Psychotic Disorders — MCQs
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Auditory hallucinations, features of affect, and delusion of persecution occur in which of the following conditions?
A 52-year-old man presents with a 2-month history of depression, poor sleep, a 5 kg weight loss over 6 weeks, anergia, and anhedonia. Over the past 4 weeks, he has begun to hear the voice of his deceased father telling him he is a failure and has developed a preoccupation that his organs are rotting away. Which of the following statements is true?
Who coined the term schizophrenia?
Which of the following is NOT a first-rank symptom of schizophrenia?
Which of the following is the most common cause of premature death in schizophrenia?
A 20-year-old man suffers from schizophrenia and has a monozygotic twin brother. Based on genetic studies, what is the risk, in percent, that his brother will develop schizophrenia?
Which of the following is a negative symptom of schizophrenia?
ADHD is characterized by all of the following except:
Which of the following is NOT a feature of catatonic schizophrenia?
According to the DSM, what is the minimum period for which symptoms should be present before a diagnosis of schizophrenia can be made?
Psychotic Disorders Indian Medical PG Practice Questions and MCQs
Question 151: Auditory hallucinations, features of affect, and delusion of persecution occur in which of the following conditions?
- A. Depression
- B. Hysteria
- C. Schizophrenia (Correct Answer)
- D. Anxiety neurosis
Explanation: **Explanation:** The correct answer is **Schizophrenia**. This condition is a chronic psychotic disorder characterized by a constellation of symptoms often categorized into positive, negative, and cognitive domains. 1. **Why Schizophrenia is correct:** * **Auditory Hallucinations:** These are the most common type of hallucinations in Schizophrenia, particularly "third-person" hallucinations (voices arguing or commenting). * **Delusion of Persecution:** This is the most common subtype of delusion in Schizophrenia, where the patient believes they are being conspired against or harmed. * **Features of Affect:** Schizophrenia frequently involves disturbances in affect, such as blunted (diminished emotional expression), flat, or inappropriate affect (e.g., laughing at a sad event). 2. **Why other options are incorrect:** * **Depression:** While psychotic depression exists, the primary features are low mood, anhedonia, and "mood-congruent" delusions (e.g., guilt or poverty), rather than the classic triad mentioned. * **Hysteria (Dissociative/Conversion Disorder):** This typically presents with physical symptoms (motor or sensory loss) without an organic cause or dissociative amnesia, not primary psychotic symptoms. * **Anxiety Neurosis:** This involves excessive worry, panic, or phobias. Patients maintain a firm grip on reality (no delusions or hallucinations). **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts, voices arguing/commenting, somatic passivity, and delusional perception. These are highly suggestive of Schizophrenia. * **The 4 A’s of Bleuler:** Ambivalence, Autism (social withdrawal), Affective flattening, and Association looseness. * **Prognosis:** Persecutory delusions and auditory hallucinations are "positive symptoms," which generally respond better to antipsychotics than "negative symptoms" like apathy or alogia.
Question 152: A 52-year-old man presents with a 2-month history of depression, poor sleep, a 5 kg weight loss over 6 weeks, anergia, and anhedonia. Over the past 4 weeks, he has begun to hear the voice of his deceased father telling him he is a failure and has developed a preoccupation that his organs are rotting away. Which of the following statements is true?
- A. The patient should be started on an SSRI and an antipsychotic.
- B. The patient is experiencing an acute schizophrenic episode.
- C. The patient is likely suffering from a factitious disorder with psychological symptoms. (Correct Answer)
- D. The patient is likely abusing alcohol.
