Psychotic Disorders Practice Questions

Q: Infidelity and jealousy involving a spouse is the thought content of which disorder?

Othello syndrome. **Explanation:** The correct answer is **Othello Syndrome**, also known as **Morbid or Delusional Jealousy**. This is a psychotic disorder characterized by the unshakable, false belief that one’s spouse or sexual partner is being unfaithful. The patient often seeks "evidence" through stalking, checking belongings, or interrogation. It is clinically significant due to the high risk of domestic violence and homicide. **Analysis of Options:** * **Othello Syndrome (Correct):** Named after Shakespeare’s character, it involves a primary delusion of infidelity. It is frequently associated with chronic alcoholism and personality disorders. * **Capgras Syndrome:** A "delusional misidentification" syndrome where the patient believes a close relative or spouse has been replaced by an identical-looking impostor. * **De Clerambault’s Syndrome (Erotomania):** The delusional belief that a person (usually of higher social status or a celebrity) is deeply in love with the patient, despite little to no contact. * **Hypochondriacal Paranomia:** This is a distracter term; however, *Monomanic Hypochondriacal Psychosis* (like Ekbom syndrome/delusional parasitosis) involves fixed false beliefs regarding physical health or infestation, not infidelity. **NEET-PG High-Yield Pearls:** * **Othello Syndrome** is most commonly associated with **Alcohol Use Disorder**. * **Fregoli Syndrome** (the opposite of Capgras) is the belief that different people are actually a single person in disguise. * **Cotard Syndrome** is the "walking corpse" delusion (nihilistic delusions of being dead or rotting). * These are all categorized as **Delusional Disorders** (ICD-10/DSM-5), where the core symptom is a non-bizarre delusion lasting >1 month without prominent hallucinations.

Q: What is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?

D. Somatic passivity. ***Somatic passivity***- This symptom describes the delusional belief that one's **bodily sensations**, movements, or actions (e.g., movements of the limbs, feelings in the body) are being controlled or imposed upon by an **external agency** or force.- It is considered one of **Schneider's First-Rank Symptoms** (FRS) of **schizophrenia**, highlighting profound disturbances in self-boundaries and agency.*Delusion of nihilism*- This delusion, often seen in severe depression or psychosis (e.g., **Cotard's syndrome**), is the belief that one is dead, does not exist, or that parts of the body or the world do not exist.- It does not involve the feeling of **external control** or influence over existing bodily movements or sensations.*Delusion of reference*- This is the belief that otherwise innocuous or neutral events, objects, or people's actions in the environment have a particular and unusual meaning specifically **referring to oneself**.- It relates to interpreting the environment (e.g., hearing a radio broadcast talking *about* them), not the feeling of bodily movements being **controlled by external forces**.*Othello syndrome*- Also known as **morbid jealousy** or **delusional jealousy**, this is a specific type of delusional disorder characterized by the fixed, unfounded belief that one's partner is being **unfaithful**.- It is focused strictly on relationships and fidelity and has no association with beliefs of external control over **somatic functions**.

Q: A person has a false belief that he owns a lot of property and that someone he knows is trying to take it away from him. Which of the following best describes the type of delusions he is experiencing?

Delusion of grandeur and persecution. ***Delusion of grandeur and persecution***- The belief in owning a lot of property reflects **delusion of grandeur**, which is characterized by an exaggerated belief in one's wealth, importance, or abilities.- The belief that someone is trying to take their property away indicates a **delusion of persecution**, where the individual feels threatened or believes others are conspiring to harm them.*Delusion of grandeur and reference*- This option correctly identifies **delusion of grandeur** (owning vast property), but incorrectly identifies the second component.- **Delusion of reference** refers to the erroneous belief that common events, objects, or people have a specific, usually negative, meaning directed towards oneself (e.g., people on TV are talking about them). The patient is directly targeted, indicating persecution.*Delusion of nihilism*- Neither of the patient's described beliefs fit **delusion of nihilism** (Cotard syndrome), which is the false conviction that one's self, parts of the body, or the entire world do not exist.- This patient exhibits high self-importance (**grandeur**) and being targeted (**persecution**), not beliefs related to non-existence.*Delusion of grandeur and nihilism*- While **delusion of grandeur** is present, the patient's worry about someone stealing property is a persecutory type of delusion, not a **delusion of nihilism**.- The themes of persecution and grandeur found here are inconsistent with the theme of non-existence or loss of existence central to **nihilistic delusions**.

Q: A patient shows flat affect. What does it indicate?

