Delusional Disorders — MCQs
Which of the following statements is true regarding delusional disorder?
An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
A patient presents with fixed, false beliefs about their partner's fidelity. What is the most likely diagnosis?
First-line pharmacological treatment for body dysmorphic disorder is:
Which of the following is not a formal thought disorder?
A 30 year old unmarried woman from a low socioeconomic status family believes that a rich boy staying in her neighbourhood is in deep love with her. The boy clearly denies his love towards this lady. Still the lady insists that his denial is a secret affirmation of his love towards her. She makes desperate attempts to meet the boy despite resistance from her family. She also develops sadness at times when her effort to meet the boy does not materialize. She is able to maintain her daily routine. She however, remains preoccupied with the thoughts of this boy. She is likely to be suffering from :
Which of the following is the most classic example of a delusion?
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 25-year-old male believes that his penis is decreasing in size every day and that it will eventually disappear, leading to his death. What is the most likely diagnosis?
Delusional Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following statements is true regarding delusional disorder?
- A. Occurs at early age
- B. Held with absolute conviction (Correct Answer)
- C. More commonly occurs in middle to late adulthood
- D. Often not amenable to reasoning
Explanation: ***Held with absolute conviction*** - This is the **BEST ANSWER** as it describes a **core diagnostic criterion** for delusions in delusional disorder per DSM-5/ICD-11. - Delusions are defined as **fixed, false beliefs held with absolute conviction** despite clear evidence to the contrary. - This unwavering certainty is what distinguishes delusions from overvalued ideas or normal beliefs. - This statement captures the fundamental **nature and defining characteristic** of the disorder itself. *More commonly occurs in middle to late adulthood* - This statement is **factually TRUE** - delusional disorder typically has onset between ages 40-55 (middle to late adulthood). - However, this describes **epidemiological data** (when it occurs), not a defining feature of the disorder. - While accurate, it is less fundamental than the absolute conviction which is a **diagnostic criterion**. *Often not amenable to reasoning* - This statement is also **factually TRUE** - patients with delusional disorder cannot be reasoned out of their false beliefs. - However, this is a **consequence** of the absolute conviction, not the primary defining feature. - The inability to respond to reasoning stems from the unwavering belief system. *Occurs at early age* - This is **FALSE** - delusional disorder is rare in early age. - Typical onset is in **middle to late adulthood** (ages 40-55), not childhood or adolescence. - Early onset would be atypical for this disorder.
Question 2: An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
- A. Olanzapine
- B. ECT (Correct Answer)
- C. Mirtazapine
- D. Clozapine
Explanation: ***ECT*** - **Electroconvulsive therapy (ECT)** is the **treatment of choice** for severe depression with **suicidal ideation** due to its rapid onset of action and high efficacy. - It is particularly indicated when there is an urgent need for symptom remission to prevent self-harm, as verbal therapies and medications take longer to exert their full effects. *Olanzapine* - **Olanzapine** is an **antipsychotic medication** with some antidepressant properties, but it is not the first-line treatment for severe depression with suicidal tendencies. - It is often used as an **adjunctive treatment** in treatment-resistant depression or in psychotic depression with delusions. *Mirtazapine* - **Mirtazapine** is an **antidepressant** that can be very effective in cases of major depressive disorder, especially when insomnia and appetite loss are prominent. - However, its onset of action is not as rapid as ECT, making it less suitable for situations requiring immediate intervention for **severe suicidal risk**. *Clozapine* - **Clozapine** is an **antipsychotic medication** primarily used for **treatment-resistant schizophrenia** and reducing suicidal behavior in schizophrenia. - It is highly effective but has significant side effects, including **agranulocytosis**, and is not a first-line treatment for major depressive disorder with suicidal tendencies.
Question 3: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
- A. Schizophrenia
- B. Major depressive disorder plus psychosis (Correct Answer)
- C. Schizoaffective disorder
- D. Schizotypal personality disorder
Explanation: ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern 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. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.
Question 4: A patient presents with fixed, false beliefs about their partner's fidelity. What is the most likely diagnosis?
