Psychotic Disorders — MCQs

A 30-year-old unmarried woman of average socio-economic background believes that her boss is secretly in love with her. She calls him at odd hours and writes love letters to him despite his serious warnings not to do so. She maintains this belief despite contradictions from family members and his denials. However, she is able to manage her daily activities as before. She is most likely suffering from which psychiatric disorder?

Q207Easy

Schizophrenia is caused by overactivity in which of the following dopaminergic systems?

Q208Medium

A 41-year-old woman is convinced that management has denied her promotion by preparing false reports about her competence and forging her signature on sensitive documents to convict her. She files a police complaint and requests security, but continues to attend work and manage her household. What is the most likely diagnosis?

Q209Easy

Catatonia is most commonly seen with which of the following psychiatric conditions?

Q210Easy

Which one of the following is NOT considered a first-rank symptom of schizophrenia?

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 201: A 70-year-old male presents with a history of auditory hallucinations and third-person auditory hallucinations. He has no prior history of similar problems. What is the most likely diagnosis?

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

Explanation: **Explanation:** The presence of **third-person auditory hallucinations** (voices talking about the patient in the third person) is a classic **Schneiderian First-Rank Symptom (FRS)**. These symptoms are highly characteristic of **Schizophrenia**. While Schizophrenia typically presents in early adulthood, "Very Late-Onset Schizophrenia-Like Psychosis" can occur in patients over age 60, presenting with prominent hallucinations and delusions. **Why the other options are incorrect:** * **Dementia:** While psychotic symptoms can occur in dementia (especially Lewy Body Dementia), the primary clinical feature must be cognitive decline and memory impairment, which are not mentioned here. * **Delusional Disorder:** This diagnosis is characterized by non-bizarre delusions *without* prominent hallucinations. The presence of auditory hallucinations generally excludes this diagnosis. * **Acute Psychosis (Brief Psychotic Disorder):** This diagnosis requires the symptoms to last more than one day but less than one month, often triggered by a stressor. The question implies a stable clinical picture of complex hallucinations, making Schizophrenia the more definitive academic answer for FRS. **Clinical Pearls for NEET-PG:** * **Schneider’s First-Rank Symptoms (FRS):** Includes audible thoughts (thought echo), voices arguing, voices commenting (3rd person), somatic passivity, and thought withdrawal/insertion/broadcast. * **Late-onset Schizophrenia:** More common in females and often associated with sensory deficits (hearing/vision loss). * **Diagnostic Tip:** If a question mentions "voices commenting on the patient's actions" or "voices arguing," always prioritize Schizophrenia as the diagnosis.

Question 202: False sense of perception without any external object or stimulus is known as:

A. Illusion
B. Impulse
C. Hallucination (Correct Answer)
D. Phobia

Explanation: ### Explanation **Correct Answer: C. Hallucination** **1. Why Hallucination is Correct:** A **hallucination** is defined as a sensory perception in the absence of an external stimulus. It is a disorder of **perception**. Key characteristics include: * It occurs in the external objective space (not just in the "mind's eye"). * It has the same force and clarity as a real perception. * It is involuntary and cannot be controlled by the subject. **2. Why Other Options are Incorrect:** * **A. Illusion:** This is a **misinterpretation** of a real external sensory stimulus (e.g., mistaking a rope for a snake in the dark). Unlike hallucinations, an external object is present. * **B. Impulse:** This is a sudden, irresistible urge to perform an action (disorder of **conation/will**), such as in Kleptomania or Pyromania. It is not a perceptual disorder. * **D. Phobia:** This is an irrational, excessive fear of a specific object or situation (disorder of **content of thought/emotion**). It does not involve false perceptions. **3. NEET-PG Clinical Pearls & High-Yield Facts:** * **Most Common Hallucination in Schizophrenia:** Auditory (specifically "Third Person" or "Running Commentary"). * **Most Common Hallucination in Organic Brain Syndromes (Delirium/Alcohol Withdrawal):** Visual. * **Hypnagogic vs. Hypnopompic:** Hallucinations occurring while falling asleep (Hypna**go**gic = **Go**ing to sleep) vs. waking up (**P**ompic = **P**ost-sleep/Pop out of bed). These can occur in normal individuals or Narcolepsy. * **Pseudohallucination:** Occurs in internal subjective space (inside the head) and is recognized by the patient as not being real. * **Formication:** A tactile hallucination (feeling of insects crawling under the skin) commonly seen in Cocaine withdrawal (**Cocaine Bugs**).

