Psychotic Disorders — MCQs

A 23-year-old engineering student presents with a history of gradual onset of suspiciousness, muttering and smiling without clear reason, decreased socialization, violent outbursts, and lack of interest in studies for 8 months. Mental status examination reveals a blunt affect, thought broadcast, relatively preserved cognition, and impaired judgment and insight. What is the most likely diagnosis?

Q175Easy

Hallucinations are seen in all of the following conditions EXCEPT:

Q176Medium

A 30-year-old man presents with a 2-month history of believing his wife is having an affair with his boss, and that his friend from abroad is involved and providing technical support. He also believes people speak ill of him. His friends have tried to convince him otherwise, but he remains unconvinced. He exhibits no thought disorder or other inappropriate behavior. What is the most likely diagnosis?

Q177Medium

Which of the following is a poor prognostic factor in schizophrenia?

Q178Medium

Which of the following is considered a good prognostic factor in schizophrenia?

Q179Easy

Pathological jealousy is defined as?

Q180Medium

Good prognosis in schizophrenia is indicated by which of the following?

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 171: A 60-year-old male suffering from auditory hallucinations states that people living upstairs are talking about him and conspiring against him. He filed a police complaint against them, but the allegations were proven to be false. What is the most likely diagnosis?

A. Depression
B. Dementia
C. Delusional disorder
D. Schizophrenia (Correct Answer)

Explanation: ### Explanation **Correct Answer: D. Schizophrenia** The patient presents with two core psychotic symptoms: **Auditory hallucinations** (hearing voices talking about him) and **Delusions of persecution** (conspiring against him). According to ICD-10 and DSM-5 criteria, the presence of persistent hallucinations accompanied by delusions is a hallmark of Schizophrenia. While the age of onset (60 years) is late, "Late-onset Schizophrenia" (onset after age 40) frequently presents with prominent persecutory delusions and sensory hallucinations, often directed at neighbors or people in the environment. **Why other options are incorrect:** * **A. Depression:** While psychotic depression exists, the primary feature must be a pervasive low mood, anhedonia, or suicidal ideation. There is no mention of mood symptoms here. * **B. Dementia:** Although delusions can occur in dementia, the primary deficit must be cognitive decline (memory loss, executive dysfunction). The vignette focuses purely on psychotic symptoms. * **C. Delusional Disorder:** This is the most common distractor. In Delusional Disorder, the patient has non-bizarre delusions, but **prominent auditory hallucinations are absent**. Since this patient has clear auditory hallucinations, it points toward Schizophrenia. **NEET-PG High-Yield Pearls:** * **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts (thought echo), voices arguing, and voices commenting. These are highly suggestive of Schizophrenia. * **Late-onset Schizophrenia:** More common in females and often characterized by paranoid themes and better preservation of affect compared to early-onset. * **Diagnostic Duration:** For a diagnosis of Schizophrenia, symptoms should generally be present for at least 1 month (ICD-10) or 6 months (DSM-5). * **Key Distinction:** Delusional Disorder = Delusions ONLY; Schizophrenia = Delusions + Hallucinations + Disorganized behavior/speech.

Question 172: Which subtype of schizophrenia carries the best prognosis?

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

Explanation: **Explanation:** The prognosis of schizophrenia is influenced by the clinical subtype, the speed of onset, and the nature of the symptoms. **1. Why Catatonic Schizophrenia is the Correct Answer:** Catatonic schizophrenia is associated with the **best prognosis** among all subtypes. This is primarily because it often presents with an **acute onset** and is frequently triggered by a clear precipitating stressor. Furthermore, catatonic symptoms (such as stupor, waxy flexibility, or mutism) show a **dramatic and rapid response** to specific treatments, namely Benzodiazepines (Lorazepam) and Electroconvulsive Therapy (ECT). **2. Analysis of Incorrect Options:** * **Simple Schizophrenia:** Carries the **worst prognosis**. It is characterized by an insidious onset of negative symptoms (apathy, withdrawal) without prominent hallucinations or delusions, making it highly resistant to treatment. * **Hebephrenic (Disorganized) Schizophrenia:** Also carries a **poor prognosis**. It typically starts at an early age (early onset) and features disorganized speech, behavior, and flat affect, leading to rapid personality deterioration. * **Paranoid Schizophrenia:** This subtype has a **good prognosis** (better than simple or hebephrenic) because patients usually have higher cognitive functioning and a later age of onset. However, it is generally considered second to Catatonic schizophrenia in terms of overall recovery potential. **Clinical Pearls for NEET-PG:** * **Best Prognosis:** Catatonic > Paranoid. * **Worst Prognosis:** Simple > Hebephrenic. * **Prognostic Factors:** Acute onset, late-age onset, presence of mood symptoms, and positive symptoms (hallucinations/delusions) all indicate a **better** prognosis. * **Negative symptoms** (5 A's: Anhedonia, Affective flattening, Alogia, Avolition, Attention deficit) are markers of a **poor** prognosis.

