Psychotic Disorders Practice Questions

Q: Delusion of grandeur, persecution, and reference is seen in which of the following?

Paranoid schizophrenia. ### Explanation **Correct Option: B. Paranoid Schizophrenia** Paranoid schizophrenia is characterized primarily by the presence of stable, often systematized **delusions** and **hallucinations** (usually auditory). The most common delusions encountered are: * **Delusion of Persecution:** The belief that one is being conspired against or harmed. * **Delusion of Grandeur:** An exaggerated sense of self-importance, power, or knowledge. * **Delusion of Reference:** The false belief that neutral external events (like a news report) have a special personal significance. In this subtype, cognitive functions and affect remain relatively preserved compared to other forms. **Why Other Options are Incorrect:** * **A. Catatonic Schizophrenia:** Dominated by psychomotor disturbances. Features include mutism, stupor, waxy flexibility, negativism, or purposeless excitement. Delusions are not the defining feature. * **C. Simple Schizophrenia:** Characterized by an insidious onset of "negative symptoms" (apathy, social withdrawal, loss of drive) without prominent hallucinations or delusions. * **D. Disorganized (Hebephrenic) Schizophrenia:** Characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect (e.g., giggling). While delusions may occur, they are fragmentary and non-systematized, unlike the stable delusions of the paranoid type. **High-Yield Clinical Pearls for NEET-PG:** * **Most common subtype:** Paranoid schizophrenia is the most frequent clinical subtype worldwide. * **Prognosis:** Paranoid schizophrenia has the **best prognosis** for occupational functioning and independent living. * **Age of onset:** Usually occurs later in life compared to disorganized or catatonic types. * **Schneider’s First Rank Symptoms (FRS):** These are highly suggestive of schizophrenia and include thought insertion, withdrawal, broadcast, and "made" phenomena.

Q: Which of the following features is not typically considered a primary symptom of psychosis?

Panic attack. **Explanation:** Psychosis is a clinical syndrome characterized by a "loss of contact with reality." The core features of psychotic disorders include delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or catatonic behavior. **Why Panic Attack is the correct answer:** A **Panic Attack** is an episode of intense fear accompanied by severe autonomic arousal (tachycardia, sweating, tremors). It is a hallmark of **Anxiety Disorders**, not Psychotic Disorders. In a panic attack, the individual’s reality testing remains intact; they are aware that their physical symptoms are a result of extreme anxiety, even if they fear they are dying. Therefore, it is not a primary symptom of psychosis. **Analysis of other options:** * **Delusion (B):** A fixed, false belief that is not amenable to change in light of conflicting evidence. It is a primary symptom of psychosis (disorder of thought content). * **Hallucination (C):** A perception in the absence of an external stimulus (e.g., hearing voices). It is a primary symptom of psychosis (disorder of perception). * **Hypochondriasis (D):** Now classified under Somatic Symptom Disorder (DSM-5), it involves a preoccupation with having a serious illness. While primarily a neurotic/somatic concern, it can reach **delusional intensity** (Somatic Delusion) in psychotic disorders, where the patient is unshakably convinced they have a disease despite medical reassurance. **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** These are pathognomonic for Schizophrenia and include audible thoughts, voices arguing/commenting, and somatic passivity. * **Reality Testing:** The fundamental distinction between Neurosis (Anxiety/Depression) and Psychosis is the **loss of reality testing** in the latter. * **Formal Thought Disorder:** This refers to disorganized thinking (e.g., loosening of associations), which is a core objective sign of psychosis.

Q: A young woman develops a delusional belief that a famous film star is in love with her. Which of the following conditions best exemplifies this presentation?

Erotomania. **Explanation:** The clinical presentation described is a classic example of **Erotomania**, also known as **de Clérambault's Syndrome**. **1. Why Erotomania is correct:** Erotomania is a subtype of delusional disorder where the individual (typically a woman) develops a fixed, false belief that another person—usually of higher social status, such as a celebrity, politician, or employer—is deeply in love with them. Despite the lack of any real contact, the patient interprets neutral actions (like a TV anchor’s smile) as secret messages of affection. **2. Why other options are incorrect:** * **Persecutory delusion:** This is the most common type of delusion, where the individual believes they are being conspired against, cheated, or harassed. It does not involve themes of romantic love. * **Grandiose delusion:** The individual possesses an inflated sense of worth, power, knowledge, or identity (e.g., believing they are a deity or have a special relationship with a deity). While erotomania involves a "famous" person, the core theme is specifically romantic love, not personal omnipotence. * **Nymphomania:** This is an outdated term for hypersexuality in women. It refers to a high frequency of sexual desire or activity and is a behavioral/impulse control issue, not a delusional thought disorder. **High-Yield Clinical Pearls for NEET-PG:** * **De Clérambault's Syndrome:** Named after the French psychiatrist who first described it. * **Demographics:** More common in females, though males with the condition are more likely to exhibit stalking behavior or legal issues. * **Management:** Delusional disorders are notoriously difficult to treat; **Second-generation antipsychotics** (e.g., Risperidone) are the first-line pharmacological treatment, often combined with psychotherapy. * **Key Distinction:** In erotomania, the "lover" is usually the one who is supposedly pursuing the patient, not the other way around (initially).

Q: What is the most common type of hallucination experienced in schizophrenia?