Question 203: A person falsely perceives that his close friend has been replaced by an exact double. This phenomenon is referred to as:

A. Cotard syndrome
B. Fregoli syndrome
C. Capgras syndrome (Correct Answer)
D. Delusional perception

Explanation: **Explanation:** The correct answer is **Capgras syndrome**. This is a type of **delusional misidentification syndrome** where a patient believes that a person close to them (usually a spouse or family member) has been replaced by an identical-looking impostor or double. It is often associated with schizophrenia, dementia, or right-sided cerebral lesions. **Analysis of Options:** * **Capgras syndrome (Correct):** The hallmark is the belief that a familiar person is an **impostor**. It is essentially a "disconnection" between facial recognition and emotional familiarity. * **Cotard syndrome:** Also known as "walking corpse syndrome," the patient holds a nihilistic delusion that they are dead, rotting, or have lost their internal organs/blood. * **Fregoli syndrome:** The inverse of Capgras. The patient believes that different strangers are actually a single familiar person in disguise. They see "familiarity" in strangers. * **Delusional perception:** This is a **First Rank Symptom (FRS)** of Schizophrenia. It occurs when a normal, real perception is suddenly given a private, delusional meaning (e.g., "The traffic light turned red, which means I am the King of England"). **High-Yield Clinical Pearls for NEET-PG:** * **Capgras** is the most common delusional misidentification syndrome. * **Ekbom syndrome:** Delusion of infestation (parasitosis). * **Othello syndrome:** Delusional jealousy (infidelity of partner). * **De Clerambault syndrome:** Erotomania (belief that a person of higher status is in love with them). * **Couvade syndrome:** A sympathetic pregnancy where the partner of an expectant mother experiences pregnancy-like symptoms.

Question 204: A 22-year-old unmarried man presents with a two-week history of sudden onset of third-person hallucinations. He has become suspicious of his family members and reports decreased sleep and appetite. What is the most likely diagnosis?

A. Schizophrenia
B. Acute Psychosis (Correct Answer)
C. Acute Mania
D. Acute Delirium

Explanation: ### Explanation The correct diagnosis is **Acute Psychosis** (specifically Acute and Transient Psychotic Disorder or ATPD). **1. Why Acute Psychosis is correct:** The key to this diagnosis is the **duration of symptoms**. According to ICD-10/11 and DSM-5 criteria, the patient presents with classic psychotic symptoms (third-person auditory hallucinations and delusions of persecution/suspicion) that have lasted for only **two weeks**. * In **ICD-10**, Acute and Transient Psychotic Disorder is diagnosed if symptoms last less than **1 month**. * In **DSM-5**, this is termed "Brief Psychotic Disorder" if symptoms last between 1 day and 1 month. The sudden onset and short duration (2 weeks) make this the most appropriate clinical fit. **2. Why other options are incorrect:** * **Schizophrenia:** Requires a minimum duration of **6 months** of symptoms (DSM-5) or **1 month** (ICD-10). A two-week history is insufficient for this diagnosis. * **Acute Mania:** While mania can present with psychosis and decreased sleep, the core features of elevated/irritable mood, grandiosity, and increased energy are absent in this clinical vignette. * **Acute Delirium:** Delirium is characterized by a **clouding of consciousness** and fluctuating levels of awareness. This patient is conscious and oriented but psychotic; there is no mention of cognitive impairment or an underlying medical cause. **Clinical Pearls for NEET-PG:** * **Duration Criteria:** <1 month = Acute Psychosis; 1–6 months = Schizophreniform Disorder; >6 months = Schizophrenia (DSM-5). * **Prognosis:** Acute psychosis generally has a better prognosis than schizophrenia, often triggered by a stressful life event. * **Third-person Hallucinations:** These are "Schneiderian First Rank Symptoms" (SFRS), highly suggestive of psychotic spectrum disorders.

