Psychotic Disorders Practice Questions

Q: Which of the following is NOT characteristic of Type I Schizophrenia?

CT, MRI shows enlarged ventricles. This question tests your knowledge of **Crow’s Classification of Schizophrenia**, which divides the disorder into Type I and Type II based on clinical features, pathophysiology, and prognosis. ### **Explanation of the Correct Answer** **Option B** is the correct answer because **enlarged ventricles** (and other structural brain abnormalities like cortical atrophy) are characteristic of **Type II Schizophrenia**, not Type I. * **Type I (Positive Schizophrenia):** This is characterized by a "hyperdopaminergic" state. There are no significant structural changes on CT or MRI. Because the underlying pathology is biochemical (excess dopamine), these patients respond well to antipsychotics. * **Type II (Negative Schizophrenia):** This is characterized by "structural brain changes." Enlarged lateral ventricles and widened sulci are hallmark findings. These patients have a poor response to traditional neuroleptics. ### **Analysis of Incorrect Options** * **Option A (Positive symptoms):** This is a core feature of Type I. It includes hallucinations, delusions, and thought disorders. * **Option C (Good prognosis):** Type I is associated with an acute onset, preserved intellectual functions, and a good response to medication, leading to a generally better prognosis compared to Type II. ### **NEET-PG High-Yield Pearls: Crow’s Classification** | Feature | Type I (Positive) | Type II (Negative) | | :--- | :--- | :--- | | **Symptoms** | Hallucinations, Delusions | Apathy, Withdrawal, Poverty of speech | | **Pathology** | Increased Dopamine receptors | **Cell loss / Ventricular enlargement** | | **Response to Rx** | Good | Poor | | **Prognosis** | Reversible/Good | Irreversible/Poor | | **Intellect** | Preserved | Impaired | **Clinical Note:** In NEET-PG, remember that **Type II** is often associated with "the 5 A's": Affective flattening, Alogia, Avolition, Anhedonia, and Attention deficit.

Q: What is the most common delusion seen in schizophrenia?

Persecution. **Explanation:** **1. Why Persecution is Correct:** Delusions of persecution (or paranoid delusions) are the most frequently encountered subtype of delusions in patients with schizophrenia. In this state, the patient falsely believes that individuals, groups, or organizations are plotting against them, spying on them, or intending to cause them physical or mental harm. This is a hallmark feature of **Paranoid Schizophrenia**, which is the most common clinical subtype of the disorder worldwide. **2. Analysis of Incorrect Options:** * **B. Grandiose:** These involve beliefs of inflated self-worth, power, or special identity. While common in the manic phase of Bipolar Disorder, they are less frequent in schizophrenia than persecutory themes. * **C. Reference:** The belief that neutral environmental cues (e.g., a news anchor’s tie or a song on the radio) have a special personal meaning. While highly characteristic of schizophrenia, it is statistically less common than persecution. * **D. Nihilistic:** The belief that oneself, others, or the world does not exist. This is most classically associated with **Cotard Syndrome** and severe psychotic depression, rather than schizophrenia. **3. NEET-PG Clinical Pearls:** * **Most common type of Hallucination in Schizophrenia:** Auditory (specifically third-person hallucinations). * **Schneiderian First Rank Symptoms (FRS):** These are highly suggestive of schizophrenia and include thought insertion, withdrawal, broadcast, and "made" phenomena. * **Prognosis:** Paranoid schizophrenia (dominated by persecutory delusions) generally has a **better prognosis** compared to the hebephrenic (disorganized) subtype. * **Capgras Syndrome:** A specific "delusional misidentification" where the patient believes a familiar person has been replaced by an identical impostor.

Q: What is the percentage of monozygotic twins who develop schizophrenia?

