Psychotic Disorders Practice Questions

Q: A 25-year-old university student had a fight with a neighbor. On the next day, while out, he felt that two men in police uniform were observing his movements. When he reached home in the evening, he was frightened and expressed that the police were after him and would arrest him. His symptoms represent which of the following?

Delusion of persecution. ### Explanation **1. Why "Delusion of Persecution" is correct:** A **delusion** is a fixed, false belief that is out of keeping with the patient’s social and cultural background and is held with absolute conviction despite contrary evidence. In this case, the student believes he is being followed and will be arrested by the police. This is a **Delusion of Persecution**, where the individual believes that harm is occurring or is going to occur, and that others (individuals or groups like the police) are intentionally targeting, spying on, or conspiring against them. **2. Why the other options are incorrect:** * **Ideas of Reference:** This involves the false belief that neutral, external events (like people talking in a corner or a news report) have a special personal significance. While the student felt observed (which can be a precursor), his firm conviction that they were "after him to arrest him" elevates this to a full-blown persecutory delusion. * **Passivity (Made Phenomena):** This is a Schneiderian First Rank Symptom (SFRS) where the patient feels their actions, impulses, or emotions are being controlled by an external agency. There is no evidence of loss of agency here. * **Thought Insertion:** This is the belief that thoughts are being put into one’s mind by an external force. This is a disorder of thought ownership, not content. **3. NEET-PG High-Yield Pearls:** * **Delusion of Persecution** is the most common type of delusion seen in **Schizophrenia**. * **Schneiderian First Rank Symptoms (SFRS):** Include thought insertion, withdrawal, broadcast, passivity, and third-person hallucinations. Note that persecutory delusions are *not* specific to SFRS but are common in psychosis. * **Differentiating Idea vs. Delusion:** An "idea" can be challenged or held with less conviction; a "delusion" is fixed and unshakable.

Q: Which type of schizophrenia is characterized by late onset and a good prognosis?

Paranoid schizophrenia. ### Explanation **Paranoid Schizophrenia** is the most common subtype and is characterized by the presence of prominent delusions (typically persecutory or grandiose) and auditory hallucinations. **Why it is the correct answer:** * **Late Onset:** Unlike other subtypes, it usually manifests in the late 20s or 30s. * **Good Prognosis:** It carries the best prognosis among all subtypes because the patient’s personality remains relatively preserved, and there is a significant absence of "negative symptoms" (apathy, withdrawal) and disorganized behavior/speech. These patients often have better cognitive functioning and social skills, leading to better treatment compliance and outcomes. **Analysis of Incorrect Options:** * **A. Simple Schizophrenia:** Characterized by early onset and an insidious progression of negative symptoms (apathy, social withdrawal) without prominent hallucinations or delusions. It has a **very poor prognosis**. * **B. Hebephrenic (Disorganized) Schizophrenia:** Features early onset (teens/early 20s), disorganized speech, and "flat" or inappropriate affect. It is associated with rapid personality deterioration and a **poor prognosis**. * **C. Catatonic Schizophrenia:** Characterized by psychomotor disturbances (stupor, waxy flexibility, or excitement). While it responds well to ECT and Lorazepam, it does not typically have the "late onset" profile characteristic of the paranoid type. **High-Yield NEET-PG Pearls:** * **Best Prognosis:** Paranoid Schizophrenia. * **Worst Prognosis:** Simple and Hebephrenic Schizophrenia. * **Schneider’s First Rank Symptoms (FRS):** Most commonly seen in Paranoid Schizophrenia. * **Prognostic Factors:** Good prognosis is associated with late onset, female sex, presence of precipitating factors, and acute onset. Poor prognosis is linked to early onset, insidious start, and negative symptoms.

