Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 91: What is the estimated percentage of schizophrenia in first-degree relatives?

A. 1.25%
B. 2.40%
C. 6.40% (Correct Answer)
D. 4.35%

Explanation: ### Explanation **Concept:** Schizophrenia has a strong genetic component, and the risk of developing the disorder increases significantly with the degree of genetic relatedness to an affected individual. In the general population, the lifetime prevalence is approximately **1%**. For **first-degree relatives** (parents, siblings, and children), the risk is substantially higher. **Why 6.40% is correct:** According to standard psychiatric textbooks (such as Kaplan & Sadock), the pooled risk for first-degree relatives is approximately **6% to 10%**. Specifically, the risk for a **sibling** of a patient with schizophrenia is often cited around **7-9%**, while the risk for a **parent** is approximately **6%**. Option C (6.40%) represents the most accurate statistical estimate among the choices provided for the average risk across all first-degree relatives. **Analysis of Incorrect Options:** * **A (1.25%):** This value is close to the **general population risk** (approx. 1%). It does not account for the increased genetic load in relatives. * **B (2.40%) & D (4.35%):** These values underestimate the genetic predisposition. While higher than the general population, they fall below the established clinical threshold for first-degree risk. **High-Yield Clinical Pearls for NEET-PG:** * **Monozygotic (Identical) Twins:** Highest risk (~40–50% concordance). * **Dizygotic (Fraternal) Twins:** ~10–15% risk. * **Both Parents Affected:** ~40–46% risk. * **One Parent Affected:** ~10–12% risk. * **Second-degree relatives (Uncles/Aunts):** ~2–3% risk. * **Key Takeaway:** If a question asks for the "highest risk group," the answer is always the **Monozygotic twin** or **offspring of two affected parents**.

Question 92: A 40-year-old male has recently started writing books. The content of his writing is incomprehensible, containing neologisms and a disjointed theme. He has become shy and self-absorbed, and when he speaks to people, he discusses metaphilosophical ideas. What is the most likely diagnosis?

A. Mania
B. Schizophrenia (Correct Answer)
C. A genius writer
D. Delusional disorder

Explanation: **Explanation:** The clinical presentation points toward **Schizophrenia**, specifically highlighting formal thought disorder and negative symptoms. 1. **Why Schizophrenia is correct:** * **Formal Thought Disorder:** The use of **neologisms** (coining new words with private meanings) and a **disjointed theme** (loosening of associations) are hallmark signs of disorganized thinking in schizophrenia. * **Metaphilosophical Preoccupation:** Patients often exhibit "vague logic" or preoccupation with esoteric, abstract, or philosophical ideas that lack concrete grounding. * **Negative Symptoms:** Becoming "shy and self-absorbed" reflects **social withdrawal** and **autistic thinking** (one of Bleuler’s 4 As), where the patient’s internal world replaces external reality. 2. **Why other options are incorrect:** * **Mania:** While manic patients show pressured speech and flight of ideas, their thoughts are usually understandable (though rapid). Mania typically presents with euphoria, hyperactivity, and decreased need for sleep, rather than social withdrawal and self-absorption. * **A genius writer:** While creativity can be unconventional, "incomprehensible" content and "neologisms" are pathological markers of a thought disorder, not artistic expression. * **Delusional disorder:** This is characterized by non-bizarre delusions (e.g., being followed) in an otherwise high-functioning individual. It does not feature neologisms, disorganized speech, or significant social withdrawal. **Clinical Pearls for NEET-PG:** * **Bleuler’s 4 As of Schizophrenia:** **A**ffective flattening, **A**utism (social withdrawal), **A**mbivalence, and **A**ssociation looseness. * **Neologism:** A "word salad" component where the patient creates new words; it is highly suggestive of schizophrenia. * **Schneider’s First Rank Symptoms (FRS):** Though not mentioned here, FRS (like thought insertion/broadcast) are diagnostic cornerstones for the exam.

