Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 121: Blunting of affect is seen in which of the following conditions?

A. Schizophrenia (Correct Answer)
B. Depression
C. Mania
D. Delirium

Explanation: **Explanation:** **1. Why Schizophrenia is Correct:** Blunting of affect (or affective flattening) refers to a significant reduction in the intensity of emotional expression. It is a hallmark **Negative Symptom** of Schizophrenia. In these patients, the face appears immobile, there is poor eye contact, and the voice lacks inflection (monotone). This occurs due to the underlying neurocognitive deficit and is often associated with a poorer prognosis compared to positive symptoms. **2. Why the Other Options are Incorrect:** * **Depression:** While patients with depression experience a "depressed mood," their affect is typically described as **constricted** (mild reduction in range) or **depressed**, rather than truly blunted. In severe cases, they may show "anhedonia," but blunting is classically associated with the schizophrenia spectrum. * **Mania:** In mania, the affect is **elated, expansive, or irritable**. It is the opposite of blunting; emotions are expressed with heightened intensity and volatility. * **Delirium:** Delirium is an acute organic brain syndrome characterized by a clouding of consciousness and fluctuating attention. While emotional lability (rapid shifts) can occur, blunting is not a diagnostic feature. **3. Clinical Pearls for NEET-PG:** * **The "4 As" of Bleuler:** Remember that **Affective Blunting** is one of Eugen Bleuler’s fundamental symptoms of schizophrenia (along with Autism, Ambivalence, and Loosening of Associations). * **Flat vs. Blunted:** "Flat" is the most severe form (no expression at all), while "Blunted" is a severe reduction. * **Differential:** If a patient on antipsychotics shows blunting, always rule out **Drug-Induced Parkinsonism** (masked facies), which can mimic affective flattening. * **Prognostic Value:** Negative symptoms like blunting are often resistant to first-generation antipsychotics and are better managed with atypical antipsychotics (e.g., Clozapine, Amisulpride).

Question 122: Which coding system in ICD-10 is used for "Schizophrenia, schizotypal and delusional disorders"?

A. F10-F19
B. F20-F29 (Correct Answer)
C. F30-F39
D. F40-F48

Explanation: ### Explanation The **ICD-10 (International Classification of Diseases, 10th Revision)**, published by the WHO, organizes mental and behavioral disorders under Chapter V (the "F" codes). **1. Why F20-F29 is Correct:** This block is specifically designated for **Schizophrenia, Schizotypal, and Delusional disorders**. These disorders are grouped together because they share common features of psychosis, such as hallucinations, delusions, and thought disturbances. * **F20:** Schizophrenia (the most significant member of this group). * **F21:** Schizotypal disorder. * **F22:** Persistent delusional disorders. * **F25:** Schizoaffective disorders. **2. Analysis of Incorrect Options:** * **F10-F19:** Refers to **Mental and behavioral disorders due to psychoactive substance use** (e.g., Alcohol, Opioids, Cannabinoids). * **F30-F39:** Refers to **Mood [affective] disorders**, including Mania (F30), Bipolar Affective Disorder (F31), and Depressive episodes (F32). * **F40-F48:** Refers to **Neurotic, stress-related, and somatoform disorders**, such as Phobic anxiety (F40), OCD (F42), and Reaction to severe stress (F43). **3. High-Yield NEET-PG Clinical Pearls:** * **Schizophrenia (F20):** Diagnosis requires symptoms to be present for at least **one month** according to ICD-10 (Note: DSM-5 requires 6 months of continuous disturbance). * **Schneider’s First Rank Symptoms (FRS):** These are highly characteristic of Schizophrenia and include audible thoughts, third-person hallucinations, and delusions of control. * **Most Common Type:** Paranoid Schizophrenia (F20.0) is the most common subtype worldwide. * **Simple Schizophrenia (F20.6):** Characterized by an insidious onset of negative symptoms (apathy, social withdrawal) *without* prominent hallucinations or delusions.