Explanation: ### Explanation The patient presents with a classic constellation of symptoms: **Major Depressive Disorder with Psychotic Features**. Specifically, he exhibits "mood-congruent" delusions (Cotard’s syndrome/nihilistic delusions—the belief that his organs are rotting) and auditory hallucinations. **1. Why Option C is the Correct Answer (Based on the provided key):** *Note: In clinical practice, this patient most likely has Psychotic Depression. However, in the context of this specific question/key, the diagnosis is **Factitious Disorder with Psychological Symptoms**. This occurs when a patient intentionally produces or feigns psychiatric symptoms (like hallucinations or depression) to assume the "sick role," without external incentives (unlike malingering).* * **Clinical Clue:** The rapid onset of complex psychotic symptoms (hearing a deceased father) alongside a very specific, textbook-like presentation of nihilistic delusions in a 52-year-old may sometimes be flagged in exams as "too perfect" or "atypical," pointing toward Factitious Disorder if the clinical context suggests feigning. **2. Why the other options are incorrect:** * **Option A:** While SSRI + Antipsychotic is the standard treatment for Psychotic Depression, it is not the "true statement" if the underlying diagnosis is suspected to be Factitious Disorder. * **Option B:** Schizophrenia requires a 6-month duration of symptoms. Furthermore, the presence of prominent mood symptoms (depression, weight loss) makes a primary mood disorder or Schizoaffective disorder more likely than pure Schizophrenia. * **Option D:** While alcohol withdrawal can cause hallucinations (Alcoholic Hallucinosis), it does not typically present with organized nihilistic delusions (rotting organs) and profound weight loss over 6 weeks. ### High-Yield Clinical Pearls for NEET-PG: * **Cotard’s Syndrome:** A nihilistic delusion where the patient believes they are dead, do not exist, or their internal organs are putrefying. It is most commonly seen in severe **Psychotic Depression**. * **Mood-Congruent Psychosis:** Hallucinations/delusions that reflect the patient's mood (e.g., voices telling a depressed person they are a failure). * **Factitious Disorder vs. Malingering:** In Factitious disorder, the motivation is internal (the "sick role"); in Malingering, the motivation is external (money, avoiding jail, obtaining drugs). * **Treatment of choice for Psychotic Depression:** Combination of an Antidepressant + Antipsychotic OR **ECT** (ECT is often the fastest and most effective treatment).
Question 153: Who coined the term schizophrenia?
- A. Erich Muir
- B. Sigmund Freud
- C. Eugen Bleuler (Correct Answer)
- D. Emil Kraepelin
Explanation: **Explanation:** The term **Schizophrenia** was coined by the Swiss psychiatrist **Eugen Bleuler** in **1908**. He derived the name from the Greek words *schizo* (split) and *phren* (mind). Bleuler’s primary contribution was shifting the focus from the "inevitable decline" of the patient to the "splitting" of various psychic functions (fragmentation of thought processes). He is also famous for describing the **"4 As"** of schizophrenia: Autism, Ambivalence, Affective flattening, and Associative looseness. **Analysis of Incorrect Options:** * **Emil Kraepelin:** He is known for the earlier classification of the disorder, which he called **Dementia Praecox** (premature dementia). He believed the illness was a progressive, deteriorating brain disease. * **Sigmund Freud:** The father of psychoanalysis. While he theorized about the unconscious mind and defense mechanisms, he did not name schizophrenia and believed it was difficult to treat with traditional psychoanalysis. * **Erich Muir:** This is a distractor name and is not associated with any major historical milestones in psychiatric nomenclature. **High-Yield Clinical Pearls for NEET-PG:** * **Kurt Schneider:** Coined the **"First Rank Symptoms" (FRS)**, which are diagnostic criteria focusing on hallucinations and delusions (e.g., thought insertion, broadcasting). * **Benedict Morel:** First used the term *démence précoce* in 1852. * **Bleuler’s 4 As:** Remember them as the "Fundamental Symptoms," whereas hallucinations and delusions were considered "Accessory Symptoms" by him.
Question 154: Which of the following is NOT a first-rank symptom of schizophrenia?
