Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 101: Folie à deux is a psychiatric syndrome in which symptoms of a delusionally biased belief system are shared by two or more individuals with unusually close social relationships. Which of the following conditions is most commonly associated with Folie à deux?

A. Obsessive-Compulsive Disorder
B. Paranoid disorder (Correct Answer)
C. Hysteria
D. Neurasthenia

Explanation: **Explanation:** **Folie à deux**, also known as **Shared Psychotic Disorder** (ICD-10: Induced Delusional Disorder), is a rare syndrome where a delusion is transmitted from one individual (the primary/inducer) to another (the secondary/recipient) who are closely related. **Why Paranoid Disorder is Correct:** The core feature of Folie à deux is a **delusion**, most commonly of a **persecutory (paranoid)** nature. The "inducer" typically suffers from a chronic psychotic illness, most frequently **Delusional Disorder (Paranoid Disorder)** or Schizophrenia. The recipient, who is often suggestible or dependent, adopts the inducer’s paranoid belief system due to social isolation and a close emotional bond. **Why Other Options are Incorrect:** * **Obsessive-Compulsive Disorder (A):** Characterized by intrusive thoughts and repetitive behaviors, not fixed false beliefs (delusions). * **Hysteria (C):** Now termed Dissociative or Conversion disorders; these involve physical symptoms or memory loss triggered by psychological stress, not shared delusional systems. * **Neurasthenia (D):** An archaic term for a condition involving fatigue, headache, and irritability; it lacks psychotic features. **NEET-PG High-Yield Pearls:** * **Management:** The primary treatment for the "recipient" is **separation** from the inducer, which often leads to the disappearance of the shared delusion. The inducer requires standard antipsychotic therapy. * **Subtypes:** If more than two people are involved, it is called *folie à trois* (three), *folie à quatre* (four), or *folie à plusieurs* (many). * **Risk Factors:** Social isolation from the outside world is the most significant factor facilitating the transfer of the delusion.

Question 102: Which neurotransmitters are related to schizophrenia pathology?

A. Dopamine and Serotonin (Correct Answer)
B. Acetylcholine and Dopamine
C. Acetylcholine and Serotonin
D. Dopamine and Norepinephrine (NA)

Explanation: ### Explanation **Correct Option: A (Dopamine and Serotonin)** The pathophysiology of Schizophrenia is primarily explained by the **Dopamine Hypothesis** and the **Serotonin Hypothesis**. 1. **Dopamine:** Excessive dopaminergic activity in the **mesolimbic pathway** is linked to positive symptoms (hallucinations, delusions), while decreased activity in the **mesocortical pathway** is linked to negative symptoms (apathy, withdrawal). 2. **Serotonin (5-HT):** The role of serotonin is evidenced by the efficacy of **Atypical Antipsychotics** (e.g., Clozapine, Risperidone), which act as 5-HT2A receptor antagonists. Serotonin modulates dopamine release; blocking 5-HT2A receptors in the cortex increases dopamine release, helping alleviate negative symptoms. **Why other options are incorrect:** * **Option B & C (Acetylcholine):** While cholinergic systems are involved in cognitive functions and smoking behaviors in schizophrenia, they are not considered primary drivers of the core psychotic pathology compared to dopamine and serotonin. * **Option D (Norepinephrine):** Norepinephrine is more significantly associated with **Mood Disorders** (Depression and Mania) and Anxiety/Panic disorders rather than the primary etiology of schizophrenia. **NEET-PG High-Yield Pearls:** * **Glutamate Hypothesis:** Another emerging theory suggests **NMDA receptor hypofunction** contributes to schizophrenia (supported by the fact that Phencyclidine/PCP, an NMDA antagonist, mimics schizophrenia symptoms). * **Pathway Specificity:** * *Mesolimbic:* Positive symptoms. * *Mesocortical:* Negative symptoms. * *Nigrostriatal:* Site for Extrapyramidal Side Effects (EPS). * *Tuberoinfundibular:* Site for Hyperprolactinemia. * **Drug of Choice:** For treatment-resistant schizophrenia, **Clozapine** is the gold standard (acts on D2 and 5-HT2A).