Question 205: Grimacing and Mannerism is characteristic of which subtype of Schizophrenia?

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

Explanation: **Explanation:** **Catatonic Schizophrenia (Option B)** is the correct answer because it is characterized by prominent psychomotor disturbances. These can manifest as either decreased motor activity (stupor, mutism, waxy flexibility) or excessive, purposeless motor activity. **Mannerisms** (stilted, unnatural voluntary movements) and **Grimacing** (odd facial expressions) are classic "positive" motor signs of catatonia. Other features include posturing, negativism, and echopraxia. **Why other options are incorrect:** * **Simple Schizophrenia (Option A):** Characterized by the insidious development of "negative symptoms" (apathy, social withdrawal, poverty of speech) without prominent hallucinations, delusions, or catatonic features. * **Hebephrenic/Disorganized Schizophrenia (Option C):** Primarily involves disorganized speech, disorganized behavior, and flat or inappropriate affect (e.g., giggling). While odd behaviors occur, specific catatonic signs like grimacing and mannerisms are not the defining diagnostic criteria here. * **Phobia (Option D):** This is an anxiety disorder characterized by an irrational fear of specific objects or situations; it has no clinical association with psychotic motor disturbances. **High-Yield Clinical Pearls for NEET-PG:** * **Mannerism vs. Stereotypy:** Mannerisms are goal-directed but executed in an odd, stilted way (e.g., a bizarre salute). Stereotypies are repetitive, non-goal-directed movements (e.g., rocking). * **Waxy Flexibility (Cerea Flexibilitas):** A hallmark of catatonia where the patient maintains positions into which they are placed by the examiner. * **Treatment of Choice:** Benzodiazepines (Lorazepam) are the first-line treatment for catatonia. If unresponsive, Electroconvulsive Therapy (ECT) is highly effective.

Question 206: A 30-year-old unmarried woman of average socio-economic background believes that her boss is secretly in love with her. She calls him at odd hours and writes love letters to him despite his serious warnings not to do so. She maintains this belief despite contradictions from family members and his denials. However, she is able to manage her daily activities as before. She is most likely suffering from which psychiatric disorder?

A. Depression
B. Schizophrenia
C. Delusional disorder (Correct Answer)
D. No psychiatric ailment

Explanation: **Explanation:** The patient presents with a classic case of **Delusional Disorder, Erotomanic type** (also known as **de Clérambault's syndrome**). **1. Why Delusional Disorder is correct:** The core feature of Delusional Disorder is the presence of one or more delusions for at least one month. In this case, the patient holds a fixed, false belief that a person of higher status (her boss) is in love with her (**Erotomania**). Key diagnostic criteria met here include: * **Non-bizarre nature:** The belief is plausible (though false) in real life. * **Preserved Functioning:** Unlike schizophrenia, the patient’s social and occupational functioning is relatively preserved, and her behavior is not obviously odd or bizarre apart from the focus of the delusion. * **Persistence:** She maintains the belief despite clear evidence and warnings to the contrary. **2. Why other options are incorrect:** * **Depression:** While depression can sometimes feature delusions (mood-congruent), the primary symptoms here are not related to low mood, anhedonia, or sleep/appetite disturbances. * **Schizophrenia:** This diagnosis requires the presence of other symptoms such as hallucinations, disorganized speech, negative symptoms, or a significant decline in overall daily functioning, none of which are present here. * **No psychiatric ailment:** The patient’s persistent stalking-like behavior (calling at odd hours) and inability to accept reality despite warnings indicate a clinical pathology that requires intervention. **Clinical Pearls for NEET-PG:** * **De Clérambault's Syndrome:** Specifically refers to the erotomanic delusion that a famous or high-status person is in love with the patient. * **Treatment of Choice:** Atypical antipsychotics (e.g., Risperidone) are used, though these disorders are often resistant to treatment. SSRIs may be used if obsessive components are prominent. * **Age of Onset:** Typically middle to late life (unlike schizophrenia, which starts earlier).