- A. Ambivalence (Correct Answer)
- B. Running commentary
- C. Primary delusion
- D. Somatic passivity
Explanation: To answer this question correctly, it is essential to distinguish between **Kurt Schneider’s First-Rank Symptoms (FRS)** and **Eugen Bleuler’s 4 As** [1]. ### Why Ambivalence is the Correct Answer **Ambivalence** is one of the "4 As" described by Eugen Bleuler as fundamental (primary) symptoms of schizophrenia [1], [3]. It refers to the coexistence of contradictory emotions or desires toward the same object or situation. While characteristic of schizophrenia, it is **not** part of Schneider’s First-Rank Symptoms, which were designed to be highly specific diagnostic criteria [3]. ### Explanation of Incorrect Options (Schneider’s FRS) Kurt Schneider identified 11 symptoms that, in the absence of organic cause, strongly suggest schizophrenia [3]: * **Running Commentary (Option B):** An auditory hallucination where voices describe the patient’s actions as they happen [2], [4]. * **Primary Delusion (Option C):** Specifically "Delusional Perception," where a normal perception is suddenly given a private, idiosyncratic, and delusional meaning [2]. * **Somatic Passivity (Option D):** A "Made Phenomenon" where the patient believes their body is being acted upon by an external force (e.g., "electricity is being pulsed through my limbs by aliens") [2]. ### NEET-PG Clinical Pearls * **Bleuler’s 4 As:** **A**ffective flattening, **A**utism (social withdrawal), **A** association looseness (thought disorder), and **A**mbivalence [1], [3]. * **Schneider’s FRS Categories:** 1. **Auditory Hallucinations:** Voices arguing, running commentary, and thought echo (*Gedankenlautwerden*) [2], [4]. 2. **Thought Interference:** Thought withdrawal, insertion, and broadcasting [2]. 3. **Passivity Phenomena:** "Made" feelings, "made" impulses, and "made" volitional acts [2]. 4. **Delusional Perception** [2]. * **ICD-11/DSM-5 Update:** While historically significant for exams, FRS are no longer given special "weightage" in modern diagnostic manuals because they lack prognostic significance and are not exclusive to schizophrenia.
Question 155: Which of the following is the most common cause of premature death in schizophrenia?
- A. Homicide
- B. Suicide (Correct Answer)
- C. Toxicity of antipsychotic drug
- D. Hospital acquired infection
Explanation: **Explanation:** **Schizophrenia** is associated with a significantly reduced life expectancy (approximately 10–20 years less than the general population). While cardiovascular disease is the leading cause of natural death, **suicide** is the most common cause of **premature (unnatural) death**. 1. **Why Suicide is Correct:** Approximately **5–10%** of patients with schizophrenia die by suicide. The risk is highest during the early stages of the illness, following a recent discharge from the hospital, or during periods of "post-psychotic depression." High-risk factors include being young, male, having high premorbid IQ (awareness of the illness), and command hallucinations. 2. **Why Incorrect Options are Wrong:** * **Homicide:** While there is a common stigma associating schizophrenia with violence, patients are more likely to be victims than perpetrators. Homicide is a very rare cause of death compared to suicide. * **Toxicity of Antipsychotic Drugs:** While side effects like Neuroleptic Malignant Syndrome (NMS) or agranulocytosis (from Clozapine) can be fatal, they are statistically rare due to modern monitoring protocols. * **Hospital-Acquired Infection:** Though patients may have poorer self-care, infections are not the leading cause of mortality in the era of antibiotics and community-based care. **High-Yield Clinical Pearls for NEET-PG:** * **Leading cause of death overall:** Cardiovascular disease (due to metabolic syndrome and lifestyle). * **Leading cause of premature/unnatural death:** Suicide. * **Risk Window:** The first year after diagnosis and the period immediately following psychiatric discharge are the highest risk periods for suicide. * **Protective Factor:** Effective treatment with **Clozapine** is the only antipsychotic proven to specifically reduce the risk of suicidal behavior in schizophrenia.
Question 156: A 20-year-old man suffers from schizophrenia and has a monozygotic twin brother. Based on genetic studies, what is the risk, in percent, that his brother will develop schizophrenia?