Negative symptom. ***Correct: Negative symptom*** Flat affect refers to the **reduction** or **absence** of emotional expression, which is defined as a deficit in normal function or experience. Along with **alogia** (poverty of speech), **avolition** (lack of motivation), and **anhedonia** (inability to feel pleasure), flat affect is a core component of the **negative symptom** cluster, particularly in **schizophrenia**. Negative symptoms represent deficits or diminutions in normal emotional, motivational, and social functioning. *Incorrect: Positive symptom* Positive symptoms involve the **presence** or **addition** of abnormal mental phenomena, such as **hallucinations** (perceptual disturbances), **delusions** (fixed false beliefs), or **disorganized behavior**. Flat affect represents a **diminution** of normal emotional expression and is therefore categorized as a negative symptom, opposite to the addition of phenomena seen in positive symptoms. *Incorrect: Affect symptom* While flat affect is fundamentally related to the expression of **affect** (emotion), "affect symptom" is not a standard clinical classification used in psychiatric diagnostic systems. Psychiatric symptoms are primarily categorized into **positive**, **negative**, and **cognitive** domains for diagnostic and treatment purposes, particularly in disorders like schizophrenia. *Incorrect: Cognitive symptom* Cognitive symptoms relate to deficits in **executive function**, **attention**, **working memory**, and **processing speed**. These involve difficulties with thinking, concentration, and mental organization. Flat affect is categorized as an **emotional expression deficit** (negative symptom), which is distinct from the primary cognitive processing difficulties related to thought and memory.

Q: You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

Schizophrenia. ***Schizophrenia***- The presence of prominent **auditory hallucinations** and **command hallucinations** lasting for 7 months fulfills the diagnostic criteria for Schizophrenia (continuous signs of disturbance for at least 6 months).- The symptoms described (hearing aliens commanding violence) represent **positive symptoms** of psychosis and are often associated with poor insight and significant functional decline characteristic of this disorder.*Mania*- Mania requires a sustained period of abnormally and persistently elevated, expansive, or irritable **mood**, and increased goal-directed activity or energy, which is not the primary complaint here.- Psychotic features in Mania are usually **mood-congruent** (e.g., grandiose delusions about immense power), whereas these command hallucinations are non-mood-congruent.*Delusional disorder*- This disorder is characterized by the presence of one or more **non-bizarre delusions** lasting >1 month, but prominent hallucinations are specifically excluded.- The patient is experiencing persistent and prominent **auditory hallucinations**, making schizophrenia a more appropriate diagnosis.*Brief psychotic disorder*- This diagnosis is reserved for psychotic symptoms (delusions, hallucinations, disorganized speech) that last for a period of **less than one month**.- Since the patient's symptoms have persisted for **7 months**, the duration clearly rules out brief psychotic disorder.

Q: A 22-year-old male presents with a 6-month history of hearing voices commenting on his actions, social withdrawal, and belief that his thoughts are being broadcast to others. He has poor self-care and blunted affect. What is the most likely diagnosis?

Schizophrenia. ***Schizophrenia*** - The patient presents with **Schneiderian first-rank symptoms**: third-person auditory hallucinations (voices commenting on his actions) and **thought broadcasting** (belief that thoughts are being broadcast to others). - Duration of **6 months** meets the DSM-5 criterion for schizophrenia (continuous signs for at least 6 months). - Prominent **negative symptoms** including blunted affect, social withdrawal, and poor self-care with functional decline. - The combination of positive symptoms, negative symptoms, and duration establishes the diagnosis of schizophrenia. *Delusional disorder* - Characterized by fixed, non-bizarre delusions lasting at least **1 month** without other prominent psychotic symptoms. - **Hallucinations are absent or not prominent** in delusional disorder, whereas this patient has clear auditory hallucinations. - Functioning is relatively preserved except in areas directly affected by the delusion; this patient shows significant functional decline. *Brief psychotic disorder* - Requires symptom duration of **less than 1 month** with eventual return to premorbid functioning. - This patient has a **6-month history**, which far exceeds the duration criterion for brief psychotic disorder. - The chronicity and progressive nature rule out this diagnosis. *Schizoaffective disorder* - Requires concurrent presence of **major mood episode** (major depression or mania) meeting full criteria along with schizophrenia symptoms. - Must have delusions or hallucinations for at least **2 weeks in the absence of mood symptoms**. - This patient shows **no evidence of mood episodes** (neither depression nor mania) in the clinical presentation, ruling out schizoaffective disorder.

Q: A man reports that he is receiving orders from God to follow white birds in a specific direction. What is the most appropriate description of this symptom?

