Psychotic Disorders Practice Questions

Q: Which of the following is not included in delusional misidentification syndromes?

Syndrome of objective doubles. **Explanation:** **Delusional Misidentification Syndromes (DMS)** are a group of disorders where a patient misidentifies people, places, or objects, believing their identity has been altered or replaced. **Why Option D is Correct:** The term **"Syndrome of objective doubles"** is not a recognized clinical entity in psychiatry. The correct term is the **Syndrome of Subjective Doubles**, in which the patient believes that a doppelgänger (a double of themselves) is living a life of its own. Because "objective doubles" is a non-existent term, it is the correct answer to this "except" style question. **Analysis of Incorrect Options:** * **A. Capgras Syndrome:** The most common DMS. The patient believes a person close to them (e.g., a spouse) has been replaced by an identical-looking **imposter**. * **B. Fregoli Syndrome:** The patient believes that different people are actually a **single familiar person** in disguise (the opposite of Capgras). * **C. Syndrome of Intermetamorphosis:** The patient believes that people have swapped identities with each other both physically and psychologically. **NEET-PG High-Yield Pearls:** * **Anatomical Correlation:** DMS is often associated with lesions in the **Right Cerebral Hemisphere** (specifically the bifrontal or right temporoparietal regions). * **Associated Conditions:** While seen in Schizophrenia, these syndromes are highly associated with **Organic Brain Disorders** (e.g., Dementia, Right-sided stroke). * **Reduplicative Paramnesia:** Another DMS where a patient believes a physical location (like a hospital) has been duplicated or moved to another site.

Q: What is the prevalence of schizophrenia in dizygotic twins of a patient with schizophrenia?

12%. **Explanation:** The risk of developing schizophrenia is heavily influenced by genetic proximity. This question tests your knowledge of the **heritability patterns** of schizophrenia. **1. Why 12% is Correct:** The prevalence of schizophrenia in the general population is approximately **1%**. However, for a **dizygotic (fraternal) twin** of an affected individual, the risk increases significantly to approximately **12%**. This is because dizygotic twins share 50% of their genetic material, similar to non-twin siblings. The slight increase over regular siblings (who have an 8%–10% risk) is often attributed to shared prenatal environments. **2. Analysis of Incorrect Options:** * **Option A (40%):** This is incorrect for dizygotic twins but close to the risk for **monozygotic (identical) twins**, which is approximately **47%–50%**. Monozygotic twins share 100% of their DNA. * **Option B (1%):** This represents the **lifetime prevalence in the general population**, not the risk for a first-degree relative. * **Option D (0.10%):** This value is significantly lower than the baseline population risk and is clinically inaccurate. **High-Yield Clinical Pearls for NEET-PG:** * **Highest Risk:** If both parents have schizophrenia, the risk to the offspring is approximately **40%–46%**. * **Monozygotic Twins:** ~47% concordance rate (highest risk for a single relative). * **Dizygotic Twins/Siblings/Children of one parent:** ~10%–12% risk. * **Second-degree relatives (Uncles/Aunts):** ~2% risk. * **Adoption Studies:** These have been crucial in proving that the risk remains high even if the child is raised away from the biological parent, confirming a strong genetic component over purely environmental factors.

Q: A 70-year-old male presents with a history of auditory hallucinations and third-person auditory hallucinations. He has no prior history of similar problems. What is the most likely diagnosis?

Schizophrenia. **Explanation:** The presence of **third-person auditory hallucinations** (voices talking about the patient in the third person) is a classic **Schneiderian First-Rank Symptom (FRS)**. These symptoms are highly characteristic of **Schizophrenia**. While Schizophrenia typically presents in early adulthood, "Very Late-Onset Schizophrenia-Like Psychosis" can occur in patients over age 60, presenting with prominent hallucinations and delusions. **Why the other options are incorrect:** * **Dementia:** While psychotic symptoms can occur in dementia (especially Lewy Body Dementia), the primary clinical feature must be cognitive decline and memory impairment, which are not mentioned here. * **Delusional Disorder:** This diagnosis is characterized by non-bizarre delusions *without* prominent hallucinations. The presence of auditory hallucinations generally excludes this diagnosis. * **Acute Psychosis (Brief Psychotic Disorder):** This diagnosis requires the symptoms to last more than one day but less than one month, often triggered by a stressor. The question implies a stable clinical picture of complex hallucinations, making Schizophrenia the more definitive academic answer for FRS. **Clinical Pearls for NEET-PG:** * **Schneider’s First-Rank Symptoms (FRS):** Includes audible thoughts (thought echo), voices arguing, voices commenting (3rd person), somatic passivity, and thought withdrawal/insertion/broadcast. * **Late-onset Schizophrenia:** More common in females and often associated with sensory deficits (hearing/vision loss). * **Diagnostic Tip:** If a question mentions "voices commenting on the patient's actions" or "voices arguing," always prioritize Schizophrenia as the diagnosis.

Q: A 22-year-old unmarried man presents with a two-week history of sudden onset of third-person hallucinations. He has become suspicious of his family members and reports decreased sleep and appetite. What is the most likely diagnosis?