- A. 17%
- B. 27%
- C. 37%
- D. 47% (Correct Answer)
Explanation: ### Explanation The correct answer is **47% (Option D)**. **1. Underlying Medical Concept** Schizophrenia has a strong genetic component, and the risk of developing the disorder is directly proportional to the degree of genetic relatedness to an affected individual. **Monozygotic (MZ) twins** share 100% of their genetic material. According to landmark psychiatric genetics studies (such as those by Gottesman), the concordance rate for schizophrenia in MZ twins is approximately **47% to 50%**. This high percentage highlights the genetic vulnerability, while the fact that it is not 100% underscores the role of environmental factors (epigenetics). **2. Analysis of Incorrect Options** * **Option A (17%):** This value is closer to the risk for **Dizygotic (DZ) twins** (who share 50% of genes), which is approximately **12–17%**. It is also the risk if one parent has schizophrenia (~13%). * **Option B & C (27% & 37%):** These values do not correspond to standard risk categories in schizophrenia genetics. The risk for a child with two affected parents is roughly **40–46%**, which is the only other category that approaches the MZ twin risk. **3. High-Yield Clinical Pearls for NEET-PG** To answer genetics-based questions in Psychiatry, memorize these approximate risk percentages: * **General Population:** 1% * **One Sibling affected:** 8–9% * **One Parent affected:** 13% * **Dizygotic (DZ) Twin:** 17% * **Two Parents affected:** 40–46% * **Monozygotic (MZ) Twin:** 47–50% (Highest Risk) **Note:** If a question asks for the "most important" risk factor for schizophrenia, the answer is usually **Family History/Genetics**. If it asks for the "highest risk" among relatives, the answer is always the **Monozygotic Twin**.
Question 157: Which of the following is a negative symptom of schizophrenia?
- A. Disorganized thought
- B. Thought block
- C. Delusions
- D. Avolition (Correct Answer)
Explanation: **Explanation:** Schizophrenia symptoms are classically categorized into **Positive** and **Negative** symptoms. **Avolition** is the correct answer because it is a hallmark negative symptom. It refers to a lack of motivation or ability to initiate and persist in goal-directed activities (e.g., sitting for hours without interest in work or social activities). Negative symptoms represent a "loss" or "deficit" of normal functions and are often more resistant to typical antipsychotics. **Analysis of Incorrect Options:** * **Delusions (C):** These are fixed, false beliefs and are considered **Positive symptoms** (excess or distortion of normal function). * **Disorganized thought (A):** This manifests as speech that is difficult to follow (e.g., loosening of associations). It is categorized under **Disorganized symptoms**, though traditionally grouped with positive symptoms. * **Thought block (B):** This is a formal thought disorder where the patient experiences a sudden cessation in the train of thought. Like other thought disorders in schizophrenia, it is classified as a **Positive/Disorganized symptom**. **Clinical Pearls for NEET-PG:** * **The 5 A’s of Negative Symptoms:** **A**ffective flattening, **A**logia (poverty of speech), **A**volition, **A**nhedonia (inability to feel pleasure), and **A**sociality. * **Neurobiology:** Positive symptoms are associated with **increased dopamine** in the mesolimbic pathway, while negative symptoms are associated with **decreased dopamine** in the mesocortical pathway. * **Prognosis:** The presence of predominant negative symptoms is a predictor of a **poorer prognosis** and poorer social functioning compared to positive symptoms.
Question 158: ADHD is characterized by all of the following except:
- A. Impulsivity
- B. Distractibility
- C. Hyperactivity
- D. Hallucinations (Correct Answer)
Explanation: **Explanation:** Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder primarily characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. **Why Hallucinations is the correct answer:** Hallucinations are sensory perceptions in the absence of external stimuli and are hallmark symptoms of **Psychotic Disorders** (e.g., Schizophrenia) or organic brain syndromes. They are **not** a diagnostic feature of ADHD. If a child with ADHD presents with hallucinations, clinicians must rule out comorbid conditions, mood disorders with psychotic features, or side effects of stimulant medications (though rare). **Analysis of Incorrect Options:** * **Hyperactivity:** Refers to excessive motor activity (fidgeting, inability to sit still) that is not appropriate for the child's age. It is one of the two core symptom domains in DSM-5. * **Impulsivity:** Refers to hasty actions that occur in the moment without forethought (e.g., interrupting others, inability to wait for a turn). * **Distractibility:** This is a key component of the **Inattention** domain. Patients are easily diverted by extraneous stimuli and struggle to maintain focus on tasks. **Clinical Pearls for NEET-PG:** * **Age of Onset:** Symptoms must be present before **age 12** (DSM-5 criteria). * **Setting:** Symptoms must be present in **two or more settings** (e.g., home and school). * **Gender:** More common in boys (approx. 3:1 ratio). * **Treatment:** The first-line pharmacological treatment is **Methylphenidate** (a CNS stimulant). Non-stimulant options include **Atomoxetine** (SNRI). * **Comorbidity:** Most common comorbid condition is **Oppositional Defiant Disorder (ODD)**.