Question 173: Which of the following is NOT associated with panic disorder?

A. Serotonin
B. GABA
C. Cholecystokinin (CCK)
D. Glutamate (Correct Answer)

Explanation: **Explanation:** Panic disorder is characterized by recurrent, unexpected panic attacks involving a complex interplay of various neurotransmitter systems. **Why Glutamate is the Correct Answer:** While **Glutamate** is the primary excitatory neurotransmitter in the brain and is heavily implicated in conditions like Schizophrenia (NMDA receptor dysfunction) and neurodegenerative diseases, it is **not** traditionally considered a primary mediator in the acute pathophysiology of Panic Disorder. Current evidence focuses more on the dysregulation of the autonomic nervous system and specific inhibitory/excitatory imbalances involving other amines and peptides. **Analysis of Incorrect Options:** * **Serotonin (5-HT):** Serotonergic dysregulation in the raphe nuclei is a hallmark of panic disorder. This is why SSRIs (Selective Serotonin Reuptake Inhibitors) are the first-line long-term treatment. * **GABA:** GABA is the brain's primary inhibitory neurotransmitter. Patients with panic disorder often have reduced GABA receptor sensitivity. Benzodiazepines, which enhance GABAergic tone, are effective in providing acute relief from panic symptoms. * **Cholecystokinin (CCK):** CCK is a neuropeptide that acts as a potent **panicogen**. Administration of CCK (specifically CCK-4) can induce a full-blown panic attack in susceptible individuals, making it a key molecule in panic disorder research. **NEET-PG High-Yield Pearls:** * **Locus Coeruleus:** The primary brain region involved in panic attacks (source of Norepinephrine). * **First-line Treatment:** SSRIs (e.g., Sertraline, Escitalopram). * **Acute Attack Management:** Benzodiazepines (e.g., Alprazolam, Clonazepam). * **Panicogens:** Substances that can trigger attacks include **CO2 inhalation**, Sodium Lactate, Caffeine, and CCK.

Question 174: A 23-year-old engineering student presents with a history of gradual onset of suspiciousness, muttering and smiling without clear reason, decreased socialization, violent outbursts, and lack of interest in studies for 8 months. Mental status examination reveals a blunt affect, thought broadcast, relatively preserved cognition, and impaired judgment and insight. What is the most likely diagnosis?

A. Delusional disorder
B. Depression
C. Schizophrenia (Correct Answer)
D. Anxiety disorder

Explanation: ### Explanation The correct diagnosis is **Schizophrenia**. According to ICD-10 and DSM-5 criteria, a diagnosis of schizophrenia requires the presence of characteristic symptoms (like delusions, hallucinations, or disorganized behavior) for a significant duration (at least 1 month of active symptoms and 6 months of total disturbance). **Why Schizophrenia is correct:** 1. **Duration:** The symptoms have persisted for **8 months**, exceeding the 6-month threshold required for schizophrenia. 2. **Positive Symptoms:** "Muttering and smiling" suggests auditory hallucinations (responding to internal stimuli), while **thought broadcast** is a Schneiderian First Rank Symptom (FRS) pathognomonic for schizophrenia. 3. **Negative Symptoms:** Decreased socialization, blunt affect, and lack of interest (avolition) are classic negative features. 4. **Functional Decline:** The patient shows a clear decline in academic performance and social functioning. **Why other options are incorrect:** * **Delusional Disorder:** Characterized by non-bizarre delusions for at least 1 month. Hallucinations are usually absent or not prominent, and social/occupational functioning is relatively preserved, unlike in this case. * **Depression:** While it can cause social withdrawal and lack of interest, it does not explain thought broadcasting or inappropriate smiling/muttering (psychotic features). * **Anxiety Disorder:** Presents with excessive worry or panic; it does not involve psychosis, thought broadcast, or a blunt affect. **NEET-PG High-Yield Pearls:** * **Schneiderian First Rank Symptoms (FRS):** Includes thought broadcast, thought insertion, thought withdrawal, and "made" phenomena. Their presence strongly suggests schizophrenia but is not 100% pathognomonic. * **Prognosis:** A gradual (insidious) onset, young age of onset, and prominent negative symptoms (as seen here) are indicators of a **poor prognosis**. * **Cognition:** In schizophrenia, consciousness and orientation are typically **preserved**, while insight and judgment are **impaired**.