- A. Schizophrenia
- B. Brief psychotic disorder
- C. Delusional Disorder (Correct Answer)
- D. Adjustment disorder
Explanation: ***Delusional Disorder*** - This condition is characterized by the presence of **non-bizarre delusions** (plausible in real life) that persist for at least one month, often involving themes such as jealousy, persecution, or grandiosity. - The patient's fixed, false beliefs about their partner's fidelity are a classic example of a **delusion of jealousy** (Othello syndrome). - According to DSM-5, the diagnosis requires the presence of delusions for at least one month, with no other symptoms of schizophrenia, and relatively preserved functioning apart from the impact of the delusion. *Schizophrenia* - Schizophrenia involves a broader range of psychotic symptoms, including **bizarre delusions**, hallucinations, disorganized thinking, and negative symptoms. - While delusions are present in schizophrenia, the absence of other symptoms like prominent **hallucinations** or disorganized speech makes this diagnosis less likely. *Brief psychotic disorder* - Brief psychotic disorder is characterized by the sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech) that last for **at least one day but less than one month**. - The key differentiator here is the **duration**: if symptoms persist beyond one month with only delusions present, delusional disorder is more appropriate. *Adjustment disorder* - Adjustment disorder is a stress-related condition characterized by emotional or behavioral symptoms that develop in response to a clearly identifiable stressor. - The symptoms are typically reactive and *do not involve psychotic features* like fixed, false beliefs (delusions).
Question 5: First-line pharmacological treatment for body dysmorphic disorder is:
- A. SSRI regular dose
- B. Benzodiazepines
- C. Antipsychotics
- D. SSRI high dose (Correct Answer)
Explanation: ***SSRI high dose*** - **High-dose SSRIs** are the recommended first-line pharmacological treatment for Body Dysmorphic Disorder due to their effectiveness in reducing repetitive behaviors and preoccupation with perceived flaws. - The efficacy often requires doses higher than those used for other anxiety or depressive disorders, reflecting the **severity of symptoms** in BDD. *SSRI regular dose* - While SSRIs are the correct class of medication, a **regular dose** is often insufficient to achieve a significant therapeutic response in individuals with Body Dysmorphic Disorder. - Patients with BDD typically require **higher doses** to adequately target the obsessive-compulsive nature of their symptoms. *Benzodiazepines* - **Benzodiazepines** are generally not indicated as a first-line treatment for BDD as they do not address the core symptoms of obsessive thoughts and compulsive behaviors. - They may be used for **short-term management** of severe anxiety, but carry risks of dependence and tolerance with long-term use. *Antipsychotics* - **Antipsychotics** are not considered first-line for Body Dysmorphic Disorder unless there are significant psychotic features or delusions, which are not universal in BDD. - They may be used as an **adjunct therapy** in refractory cases, particularly when there is a delusional intensity to the perceived flaws.
Question 6: Which of the following is not a formal thought disorder?
- A. Neologism
- B. Derailment
- C. Tangentiality
- D. Delusion (Correct Answer)
Explanation: ***Delusion*** - A **delusion** is a **fixed, false belief** that is firmly held despite clear evidence to the contrary and is not consistent with the person's cultural or religious background. It is a **disorder of thought content**, not thought form or process. - While delusions are a hallmark symptom of many psychotic disorders, they represent what a person thinks, rather than how they think. *Neologism* - **Neologism** refers to the **creation of new, nonsensical words or phrases** that are intelligible only to the person coining them. - This is a formal thought disorder because it reflects a break in the conventional structure and coherence of language. *Derailment* - **Derailment**, also known as **loose associations**, is a thought disorder where the person's thoughts shift from one topic to another in a way that is loosely connected or completely unrelated. - This represents a disruption in the logical flow and organization of ideas, making it a formal thought disorder. *Tangentiality* - **Tangentiality** is a thought disorder where the person **strays from the main topic** and never returns to the original point or answers the question asked. - It reflects an inability to maintain focused thought and is a formal thought disorder related to the process of thinking.
Question 7: A 30 year old unmarried woman from a low socioeconomic status family believes that a rich boy staying in her neighbourhood is in deep love with her. The boy clearly denies his love towards this lady. Still the lady insists that his denial is a secret affirmation of his love towards her. She makes desperate attempts to meet the boy despite resistance from her family. She also develops sadness at times when her effort to meet the boy does not materialize. She is able to maintain her daily routine. She however, remains preoccupied with the thoughts of this boy. She is likely to be suffering from :
- A. Depression
- B. Delusional disorder (Correct Answer)
- C. Schizophrenia
- D. Mania
Explanation: ***Delusional disorder*** - The central feature of delusional disorder is the presence of one or more **non-bizarre delusions** for at least one month, without other psychotic symptoms or significant impairment in functioning. In this case, the woman's fixed belief that the rich boy is in love with her, despite clear evidence to the contrary, fits the description of an **erotomanic delusion**. - She is able to maintain a **normal daily routine** and her sadness is a reaction to her efforts to meet the boy not materialising, rather than a pervasive mood disorder, which is consistent with delusional disorder where functioning is often not markedly impaired outside the delusion's specific impact. *Depression* - While the patient experiences sadness, this is episodic and directly related to her inability to pursue her delusion, not a pervasive **depressed mood** with associated neurovegetative symptoms (e.g., significant changes in sleep, appetite, energy, concentration, or feelings of worthlessness/guilt). - The presence of a **fixed, false belief** (delusion) as the primary pathology is not characteristic of depression, although psychotic features can occur in severe depression, they would be accompanied by clear depressive symptoms. *Schizophrenia* - Schizophrenia typically involves a broader range of symptoms, including **hallucinations**, **disorganized speech**, **negative symptoms**, and significant **functional impairment**. These are not described in the patient's presentation. - The patient's delusions in schizophrenia are often **bizarre** (i.e., clearly implausible and not understandable to same-culture peers) and are accompanied by other characteristic symptoms, which are absent here. *Mania* - Mania is characterized by an elevated, expansive, or irritable mood, along with increased energy and goal-directed activity, often accompanied by **grandiosity**, **decreased need for sleep**, **talkativeness**, **flight of ideas**, and **reckless behavior**. - While the patient's persistent pursuit of the boy might seem driven, it lacks the broad constellation of manic symptoms, and her sadness further differentiates her presentation from a manic episode.
