Psychotic Disorders Practice Questions

Q: A 24-year-old occasional alcoholic presents with a change in behavior, including suspiciousness that people are conspiring against him, despite his father stating there is no apparent reason for his fears. He is also experiencing auditory hallucinations where voices comment on his actions. What is the most probable diagnosis?

Schizophrenia. **Explanation:** The diagnosis is **Schizophrenia** based on the presence of characteristic "First Rank Symptoms" (FRS) and the patient’s age. **1. Why Schizophrenia is correct:** The patient exhibits two core diagnostic features of Schizophrenia according to ICD-11 and DSM-5: * **Persecutory Delusions:** Suspiciousness and the belief that people are conspiring against him (fixed false beliefs). * **Third-person Auditory Hallucinations:** Voices "commenting on his actions" are a classic Schneiderian First Rank Symptom, highly specific to schizophrenia. * **Demographics:** A 24-year-old male is in the peak age group for the onset of schizophrenia. **2. Why other options are incorrect:** * **Delirium Tremens:** This is a medical emergency characterized by autonomic hyperactivity (tachycardia, tremors, sweating) and clouded consciousness (disorientation) occurring 48–72 hours after alcohol withdrawal. This patient is an "occasional" drinker and lacks physical withdrawal signs. * **Alcohol-induced Psychosis:** While alcohol can cause hallucinations, they typically occur during or immediately after heavy intoxication or withdrawal. The presence of complex commentary hallucinations and the "occasional" nature of his drinking point toward a primary psychiatric disorder. * **Delusional Disorder:** This diagnosis is characterized by non-bizarre delusions *without* prominent hallucinations. The presence of auditory commentary voices excludes this diagnosis. **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Include audible thoughts (thought echo), voices arguing, voices commenting on one's actions, and thought withdrawal/insertion/broadcast. * **Duration Criteria:** For a diagnosis of Schizophrenia, symptoms must persist for at least **1 month** (ICD-11) or **6 months** (DSM-5). * **Prognosis:** Early onset (younger age) and being male are generally associated with a poorer prognosis in schizophrenia.

Q: The defect of conation is typically seen in which type of schizophrenia?

Catatonic schizophrenia. **Explanation:** **Conation** refers to the mental faculty of purpose, desire, or the "will to act." It is the link between thought and physical movement. In **Catatonic Schizophrenia**, the primary pathology lies in the motor expression of this will. Patients exhibit profound disturbances in conation, manifesting as either extreme lack of movement (stupor, mutism, or negativism) or excessive, purposeless motor activity (catatonic excitement). The classic signs like waxy flexibility and posturing are direct results of this "defect of conation." **Analysis of Incorrect Options:** * **Simple Schizophrenia:** Characterized primarily by negative symptoms (apathy, social withdrawal, loss of drive) without prominent hallucinations or delusions. While there is a loss of volition, it lacks the specific motoric "conative" disturbances seen in catatonia. * **Hebephrenic (Disorganized) Schizophrenia:** Defined by disorganized speech, disorganized behavior, and flat or inappropriate affect. The primary defect is in **thought and affect**, not conation. * **Paranoid Schizophrenia:** Characterized by stable delusions and hallucinations. It is the most common type and usually has the best prognosis, but motor/conative symptoms are typically absent. **NEET-PG High-Yield Pearls:** * **Waxy Flexibility (Cerea Flexibilitas):** A hallmark of catatonia where the patient maintains positions in which they are placed by the examiner. * **Ambitendency:** A conative conflict where the patient makes a series of tentative, incomplete movements when asked to perform an action (e.g., reaching for a hand to shake but withdrawing). * **Treatment of Choice:** Benzodiazepines (Lorazepam) are the first-line treatment for catatonia; Electroconvulsive Therapy (ECT) is the most effective treatment for refractory cases.

Q: A 24-year-old unmarried male was brought by his family members with complaints of sudden onset of suspiciousness towards his family members and neighbors. He had stopped consuming home-cooked food, stating it was poisoned. He also exhibited restlessness and decreased sleep. What is the most likely diagnosis?