Passivity phenomenon. ***Passivity phenomenon*** - This symptom describes **delusions of control** (also called **made acts** or **passivity of volition**), which is a type of **passivity phenomenon**. - The patient believes that an **external force (God) is giving orders** and directing their actions (following white birds in a specific direction). - This represents the experience of **being controlled or influenced by an external agency**, which is a **First Rank Symptom** of schizophrenia according to Kurt Schneider. - The key feature is the belief in **external control over one's will or actions**, not merely attaching meaning to a perception. *Delusional perception* - This requires a **two-step process**: (1) a normal perception occurs, then (2) this perception is suddenly given **delusional significance** (e.g., "I saw the traffic light turn red and instantly knew I was the Messiah"). - The scenario described does **not** show the birds triggering a new delusional belief; rather, the patient already has an **established delusion of receiving divine commands**. - The birds are the **medium** through which control is exerted, not a perception given new meaning. *Visual hallucination* - A **hallucination** is a perception occurring in the **absence of an external stimulus**. - Since the white birds are actually present and the patient is seeing real birds, this is **not** a hallucination. - The pathology lies in the **delusional belief about being commanded**, not in perceiving something that isn't there. *Thought insertion* - This is a First Rank Symptom where the patient believes **thoughts are being inserted into their mind** by an external force. - The current scenario involves **receiving orders to perform actions** (passivity of volition), not the experience of alien thoughts being placed in one's mind. - While both involve external agency, thought insertion specifically concerns **thoughts**, whereas this case concerns **volitional control**.

Q: The following are manifestations of psychosis except:

Psychoneurosis. ***Psychoneurosis*** - **Psychoneurosis** is an older term referring to **neurotic disorders**, which involve distress but do not typically feature classic psychotic symptoms like **hallucinations**, **delusions**, or **disorganized thought**. - Individuals with neurotic disorders usually retain a grasp of reality and insight into their condition, distinguishing them from psychosis. *Manic depressive psychosis* - This is an archaic term for **bipolar disorder**, which can indeed involve psychotic features during severe manic or depressive episodes. - During these episodes, individuals may experience **hallucinations** or **delusions** consistent with their mood state. *Schizophrenia* - **Schizophrenia** is a chronic and severe mental disorder characterized by profound disruptions in thinking, perception, emotion, and behavior. - Its hallmark features include **delusions**, **hallucinations**, disorganized speech, and grossly disorganized or catatonic behavior, all of which are classic manifestations of psychosis. *Paranoia* - **Paranoia** involves intense anxious or fearful thoughts and beliefs, often centering on persecution, conspiracy, or threat. - Severe paranoia can develop into **paranoid delusions**, which are fixed false beliefs that are characteristic of psychotic disorders, such as **paranoid schizophrenia** or delusional disorder.

Question 1

Infidelity and jealousy involving a spouse is the thought content of which disorder?

Accepted Answer

Othello syndrome

Answer

Capgras syndrome

Answer

Hypochondrial paranomia

Answer

Declerambault's syndrome

Question 2

Arrange the following subtypes of schizophrenia in order of prognosis, with the best prognosis first and the worst prognosis last: 1. Paranoid schizophrenia 2. Catatonic schizophrenia 3. Simple schizophrenia 4. Disorganised schizophrenia

Accepted Answer

2-1-4-3

Answer

4-2-1-3

Answer

2-1-3-4

Answer

1-2-4-3

Question 3

What is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?

Accepted Answer

D. Somatic passivity

Answer

C. Othello syndrome

Answer

A. Delusion of nihilism

Answer

B. Delusion of reference

Question 4

A person has a false belief that he owns a lot of property and that someone he knows is trying to take it away from him. Which of the following best describes the type of delusions he is experiencing?

Accepted Answer

Delusion of grandeur and persecution

Answer

Delusion of grandeur and nihilism

Answer

Delusion of grandeur and reference

Answer

Delusion of nihilism

Question 5

A patient shows flat affect. What does it indicate?

Accepted Answer

Negative symptom

Answer

Affect symptom

Answer

Cognitive symptom

Answer

Positive symptom

Question 6

You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Delusional disorder

Answer

Brief psychotic disorder

Question 7

A 22-year-old male presents with a 6-month history of hearing voices commenting on his actions, social withdrawal, and belief that his thoughts are being broadcast to others. He has poor self-care and blunted affect. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Delusional disorder

Answer

Brief psychotic disorder

Answer

Schizoaffective disorder

Question 8

A patient with schizophrenia says, "Lord Hanuman was celibate, I am celibate too, so I am Lord Hanuman." Which thought abnormality is present in this patient?

Accepted Answer

Autistic thinking

Answer

Verbigeration

Answer

Neologism

Answer

Loosening of association

Question 9

A man reports that he is receiving orders from God to follow white birds in a specific direction. What is the most appropriate description of this symptom?

Accepted Answer

Passivity phenomenon

Answer

Delusional perception

Answer

Visual hallucination

Answer

Thought insertion

Question 10

The following are manifestations of psychosis except:

Accepted Answer

Psychoneurosis

Answer

Manic depressive psychosis

Answer

Schizophrenia

Answer

Paranoia

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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