Question 93: What is the drug of choice for the treatment of negative symptoms of schizophrenia?

A. Chlorpromazine
B. Haloperidol
C. Clozapine (Correct Answer)
D. Doxepin

Explanation: **Explanation:** The treatment of schizophrenia involves managing both **positive symptoms** (hallucinations, delusions) and **negative symptoms** (apathy, social withdrawal, anhedonia, alogia). **Why Clozapine is the Correct Answer:** Clozapine is an **Atypical Antipsychotic (Second-Generation Antipsychotic)**. Unlike typical antipsychotics that primarily block Dopamine (D2) receptors, atypical agents like Clozapine also block **Serotonin (5-HT2A) receptors**. This dual action increases dopamine release in the prefrontal cortex, which is physiologically linked to the improvement of negative symptoms and cognitive deficits. Clozapine is considered the "gold standard" for treatment-resistant schizophrenia and is particularly effective for persistent negative symptoms. **Analysis of Incorrect Options:** * **A & B (Chlorpromazine & Haloperidol):** These are **Typical Antipsychotics (First-Generation)**. They are potent D2 receptor antagonists. While highly effective against positive symptoms, they are generally ineffective against negative symptoms and may even worsen them by causing "secondary negative symptoms" due to extrapyramidal side effects (EPS) and sedation. * **D (Doxepin):** This is a **Tricyclic Antidepressant (TCA)**. It is used for depression and insomnia, not for the primary treatment of psychotic disorders or negative symptoms of schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Clozapine Side Effects:** Most serious is **Agranulocytosis** (requires mandatory WBC monitoring). It also has the highest risk of **seizures**, weight gain, and sialorrhea (drooling), but the **lowest risk of EPS**. * **Drug of Choice (DOC):** While Clozapine is the DOC for negative symptoms and treatment-resistant cases, **Risperidone** or other atypicals are often first-line due to Clozapine's side-effect profile. * **Suicide:** Clozapine is the only antipsychotic proven to reduce the risk of suicide in schizophrenia.

Question 94: Erotomania is a feature of which of the following conditions?

A. Bipolar mania (Correct Answer)
B. Unipolar mania
C. Neurosis
D. Obsessive-compulsive disorder

Explanation: **Explanation:** **Erotomania** (also known as **De Clérambault's Syndrome**) is a delusional belief that another person, usually of higher social status or a celebrity, is deeply in love with the patient. 1. **Why Bipolar Mania is correct:** Erotomania is most commonly encountered as a symptom of **Delusional Disorder (Erotomanic type)** or as a feature of **Bipolar I Disorder during a manic episode**. In the context of mania, the patient’s heightened self-esteem (grandiosity) and increased psychomotor agitation often manifest as the delusional conviction that they are the object of someone’s affection. Since "Delusional Disorder" is not an option, Bipolar Mania is the most clinically relevant choice. 2. **Why other options are incorrect:** * **Unipolar Mania:** This is an outdated clinical term. Almost all patients who experience mania will eventually experience depression, thus they are classified under Bipolar Disorder. * **Neurosis:** This is a broad, archaic term for non-psychotic conditions (like anxiety). Erotomania is a **psychotic** symptom (delusion) and does not fit here. * **Obsessive-Compulsive Disorder (OCD):** OCD involves intrusive thoughts (obsessions) recognized as irrational by the patient. Erotomania is a fixed, false belief (delusion) held with absolute certainty, making it a psychotic feature rather than an obsession. **High-Yield Clinical Pearls for NEET-PG:** * **De Clérambault's Syndrome:** Primary erotomania occurring in the absence of other psychotic symptoms. * **Demographics:** More common in females in clinical settings, though forensic cases often involve males (stalking behavior). * **Old vs. New:** In the DSM-5, it is classified under **Delusional Disorder**. * **Key Distinction:** Unlike simple infatuation, the patient believes the "lover" initiated the relationship through "secret signals" (e.g., telepathy or TV messages).