Acute psychosis. ### Explanation **Correct Option: B. Acute psychosis** The patient presents with a **sudden onset** of core psychotic symptoms: **delusions of persecution** (suspiciousness, belief that food is poisoned) and **behavioral disturbances** (restlessness, decreased sleep). In the context of NEET-PG, "Acute Psychosis" (often referred to as Brief Psychotic Disorder in DSM-5 or Acute and Transient Psychotic Disorder in ICD-10) is characterized by symptoms lasting less than one month, often triggered by stress, and a rapid return to premorbid functioning. The absence of long-term history or organic causes makes this the most likely diagnosis. **Why other options are incorrect:** * **A. Acute Mania:** While mania involves restlessness and decreased sleep, the primary features are elevated/irritable mood, grandiosity, and pressured speech. The clinical picture here is dominated by persecutory delusions rather than mood symptoms. * **C. Delirium:** This is an organic brain syndrome characterized by a **clouding of consciousness** and fluctuating levels of attention. The vignette does not mention disorientation, cognitive impairment, or an underlying medical illness. * **D. PTSD:** This requires a history of a traumatic event followed by intrusive symptoms (flashbacks/nightmares), avoidance, and hyperarousal. Suspiciousness about poisoned food is not a classic feature of PTSD. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** * 6 months: Schizophrenia. * **Delusion of Persecution:** The most common type of delusion in psychiatric practice. * **First-line Treatment:** Atypical antipsychotics (e.g., Risperidone or Olanzapine) are generally the treatment of choice for acute psychotic episodes.

Q: Which of the following is a delusion of persecution?

Delusion of being cheated. **Explanation:** **Delusion of persecution** is the most common type of delusion. It involves the false, fixed belief that one is being harmed, harassed, conspired against, or obstructed by others (individuals or groups). 1. **Why Option B is Correct:** The **delusion of being cheated**, spied upon, poisoned, or followed are all classic manifestations of persecutory delusions. The patient believes that external forces are intentionally acting to disadvantage or harm them. 2. **Analysis of Incorrect Options:** * **Option A (Delusion of Jealousy):** Also known as **Othello Syndrome**, this is the false belief that one’s spouse or partner is unfaithful. While it involves suspicion, it is categorized separately from general persecution. * **Option C (Delusion of a defective body part):** This is a **Somatic Delusion** (specifically Monosymptomatic Hypochondriacal Psychosis). The patient believes a part of their body is misshapen, malfunctioning, or emitting a foul odor. * **Option D (Delusion of Love):** Also known as **Erotomania** or **De Clerambault’s Syndrome**, this is the belief that another person (usually of higher social status) is in love with the patient. **High-Yield Clinical Pearls for NEET-PG:** * **Most common delusion in Schizophrenia:** Delusion of Persecution. * **Schneiderian First Rank Symptoms (FRS):** Delusional perception is a key FRS, but persecutory delusions are *not* pathognomonic for schizophrenia as they occur in various psychoses. * **Nihilistic Delusion (Cotard’s Syndrome):** Belief that one is dead, non-existent, or the world is ending; typically seen in severe agitated depression. * **Capgras Syndrome:** A "delusional misidentification" where the patient believes a familiar person has been replaced by an identical impostor.

Q: All of the following are Schneider's first rank symptoms EXCEPT:

Delusion of guilt. **Explanation:** Kurt Schneider’s **First Rank Symptoms (FRS)** are a group of specific auditory hallucinations and delusions that, while not pathognomonic, are highly suggestive of **Schizophrenia** in the absence of organic brain disease. **Why "Delusion of Guilt" is the correct answer:** Delusion of guilt is a **Second Rank Symptom**. It is more commonly associated with **Severe Depressive Episodes with Psychotic Features** (Melancholic Depression) rather than being a core diagnostic feature of Schizophrenia. **Analysis of Incorrect Options:** * **Running Commentary (Option A):** A classic FRS where the patient hears voices describing their actions as they happen (e.g., "He is now opening the door"). * **Primary Delusion (Option B):** Also known as an **Autochthonous delusion**, this is a "bolt from the blue" belief that arises without any preceding sensory event. It is a hallmark FRS. * **Thought Insertion (Option C):** A "Passivity Phenomenon" where the patient believes thoughts are being put into their mind by an external agency. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for FRS (ABCD):** * **A**uditory Hallucinations (Third person, Running commentary, Echo/Gedankenlautwerden). * **B**roadcasting of thoughts (and Insertion/Withdrawal). * **C**ontrolled feelings/impulses (Passivity/Made phenomena). * **D**elusional Perception (Attributing a private, abnormal meaning to a normal perception). * **ICD-11/DSM-5 Update:** While historically vital, FRS have been de-emphasized in recent diagnostic criteria because they lack high specificity (they can occur in bipolar disorder). * **Somatic Passivity:** The belief that bodily sensations are being imposed by an external force is also an FRS.