Question 103: A delusional belief about having a subjective double is called:

A. Doppelganger (Correct Answer)
B. Autoscopy
C. Delusion of misidentification
D. Depersonalization

Explanation: **Explanation:** The correct answer is **Doppelganger (Option A)**. This phenomenon, also known as the "phenomenon of the double," is a delusional belief where a person believes they have a subjective double who looks exactly like them and exists in the external world. Unlike other visual hallucinations, the patient does not necessarily see the double with their eyes but "knows" it exists, often perceiving it as an omen of bad luck or death. **Analysis of Options:** * **Autoscopy (Option B):** This is a visual hallucination where the individual sees an image of themselves in external space (an "out-of-body" experience). The key difference is that Autoscopy is a **perceptual** experience (seeing), whereas a Doppelganger is primarily a **delusional** belief or a sense of presence. * **Delusion of Misidentification (Option C):** This is a broad category of syndromes (like Capgras or Fregoli) where patients misidentify familiar people or places. While Doppelganger is technically a subtype, it specifically refers to the "subjective double" of the self, making Option A the most specific answer. * **Depersonalization (Option D):** This is a dissociative symptom where the individual feels detached from themselves, as if they are an outside observer of their own body or mental processes. There is no "double" involved; rather, the self feels "unreal." **High-Yield Clinical Pearls for NEET-PG:** * **Capgras Syndrome:** The belief that a familiar person has been replaced by an identical-looking impostor (the most common delusional misidentification). * **Fregoli Syndrome:** The belief that different people are actually a single person in disguise. * **Intermetamorphosis:** The belief that people have swapped identities with each other both physically and psychologically. * **Heautoscopy:** A variant of autoscopy where the person sees their double but is unsure which "self" is the real one.

Question 104: Which of the following is a first-rank symptom in Schizophrenia?

A. Delusions
B. Thought insertion (Correct Answer)
C. Perceptional hallucinations
D. Word salad

Explanation: **Explanation:** The concept of **First-Rank Symptoms (FRS)** was introduced by **Kurt Schneider** in 1959. These symptoms are considered highly suggestive of Schizophrenia in the absence of organic brain disease, though they are not pathognomonic. **Why Thought Insertion is Correct:** Thought insertion is a classic Schneiderian First-Rank Symptom. It belongs to the category of **"Thought Alienation,"** where the patient believes that thoughts are being put into their mind by an external agency. Other FRS include: * **Auditory Hallucinations:** Specifically third-person voices, running commentary, or thoughts spoken aloud (*Gedankenlautwerden*). * **Thought Alienation:** Thought withdrawal and thought broadcasting. * **Delusional Perception:** A normal perception followed by a private, idiosyncratic delusional interpretation. * **Somatic Passivity:** The belief that bodily sensations are being imposed by an external force. * **Made Phenomena:** Made affect, made volition, and made impulses (feeling that one's feelings or actions are controlled by others). **Why Other Options are Incorrect:** * **Delusions:** While common in Schizophrenia, general delusions are considered **Second-Rank Symptoms** unless they meet the specific criteria of "Delusional Perception." * **Perceptional Hallucinations:** General hallucinations (like visual or simple auditory ones) are not FRS. Only specific types of auditory hallucinations (as listed above) qualify. * **Word Salad:** This is a sign of formal thought disorder (disorganized speech), which is a common feature of Schizophrenia but is not part of Schneider’s FRS. **Clinical Pearls for NEET-PG:** * **Kurt Schneider** defined FRS; **Eugen Bleuler** defined the "4 As" (Autism, Ambivalence, Affective blunting, Association looseness). * FRS are no longer required for a diagnosis in **DSM-5**, but they remain high-yield for exams and are still relevant in **ICD-11**. * The presence of FRS does not necessarily mean a worse prognosis.

Question 105: Who coined the term "Dementia praecox"?

A. Freud
B. Bleuler
C. Kraepelin (Correct Answer)
D. Schneider

Explanation: **Explanation:** The term **"Dementia Praecox"** was coined by **Emil Kraepelin** (Option C). He used this term to describe a group of conditions characterized by a chronic, deteriorating course involving cognitive decline (dementia) and an early onset (praecox), typically in adolescence or early adulthood. Kraepelin is famously known for the **"Kraepelinian Dichotomy,"** where he distinguished between Dementia Praecox (now Schizophrenia) and Manic-Depressive Psychosis (now Bipolar Disorder) based on their clinical course and prognosis. **Analysis of Incorrect Options:** * **A. Sigmund Freud:** Known as the father of psychoanalysis; he focused on the unconscious mind, defense mechanisms, and psychosexual development rather than the classification of psychoses. * **B. Eugen Bleuler:** He replaced the term "Dementia Praecox" with **"Schizophrenia"** in 1911. He argued that the condition did not always lead to dementia and was characterized by a "splitting" of mental functions. He is also famous for the **4 A’s of Schizophrenia** (Ambivalence, Autism, Affective flattening, and Association looseness). * **D. Kurt Schneider:** He focused on the symptomatology of schizophrenia rather than its nomenclature. He is renowned for defining the **"First Rank Symptoms" (FRS)**, which were long used as diagnostic criteria. **High-Yield Clinical Pearls for NEET-PG:** * **Emil Kraepelin:** Coined "Dementia Praecox" and "Paranoia." * **Eugen Bleuler:** Coined "Schizophrenia," "Autism," and "Ambivalence." * **Bénédict Morel:** First used the French term *démence précoce*, but Kraepelin popularized and formalized the clinical entity in his classification system. * **Kurt Schneider:** His First Rank Symptoms (e.g., auditory hallucinations, thought withdrawal/insertion) are classic exam topics.