50%. ### Explanation The correct answer is **D. 50%**. Schizophrenia has a strong genetic component, and the risk of developing the disorder increases with the degree of genetic relatedness to an affected individual. Since **monozygotic (MZ) twins** share 100% of their genetic material, they have the highest concordance rate for schizophrenia, which is approximately **40% to 50%**. This high percentage underscores the significant role of genetics in the etiology of the disease. #### Analysis of Options: * **A. 0.10%:** This is significantly lower than the risk in the general population. * **B. 1%:** This represents the **lifetime prevalence** of schizophrenia in the **general population**. * **C. 10%:** This is the approximate risk for **first-degree relatives** (e.g., children of one affected parent or dizygotic/fraternal twins who share 50% of their genes). * **D. 50%:** This is the established concordance rate for monozygotic twins. Note that because it is not 100%, it also proves that environmental factors play a crucial role. #### High-Yield Clinical Pearls for NEET-PG: * **Highest Risk:** The highest risk of developing schizophrenia is in an individual with **two affected parents (approx. 40-46%)** or a **monozygotic twin (approx. 47-50%)**. * **Dizygotic (DZ) Twins:** The risk is approximately **12-15%**. * **Sibling Risk:** If one sibling is affected, the risk for another sibling is about **10%**. * **Second-degree relatives:** The risk drops to approximately **2-3%**. * **Key Concept:** If a question asks for the "most important factor" in the etiology of schizophrenia, the answer is **Genetics**.

Q: Ekbom syndrome is referred to as:

Delusion of infestation. **Explanation:** **Ekbom syndrome**, also known as **Delusional Parasitosis** or **Delusion of Infestation**, is a monosymptomatic hypochondriacal psychosis. Patients hold a fixed, false belief (delusion) that they are infested with small living organisms like insects, lice, worms, or mites, despite medical evidence to the contrary. * **Why Option A is correct:** The hallmark of Ekbom syndrome is the patient's conviction of being infested. Patients often present with the **"Matchbox Sign"** (or "Ziploc bag sign"), where they bring samples of skin debris, lint, or dust to the clinic, claiming they are the parasites. * **Why Option B is incorrect:** **Delusion of persecution** is the belief that one is being conspired against or harmed (common in Schizophrenia). * **Why Option C is incorrect:** **Delusion of love** is known as **De Clerambault’s syndrome** (Erotomania), where a patient believes a person of higher status is in love with them. * **Why Option D is incorrect:** **Delusion of infidelity** is known as **Othello syndrome**, characterized by the irrational belief that one’s partner is being unfaithful. **High-Yield Clinical Pearls for NEET-PG:** 1. **Formication:** The tactile hallucination of insects crawling on or under the skin (often associated with Ekbom syndrome or Cocaine/Amphetamine withdrawal). 2. **Treatment:** The drug of choice is typically an atypical antipsychotic like **Risperidone**. Historically, **Pimozide** was the gold standard. 3. **Differential:** It must be distinguished from organic causes like Vitamin B12 deficiency or drug-induced states.

Q: Monosymptomatic hypochondriasis means:

Somatic type delusional disorder. **Explanation:** **Monosymptomatic hypochondriasis** is a term historically used to describe a condition where a patient holds a single, fixed, false belief (delusion) regarding their physical health or bodily functions, despite medical reassurance. In modern psychiatric classification (DSM-5/ICD-11), this is categorized as **Somatic type Delusional Disorder**. **Why the correct answer is right:** In Somatic type delusional disorder, the delusion is limited to physical sensations or abnormalities (e.g., believing one emits a foul odor, is infested with parasites, or has misshapen body parts). Unlike "Hypochondriasis" (Illness Anxiety Disorder), where there is a *fear* of having a disease, in Monosymptomatic Hypochondriasis, there is a *conviction* that the disease or defect is present. **Analysis of incorrect options:** * **Paranoid type (Persecutory):** The central theme is being conspired against, cheated, or harassed. * **De Clerambault syndrome (Erotomania):** The delusion that another person, usually of higher status, is in love with the patient. * **Othello syndrome (Morbid Jealousy):** The delusion that one’s spouse or partner is unfaithful. **High-Yield Clinical Pearls for NEET-PG:** * **Ekbom Syndrome:** A specific form of somatic delusional disorder where patients believe they are infested with insects (Delusional Parasitosis). * **Key Distinction:** Delusional disorder is characterized by **non-bizarre delusions** (situations that could occur in real life) and the absence of other prominent psychotic symptoms like hallucinations or thought disorder. * **Treatment:** Second-generation antipsychotics (e.g., Risperidone) are the first-line treatment. Historically, Pimozide was considered the drug of choice for the somatic type.