Q: Who proposed the concept of the paranoid pseudocommunity?

Norman Cameron. The concept of the **paranoid pseudocommunity** was proposed by **Norman Cameron** in 1943. According to Cameron, this is a psychological construct developed by a paranoid individual who lacks basic trust and misinterprets the actions of others. Due to impaired social communication, the individual weaves together real and imaginary people into a complex, organized "community" that they believe is conspiring against them. This "pseudocommunity" provides a perceived structure to their delusions of persecution, justifying their defensive or aggressive reactions. **Analysis of Incorrect Options:** * **B. K. Schneider:** Known for defining the **First Rank Symptoms (FRS)** of Schizophrenia, which are pivotal in clinical diagnosis but unrelated to the pseudocommunity concept. * **C. Benedict Morel:** A French psychiatrist who coined the term **"Démence précoce"** (early dementia) to describe what we now know as schizophrenia, focusing on its deteriorating course. * **D. Eugene Bleuler:** He replaced Morel’s term with **"Schizophrenia"** and described the **"4 As"** (Association, Affect, Ambivalence, and Autism) as the primary symptoms of the disorder. **Clinical Pearls for NEET-PG:** * **Norman Cameron** also described **"Asyndesis"** (a lack of logical connection between thoughts) and **"Metonyms"** (use of imprecise words), which are features of schizophrenic thought disorders. * The paranoid pseudocommunity is a classic example of how **social isolation** and **faulty social learning** contribute to the systematization of delusions. * Remember: **Schneider = FRS**; **Bleuler = 4 As**; **Morel = Démence précoce**; **Cameron = Pseudocommunity.**

Q: What is the most common type of delusion?

Delusion of persecution. **Explanation:** **Delusion of persecution** is the most common type of delusion across various psychiatric conditions, particularly in Schizophrenia and Delusional Disorders. It involves the false, fixed belief that one is being harassed, followed, cheated, poisoned, or conspired against by individuals or groups. This is a core symptom of the paranoid subtype of schizophrenia and is frequently encountered in clinical practice globally. **Analysis of Options:** * **Delusion of persecution (Correct):** Statistically the most prevalent delusion. It is characterized by the patient feeling that harm is occurring or is going to occur to them. * **Delusion of reference (Incorrect):** This is the belief that neutral external events (like a news report or a stranger’s conversation) have a special personal significance. While very common in schizophrenia, it is statistically less frequent than persecutory delusions. * **Paranoid delusion (Incorrect):** This is a broad umbrella term that encompasses delusions of persecution, reference, and jealousy. In exams, when "persecution" is an option, it is the more specific and correct answer. * **Delusion of guilt (Incorrect):** This is a "depressive delusion" (holothymic) commonly seen in severe Major Depressive Disorder with psychotic features or Melancholic Depression, rather than primary psychotic disorders. **Clinical Pearls for NEET-PG:** * **Most common hallucination:** Auditory (especially in Schizophrenia). * **Most common type of Auditory Hallucination:** Third-person (discussing the patient). * **Bizarre Delusions:** A hallmark of Schizophrenia (e.g., "Aliens have replaced my internal organs with sensors"). * **Nihilistic Delusions (Cotard Syndrome):** Belief that one is dead or their organs have ceased to exist; seen in severe depression. * **Capgras Syndrome:** The delusion that a familiar person has been replaced by an identical impostor.

Q: Van Gogh syndrome is seen in which of the following conditions?