Acute Psychosis. ### Explanation The correct diagnosis is **Acute Psychosis** (specifically Acute and Transient Psychotic Disorder or ATPD). **1. Why Acute Psychosis is correct:** The key to this diagnosis is the **duration of symptoms**. According to ICD-10/11 and DSM-5 criteria, the patient presents with classic psychotic symptoms (third-person auditory hallucinations and delusions of persecution/suspicion) that have lasted for only **two weeks**. * In **ICD-10**, Acute and Transient Psychotic Disorder is diagnosed if symptoms last less than **1 month**. * In **DSM-5**, this is termed "Brief Psychotic Disorder" if symptoms last between 1 day and 1 month. The sudden onset and short duration (2 weeks) make this the most appropriate clinical fit. **2. Why other options are incorrect:** * **Schizophrenia:** Requires a minimum duration of **6 months** of symptoms (DSM-5) or **1 month** (ICD-10). A two-week history is insufficient for this diagnosis. * **Acute Mania:** While mania can present with psychosis and decreased sleep, the core features of elevated/irritable mood, grandiosity, and increased energy are absent in this clinical vignette. * **Acute Delirium:** Delirium is characterized by a **clouding of consciousness** and fluctuating levels of awareness. This patient is conscious and oriented but psychotic; there is no mention of cognitive impairment or an underlying medical cause. **Clinical Pearls for NEET-PG:** * **Duration Criteria:** 6 months = Schizophrenia (DSM-5). * **Prognosis:** Acute psychosis generally has a better prognosis than schizophrenia, often triggered by a stressful life event. * **Third-person Hallucinations:** These are "Schneiderian First Rank Symptoms" (SFRS), highly suggestive of psychotic spectrum disorders.

Q: Grimacing and Mannerism is characteristic of which subtype of Schizophrenia?

Catatonic Schizophrenia. **Explanation:** **Catatonic Schizophrenia (Option B)** is the correct answer because it is characterized by prominent psychomotor disturbances. These can manifest as either decreased motor activity (stupor, mutism, waxy flexibility) or excessive, purposeless motor activity. **Mannerisms** (stilted, unnatural voluntary movements) and **Grimacing** (odd facial expressions) are classic "positive" motor signs of catatonia. Other features include posturing, negativism, and echopraxia. **Why other options are incorrect:** * **Simple Schizophrenia (Option A):** Characterized by the insidious development of "negative symptoms" (apathy, social withdrawal, poverty of speech) without prominent hallucinations, delusions, or catatonic features. * **Hebephrenic/Disorganized Schizophrenia (Option C):** Primarily involves disorganized speech, disorganized behavior, and flat or inappropriate affect (e.g., giggling). While odd behaviors occur, specific catatonic signs like grimacing and mannerisms are not the defining diagnostic criteria here. * **Phobia (Option D):** This is an anxiety disorder characterized by an irrational fear of specific objects or situations; it has no clinical association with psychotic motor disturbances. **High-Yield Clinical Pearls for NEET-PG:** * **Mannerism vs. Stereotypy:** Mannerisms are goal-directed but executed in an odd, stilted way (e.g., a bizarre salute). Stereotypies are repetitive, non-goal-directed movements (e.g., rocking). * **Waxy Flexibility (Cerea Flexibilitas):** A hallmark of catatonia where the patient maintains positions into which they are placed by the examiner. * **Treatment of Choice:** Benzodiazepines (Lorazepam) are the first-line treatment for catatonia. If unresponsive, Electroconvulsive Therapy (ECT) is highly effective.

Q: Schizophrenia is caused by overactivity in which of the following dopaminergic systems?

Mesolimbic/Mesocortical pathway. **Explanation:** The **Dopamine Hypothesis** of Schizophrenia suggests that the symptoms of the disorder are caused by dysregulation of dopamine in specific brain pathways. 1. **Mesolimbic Pathway:** Overactivity (increased dopamine) in this pathway, which projects from the ventral tegmental area (VTA) to the nucleus accumbens, is responsible for the **positive symptoms** of schizophrenia, such as hallucinations and delusions. 2. **Mesocortical Pathway:** Conversely, underactivity (decreased dopamine) in this pathway, projecting from the VTA to the prefrontal cortex, is associated with **negative symptoms** (e.g., apathy, withdrawal) and cognitive deficits. Because schizophrenia involves a complex interplay of both overactivity and underactivity within these two systems, Option C is the most accurate choice. **Analysis of Incorrect Options:** * **A. Nigrostriatal Pathway:** This pathway controls motor function. It is generally unaffected in schizophrenia but is responsible for **Extrapyramidal Symptoms (EPS)** and Tardive Dyskinesia when dopamine receptors are blocked by antipsychotic medications. * **B. Tuberoinfundibular Pathway:** This pathway regulates prolactin secretion. Dopamine normally inhibits prolactin; therefore, blockade of this pathway by antipsychotics leads to **hyperprolactinemia** (causing galactorrhea and gynecomastia). **High-Yield Clinical Pearls for NEET-PG:** * **Positive Symptoms:** Linked to D2 receptors in the Mesolimbic tract. * **Negative Symptoms:** Linked to D1/D2 receptors in the Mesocortical tract. * **Antipsychotic Mechanism:** Typical antipsychotics primarily block D2 receptors, effectively treating positive symptoms but often worsening negative symptoms or causing EPS due to non-selective blockade across all pathways.