Question 106: "Agarophobia" is described as which of the following?

A. Fear of closed spaces
B. Fear of crowds (Correct Answer)
C. Fear of night
D. Fear of height

Explanation: **Explanation:** **Agoraphobia** is characterized by an intense fear or anxiety triggered by real or anticipated exposure to situations where escape might be difficult or help might not be available in the event of developing panic-like symptoms. While often simplified as a "fear of open spaces," it clinically manifests as a fear of **crowds**, public transport, or being outside the home alone. In the context of this question, **Option B (Fear of crowds)** is the most accurate description of a situation where an individual feels trapped and vulnerable. **Analysis of Incorrect Options:** * **Option A: Fear of closed spaces** is known as **Claustrophobia**. While agoraphobics may avoid enclosed places (like elevators), the underlying fear is the inability to escape, whereas claustrophobia is specifically about the confinement itself. * **Option C: Fear of night** (or darkness) is known as **Nyctophobia**. * **Option D: Fear of height** is known as **Acrophobia**. **Clinical Pearls for NEET-PG:** * **ICD-10/DSM-5 Criteria:** Agoraphobia is now considered a standalone diagnosis, independent of Panic Disorder, though they frequently co-occur. * **Gender Predominance:** It is significantly more common in females (approx. 2:1 ratio). * **Treatment of Choice:** **Cognitive Behavioral Therapy (CBT)**, specifically graded exposure/flooding, is the most effective psychological intervention. * **Pharmacotherapy:** SSRIs (e.g., Escitalopram, Sertraline) are the first-line pharmacological treatment for long-term management.

Question 107: All are negative symptoms of schizophrenia, except:

A. Anhedonia
B. Hallucination (Correct Answer)
C. Alogia
D. Affective flattening

Explanation: To understand schizophrenia symptoms for NEET-PG, it is essential to distinguish between **Positive** and **Negative** symptoms using the framework of Crow’s Type I and Type II syndromes. ### **Explanation** **Positive symptoms** (Option B) represent an "excess" or distortion of normal function. **Hallucinations** (perception in the absence of external stimuli) and **Delusions** are the hallmark positive symptoms. These are typically associated with dopaminergic hyperactivity in the mesolimbic pathway and generally show a good response to typical antipsychotics. **Negative symptoms** (Options A, C, and D) represent a "loss" or deficit of normal functions. They are often associated with structural brain changes (e.g., ventricular enlargement) and dopaminergic hypoactivity in the mesocortical pathway. * **Anhedonia (Option A):** The inability to experience pleasure from activities usually found enjoyable. * **Alogia (Option C):** Poverty of speech or a reduction in the amount/content of spontaneous speech. * **Affective Flattening (Option D):** A restricted range of emotional expression, characterized by a lack of facial expression and poor eye contact. ### **High-Yield NEET-PG Pearls** * **The 5 A’s of Negative Symptoms:** **A**ffective flattening, **A**logia, **A**volition (lack of motivation), **A**nhedonia, and **A**ttentional impairment. * **Schneider’s First Rank Symptoms (FRS):** These are primarily **positive symptoms** (e.g., audible thoughts, somatic passivity, delusional perception). Note that negative symptoms are *not* part of Schneider’s FRS. * **Prognosis:** The presence of predominant negative symptoms is a predictor of **poor prognosis**, poor social functioning, and resistance to traditional antipsychotic treatment. * **Treatment:** While typical antipsychotics treat positive symptoms, **Atypical Antipsychotics** (e.g., Clozapine, Cariprazine) are preferred for managing negative symptoms.

Question 108: All are formal thought disorders except?