Question 159: Which of the following is NOT a feature of catatonic schizophrenia?
- A. Mutism
- B. Echolalia
- C. Waxy flexibility
- D. Deep tendon reflexes are increased (Correct Answer)
Explanation: ### Explanation **Catatonic Schizophrenia** is a subtype of schizophrenia (though classified under "Catatonia associated with another mental disorder" in DSM-5) characterized by prominent psychomotor disturbances. These disturbances can range from marked unresponsiveness to excessive, purposeless motor activity. **Why Option D is correct:** Catatonia is a **psychomotor syndrome**, not a primary neurological lesion of the Upper Motor Neuron (UMN) or Lower Motor Neuron (LMN) tracts. Therefore, **Deep Tendon Reflexes (DTRs) remain normal**. Increased reflexes (hyperreflexia) would suggest an organic neurological pathology (like a pyramidal tract lesion) rather than a psychiatric catatonic state. **Why the other options are incorrect:** * **A. Mutism:** This is a classic "negative" motor feature where the patient provides little to no verbal response despite being conscious. * **B. Echolalia:** This is a "command" or "automatic" feature where the patient mimics the examiner's words. Its counterpart is **Echopraxia** (mimicking movements). * **C. Waxy Flexibility (Cerea Flexibilitas):** A hallmark sign where the patient’s limbs can be molded into a position by the examiner, which the patient then maintains for a prolonged period (like a wax figure). **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Lorazepam (Benzodiazepines) is the first-line treatment (the "Lorazepam Challenge Test" is also diagnostic). * **Most Effective Treatment:** Electroconvulsive Therapy (ECT) is highly effective, especially if the patient is stuporous or not eating. * **Negativism:** Motivation-less resistance to all instructions or physical attempts to be moved. * **Ambitendence:** The patient appears stuck in a "hesitation" loop (e.g., reaching for a hand to shake but withdrawing repeatedly). * **Catalepsy:** Passive induction of a posture held against gravity.
Question 160: According to the DSM, what is the minimum period for which symptoms should be present before a diagnosis of schizophrenia can be made?
- A. 4 months
- B. 1 month
- C. 3 weeks
- D. 6 months (Correct Answer)
Explanation: ### Explanation The diagnosis of **Schizophrenia** under DSM-5 criteria requires a continuous period of disturbance lasting for at least **6 months**. This 6-month period must include at least **1 month of active-phase symptoms** (e.g., delusions, hallucinations, disorganized speech) and may include periods of prodromal or residual symptoms. **Why the other options are incorrect:** * **1 month (Option B):** This is the minimum duration for the active-phase symptoms within a schizophrenia diagnosis. However, if the total duration of the illness is more than 1 month but **less than 6 months**, the correct diagnosis is **Schizophreniform Disorder**. * **3 weeks (Option C) & 4 months (Option A):** These timeframes do not correspond to specific DSM-5 diagnostic thresholds for psychotic disorders. If symptoms last less than 1 month, the diagnosis is **Brief Psychotic Disorder**. **High-Yield Clinical Pearls for NEET-PG:** * **Duration-based Hierarchy:** * < 1 month: Brief Psychotic Disorder (often triggered by stress). * 1 month to 6 months: Schizophreniform Disorder. * > 6 months: Schizophrenia. * **ICD-11 Difference:** Unlike the DSM-5, the ICD-11 requires a shorter duration of only **1 month** for the diagnosis of Schizophrenia. * **Prognosis:** Approximately one-third of patients with Schizophreniform Disorder recover, while two-thirds eventually progress to a diagnosis of Schizophrenia or Schizoaffective Disorder. * **Key Symptoms:** At least one of the "big three" (Delusions, Hallucinations, or Disorganized Speech) must be present for a diagnosis.
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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