Q: T.J. Crow proposed a classification of schizophrenia patients into type I and type II. Type II schizophrenia is characterized by all of the following, EXCEPT:

Disorganized behavior. **Explanation:** T.J. Crow’s classification (1980) divides schizophrenia into two distinct syndromes based on clinical features, treatment response, and underlying pathology. **Why "Disorganized Behavior" is the correct answer:** Disorganized behavior is considered a **positive symptom**. According to Crow’s classification, positive symptoms (like hallucinations, delusions, and thought disorders) are the hallmark of **Type I Schizophrenia**, not Type II. Type I is associated with dopaminergic hyperactivity and generally carries a better prognosis. **Analysis of Incorrect Options (Features of Type II):** * **A. Negative Symptoms:** Type II is primarily characterized by negative symptoms such as affective flattening, poverty of speech (alogia), and loss of drive (avolition). * **B. Poor response to medications:** Unlike Type I, which responds well to typical antipsychotics (D2 blockers), Type II patients typically show a **poor or partial response** to traditional medication. * **D. CT scan abnormalities:** Type II is associated with structural brain changes, most notably **ventricular enlargement** and cortical atrophy, suggesting a neurodegenerative component rather than just neurochemical dysfunction. **High-Yield Clinical Pearls for NEET-PG:** * **Type I (Positive):** "Dopamine Hypothesis" – Normal CT scan, good premorbid adjustment, reversible symptoms, good prognosis. * **Type II (Negative):** "Structural Hypothesis" – Abnormal CT (ventriculomegaly), poor premorbid adjustment, intellectual impairment, chronic course. * **Memory Aid:** Think of **Type I** as "Reactive/Chemical" and **Type II** as "Structural/Deficit."

Q: Who coined the term "Ambivalence"?

Eugen Bleuler. **Explanation:** The term **Ambivalence** was coined by the Swiss psychiatrist **Eugen Bleuler** in 1911. Ambivalence refers to the simultaneous existence of contradictory feelings (such as love and hate), attitudes, or wishes toward the same object, person, or situation. Bleuler is most famous for defining the **"4 As" of Schizophrenia**, which are considered the primary (fundamental) symptoms of the disorder: 1. **Ambivalence** 2. **Autism** (Social withdrawal/internalized world) 3. **Affective Incongruity** (Inappropriate emotional response) 4. **Association Looseness** (Disordered thought process) **Analysis of Incorrect Options:** * **Hippocrates:** Known as the "Father of Medicine," he proposed the Humoral Theory (imbalance of black bile, yellow bile, blood, and phlegm) to explain mental illness but did not define modern psychiatric terminology. * **Emil Kraepelin:** Often called the founder of modern scientific psychiatry, he is best known for the **"Kraepelinian Dichotomy,"** which distinguished between *Dementia Praecox* (now Schizophrenia) and Manic-Depressive Psychosis. * **Sigmund Freud:** The founder of Psychoanalysis. While he extensively utilized the concept of ambivalence in his theories regarding the unconscious and the Oedipus complex, he was not the one who coined the term. **High-Yield NEET-PG Pearls:** * **Eugen Bleuler** also coined the term **"Schizophrenia"** (replacing Kraepelin’s *Dementia Praecox*) and **"Autism."** * **Kurt Schneider** later proposed the **"First Rank Symptoms" (FRS)** of Schizophrenia, which are different from Bleuler’s 4 As and focus on hallucinations and delusions. * Bleuler’s symptoms are considered "fundamental," while Schneider’s are "diagnostic" in many traditional frameworks.

Q: An elderly patient presents with auditory hallucinations and a delusion that unknown people are conspiring against him and commenting on his actions. What is the most likely diagnosis?