Question 123: All of the following are considered positive symptoms of schizophrenia EXCEPT:

A. Anhedonia (Correct Answer)
B. Hallucination
C. Delusion
D. Thought broadcast

Explanation: **Explanation:** Schizophrenia symptoms are classically categorized into **Positive** and **Negative** symptoms. Positive symptoms represent an "excess" or distortion of normal function, while negative symptoms represent a "deficit" or loss of normal function. **Why Anhedonia is the correct answer:** **Anhedonia** is defined as the inability to experience pleasure from activities usually found enjoyable. It is a classic **Negative Symptom** (along with the other "5 A's": Affective flattening, Alogia, Avolition, and Asociality). These symptoms are often more resistant to typical antipsychotics and are associated with a poorer long-term prognosis. **Analysis of Incorrect Options (Positive Symptoms):** * **Hallucinations (B):** Sensory perceptions in the absence of external stimuli (most commonly auditory in schizophrenia). * **Delusions (C):** Fixed, false beliefs that are not amenable to change in light of conflicting evidence. * **Thought Broadcast (D):** A Schneiderian First Rank Symptom where the patient believes their thoughts are being transmitted to others. **Clinical Pearls for NEET-PG:** * **Dopamine Hypothesis:** Positive symptoms are associated with **hyperactivity** of dopamine in the **mesolimbic pathway**, while negative symptoms are associated with **hypoactivity** in the **mesocortical pathway**. * **First Rank Symptoms (FRS):** Kurt Schneider’s FRS (like thought broadcast, insertion, and withdrawal) are all considered **positive symptoms**. * **Prognosis:** The presence of predominant positive symptoms usually predicts a better response to treatment compared to predominant negative symptoms.

Question 124: Delusions of persecution are characteristic of which of the following conditions?

A. Schizophrenia
B. Paranoid psychosis
C. Manic episode
D. All of the above (Correct Answer)

Explanation: **Explanation:** Delusions of persecution (the false belief that one is being conspired against, spied on, or harmed) are the most common type of delusion across various psychiatric disorders. While they are the hallmark of paranoid states, they are not pathognomonic for a single diagnosis. 1. **Schizophrenia:** Specifically in the **Paranoid subtype**, persecutory delusions are the most frequent symptom. They are often bizarre or associated with auditory hallucinations (e.g., "The government is using radio waves to poison my food"). 2. **Paranoid Psychosis (Delusional Disorder):** In this condition, the primary symptom is a non-bizarre, systematized delusion. In the **Persecutory type**, the patient believes they are being cheated, followed, or harassed, often leading to legal actions (querulous paranoia). 3. **Manic Episode:** In Bipolar Disorder, patients may experience **mood-congruent delusions**. While grandiosity is more common, persecutory delusions frequently occur when the patient believes others are jealous of their special powers or are trying to thwart their "great plans." **Clinical Pearls for NEET-PG:** * **Most common delusion overall:** Delusion of Persecution. * **Most common delusion in Depression:** Delusion of Guilt (followed by Poverty and Nihilism). * **Most common delusion in Mania:** Delusion of Grandeur. * **Schneider’s First Rank Symptoms (FRS):** While delusions of persecution are common in Schizophrenia, they are **not** considered a First Rank Symptom (Delusional Perception is the FRS). * **Differential Diagnosis:** Always rule out organic causes (e.g., stimulant abuse or dementia) when persecutory delusions present acutely in older or non-psychiatric patients.

Question 125: A patient presents with waxy flexibility, negativism, and rigidity. What is the most likely diagnosis?

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

Explanation: **Explanation:** The correct answer is **Catatonic schizophrenia (Option B)**. This diagnosis is characterized by prominent psychomotor disturbances that can involve decreased motor activity, excessive motor activity, or peculiar behaviors. **Why it is correct:** The symptoms described—**waxy flexibility** (catalepsy, where the patient maintains a posture even if it is uncomfortable), **negativism** (motiveless resistance to instructions or attempts to be moved), and **rigidity**—are classic hallmarks of catatonia. In the ICD-10 classification, when these motor symptoms dominate the clinical picture, the diagnosis is Catatonic Schizophrenia. **Why the other options are incorrect:** * **Paranoid schizophrenia (A):** Characterized primarily by stable, often systematized delusions (usually persecutory or grandiose) and hallucinations. Motor symptoms are typically absent. * **Hebephrenic (Disorganized) schizophrenia (C):** Marked by disorganized speech, disorganized behavior, and flat or inappropriate affect. It typically has an earlier onset and poor prognosis. * **Simple schizophrenia (D):** Characterized by an insidious but progressive development of negative symptoms (apathy, social withdrawal) without overt psychotic symptoms like hallucinations, delusions, or catatonia. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Benzodiazepines (specifically **Lorazepam**) are the first-line treatment for catatonia. * **Definitive Treatment:** If medication fails or if the condition is life-threatening (Malignant Catatonia), **Electroconvulsive Therapy (ECT)** is highly effective. * **DSM-5 Update:** Note that in DSM-5, "Catatonia" is no longer a subtype of schizophrenia but is treated as a specifier that can be associated with various mental disorders (mood disorders or schizophrenia) or medical conditions. * **Other Catatonic Signs:** Mutism, stupor, posturing, and echolalia/echopraxia.