Q: Which one of the following is NOT considered a first-rank symptom of schizophrenia?

Compulsive acts that relieve tension. The correct answer is **D. Compulsive acts that relieve tension.** ### Explanation **Schneider’s First-Rank Symptoms (FRS)** are a group of specific symptoms identified by Kurt Schneider in 1959 that, while not pathognomonic, carry high diagnostic weight for Schizophrenia in the absence of organic brain disease. **Compulsive acts that relieve tension** are characteristic of **Obsessive-Compulsive Disorder (OCD)**, not schizophrenia. In OCD, the patient feels an internal urge to perform an act to neutralize the anxiety caused by an obsession. While schizophrenia can involve "made acts" (the feeling that one's actions are controlled by an external force), the element of tension relief and the recognition of the act as one's own (ego-dystonic) are hallmarks of OCD. ### Why the other options are wrong: * **A. Auditory hallucinations:** Specifically, third-person hallucinations (voices arguing or commenting on the patient's behavior) and "Gedankenlautwerden" (thought echo) are core FRS. * **B. Insertion of thoughts:** This is a **Thought Alienation** phenomenon where the patient believes thoughts are being put into their mind by an external agency. * **C. Delusional perceptions:** This is a two-stage process where a normal perception is suddenly given a private, highly significant, and delusional meaning (e.g., "The traffic light turned red, so I knew I was the King of England"). ### NEET-PG High-Yield Pearls: * **Mnemonic for FRS (ABCD):** **A**uditory Hallucinations, **B**roadcasting of thoughts, **C**ontrolled feelings/acts (Passivity), **D**elusional Perception. * **Thought Alienation:** Includes Thought Insertion, Thought Withdrawal, and Thought Broadcasting. * **Passivity Phenomena:** Includes "Made" Volition, "Made" Affect, and "Made" Impulses. * **Note:** ICD-11 and DSM-5 have de-emphasized FRS because they are not specific to schizophrenia and can occur in bipolar affective disorder.

Question 1

Which of the following is not included in delusional misidentification syndromes?

Accepted Answer

Syndrome of objective doubles

Answer

Capgras syndrome

Answer

Fregoli syndrome

Answer

Syndrome of intermetamorphosis

Question 2

What is the prevalence of schizophrenia in dizygotic twins of a patient with schizophrenia?

Accepted Answer

12%

Answer

40%

Answer

1%

Answer

0.10%

Question 3

A 70-year-old male presents with a history of auditory hallucinations and third-person auditory hallucinations. He has no prior history of similar problems. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Dementia

Answer

Delusional disorder

Answer

Acute psychosis

Question 4

A distinguishing feature of psychotic disorders is

Accepted Answer

Confusion between fantasy and reality

Answer

Suspiciousness

Answer

Obsessions and Compulsions

Answer

Presence of severe depression

Question 5

A 22-year-old unmarried man presents with a two-week history of sudden onset of third-person hallucinations. He has become suspicious of his family members and reports decreased sleep and appetite. What is the most likely diagnosis?

Accepted Answer

Acute Psychosis

Answer

Schizophrenia

Answer

Acute Mania

Answer

Acute Delirium

Question 6

Grimacing and Mannerism is characteristic of which subtype of Schizophrenia?

Accepted Answer

Catatonic Schizophrenia

Answer

Simple Schizophrenia

Answer

Hebephrenic Schizophrenia

Answer

Phobia

Question 7

A 30-year-old unmarried woman of average socio-economic background believes that her boss is secretly in love with her. She calls him at odd hours and writes love letters to him despite his serious warnings not to do so. She maintains this belief despite contradictions from family members and his denials. However, she is able to manage her daily activities as before. She is most likely suffering from which psychiatric disorder?

Accepted Answer

Delusional disorder

Answer

Depression

Answer

Schizophrenia

Answer

No psychiatric ailment

Question 8

Schizophrenia is caused by overactivity in which of the following dopaminergic systems?

Accepted Answer

Mesolimbic/Mesocortical pathway

Answer

Nigrostriatal pathway

Answer

Tuberoinfundibular pathway

Answer

None of the above

Question 9

A 41-year-old woman is convinced that management has denied her promotion by preparing false reports about her competence and forging her signature on sensitive documents to convict her. She files a police complaint and requests security, but continues to attend work and manage her household. What is the most likely diagnosis?

Accepted Answer

Persistent delusional disorder

Answer

Paranoid schizophrenia

Answer

Late onset psychosis

Answer

Obsessive compulsive disorder

Question 10

Which one of the following is NOT considered a first-rank symptom of schizophrenia?

Accepted Answer

Compulsive acts that relieve tension

Answer

Auditory hallucinations

Answer

Insertion of thoughts

Answer

Delusional perceptions

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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