Q: What is the incidence rate of schizophrenia in the general population?

0.50%. **Explanation:** The correct answer is **0.50%**. In psychiatry, it is crucial to distinguish between **incidence** (the rate of new cases occurring over a specific period) and **prevalence** (the total number of cases existing in a population at a given time). 1. **Why A is correct:** The annual **incidence** of schizophrenia is relatively low, typically cited as **0.5 to 1 per 10,000 adults**, which translates to a cumulative incidence of approximately **0.5%** over a lifetime. While some older texts used broader ranges, current epidemiological standards for NEET-PG emphasize this lower figure for incidence. 2. **Why B is incorrect:** **1%** is the classic figure for the **Lifetime Prevalence** of schizophrenia worldwide. This is a common "trap" in exams; students often confuse the total burden of the disease (prevalence) with the rate of new cases (incidence). 3. **Why C & D are incorrect:** Rates of **1.5% to 2%** are significantly higher than the established global average for schizophrenia. Such high figures are generally only seen in specific high-risk cohorts (e.g., children of one affected parent) rather than the general population. **High-Yield Clinical Pearls for NEET-PG:** * **Prevalence:** ~1% (Lifetime); ~0.5% (Point prevalence). * **Incidence:** ~0.5% (Cumulative). * **Gender:** Incidence is roughly equal in males and females, but males have an earlier onset (15–25 years) compared to females (25–35 years). * **Genetic Risk:** The highest risk is in **Monozygotic twins (47-50%)**, followed by children of two affected parents (40-46%). If one sibling has schizophrenia, the risk to another sibling is ~10%.

Question 1

Which of the following is NOT characteristic of Type I Schizophrenia?

Accepted Answer

CT, MRI shows enlarged ventricles

Answer

Positive symptoms

Answer

Good prognosis

Answer

None of the above

Question 2

A 25-year-old male patient presents with eccentric behavior for 3 years. He is unemployed and has difficulty with self-care, such as bathing and eating. He complains of auditory hallucinations and talking to himself when alone. On examination, he exhibits a flat affect, inappropriate emotions, and disorganized behavior, along with suicidal ideation. What is the most appropriate diagnosis?

Accepted Answer

Hebephrenic schizophrenia

Answer

Paranoid schizophrenia

Answer

Catatonic schizophrenia

Answer

Undifferentiated schizophrenia

Question 3

What is the most common delusion seen in schizophrenia?

Accepted Answer

Persecution

Answer

Grandiose

Answer

Reference

Answer

Nihilistic

Question 4

A 41-year-old woman believes that her management has fabricated negative reports about her competence and forged her signature on sensitive documents to undermine her. She has reported this to the police and requested security, yet she continues to attend work and manage her household. She is suffering from:

Accepted Answer

Persistent Delusional Disorder

Answer

Late onset Psychosis

Answer

Paranoid Schizophrenia

Answer

Obsessive Compulsive Disorder

Question 5

Schizophrenia is characterized by which of the following?

Accepted Answer

Altered sensorium

Answer

Formal thought disorder

Answer

Delusion of reference

Answer

Waxy flexibility

Question 6

A man hits his neighbour. The next day, he feels that the police are pursuing him and that his brain is being controlled by radio waves transmitted by his neighbour. What is the probable diagnosis?

Accepted Answer

Delusion of persecution

Answer

Thought insertion

Answer

Passivity feeling

Answer

Obsessive-Compulsive Disorder

Question 7

What is the percentage of monozygotic twins who develop schizophrenia?

Accepted Answer

50%

Answer

0.10%

Answer

1%

Answer

10%

Question 8

Ekbom syndrome is referred to as:

Accepted Answer

Delusion of infestation

Answer

Delusion of persecution

Answer

Delusion of love

Answer

Delusion of infidelity

Question 9

Monosymptomatic hypochondriasis means:

Accepted Answer

Somatic type delusional disorder

Answer

Paranoid type delusional disorder

Answer

De Clerambault syndrome

Answer

Othello syndrome

Question 10

What is the incidence rate of schizophrenia in the general population?

Accepted Answer

0.50%

Answer

1%

Answer

1.50%

Answer

2%

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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