Question 95: A 56-year-old man is brought to the clinic by his wife due to a noted personality change over the past 3 months. During the interview, the patient answers every question with the same three words. Which symptom best describes this patient's behavior?

A. Negative symptoms
B. Disorientation
C. Concrete thinking
D. Perseveration (Correct Answer)

Explanation: ### Explanation **Correct Option: D. Perseveration** Perseveration is a formal thought disorder characterized by the **persistent repetition of a specific response** (words, phrases, or gestures) despite the absence or cessation of the original stimulus. In this clinical scenario, the patient’s inability to shift his mental set, resulting in the same three-word answer for every question, is a classic hallmark of perseveration. It is frequently associated with organic brain syndromes, particularly **Frontal Lobe lesions** or dementias. **Why other options are incorrect:** * **A. Negative symptoms:** These are core features of schizophrenia (e.g., anhedonia, avolition, affective flattening, alogia). While "alogia" involves poverty of speech, it does not specifically describe the repetitive, "stuck" nature of the patient's responses. * **B. Disorientation:** This refers to a lack of awareness regarding time, place, or person. While a disoriented patient might give incorrect answers, they do not typically repeat the same phrase for every different query. * **C. Concrete thinking:** This is the inability to understand abstract concepts or metaphors (e.g., failing to interpret a proverb). The patient would provide literal answers rather than repetitive ones. **High-Yield Clinical Pearls for NEET-PG:** * **Perseveration vs. Palilalia:** Perseveration is repeating a response to different stimuli; **Palilalia** is the repetition of one’s own words with increasing frequency and decreasing volume (common in Parkinsonism). * **Verbigeration (Word Salad):** Senseless repetition of specific words/phrases without any stimulus (often seen in Catatonic Schizophrenia). * **Echolalia:** Meaningless repetition of another person’s spoken words (seen in Autism, Schizophrenia, and Tourette’s). * **Frontal Lobe Signs:** Personality changes combined with perseveration strongly suggest a frontal lobe pathology (e.g., Pick’s disease or tumors).

Question 96: A 30-year-old man believes that aliens have put an implant in his body and he feels a pushing sensation. Which type of hallucination best suits his description?

A. Auditory hallucination
B. Cenesthetic hallucination (Correct Answer)
C. Gustatory hallucination
D. Visual hallucination

Explanation: ### Explanation **Correct Option: B. Cenesthetic hallucination** The patient is describing a **cenesthetic hallucination**, which refers to a false perception of internal visceral or bodily sensations in the absence of an external stimulus. In this case, the "pushing sensation" attributed to an alien implant is a classic example. Unlike tactile hallucinations (which occur on the skin surface), cenesthetic hallucinations involve deep-seated sensations within the body, such as feelings of organs being pulled, twisted, or foreign objects being implanted. These are frequently associated with Schizophrenia. **Analysis of Incorrect Options:** * **A. Auditory hallucination:** These involve hearing sounds or voices (e.g., running commentary or third-person voices). While they are the most common type of hallucination in Schizophrenia, they do not match the physical "pushing" sensation described. * **C. Gustatory hallucination:** These involve false perceptions of taste (often unpleasant or metallic). These are rare and more commonly associated with temporal lobe epilepsy or organic brain lesions. * **D. Visual hallucination:** These involve seeing things that are not present. While common in organic brain syndromes (delirium) or drug withdrawal, they do not account for the internal bodily sensation mentioned. **High-Yield Clinical Pearls for NEET-PG:** * **Tactile (Haptic) Hallucinations:** Occur on the skin. A specific subtype is **Formication** (feeling of insects crawling under the skin), highly characteristic of **Cocaine withdrawal** (Cocaine bugs) or Delirium Tremens. * **Extracampine Hallucination:** A hallucination that occurs outside the normal sensory field (e.g., seeing someone standing behind you while looking forward). * **Functional Hallucination:** A hallucination triggered by a real stimulus in the same sensory modality (e.g., hearing voices only when the tap is running). * **Reflex Hallucination:** A stimulus in one sensory modality triggers a hallucination in another (e.g., seeing colors when hearing music).