Question 175: Hallucinations are seen in all of the following conditions EXCEPT:

A. Schizophrenia
B. Seizures due to intracerebral space occupying lesions
C. Lysergic acid diethyl amide intoxication
D. Anxiety (Correct Answer)

Explanation: **Explanation:** Hallucinations are defined as sensory perceptions in the absence of an external stimulus. They are a hallmark of psychosis and organic brain dysfunction but are typically absent in pure neurotic disorders. **Why Anxiety is the Correct Answer:** Anxiety is a neurotic disorder characterized by excessive worry, apprehension, and autonomic hyperactivity. While patients with severe anxiety may experience "illusions" (misinterpretations of real stimuli) or "pseudohallucinations" (where the patient maintains insight), true hallucinations are not a diagnostic feature of anxiety disorders. If a patient with anxiety presents with hallucinations, a co-morbid psychotic or organic condition must be ruled out. **Analysis of Incorrect Options:** * **Schizophrenia:** This is the prototypical psychotic disorder. Auditory hallucinations (especially third-person or running commentary) are a core "Schneiderian First Rank Symptom." * **Seizures (ICSOL):** Intracerebral Space Occupying Lesions (like tumors) can irritate the cortex. Depending on the location (e.g., temporal or occipital lobes), they can trigger focal seizures manifesting as complex visual or olfactory hallucinations. * **LSD Intoxication:** Lysergic acid diethyl amide is a potent hallucinogen. It primarily causes vivid visual hallucinations, synesthesia (blending of senses), and "trips" due to its agonism at 5-HT2A receptors. **High-Yield Clinical Pearls for NEET-PG:** * **Most common hallucination in Psychiatry:** Auditory (Schizophrenia). * **Most common hallucination in Organic Brain Syndrome:** Visual (Delirium/Drug toxicity). * **Hypnagogic/Hypnopompic Hallucinations:** Seen in Narcolepsy (occurring while falling asleep or waking up, respectively). * **Lilliputian Hallucinations:** Seeing small people/objects; classically associated with Alcohol Withdrawal or Cocaine use.

Question 176: A 30-year-old man presents with a 2-month history of believing his wife is having an affair with his boss, and that his friend from abroad is involved and providing technical support. He also believes people speak ill of him. His friends have tried to convince him otherwise, but he remains unconvinced. He exhibits no thought disorder or other inappropriate behavior. What is the most likely diagnosis?

A. Paranoid personality disorder
B. Persistent delusional disorder (Correct Answer)
C. Schizophrenia
D. Acute and transient psychotic disorder