Question 8: Which of the following is the most classic example of a delusion?
- A. Othello syndrome (Correct Answer)
- B. Pyromania
- C. Kleptomania
- D. De Clérambault's syndrome
Explanation: ***Othello syndrome*** - **Othello syndrome**, also known as **delusional jealousy**, is characterized by a *fixed, unfounded belief* that one's partner is being unfaithful. - This is a classic example of a **delusion** because it involves a **fixed, false belief** that is firmly held despite clear evidence to the contrary and is not amenable to logic or persuasion. - The syndrome demonstrates all core features of a delusion: **unshakeable conviction**, **imperviousness to contradictory evidence**, and **significant impact on behavior**. *De Clérambault's syndrome* - **De Clérambault's syndrome**, or **erotomania**, is a delusional disorder where an individual *believes another person, often of higher status, is in love with them*. - While this is also a classic example of a delusional disorder, **Othello syndrome** is more frequently cited in clinical teaching as the prototypical example of an isolated, circumscribed delusion. *Pyromania* - **Pyromania** is an **impulse control disorder** characterized by recurrent, deliberate fire-setting driven by tension or arousal. - It involves **behavioral impulsivity** and *not a fixed false belief*, thus it is not a delusion. *Kleptomania* - **Kleptomania** is another **impulse control disorder** characterized by recurrent failure to resist urges to steal objects not needed for personal use. - Like pyromania, it represents a **disorder of impulse control** rather than a disorder of thought content or belief system.
Question 9: 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.
Question 10: A 25-year-old male believes that his penis is decreasing in size every day and that it will eventually disappear, leading to his death. What is the most likely diagnosis?
- A. Somatic Symptom Disorder
- B. Delusional Disorder (Correct Answer)
- C. Illness Anxiety Disorder
- D. Obsessive-Compulsive Disorder
Explanation: ***Delusional Disorder*** - This patient presents with a **fixed, false belief** (penis shrinkage and disappearance) that is not amenable to change in light of conflicting evidence, which is the hallmark of a **delusion**. - This is specifically a **somatic-type delusion** involving bodily functions or sensations. - The clinical presentation is characteristic of **Koro syndrome (genital retraction syndrome)**, a culture-bound syndrome where the patient has an intense fear that their genitalia are retracting and will disappear, leading to death. - Koro is classified under **Delusional Disorder, somatic type** in standard psychiatric classification, making this the most appropriate diagnosis among the given options. *Somatic Symptom Disorder* - Characterized by **distressing somatic symptoms** accompanied by excessive thoughts, feelings, or behaviors related to the symptoms, but without a fixed, false belief. - The patient here has a **delusion** (fixed false belief about genital disappearance), not merely excessive worry about somatic symptoms. - Patients with Somatic Symptom Disorder may be partially reassured; patients with delusions cannot be reassured. *Illness Anxiety Disorder* - Involves **preoccupation with having or acquiring a serious illness** despite absence or mildness of somatic symptoms. - Unlike a delusion, the fear in Illness Anxiety Disorder is **not a fixed, false belief** and patients can often be temporarily reassured. - The patient's belief about penis disappearance is a somatic delusion, not health anxiety. *Obsessive-Compulsive Disorder* - Distinguished by **obsessions** (recurrent, intrusive thoughts recognized as irrational) and/or **compulsions** (repetitive behaviors to neutralize anxiety). - The key difference: in OCD, patients have **insight** that their thoughts are irrational; in delusional disorder, there is **no insight** - the belief is held with conviction. - The patient's fixed belief about genital disappearance is a delusion, not an obsession with doubt.
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