Question 97: A 23-year-old male with schizophrenia, currently maintained on risperidone for 2 months, has no family history of the disease. For how long should the medication be continued?

A. 5 years
B. 6 months
C. 2 years (Correct Answer)
D. 12 months

Explanation: **Explanation:** The duration of maintenance therapy in schizophrenia is primarily determined by the number of psychotic episodes and the risk of relapse. 1. **Why Option C (2 years) is correct:** According to standard psychiatric guidelines (APA and Maudsley), for a patient experiencing their **first episode of schizophrenia** who has achieved clinical remission, maintenance treatment with antipsychotics should be continued for **1 to 2 years**. This period is crucial to prevent relapse and ensure neuronal stabilization. Since the patient is 23 years old and there is no mention of prior episodes, this is treated as a first-episode case, making 2 years the most appropriate choice among the options. 2. **Why other options are incorrect:** * **Option B (6 months):** This duration is typically reserved for a "Brief Psychotic Disorder" or the initial stabilization phase, but it is insufficient for Schizophrenia, where the risk of relapse is high. * **Option D (12 months):** While some guidelines suggest 1 year, most competitive exams and clinical standards prefer the 2-year mark for a first episode to ensure long-term stability. * **Option A (5 years):** This duration is indicated for patients who have had **multiple episodes** (recurrent schizophrenia) or those with a history of violent behavior or severe relapses. **High-Yield Clinical Pearls for NEET-PG:** * **First Episode:** 1–2 years of maintenance. * **Second/Multiple Episodes:** At least 5 years of maintenance. * **Chronic/Severe Relapses:** May require lifelong treatment. * **Risk of Relapse:** Approximately 80% of patients relapse within 5 years if medication is discontinued prematurely. * **Risperidone:** An atypical antipsychotic; monitor for hyperprolactinemia and extrapyramidal symptoms (EPS) at higher doses.

Question 98: A 36-year-old individual has a firm belief that his wife is having an affair. He often sits alone, muttering to himself, and hears voices commenting about him. He was completely normal two weeks prior. What is the most likely diagnosis?

A. Schizophrenia
B. Delusional disorder
C. Acute psychosis (Correct Answer)
D. Somatoform disorder

Explanation: **Explanation:** The correct diagnosis is **Acute Psychosis** (specifically Acute and Transient Psychotic Disorder as per ICD-10, or Brief Psychotic Disorder as per DSM-5). **1. Why Acute Psychosis is correct:** The clinical presentation includes core psychotic symptoms: a **delusion** (belief of infidelity/delusional jealousy) and **auditory hallucinations** (voices commenting). The defining factor in this case is the **duration**. The patient was "completely normal two weeks prior," meaning the symptoms have lasted less than one month. In psychiatric classification, psychotic symptoms lasting more than one day but less than one month are categorized as Acute Psychotic Disorder. **2. Why other options are incorrect:** * **Schizophrenia:** Requires a minimum duration of **6 months** (DSM-5) or **1 month** (ICD-10) of continuous symptoms. A two-week duration is insufficient for this diagnosis. * **Delusional Disorder:** Characterized by non-bizarre delusions lasting at least 1 month. Crucially, in Delusional Disorder, prominent hallucinations (like the commenting voices seen here) are typically absent, and the patient’s functioning is not markedly impaired outside the delusion. * **Somatoform Disorder:** This involves physical symptoms (pain, fatigue) that suggest a medical condition but are not fully explained by one. It does not involve psychosis (delusions or hallucinations). **Clinical Pearls for NEET-PG:** * **Duration Criteria:** * < 1 month: Acute/Brief Psychotic Disorder. * 1 to 6 months: Schizophreniform Disorder. * \> 6 months: Schizophrenia. * **Prognosis:** Acute psychosis often has a sudden onset (within 2 weeks) and a good prognosis, frequently triggered by a stressful life event. * **Delusional Jealousy:** Also known as **Othello Syndrome**, it can be a feature of various psychotic disorders or chronic alcoholism.

