Outcome and Prognosis — MCQs
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?
Early onset and bad prognosis is seen in
In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?
NOT a good prognostic factor for TB spine
Which of the following is considered a good prognostic factor for schizophrenia?
Which of the following statements is NOT true about type 1 schizophrenia?
A patient inventing new words is a feature of?
A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?
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?
Best predictor of good prognosis in anorexia nervosa is:
Outcome and Prognosis Indian Medical PG Practice Questions and MCQs
Question 1: 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 2: Early onset and bad prognosis is seen in
- A. Hebephrenic (Correct Answer)
- B. Catatonic
- C. Paranoid
- D. Schizo affective
Explanation: ***Hebephrenic*** - **Hebephrenic schizophrenia** (now typically referred to as **disorganized type**) often has an **early onset** in adolescence or young adulthood. - It is characterized by severe disorganization of thought, affect, and behavior, leading to a generally **poor prognosis** due to rapid deterioration and chronic course. *Catatonic* - **Catatonic schizophrenia** is marked by prominent psychomotor disturbances, such as stupor, catalepsy, or excitement. - While it can be severe, its **prognosis can vary** significantly and is not consistently worse than hebephrenic, especially with antipsychotic treatment. *Paranoid* - **Paranoid schizophrenia** is characterized by prominent delusions (often persecutory or grandiose) and hallucinations, typically with a later onset than disorganized type. - It generally has a **better prognosis** than disorganized or catatonic types, as cognitive function and affect may be relatively preserved. *Schizo affective* - **Schizoaffective disorder** involves features of both schizophrenia and a mood disorder (depressive or bipolar type). - Its prognosis is considered to be **intermediate** between that of schizophrenia and mood disorders, generally better than disorganized schizophrenia but worse than mood disorders alone.
Question 3: In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?
- A. Magical thinking
- B. Contamination
- C. Hoarding (Correct Answer)
- D. Pathological doubt
Explanation: ***Hoarding*** - **Hoarding** in OCD is considered a **poor prognostic factor** for ERP therapy due to the severe avoidance of discarding items and the strong emotional attachment to possessions. - Individuals with hoarding symptoms often display **low insight** into the irrationality of their hoarding behavior, making it more challenging to engage in and benefit from ERP. *Magical thinking* - While magical thinking can be a feature of OCD, it is not consistently associated with a **worse prognosis** in ERP compared to other symptom dimensions, especially when compared to hoarding. - ERP can effectively target rituals and compulsions driven by magical thoughts by gradually exposing the individual to feared outcomes without enacting the ritual. *Contamination* - **Contamination fears**, though distressing, often respond well to ERP through exposure to feared contaminants and prevention of washing/cleaning rituals. - While challenging, it is generally considered to have a **better prognosis** with ERP than hoarding. *Pathological doubt* - **Pathological doubt**, a core feature of many OCD presentations, is addressed in ERP by exposing individuals to situations that trigger doubt and preventing excessive checking or seeking reassurance. - Like contamination, it typically has a **more favorable prognosis** with ERP compared to hoarding due to the direct ability to target and prevent the compulsive behaviors.
Question 4: NOT a good prognostic factor for TB spine
- A. Young age
- B. Good immunity
- C. Rapid onset (Correct Answer)
- D. Early diagnosis
Explanation: ***Rapid onset*** - A **rapid onset** of symptoms in TB spine can indicate aggressive disease progression and may be associated with a poorer prognosis [1]. - This suggests the infection is advancing quickly, potentially leading to more severe neurological deficits or bone destruction before effective treatment can be initiated [1]. *Young age* - **Young age** is generally considered a good prognostic factor for TB spine, as younger patients often have better bone healing capacity and immune responses. - They tend to respond more effectively to antitubercular treatment and have a lower incidence of severe complications compared to older adults. *Good immunity* - A **robust immune system** is crucial for controlling *Mycobacterium tuberculosis* infection and is a key factor in achieving a favorable outcome in TB spine. - Patients with good immunity are more likely to clear the infection, prevent widespread dissemination, and experience less severe bone and neurological damage. *Early diagnosis* - **Early diagnosis** allows for prompt initiation of appropriate antitubercular therapy, which is essential for preventing disease progression and minimizing complications. - **Timely treatment** reduces the risk of spinal deformities, neurological deficits, and the need for extensive surgical intervention, leading to a better prognosis.
Question 5: Which of the following is considered a good prognostic factor for schizophrenia?
- A. Childhood onset of symptoms
- B. Acute onset of symptoms (Correct Answer)
- C. Poor premorbid functioning
- D. Predominant negative symptoms
Explanation: ***Acute onset of symptoms*** - An **acute onset of symptoms** is one of the most well-established **good prognostic factors** in schizophrenia. - It suggests a more sudden disturbance rather than a gradual deterioration process, indicating better potential for treatment response and remission. - This typically means the individual experienced a more defined break from baseline functioning, which is more amenable to intervention. *Childhood onset of symptoms* - **Childhood onset** (or very early onset) schizophrenia is associated with a **poor prognosis**, often due to more pervasive neurodevelopmental abnormalities and prolonged impact on development. - Individuals with childhood onset often have more severe symptoms, greater cognitive deficits, and poorer functional outcomes. *Poor premorbid functioning* - **Poor premorbid functioning** (e.g., social isolation, academic difficulties before symptom onset) is a well-established indicator of **poor prognosis** in schizophrenia. - This suggests pre-existing vulnerabilities and less developed coping mechanisms, making recovery more challenging. *Predominant negative symptoms* - **Predominant negative symptoms** (e.g., avolition, alogia, affective flattening, anhedonia) are associated with **poor prognosis** in schizophrenia. - Negative symptoms are less responsive to antipsychotic medications compared to positive symptoms and are strongly associated with worse functional outcomes and greater disability.
