First Episode Psychosis — MCQs
In treatment-resistant OCD, which augmentation has strongest evidence?
Which of the following statements is true regarding delusional disorder?
Which class of drugs is primarily used for the treatment of schizophrenia?
Which of the following is NOT a feature of neurosis?
F00 in ICD denotes
Insane paresis is associated with -
Which of the following behavioral problems would suggest an organic brain lesion?
Most reliable marker of conversion to psychosis in high-risk individuals:
What is the most reliable marker of conversion to psychosis in high-risk individuals?
Which of the following is not a feature of psychosis?
First Episode Psychosis Indian Medical PG Practice Questions and MCQs
Question 1: In treatment-resistant OCD, which augmentation has strongest evidence?
- A. Clomipramine
- B. Risperidone
- C. Aripiprazole (Correct Answer)
- D. Lamotrigine
Explanation: ***Correct Option: Aripiprazole*** - **Aripiprazole** has the **strongest and most consistent evidence** as an augmentation strategy for **treatment-resistant OCD** not responding to SSRIs, based on multiple meta-analyses and clinical trials. - It is a **second-generation antipsychotic** that acts as a partial agonist of **dopamine D2** and **serotonin 5-HT1A** receptors, and an antagonist of **serotonin 5-HT2A** receptors. - **Better tolerability profile** compared to other antipsychotics, making it a preferred choice for augmentation. - Recommended in major treatment guidelines as first-line augmentation for treatment-resistant OCD. *Incorrect Option: Risperidone* - While **risperidone** is a **second-generation antipsychotic** with evidence for augmentation in treatment-resistant OCD, it has **less consistent evidence** compared to aripiprazole. - Acts by modulating **dopamine D2** and **serotonin 5-HT2A** receptors. - May be considered as an alternative augmentation option, but not the first choice based on current evidence. *Incorrect Option: Clomipramine* - A **highly effective first-line treatment** for OCD, being a **tricyclic antidepressant (TCA)** with significant serotonin reuptake inhibition. - **Not typically used as augmentation** for SSRI treatment-resistant cases; rather, it would be used as an alternative first-line agent if SSRIs have failed. - Limited by a **less favorable side effect profile** compared to SSRIs. *Incorrect Option: Lamotrigine* - Primarily used as a **mood stabilizer** in bipolar disorder and for seizure control. - Has **limited and inconsistent evidence** to support its efficacy as an augmentation strategy for treatment-resistant OCD. - Not recommended as a standard augmentation option in treatment guidelines.
Question 2: 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 3: Which class of drugs is primarily used for the treatment of schizophrenia?
- A. Mood stabilizers
- B. Antihistamines
- C. Antipsychotic medications (Correct Answer)
- D. Antidepressants
Explanation: ***Antipsychotic medications*** - **Antipsychotic medications** primarily target **dopamine receptors** in the brain, which are implicated in the positive symptoms of schizophrenia like **hallucinations** and **delusions**. - They also have effects on other neurotransmitter systems, such as **serotonin**, contributing to their efficacy in managing negative and cognitive symptoms. *Mood stabilizers* - **Mood stabilizers** are primarily used for conditions characterized by extreme mood swings, such as **bipolar disorder**. - While they may be used adjunctively in some cases of schizophrenia to manage mood symptoms, they are not the primary treatment class. *Antihistamines* - **Antihistamines** are primarily used to treat **allergic reactions**, **insomnia**, or **nausea**. - They do not address the core neurochemical imbalances associated with schizophrenia and are not indicated for its treatment. *Antidepressants* - **Antidepressants** are primarily used to treat **depressive disorders** by modulating neurotransmitters like serotonin and norepinephrine. - While depression can co-occur with schizophrenia, antidepressants are not the primary treatment for the psychotic symptoms of schizophrenia and may even exacerbate psychosis in some individuals.
Question 4: Which of the following is NOT a feature of neurosis?
- A. Symptoms cause subjective distress
- B. Contact with reality preserved
- C. Personality disturbances (Correct Answer)
- D. Insight is maintained
Explanation: ***Personality disturbances*** - While neurosis can cause significant distress and impact functioning, it does not typically involve **fundamental alterations in personality structure or identity**. - **Personality disorders**, not neuroses, are characterized by deeply ingrained, inflexible, and maladaptive patterns of perceiving, thinking, and behaving that deviate markedly from cultural expectations. *Symptoms cause subjective distress* - A core characteristic of neurosis is that the individual experiences significant **emotional suffering** and discomfort due to their symptoms, such as anxiety, phobias, or obsessions. - This **subjective distress** is often a primary motivator for seeking treatment. *Contact with reality preserved* - Individuals with neurosis maintain their ability to **distinguish between internal experiences and external reality**, unlike in psychosis where this distinction is lost. - They may understand that their fears or anxieties are irrational, but they are unable to control them. *Insight is maintained* - People with neurosis generally have some level of **awareness** that they have a problem or that their symptoms are unreasonable or excessive. - This **insight** allows them to recognize the need for help and engage in therapeutic processes.