Explanation: ### Explanation **1. Why Persistent Delusional Disorder (PDD) is correct:** The patient presents with a **well-systematized delusion** (infidelity/jealousy) lasting for **2 months**. According to ICD-10/11 and DSM-5, the core feature of PDD is the presence of one or more delusions for at least **1 month** (ICD-10 specifies 3 months, but clinically 1-3 months is the threshold) in the **absence** of other psychotic symptoms like hallucinations, thought disorder, or negative symptoms. Crucially, the patient’s behavior remains organized and "non-bizarre" apart from the impact of the delusion. **2. Why other options are incorrect:** * **Paranoid Personality Disorder:** This involves a pervasive pattern of mistrust and suspiciousness since early adulthood. It does not involve fixed, firm **delusions**; the beliefs are usually "ideas of reference" or overvalued ideas that lack the intensity of a true delusion. * **Schizophrenia:** Requires a duration of at least 6 months (DSM-5) or 1 month (ICD-10) and must include other features like hallucinations, disorganized speech (thought disorder), or negative symptoms, all of which are absent here. * **Acute and Transient Psychotic Disorder (ATPD):** This diagnosis is reserved for psychotic episodes with an acute onset (within 2 weeks) and a total duration of **less than 1 month**. This patient’s symptoms have already persisted for 2 months. **3. NEET-PG High-Yield Pearls:** * **Delusional Disorder - Jealous Type:** Also known as **Othello Syndrome** or Conjugal Paranoia. * **Erotomania:** Also known as **de Clerambault’s Syndrome** (delusion that a person of higher status is in love with the patient). * **Key Differentiator:** In PDD, the personality is preserved, and the patient can often function well socially, unlike in Schizophrenia where there is a "downward drift" in socio-occupational functioning. * **Treatment of Choice:** Atypical antipsychotics (e.g., Risperidone) and psychotherapy (though insight is often poor).

Question 177: Which of the following is a poor prognostic factor in schizophrenia?

A. Acute onset
B. Family history of affective disorder
C. Middle age of onset
D. Past history of schizophrenia (Correct Answer)

Explanation: **Explanation:** The prognosis of schizophrenia is determined by several clinical and demographic variables. A **past history of schizophrenia** (or multiple previous episodes) is a significant **poor prognostic factor** because it indicates a chronic, relapsing course. Each subsequent episode often leads to a lower baseline of functioning, increased resistance to treatment, and more pronounced negative symptoms (the "deteriorating" nature of the illness). **Analysis of Options:** * **A. Acute onset:** This is a **good prognostic factor**. A sudden onset (usually triggered by a stressor) suggests a better chance of recovery compared to an insidious, creeping onset where the patient slowly withdraws over years. * **B. Family history of affective disorder:** Interestingly, a family history of mood disorders (like Bipolar or Depression) is associated with a **better prognosis** in schizophrenia, as it suggests the patient’s psychosis may have an "affective" component, which typically responds better to treatment. Conversely, a family history of schizophrenia is a poor prognostic factor. * **C. Middle age of onset:** **Late or middle-age onset** is a **good prognostic factor**. Patients who develop the illness later in life usually have better premorbid social and occupational adjustment (e.g., they are married or have held jobs), which aids recovery. Early (adolescent) onset is associated with poor outcomes. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognostic Indicators:** Female sex, married status, presence of positive symptoms (hallucinations/delusions), and identifiable precipitating stressors. * **Worst Prognostic Indicators:** Male sex, single/divorced status, presence of negative symptoms (apathy/withdrawal), and early/insidious onset. * **The "Rule of Thirds":** One-third of patients lead a normal life, one-third have moderate symptoms, and one-third are significantly impaired.

Question 178: Which of the following is considered a good prognostic factor in schizophrenia?

A. Insidious onset
B. Positive symptoms (Correct Answer)
C. Disorganized subtype
D. Absence of depression

Explanation: **Explanation:** Prognosis in Schizophrenia is determined by various clinical, social, and demographic factors. Understanding these is crucial for NEET-PG as they frequently appear in clinical vignettes. **Why "Positive Symptoms" is correct:** Positive symptoms (hallucinations, delusions) are associated with a **better prognosis** because they often respond well to typical and atypical antipsychotics. These symptoms are typically associated with a more acute presentation and relatively preserved brain structure, unlike negative symptoms, which are linked to structural brain changes and poor treatment response. **Analysis of Incorrect Options:** * **A. Insidious onset:** A slow, creeping onset is a **poor** prognostic factor. It often indicates a long duration of untreated psychosis (DUP). Conversely, an **acute/sudden onset** (precipitated by stress) suggests a better outcome. * **C. Disorganized subtype:** This subtype (formerly Hebephrenic) is associated with an early onset, poor emotional expression, and significant cognitive decline, leading to a **poor** prognosis. The **Paranoid subtype** generally has the best prognosis. * **D. Absence of depression:** Interestingly, the **presence of mood symptoms** (depression or anxiety) is actually a **good** prognostic factor. It suggests a more "affective" component to the illness, which typically correlates with better social functioning and treatment response compared to "pure" schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognostic Factors:** Late onset, female sex, married status, high IQ, positive symptoms, and clear precipitating factors. * **Worst Prognostic Factors:** Early onset (childhood/adolescence), male sex, single/divorced status, negative symptoms (apathy, anhedonia), and family history of schizophrenia. * **Key Concept:** The single most important predictor of a poor outcome is a **long Duration of Untreated Psychosis (DUP).**

Question 179: Pathological jealousy is defined as?