Question 6: 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 7: A patient inventing new words is a feature of?
- A. Schizophrenia (Correct Answer)
- B. Aphasia
- C. Neurotic disorders
- D. Obsessive-Compulsive Disorder (OCD)
Explanation: ***Schizophrenia*** - The invention of new words, known as **neologisms**, is a characteristic symptom of **thought disorder** in schizophrenia. - These words often have personal meaning to the patient but are unintelligible to others, reflecting disturbed communication. *Neurotic disorders* - These disorders, such as anxiety and phobias, primarily involve **distress and maladaptive coping mechanisms** but do not typically feature neologisms. - **Thought content** may be ruminative or anxious, but not disorganized to the extent of inventing new words. *Aphasia* - Aphasia is a **language disorder caused by brain damage** (e.g., stroke), resulting in difficulty with language production or comprehension. - While it can involve word-finding difficulties or paraphasias (word substitutions), it is distinctly different from the deliberate invention of new, non-existent words seen in psychosis. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by **recurrent, intrusive thoughts (obsessions)** and repetitive behaviors (compulsions). - It does not involve thought disorganization or the creation of neologisms; language remains structured, though often focused on obsessive themes.
Question 8: A 45-year-old female presents to the OPD with complaints of "feeling tense" and experiencing stomach upset with heartburn and diarrhea. She reports having these symptoms for many years and mentions that her family members also usually feel tense and nervous. Which of the following symptoms is most likely to be seen in this patient?
- A. Ideas of reference
- B. Tingling of extremities (Correct Answer)
- C. Hallucination
- D. Neologism
Explanation: ***Tingling of extremities*** - The patient's presentation of "feeling tense," **stomach upset, heartburn, and diarrhea** for many years, alongside a family history of similar issues, suggests significant **anxiety**. - **Peripheral neurological symptoms** such as **tingling of extremities (paresthesia)** are common manifestations of anxiety and panic attacks due to **hyperventilation** (causing respiratory alkalosis and decreased ionized calcium) and **physiological arousal**. *Ideas of reference* - **Ideas of reference** are typically seen in **psychotic disorders** (e.g., schizophrenia) where a person believes that unrelated, external events have a special, personal meaning. - While anxiety can sometimes lead to misinterpretations, **ideas of reference** at a delusional level are not characteristic of generalized anxiety. *Hallucination* - **Hallucinations** are perceptual disturbances where an individual experiences sensory perceptions (e.g., hearing voices, seeing things) in the absence of an external stimulus. - These are core symptoms of **psychotic disorders** and are not typical findings in anxiety disorders without comorbid conditions. *Neologism* - A **neologism** is the coining of new words or phrases, often without clear meaning, which is a hallmark feature of disorganized thought in **psychotic disorders** (e.g., schizophrenia). - This symptom is related to severe thought disorganization and is not associated with anxiety disorders.
Question 9: 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.
Question 10: Best predictor of good prognosis in anorexia nervosa is:
- A. Early treatment
- B. Higher BMI at diagnosis
- C. Shorter duration (Correct Answer)
- D. Supportive family
Explanation: ***Shorter duration*** - **Shorter duration of illness** before treatment is consistently identified as one of the strongest predictors of good prognosis in anorexia nervosa. - Duration encompasses the total time the illness has existed, capturing the chronicity and entrenchment of maladaptive eating behaviors, psychological patterns, and physiological complications. - Patients with **brief illness duration** before intervention have higher rates of **full recovery** (up to 50-70% in some studies) compared to those with chronic illness (20-30% recovery rates). - Shorter duration indicates less time for the development of severe medical complications (osteoporosis, cardiac abnormalities) and entrenched psychological patterns that are harder to reverse. *Early treatment* - While **early treatment initiation** is extremely important and strongly correlated with better outcomes, it is typically a function of recognizing and intervening in an illness of short duration. - The benefit of early treatment is largely because it prevents the illness from becoming chronic; thus, duration remains the more fundamental prognostic indicator. - Both concepts overlap significantly, but duration captures the complete timeframe of illness pathology. *Higher BMI at diagnosis* - A **higher BMI at diagnosis** suggests less severe weight loss and may indicate less severe restriction, but it is not as strong a predictor as duration. - Patients can have relatively higher BMI but still have chronic illness with poor prognosis if the duration has been extended. *Supportive family* - A **supportive family** is crucial for treatment adherence, recovery, and relapse prevention, and is indeed a positive prognostic factor. - However, family support alone cannot overcome the physiological and psychological damage of prolonged illness duration. - In pediatric/adolescent populations, family-based therapy (FBT) outcomes are best when the **illness duration is short** at treatment onset.
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