A. Flight of ideas
B. Circumstantiality
C. Loosening of association
D. Obsessive compulsive neurosis (Correct Answer)

Explanation: ### Explanation The core of this question lies in distinguishing between **disorders of the form of thought** (Formal Thought Disorders) and **disorders of the content of thought**. **1. Why "Obsessive Compulsive Neurosis" is the correct answer:** Obsessive-Compulsive Disorder (OCD) is primarily a **disorder of thought content**. In OCD, the patient experiences obsessions—persistent, intrusive, and ego-dystonic ideas, images, or impulses. While the *content* is pathological, the logical structure and flow of the thought process remain intact. Therefore, it is not classified as a formal thought disorder (FTD). **2. Analysis of Incorrect Options (Formal Thought Disorders):** Formal Thought Disorders (FTDs) involve a breakdown in the logical connection between ideas or the speed and flow of thinking. * **Flight of Ideas:** Characterized by rapid shifting from one idea to another, usually connected by rhymes, puns, or environmental stimuli (seen typically in **Mania**). * **Circumstantiality:** The patient includes excessive, unnecessary detail before eventually reaching the goal of the thought. * **Loosening of Association (Knight’s Move Thinking):** A hallmark of **Schizophrenia**, where there is a lack of logical connection between successive thoughts, making the speech incoherent. ### NEET-PG Clinical Pearls * **Thought Content Disorders:** Include Delusions, Obsessions, Phobias, and Overvalued ideas. * **Thought Form (FTD) Disorders:** Include Derailment, Tangentiality, Neologisms, and Word Salad. * **Circumstantiality vs. Tangentiality:** In circumstantiality, the patient eventually reaches the goal; in tangentiality, they never return to the original point. * **Pressure of Speech:** Often accompanies Flight of Ideas in manic episodes.

Question 109: Which of the following indicates a poor prognosis in Schizophrenia?

A. Late age at onset
B. Family history of mania
C. Type I Schizophrenia
D. Insidious onset (Correct Answer)

Explanation: In Schizophrenia, prognosis is determined by the clinical presentation, onset, and premorbid functioning of the patient. **Explanation of the Correct Answer:** **Insidious onset** (Option D) is a major indicator of a **poor prognosis**. A slow, creeping onset often reflects a deep-seated neurodevelopmental pathology. It is frequently associated with "negative symptoms" (apathy, withdrawal), poor premorbid adjustment, and structural brain changes. Because the illness develops gradually, there is often a long **Duration of Untreated Psychosis (DUP)**, which is strongly correlated with poor treatment response and cognitive decline. **Analysis of Incorrect Options:** * **A. Late age at onset:** This is a **good prognostic factor**. Patients who develop schizophrenia later in life usually have better social and occupational development (premorbid adjustment) and more "positive symptoms" which respond better to antipsychotics. * **B. Family history of mania:** A family history of **Mood Disorders** (like Mania or Depression) is actually a **good prognostic factor**. It suggests that the patient’s psychosis may have an affective component, which generally carries a better outcome than a pure schizophrenic lineage. * **C. Type I Schizophrenia:** Proposed by Timothy Crow, Type I is characterized by **positive symptoms** (hallucinations, delusions), normal brain structure, and good response to medication. Therefore, it has a **better prognosis** than Type II (negative symptoms). **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognostic Factor:** Good premorbid adjustment. * **Gender:** Females generally have a better prognosis than males (later onset, better social functioning). * **Environment:** Patients in developing countries often have a better prognosis than those in developed countries (due to better social support systems). * **Precipitating factors:** The presence of a clear stressful trigger (reactive schizophrenia) indicates a better prognosis compared to no trigger.

Question 110: Which psychiatric condition is characterized by the psychopathologies of waxy flexibility, negativism, and rigidity?

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

Explanation: **Explanation:** The correct answer is **Catatonic Schizophrenia**. This subtype is primarily characterized by marked psychomotor disturbances, which can involve either motoric immobility (stupor) or excessive motor activity. **1. Why Catatonic Schizophrenia is Correct:** The symptoms listed—**waxy flexibility** (cerea flexibilitas), **negativism**, and **rigidity**—are classic "catatonic signs." * **Waxy Flexibility:** The patient can be molded into a position and maintains it for a prolonged period. * **Negativism:** An apparently motiveless resistance to all instructions or attempts to be moved. * **Rigidity:** Maintaining a stiff posture against all efforts to be moved. Other features include mutism, posturing, echolalia (repeating words), and echopraxia (repeating actions). **2. Why Other Options are Incorrect:** * **Paranoid Schizophrenia:** Characterized predominantly by delusions (usually persecutory or grandiose) and hallucinations. Psychomotor disturbances are typically absent. * **Hebephrenic (Disorganized) Schizophrenia:** Characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect (silliness). * **Negative Schizophrenia:** Refers to Type II schizophrenia dominated by the "5 A's": Affective flattening, Alogia, Avolition, Anhedonia, and Attention deficit. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Benzodiazepines (specifically **Lorazepam**) are the first-line treatment for catatonia. * **Most Effective Treatment:** Electroconvulsive Therapy (ECT) is highly effective, especially if the patient is non-responsive to Lorazepam or is in a life-threatening state (Lethal Catatonia). * **ICD-11/DSM-5 Update:** In modern psychiatry, "Catatonia" is now treated as a specifier that can be associated with various mental disorders (like Bipolar or Depression), not just schizophrenia.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free