Question 5: F00 in ICD denotes
- A. mood disorders
- B. organic disorders (Correct Answer)
- C. substance use
- D. psychosis
Explanation: ***Organic disorders - CORRECT*** - **F00-F09** in the **International Classification of Diseases (ICD-10)** Chapter V (Mental and behavioural disorders) specifically denotes **organic, including symptomatic, mental disorders** - These disorders are characterized by brain disease, brain injury, or other insult leading to **cerebral dysfunction** - **F00** specifically refers to **Dementia in Alzheimer's disease** *Mood disorders - Incorrect* - Mood disorders are classified under codes **F30-F39** in ICD-10 - This category includes conditions like bipolar affective disorder, depressive episodes, and recurrent depressive disorders *Substance use - Incorrect* - Mental and behavioral disorders due to psychoactive substance use are classified under codes **F10-F19** in ICD-10 - This section covers disorders resulting from the use of alcohol, opioids, cannabis, sedatives, hypnotics, and other substances *Psychosis - Incorrect* - Specific psychotic disorders like schizophrenia are classified under codes **F20-F29** in ICD-10 - Psychosis can be a symptom of various mental disorders, including some organic conditions
Question 6: Insane paresis is associated with -
- A. Leishmaniasis
- B. Yellow fever
- C. Syphilis (Correct Answer)
- D. Neisseria meningitidis
Explanation: ***Syphilis*** - **General paresis**, or "insane paresis," is a neuropsychiatric manifestation of **tertiary syphilis**, resulting from chronic meningoencephalitis. - It presents with progressive **dementia**, personality changes, delusions, and neurological deficits. *Leishmaniasis* - This parasitic disease is characterized by various forms including **cutaneous**, **mucocutaneous**, and **visceral leishmaniasis** (kala-azar). - It typically causes skin lesions, mucocutaneous destruction, or systemic symptoms like fever, hepatosplenomegaly, and pancytopenia, but not general paresis. *Yellow fever* - **Yellow fever** is a viral hemorrhagic disease transmitted by mosquitoes, primarily affecting the liver and kidneys. - Symptoms include fever, jaundice, hemorrhage, and shock, but not the neurological degeneration seen in general paresis. *Neisseria meningitidis* - This bacterium causes **meningococcal meningitis** and **meningococcemia**, which are acute and severe infectious diseases. - While it can lead to acute neurological symptoms due to meningitis, it does not cause the chronic, progressive neuropsychiatric syndrome known as general paresis.
Question 7: Which of the following behavioral problems would suggest an organic brain lesion?
- A. Auditory hallucinations
- B. Formal thought disorder
- C. Depression
- D. Visual hallucinations (Correct Answer)
Explanation: ***Visual hallucinations*** - While visual hallucinations can occur in primary psychiatric disorders, they are *more commonly* associated with **organic brain lesions** (e.g., tumors, delirium, dementia, substance withdrawal) compared to auditory hallucinations. - They often indicate **neurological dysfunction** and warrant further investigation for an underlying physical cause. *Auditory hallucinations* - **Auditory hallucinations** are a hallmark symptom of **psychotic disorders** such as **schizophrenia**, and are less specific for organic brain lesions unless they are complex and multimodal. - While possible in organic conditions (e.g., temporal lobe epilepsy), they are more strongly linked to functional psychiatric illness than visual hallucinations. *Formal thought disorder* - **Formal thought disorder** (e.g., loosening of associations, word salad, tangentiality) is a core symptom of **schizophrenia** and other primary psychotic disorders. - It is a disturbance in the *form* of thought rather than its content, and is primarily a **psychiatric phenomenon**. *Depression* - **Depression** is a common mood disorder with diverse etiologies, including psychosocial stressors and neurochemical imbalances, but it is not typically indicative of a focal **organic brain lesion**. - Although depression can coexist with neurological conditions, it is not a direct behavioral symptom of a localized brain injury.
Question 8: 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 9: What is the most reliable marker of conversion to psychosis in high-risk individuals?
- A. Social withdrawal
- B. Cognitive decline
- C. Basic symptoms (Correct Answer)
- D. Sleep disruption
Explanation: ***Basic symptoms*** - **Basic symptoms** (BS) are self-experienced, subtle disturbances in mental processes that are considered the most reliable predictors of conversion to psychosis in high-risk individuals. - They reflect early, subclinical alterations in information processing and are often reported before the emergence of more overt psychotic symptoms. *Social withdrawal* - While **social withdrawal** is a common prodromal symptom of psychosis, it is not as specific or reliable as basic symptoms for predicting conversion. - It can be present in various mental health conditions, including depression and anxiety, and may not directly indicate an impending psychotic episode. *Cognitive decline* - **Cognitive decline** can be a feature of the prodromal phase of psychosis but is often measured using objective neuropsychological tests and may not be consistently reported by individuals as a subjective experience in the same way as basic symptoms. - Its predictive power might be lower compared to the direct self-reported nature of basic symptoms. *Sleep disruption* - **Sleep disruption** is a frequent symptom in individuals at high risk for psychosis and can exacerbate other symptoms. - However, it is a non-specific symptom that is common across a wide range of psychiatric disorders and lacks the diagnostic precision of basic symptoms for predicting conversion to psychosis.
Question 10: Which of the following is not a feature of psychosis?
- A. Loss of insight
- B. Preserved contact with reality (Correct Answer)
- C. Personality disturbances
- D. Presence of delusions
Explanation: ***Preserved contact with reality*** - Psychosis is fundamentally characterized by a **loss of contact with reality**, making this option a defining non-feature of the condition. - Individuals experiencing psychosis often have profound difficulties distinguishing between what is real and what is not. *Loss of insight* - **Lack of insight** into one's own mental illness is a hallmark feature of psychosis, meaning the affected individual may not recognize their thoughts or perceptions as abnormal. - This symptom contributes to the difficulty in engaging individuals with psychosis in treatment. *Presence of delusions* - **Delusions** are fixed, false beliefs that are resistant to reason or evidence, and they are a core positive symptom of psychosis. - These beliefs are often bizarre and can significantly impair an individual's functioning and perception of reality. *Personality disturbances* - While not a primary diagnostic criterion, **personality disturbances** can be associated with psychotic disorders. - Changes in personality, mood, and behavior may occur as a result of the psychotic experience or the underlying illness.
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