis is which of the following?
- A. Disorganized type (Correct Answer)
- B. Catatonic type
- C. Paranoid type
- D. Undifferentiated type
Explanation: ***Disorganized type*** - This subtype, also known as **hebephrenic schizophrenia**, is characterized by prominent **disorganized speech**, **behavior**, and **flat or inappropriate affect**. - The combination of severe thought disorder and affective disturbance typically leads to a **poorer long-term outcome** and **greater functional impairment**. *Catatonic type* - Characterized by prominent psychomotor disturbances, such as **stupor**, **catalepsy**, **waxy flexibility**, mutism, or excessive motor activity. - While acute episodes can be severe, the long-term prognosis is generally considered better than the disorganized type, especially if treatment is initiated early. *Paranoid type* - This subtype is characterized by prominent **delusions** (often persecutory or grandiose) and **auditory hallucinations**, with relatively preserved cognitive function and affect. - Patients with paranoid schizophrenia often have a **better prognosis** and are more likely to achieve functional recovery compared to disorganized type. *Undifferentiated type* - This diagnosis is given when the criteria for the paranoid, disorganized, or catatonic types are not met, but prominent **positive (e.g., delusions, hallucinations)** and **negative (e.g., avolition, anhedonia)** symptoms of schizophrenia are present. - The prognosis varies widely and is not inherently worse than the disorganized type; it simply indicates that the clinical picture doesn't fit neatly into other defined subtypes.
Question 6: Prognosis of schizophrenia is best, if:
- A. Acute onset (Correct Answer)
- B. Negative symptoms
- C. Insidious onset
- D. Family history is positive
Explanation: ***Acute onset*** - An **acute onset** of schizophrenia is associated with a better prognosis, as it often indicates a more favorable response to treatment and less pervasive deterioration of daily functioning. - This typically suggests that the individual had a relatively intact baseline level of functioning before the emergence of psychotic symptoms. *Negative symptoms* - The presence of prominent **negative symptoms** (e.g., avolition, anhedonia, alogia) is usually associated with a poorer prognosis in schizophrenia. - Negative symptoms are generally harder to treat and often lead to greater functional impairment and disability. *Insidious onset* - An **insidious onset** of schizophrenia, where symptoms develop gradually over time, is typically linked to a poorer prognosis. - This often implies more severe and persistent neurodevelopmental abnormalities and a less robust response to interventions. *Family history is positive* - A **positive family history** of schizophrenia indicates a higher genetic predisposition but does not directly predict the individual's prognosis. - While genetics play a role in susceptibility, the course and outcome of the illness are influenced by many other factors, including symptom presentation and treatment adherence.
Question 7: 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 8: Which of the following hallucinations is pathognomonic of schizophrenia?
- A. Auditory hallucinations commanding the patient
- B. Auditory hallucinations giving running commentary (Correct Answer)
- C. Auditory hallucinations criticizing the patient
- D. Auditory hallucinations talking to patient
Explanation: ***Auditory hallucinations giving running commentary*** - **Third-person auditory hallucinations**, particularly those giving a continuous descriptive commentary on the patient's actions, thoughts, or movements, are considered **pathognomonic of schizophrenia** within Schneider's first-rank symptoms. - These are distinguished from other types of auditory hallucinations by their specific content and the perspective from which they are perceived, indicating a fundamental disruption in self-perception and reality testing. *Auditory hallucinations commanding the patient* - **Command hallucinations** involve voices instructing the patient to perform specific actions and can occur in various psychiatric conditions, including other psychoses, mood disorders with psychotic features, and even non-psychotic states. - While significant and potentially dangerous, they are **not unique to schizophrenia** and therefore not pathognomonic. *Auditory hallucinations criticizing the patient* - **Critical auditory hallucinations** involve voices that demean, scold, or negatively evaluate the patient, contributing to distress and low self-esteem. - These are also **nonspecific** and can be found in a range of mental health conditions, including depression with psychotic features and bipolar disorder. *Auditory hallucinations talking to patient* - **Second-person auditory hallucinations**, where voices communicate directly with the patient in a conversational manner, are common in various psychotic disorders. - They are a general feature of psychosis and **do not specifically indicate schizophrenia** over other conditions; the *content* and *form* of the hallucination are crucial for differential diagnosis.
Question 9: Most reliable marker of conversion to psychosis in high-risk individuals:
- A. Cognitive decline
- B. Sleep disruption
- C. Social withdrawal
- D. Basic symptoms (Correct Answer)
Explanation: ***Basic symptoms*** - **Basic symptoms** are subtle, subjective disturbances of thought, perception, and motor control that are often precursors to full-blown psychotic episodes. - They are considered the **most reliable markers** for predicting conversion to psychosis in high-risk individuals because they directly reflect underlying neurobiological vulnerabilities. *Cognitive decline* - While **cognitive decline** can be a feature in individuals at high risk for psychosis, it is a less specific predictor as it can occur in various other neurological and psychiatric conditions. - It often represents a broader, non-specific marker of underlying brain dysfunction rather than a direct indicator of impending psychosis. *Sleep disruption* - **Sleep disruption** is a common symptom reported by individuals at high risk for psychosis and can exacerbate psychiatric symptoms. - However, **sleep disturbances** are highly prevalent in the general population and across many psychiatric disorders, making them a less specific and reliable predictor of psychosis conversion compared to basic symptoms. *Social withdrawal* - **Social withdrawal** is a frequently observed prodromal symptom in individuals who later develop psychosis. - While it indicates a change in functioning, it is a non-specific behavioral change that can be linked to depression, anxiety, or other stressors, making it less specific than basic symptoms in predicting psychosis.
Question 10: A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?
- A. Cotard syndrome
- B. Delusional disorder (Correct Answer)
- C. Illusions
- D. Hallucinations
Explanation: ***Delusional disorder*** - This diagnosis fits the scenario as the patient holds a **false, fixed belief** (daughter wanting to kill him) that is not amenable to change in light of conflicting evidence. - The delusion is **non-bizarre** and relates to situations that can occur in real life, consistent with delusional disorder, and there are no other significant psychotic symptoms or impairment in functioning. *Cotard syndrome* - This is a rare syndrome characterized by **nihilistic delusions** (e.g., belief that one is dead, does not exist, or that organs have putrefied). - The patient's delusion in the question is persecutory, not nihilistic. *Illusions* - **Illusions** are misinterpretations of real external stimuli (e.g., seeing a coat in the dark and believing it's a person). - The patient's belief is a **false belief** without an external stimulus being misinterpreted. *Hallucinations* - **Hallucinations** are sensory experiences that occur in the absence of an external stimulus (e.g., hearing voices when no one is speaking). - The patient's presentation is characterized by a **fixed false belief**, not primarily by sensory perceptions without external stimuli.
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