Schizophrenia. **Explanation:** The correct diagnosis is **Schizophrenia**. According to ICD and DSM criteria, the presence of **auditory hallucinations** (specifically running commentary) combined with **delusions of persecution** (conspiracy) are hallmark "First Rank Symptoms" (FRS) of Schizophrenia. While Schizophrenia typically has an onset in early adulthood, it can present in the elderly (Late-onset Schizophrenia, usually after age 45), often characterized by more prominent persecutory delusions and sensory hallucinations with fewer negative symptoms. **Why other options are incorrect:** * **Dementia:** While elderly patients with dementia (like Alzheimer’s) can have delusions, the primary deficit is cognitive decline (memory loss, disorientation). Hallucinations in dementia are more commonly visual rather than complex auditory commentary. * **Delusional Disorder:** This diagnosis is characterized by non-bizarre delusions *without* prominent hallucinations. The presence of auditory hallucinations (commenting on actions) effectively rules out pure Delusional Disorder. * **Acute Psychosis:** This term usually refers to symptoms lasting less than one month. Given the complexity of the symptoms (conspiracy + commentary), Schizophrenia is the more specific and likely clinical diagnosis in a standard board-style question unless a very short duration is explicitly mentioned. **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Include audible thoughts (thought echo), voices arguing, voices commenting on one's action, and delusions of control/passivity. * **Late-onset Schizophrenia:** More common in females and often associated with sensory deficits (hearing/vision loss). * **Treatment:** Low-dose atypical antipsychotics are the mainstay, but one must always rule out organic causes (delirium/electrolyte imbalance) in elderly psychiatric presentations.

Question 1

A 25-year-old university student had a fight with a neighbor. On the next day, while out, he felt that two men in police uniform were observing his movements. When he reached home in the evening, he was frightened and expressed that the police were after him and would arrest him. His symptoms represent which of the following?

Accepted Answer

Delusion of persecution

Answer

Ideas of reference

Answer

Passivity

Answer

Thought insertion

Question 2

A 25-year-old female complains that her jawline is too long, a perception not shared by her husband or family members. She has consulted multiple plastic surgeons who have not recommended any surgical modification. What condition is she most likely suffering from?

Accepted Answer

Delusional Disorder

Answer

Body Dysmorphic Disorder

Answer

Hypochondriasis

Answer

Somatization Disorder

Question 3

Which of the following is an example of a bizarre delusion?

Accepted Answer

Delusion of persecution: "My brain is controlled by a microchip."

Answer

Delusion of infidelity: "My wife has an affair with another person."

Answer

Delusion of grandiosity: "I am the greatest person in the world."

Answer

Delusion of reference: "I am being prosecuted often."

Question 4

Which type of schizophrenia is characterized by late onset and a good prognosis?

Accepted Answer

Paranoid schizophrenia

Answer

Simple schizophrenia

Answer

Hebephrenic schizophrenia

Answer

Catatonic schizophrenia

Question 5

Which of the following statements regarding schizophrenia and delusional disorder is FALSE?

Accepted Answer

Socially inappropriate behavior is seen in delusional disorders.

Answer

Delusions and hallucinations are positive symptoms of schizophrenia.

Answer

Hallucinations are absent in delusional disorder.

Answer

Symptoms need to be present for at least 6 months to diagnose schizophrenia (according to DSM-5).

Question 6

What is the definition of treatment-resistant schizophrenia (TRS)?

Accepted Answer

Lack of response to two different antipsychotics at adequate doses for four weeks

Answer

Lack of response to one antipsychotic at an adequate dose for four weeks

Answer

Lack of response to one antipsychotic at an adequate dose for ten weeks

Answer

Lack of response to two same antipsychotics at adequate doses for four weeks

Question 7

T.J. Crow proposed a classification of schizophrenia patients into type I and type II. Type II schizophrenia is characterized by all of the following, EXCEPT:

Accepted Answer

Disorganized behavior

Answer

Negative symptoms

Answer

Poor response to medications

Answer

CT scan abnormalities

Question 8

Who coined the term "Ambivalence"?

Accepted Answer

Eugen Bleuler

Answer

Hippocrates

Answer

Kraeplin

Answer

Sigmund Freud

Question 9

An elderly patient presents with auditory hallucinations and a delusion that unknown people are conspiring against him and commenting on his actions. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Dementia

Answer

Delusional disorder

Answer

Acute psychosis

Question 10

A 42-year-old man, employed by a company for 2 years, believes his fellow employees have conspired to get him fired. He suspects his phone is tapped and that he is followed home, frequently checking his residence for surveillance. He denies auditory hallucinations and has no other symptoms. What is the most appropriate diagnosis?

Accepted Answer

Delusional disorder (paranoid type)

Answer

Paranoid schizophrenia

Answer

Catatonic schizophrenia

Answer

Paranoid personality disorder

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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