Question 126: Erotomania means

A. delusion of love (Correct Answer)
B. delusion of doubles
C. delusion of persecution
D. delusion of nihilism

Explanation: **Explanation:** **Erotomania**, also known as **De Clérambault’s Syndrome**, is a type of delusional disorder where the patient holds a fixed, false belief that another person—usually of higher social, financial, or professional status (e.g., a celebrity or a boss)—is deeply in love with them. Despite a lack of evidence or even direct denial from the object of affection, the patient interprets neutral actions as secret signs of love. **Analysis of Options:** * **A. Delusion of love (Correct):** This is the defining feature of Erotomania. It is more common in females, though males with the condition are more likely to exhibit stalking behavior. * **B. Delusion of doubles:** This refers to **Capgras Syndrome**, a delusional misidentification syndrome where the patient believes a familiar person has been replaced by an identical-looking impostor. * **C. Delusion of persecution:** This is the most common type of delusion, where the individual believes they are being conspired against, cheated, or harassed. It is a hallmark of Paranoid Schizophrenia. * **D. Delusion of nihilism:** Also known as **Cotard’s Syndrome**, the patient believes they are dead, non-existent, or that their internal organs are rotting/missing. It is typically seen in severe depressive psychosis. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Erotomania:** Occurs suddenly without other psychiatric symptoms. * **Secondary Erotomania:** Occurs in the context of other disorders like Schizophrenia or Bipolar Disorder. * **Fregoli Syndrome:** The opposite of Capgras; the belief that different strangers are actually a single familiar person in disguise. * **Othello Syndrome:** Delusion of infidelity (pathological jealousy).

Question 127: What is the absolute contraindication for Electroconvulsive Therapy (ECT)?

A. Raised intracranial tension (Correct Answer)
B. Vascular dementia
C. Diabetic retinopathy
D. Peripheral neuropathy

Explanation: **Explanation:** **1. Why Raised Intracranial Tension (ICT) is the Correct Answer:** In modern psychiatry, there are **no absolute contraindications** for ECT; however, **Raised Intracranial Tension (ICT)** is traditionally considered the most significant "relative" contraindication that is frequently tested as "absolute" in exams. During the tonic phase of a seizure, there is a transient but significant increase in cerebral blood flow and intrathoracic pressure, which further elevates ICT. In patients with space-occupying lesions (SOL) or cerebral edema, this can lead to **brainstem herniation**, which is fatal. **2. Analysis of Incorrect Options:** * **Vascular Dementia:** ECT is not contraindicated; in fact, it can be used to treat severe depression or behavioral disturbances associated with dementia when medications fail. * **Diabetic Retinopathy:** While there is a risk of retinal detachment due to the transient rise in blood pressure during the seizure, it is a relative contraindication. It can be managed with adequate muscle relaxation and blood pressure control. * **Peripheral Neuropathy:** This has no bearing on the central nervous system effects or the muscular contractions of ECT and is not a contraindication. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves within 6 months). * **Most common cause of death:** Cardiovascular complications (Arrhythmias/Myocardial Infarction). * **Gold Standard Indication:** Severe depression with high suicidal risk. * **Drug of choice for Pre-medication:** Atropine (to reduce secretions and prevent vagal bradycardia). * **Anesthetic of choice:** Methohexital (Gold standard); Propofol is also commonly used. * **Muscle Relaxant of choice:** Succinylcholine (Short-acting).

Question 128: Which of the following is not a disorder of form of thought?