Schizophrenia. **Explanation:** **Van Gogh Syndrome** refers to a condition where an individual performs **self-mutilation** (specifically cutting off a body part), usually in response to command hallucinations or intense delusional beliefs. It is named after the famous painter Vincent van Gogh, who famously cut off his own ear. 1. **Why Schizophrenia is correct:** This syndrome is most commonly associated with **Schizophrenia**, particularly the paranoid subtype. Patients may experience **command auditory hallucinations** (voices telling them to harm themselves) or **somatic delusions** that lead them to believe a body part is diseased or possessed, necessitating its removal. 2. **Why other options are incorrect:** * **Mania:** While patients in a manic episode may exhibit impulsivity or agitation, organized self-mutilation based on psychotic imperatives is not a hallmark feature. * **Depression:** While self-harm (suicidality) is common in depression, the specific act of surgical-like self-mutilation (Van Gogh Syndrome) is distinct from typical depressive self-injury. * **OCD:** OCD involves repetitive compulsions to neutralize anxiety. While "Body Dysmorphic Disorder" (related to OCD) involves preoccupation with flaws, it rarely leads to the acute self-amputation seen in Van Gogh Syndrome. **Clinical Pearls for NEET-PG:** * **Diogenes Syndrome:** Characterized by extreme self-neglect, social withdrawal, and hoarding (often seen in the elderly/dementia). * **Cotard Syndrome:** The "Walking Corpse" delusion; the belief that one is dead or their organs are missing (seen in severe Depression/Schizophrenia). * **Capgras Syndrome:** The delusion that a familiar person has been replaced by an identical impostor. * **Fregoli Syndrome:** The belief that different people are actually a single person in disguise.

Question 1

A 24-year-old occasional alcoholic presents with a change in behavior, including suspiciousness that people are conspiring against him, despite his father stating there is no apparent reason for his fears. He is also experiencing auditory hallucinations where voices comment on his actions. What is the most probable diagnosis?

Accepted Answer

Schizophrenia

Answer

Delirium tremens

Answer

Alcohol-induced psychosis

Answer

Delusional disorder

Question 2

The defect of conation is typically seen in which type of schizophrenia?

Accepted Answer

Catatonic schizophrenia

Answer

Simple schizophrenia

Answer

Hebephrenic schizophrenia

Answer

Paranoid schizophrenia

Question 3

A 24-year-old unmarried male was brought by his family members with complaints of sudden onset of suspiciousness towards his family members and neighbors. He had stopped consuming home-cooked food, stating it was poisoned. He also exhibited restlessness and decreased sleep. What is the most likely diagnosis?

Accepted Answer

Acute psychosis

Answer

Acute mania

Answer

Delirium

Answer

Post-traumatic stress disorder (PTSD)

Question 4

Which of the following is a delusion of persecution?

Accepted Answer

Delusion of being cheated

Answer

Delusion of jealousy

Answer

Delusion of a defective body part

Answer

Delusion of love

Question 5

All of the following are Schneider's first rank symptoms EXCEPT:

Accepted Answer

Delusion of guilt

Answer

Running commentary

Answer

Primary delusion

Answer

Thought insertion

Question 6

Who proposed the concept of the paranoid pseudocommunity?

Accepted Answer

Norman Cameron

Answer

K. Schneider

Answer

Benedict Morel

Answer

Eugene Bleuler

Question 7

A 41-year-old woman believes her management has falsely accused her of incompetence and forged her signature on documents to incriminate her. She has reported this to the police and requested security, yet continues to perform her work duties and manage her household. What is she most likely suffering from?

Accepted Answer

Persistent Delusional Disorder

Answer

Paranoid Schizophrenia

Answer

Late onset Psychosis

Answer

Obsessive Compulsive Disorder

Question 8

What is the most common type of delusion?

Accepted Answer

Delusion of persecution

Answer

Delusion of reference

Answer

Paranoid delusion

Answer

Delusion of guilt

Question 9

Capgras syndrome is more common in which of the following conditions?

Accepted Answer

Paranoid schizophrenia

Answer

Obsessive compulsive disorder

Answer

Hysteria

Answer

Schizoid personality disorder

Question 10

Van Gogh syndrome is seen in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Depression

Answer

OCD

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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