A. A delusion of infidelity (Correct Answer)
B. A delusion of love
C. A delusion of doubles
D. A delusion of grandeur

Explanation: **Explanation:** **Pathological jealousy**, also known as **Othello Syndrome** or Conjugal Paranoia, is a type of delusional disorder where an individual is firmly convinced, without adequate evidence, that their spouse or sexual partner is being unfaithful. 1. **Why Option A is Correct:** Pathological jealousy is characterized by a **delusion of infidelity**. The patient often collects "evidence" (e.g., checking phone logs, examining bedsheets, or following the partner) to prove the perceived betrayal. It is more common in males and is strongly associated with chronic alcoholism and personality disorders. 2. **Why Other Options are Incorrect:** * **Option B (Delusion of Love):** Known as **Erotomania** or **de Clerambault’s Syndrome**, where the patient believes a person of higher status (e.g., a celebrity) is in love with them. * **Option C (Delusion of Doubles):** Known as **Capgras Syndrome**, where the patient believes a familiar person has been replaced by an identical-looking impostor. * **Option D (Delusion of Grandeur):** Common in Mania, where the patient has an exaggerated sense of their own importance, power, or identity. **High-Yield Clinical Pearls for NEET-PG:** * **Othello Syndrome** is frequently associated with **Alcohol Dependence Syndrome**. * It carries a high risk of **violence and homicide** toward the partner. * **Treatment:** Antipsychotics (e.g., Risperidone) and treating the underlying substance abuse. * **Fregoli Syndrome:** The opposite of Capgras; the belief that different people are actually a single person in disguise.

Question 180: Good prognosis in schizophrenia is indicated by which of the following?

A. Soft neurological signs
B. Affective symptoms (Correct Answer)
C. Emotional blunting
D. Insidious onset

Explanation: In schizophrenia, prognosis is determined by the clinical presentation, onset, and associated features. **Why Affective Symptoms are Correct:** The presence of **affective symptoms** (mood symptoms like depression or anxiety) is a strong indicator of a **good prognosis**. This is because patients with prominent mood components often have a clinical picture closer to "Schizoaffective Disorder" or "Mood Disorder with Psychotic Features," which generally respond better to treatment and have higher rates of remission compared to "pure" schizophrenia. **Explanation of Incorrect Options:** * **Soft Neurological Signs (A):** These are non-specific motor or sensory abnormalities (e.g., poor coordination, dysdiadochokinesia). Their presence suggests underlying neurodevelopmental brain damage and is associated with a **poor prognosis**. * **Emotional Blunting (C):** This is a "Negative Symptom." Negative symptoms (the 5 A’s: Affective flattening, Alogia, Avolition, Anhedonia, Attention deficit) are notoriously resistant to antipsychotic treatment and indicate a **poor prognosis**. * **Insidious Onset (D):** A slow, gradual onset of symptoms usually implies a long duration of untreated psychosis (DUP) and a chronic course. Conversely, an **acute/sudden onset** (triggered by a stressor) is a **good prognostic factor**. **High-Yield Clinical Pearls for NEET-PG:** * **Good Prognostic Factors:** Late onset, female gender, married status, positive symptoms (hallucinations/delusions), and good premorbid adjustment. * **Poor Prognostic Factors:** Early onset (childhood/adolescence), male gender, single/divorced status, family history of schizophrenia, and structural brain changes (e.g., enlarged ventricles). * **Key Fact:** The single most important predictor of outcome in schizophrenia is the **duration of untreated psychosis (DUP)**.

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

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Psychosis in Medical Conditions

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First Episode Psychosis

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Treatment-Resistant Psychosis

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Rehabilitation in Psychotic Disorders

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Outcome and Prognosis

Practice Questions

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