Auditory. **Explanation:** In the context of schizophrenia, **Auditory Hallucinations** are the most common and characteristic perceptual disturbances, occurring in approximately 70-80% of patients. These typically manifest as "voices" that may be derogatory, commanding, or conversational. Specifically, **third-person hallucinations** (voices discussing the patient among themselves) and **running commentaries** are considered Schneiderian First-Rank Symptoms (FRS), which carry high diagnostic weight for schizophrenia. **Analysis of Incorrect Options:** * **B. Visual Hallucinations:** While they can occur in schizophrenia, they are much less frequent than auditory ones. Their presence should always prompt a clinician to rule out **organic brain syndromes**, substance withdrawal (e.g., Delirium Tremens), or complex partial seizures. * **C. Olfactory Hallucinations:** These involve smelling non-existent odors (often unpleasant like burning rubber or sulfur). They are rare in schizophrenia and are most commonly associated with **Temporal Lobe Epilepsy** (uncinate fits). * **D. Tactile Hallucinations:** Also known as haptic hallucinations, these are uncommon in schizophrenia. They are classically associated with **cocaine intoxication** ("cocaine bugs" or Formication) and alcohol withdrawal. **Clinical Pearls for NEET-PG:** * **Most common subtype of Schizophrenia:** Paranoid Schizophrenia. * **Best Prognosis:** Paranoid Schizophrenia; **Worst Prognosis:** Hebephrenic (Disorganized) Schizophrenia. * **Functional Hallucination:** A real external stimulus triggers a simultaneous hallucination in the same sensory modality (e.g., hearing voices only when the tap is running). * **Reflex Hallucination:** A stimulus in one sensory modality triggers a hallucination in another (e.g., seeing a ghost when hearing a bell).

Q: What is Folie à deux?

Shared delusional disorder. **Explanation:** **Folie à deux** (literally "madness of two") is a rare clinical syndrome characterized by the transmission of delusional beliefs from one individual to another. In modern psychiatric classification (ICD-10), it is termed **Shared Psychotic Disorder** or **Induced Delusional Disorder**. 1. **Why Option B is Correct:** The disorder typically involves two people (usually family members with a close emotional bond) living in relative isolation. The **"primary" (inducer/dominant)** individual has a genuine psychotic disorder with stable delusions, which are then "passed on" to the **"secondary" (passive/submissive)** individual. A key diagnostic and therapeutic feature is that the secondary person’s delusions often resolve or significantly improve once they are separated from the primary individual. 2. **Why Other Options are Incorrect:** * **A. Obsessive-compulsive disorder:** Characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), not shared delusions. * **C. Hysteria:** An archaic term for Dissociative or Conversion disorders, involving physical symptoms without organic causes or emotional dissociation. * **D. Neurasthenia:** An older term (ICD-10) for a condition involving chronic fatigue, lassitude, and somatic complaints, often linked to stress. **Clinical Pearls for NEET-PG:** * **Treatment:** The first step in management is **separation** of the two individuals. The primary person usually requires antipsychotics, while the secondary may only need observation after separation. * **Variants:** If three people are involved, it is *Folie à trois*; if an entire family, it is *Folie à famille*. * **ICD-11 Update:** Under the newer ICD-11, this is categorized under "Induced Delusional Disorder."

Question 1

A 22-year-old male presented with a 2-day history of auditory hallucinations (hearing voices when no one is around) and aggressive behavior. He also reports that people are abusing him. He has had a fever for the past 2 days. There is no significant past medical history. What is the most likely diagnosis?

Accepted Answer

Acute psychosis

Answer

Dementia

Answer

Delirium

Answer

Delusion

Question 2

Delusion of grandeur, persecution, and reference is seen in which of the following?

Accepted Answer

Paranoid schizophrenia

Answer

Catatonic schizophrenia

Answer

Simple schizophrenia

Answer

Disorganized schizophrenia

Question 3

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

Accepted Answer

Late age of onset (e.g., 40 years)

Answer

Early age of onset (e.g., 18 years)

Answer

Gradual onset

Answer

Male gender

Question 4

Which of the following features is not typically considered a primary symptom of psychosis?

Accepted Answer

Panic attack

Answer

Delusion

Answer

Hallucination

Answer

Hypochondriasis

Question 5

A young woman develops a delusional belief that a famous film star is in love with her. Which of the following conditions best exemplifies this presentation?

Accepted Answer

Erotomania

Answer

Persecutory delusion

Answer

Grandiose delusion

Answer

Nymphomania

Question 6

A 22-year-old, unmarried man is suffering from sudden onset of third person hallucination for the past 12 days. He is suspicious of his relatives and close friends and is having reduced appetite and improper sleep. What is he most likely suffering from?

Accepted Answer

Schizophrenia

Answer

Acute depression

Answer

Acute mania

Answer

Acute psychosis

Question 7

What is the most common type of persistent delusional disorder?

Accepted Answer

Delusion of persecution

Answer

Somatic delusion

Answer

Delusion of jealousy

Answer

Delusion of grandeur

Question 8

What is the most common type of hallucination experienced in schizophrenia?

Accepted Answer

Auditory

Answer

Visual

Answer

Olfactory

Answer

Tactile

Question 9

A 20-year-old male presents with auditory hallucinations and aggressive behavior for the past 2 days. He also reports fever during the same period. His family states he has been muttering to himself and gesturing. There is no prior history of psychiatric illness. What is the most likely diagnosis?

Accepted Answer

Acute psychosis

Answer

Dementia

Answer

Delirium

Answer

Delusional disorder

Question 10

What is Folie à deux?

Accepted Answer

Shared delusional disorder

Answer

Obsessive-compulsive disorder

Answer

Hysteria

Answer

Neurasthenia

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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