A. Derailment
B. Tangentiality
C. Hallucination (Correct Answer)
D. Loosening of association

Explanation: **Explanation:** To answer this question, one must distinguish between the different components of thought and perception. Thought disorders are broadly classified into disorders of **Stream**, **Form**, **Content**, and **Possession**. **Why Hallucination is the correct answer:** **Hallucination** is a disorder of **Perception**, not thought. It is defined as a sensory perception in the absence of an external stimulus (e.g., hearing voices when no one is speaking). Since it belongs to the domain of sensory experience rather than the logical structure of thinking, it is the odd one out. **Analysis of incorrect options (Disorders of Form of Thought):** Formal Thought Disorders (FTD) refer to a breakdown in the logical connection between ideas and the structure of speech. * **Derailment:** A pattern of speech where ideas slip off one track onto another that is completely unrelated. * **Tangentiality:** The patient replies to a question in an oblique or irrelevant manner; the answer begins to address the topic but never reaches the goal. * **Loosening of Association:** A severe form of FTD where the connection between successive thoughts is fragmented or non-existent (often seen in Schizophrenia). **High-Yield Clinical Pearls for NEET-PG:** * **Disorder of Content:** Delusions (fixed false beliefs), Obsessions, and Phobias. * **Disorder of Possession:** Thought insertion, withdrawal, and broadcasting (Schneiderian First Rank Symptoms). * **Neologism:** Coining new words; a classic example of Formal Thought Disorder. * **Word Salad:** The most extreme form of loosening of association where speech is a random jumble of words.

Question 129: Waxy flexibility, stereotyped verbal and behavioural signs, and negative symptoms are features of which of the following conditions?

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

Explanation: **Explanation:** The correct answer is **Catatonic Schizophrenia**. This subtype is primarily characterized by psychomotor disturbances that can range from motoric immobility (stupor) to extreme agitation. **1. Why Catatonic Schizophrenia is correct:** The symptoms mentioned—**waxy flexibility** (cerea flexibilitas), where a patient maintains a posture imposed by an examiner for long periods, and **stereotypy** (repetitive, non-goal-directed movements or speech)—are hallmark signs of catatonia. While negative symptoms (apathy, withdrawal) are common across schizophrenia subtypes, they are prominently seen in the stuporous phase of catatonia. **2. Why other options are incorrect:** * **Paranoid Schizophrenia:** Characterized by stable, systematized delusions and hallucinations (usually auditory). Motor symptoms and negative symptoms are typically less prominent. * **Hebephrenic (Disorganized) Schizophrenia:** Features disorganized speech, disorganized behavior, and flat or inappropriate affect (e.g., giggling). It has an early onset and poor prognosis. * **Simple Schizophrenia:** Characterized by the insidious development of negative symptoms (avolition, social withdrawal) *without* prominent hallucinations or delusions. It does not feature catatonic motor signs. **Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** For acute catatonia, the first-line treatment is **Lorazepam** (Benzodiazepines). If unresponsive, **Electroconvulsive Therapy (ECT)** is the most effective treatment. * **Other Catatonic Signs:** Look for *Negativism* (resistance to instructions), *Echolalia* (mimicking speech), and *Echopraxia* (mimicking movements). * **ICD-11/DSM-5 Update:** Modern classifications now treat catatonia as a specifier that can occur across various psychiatric and medical conditions, rather than just a subtype of schizophrenia.

Question 130: The term "Othello syndrome" relates to which of the following?

A. Psychopathic killer
B. Alcoholic killer
C. Sexual killer
D. Jealous killer (Correct Answer)

Explanation: **Explanation:** **Othello Syndrome**, also known as **Morbid Jealousy** or **Delusional Jealousy**, is a type of delusional disorder where the primary symptom is a fixed, false belief that one's spouse or partner is being unfaithful. 1. **Why the correct answer is right:** The syndrome is named after the protagonist in Shakespeare’s play *Othello*, who murders his wife due to unfounded suspicions of infidelity. In psychiatry, this condition is characterized by intense jealousy and stalking behavior. It is classified as a **"Jealous killer"** because the delusional conviction often leads to extreme irritability, domestic violence, and in severe cases, the homicide of the partner or the alleged lover. 2. **Why the incorrect options are wrong:** * **Psychopathic killer:** While psychopaths (Antisocial Personality Disorder) may kill, their motives are usually lack of empathy, personal gain, or impulsivity, rather than a specific delusion of infidelity. * **Alcoholic killer:** Although Othello syndrome is **strongly associated with chronic alcoholism** (which can impair judgment and fuel suspicion), the term itself specifically refers to the jealousy aspect, not the act of killing due to intoxication alone. * **Sexual killer:** This usually refers to paraphilic motivations (e.g., sadism), which is distinct from the delusional framework of Othello syndrome. **Clinical Pearls for NEET-PG:** * **Association:** Most commonly associated with **Chronic Alcoholism** and Organic Brain Disorders. * **Gender:** More common in **males**. * **Risk:** It is a high-risk condition for **homicide-suicide**. * **Classification:** It falls under **Delusional Disorders (ICD-10: F22)**. * **Management:** Antipsychotics and strict separation from the partner are often required for safety.

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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