Question 99: In which subtype of schizophrenia is grimacing a characteristic feature?

A. Juvenile
B. Hebephrenic
C. Paranoid
D. Catatonic (Correct Answer)

Explanation: ### Explanation **Correct Option: D. Catatonic** **Why it is correct:** Grimacing is a classic feature of **Catatonic Schizophrenia**. In this subtype, patients exhibit prominent psychomotor disturbances. Grimacing falls under the category of **mannerisms** or **stereotypies**, where the patient maintains odd, fixed facial expressions or performs repetitive, purposeless facial movements. According to ICD-10 and DSM criteria, catatonia involves a constellation of motor signs including stupor, waxy flexibility, mutism, posturing, and mannerisms (like grimacing). **Analysis of Incorrect Options:** * **A. Juvenile:** This is not a formal clinical subtype in modern classification (ICD/DSM). While schizophrenia can occur in childhood (Early Onset Schizophrenia), it is not defined by grimacing. * **B. Hebephrenic (Disorganized):** While hebephrenic schizophrenia is characterized by shallow/inappropriate affect, giggling, and disorganized speech, the specific motor sign of "grimacing" is classically associated with the motoric pathology of catatonia. However, some overlap exists as hebephrenics may show "facies" changes, but catatonia remains the primary association for this sign in exams. * **C. Paranoid:** This is the most common subtype, characterized by delusions of persecution or grandeur and auditory hallucinations. Motor symptoms like grimacing are typically absent. **Clinical Pearls for NEET-PG:** * **Waxy Flexibility (Cerea Flexibilitas):** The patient's limbs can be molded into positions that are then maintained for long periods. * **Mitmachen:** The patient moves their body in response to slight pressure, even if told to resist. * **Mitgehen:** An extreme form of Mitmachen where the patient moves with the slightest touch ("anglepoise lamp" effect). * **Drug of Choice:** Benzodiazepines (Lorazepam) are the first-line treatment for catatonia; if ineffective, Electroconvulsive Therapy (ECT) is the most effective treatment.

Question 100: What is nihilistic delusion?

A. A false feeling of remorse or guilt.
B. A false belief about having a severe medical illness.
C. A false belief that the world is about to end. (Correct Answer)
D. A false belief that one is infested with small but visible organisms.

Explanation: **Explanation** **Nihilistic delusion** (also known as delusion of negation) is a psychopathological state where a patient believes that they, a part of their body, or the external world no longer exists or is about to cease existing. The correct answer is **C** because the belief that the world is coming to an end is a classic manifestation of nihilistic thinking. **Analysis of Options:** * **Option A:** This describes a **delusion of guilt**, commonly seen in severe depressive episodes where patients feel responsible for catastrophes or minor past transgressions. * **Option B:** This refers to **hypochondriacal delusions** (somatic delusions), where the patient is convinced they have a specific disease (e.g., cancer or HIV) despite negative medical evidence. * **Option D:** This is the definition of **Ekbom’s syndrome** (delusional parasitosis), often associated with tactile hallucinations (formication). **Clinical Pearls for NEET-PG:** 1. **Cotard’s Syndrome:** This is the extreme form of nihilistic delusion where a patient claims they are "dead," "rotting," or have "lost their internal organs." 2. **Diagnostic Association:** While nihilistic delusions can occur in schizophrenia, they are most characteristically associated with **Psychotic Depression** (especially in the elderly). 3. **Key Distinction:** Do not confuse nihilism with *suicidal ideation*; while both occur in depression, nihilism is a formal thought content disorder involving the denial of existence. 4. **Management:** Severe cases with Cotard’s syndrome often require **Electroconvulsive Therapy (ECT)** due to the high risk of self-neglect and refusal to eat.

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

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