Question 207: Schizophrenia is caused by overactivity in which of the following dopaminergic systems?

A. Nigrostriatal pathway
B. Tuberoinfundibular pathway
C. Mesolimbic/Mesocortical pathway (Correct Answer)
D. None of the above

Explanation: **Explanation:** The **Dopamine Hypothesis** of Schizophrenia suggests that the symptoms of the disorder are caused by dysregulation of dopamine in specific brain pathways. 1. **Mesolimbic Pathway:** Overactivity (increased dopamine) in this pathway, which projects from the ventral tegmental area (VTA) to the nucleus accumbens, is responsible for the **positive symptoms** of schizophrenia, such as hallucinations and delusions. 2. **Mesocortical Pathway:** Conversely, underactivity (decreased dopamine) in this pathway, projecting from the VTA to the prefrontal cortex, is associated with **negative symptoms** (e.g., apathy, withdrawal) and cognitive deficits. Because schizophrenia involves a complex interplay of both overactivity and underactivity within these two systems, Option C is the most accurate choice. **Analysis of Incorrect Options:** * **A. Nigrostriatal Pathway:** This pathway controls motor function. It is generally unaffected in schizophrenia but is responsible for **Extrapyramidal Symptoms (EPS)** and Tardive Dyskinesia when dopamine receptors are blocked by antipsychotic medications. * **B. Tuberoinfundibular Pathway:** This pathway regulates prolactin secretion. Dopamine normally inhibits prolactin; therefore, blockade of this pathway by antipsychotics leads to **hyperprolactinemia** (causing galactorrhea and gynecomastia). **High-Yield Clinical Pearls for NEET-PG:** * **Positive Symptoms:** Linked to D2 receptors in the Mesolimbic tract. * **Negative Symptoms:** Linked to D1/D2 receptors in the Mesocortical tract. * **Antipsychotic Mechanism:** Typical antipsychotics primarily block D2 receptors, effectively treating positive symptoms but often worsening negative symptoms or causing EPS due to non-selective blockade across all pathways.

Question 208: A 41-year-old woman is convinced that management has denied her promotion by preparing false reports about her competence and forging her signature on sensitive documents to convict her. She files a police complaint and requests security, but continues to attend work and manage her household. What is the most likely diagnosis?

A. Paranoid schizophrenia
B. Late onset psychosis
C. Persistent delusional disorder (Correct Answer)
D. Obsessive compulsive disorder

Explanation: ### Explanation **Correct Answer: C. Persistent Delusional Disorder (PDD)** The clinical presentation is classic for **Persistent Delusional Disorder**. The core feature is the presence of a single or a set of related delusions (in this case, **persecutory delusions**) that are held for at least 3 months (ICD-10) or 1 month (DSM-5). The key distinguishing factor in this case is the **preservation of personality and social functioning**. Despite her conviction that her management is conspiring against her, she continues to attend work and manage her household effectively. In PDD, apart from the impact of the delusion, the patient’s behavior is not obviously odd or bizarre, and their functional capacity remains intact. **Why other options are incorrect:** * **A. Paranoid Schizophrenia:** This would typically involve more bizarre delusions, prominent hallucinations (especially auditory), and a significant decline in social and occupational functioning. The patient’s ability to maintain her household and job makes this diagnosis unlikely. * **B. Late-onset Psychosis:** While this patient is 41, this is a descriptive term rather than a specific ICD/DSM diagnosis. PDD is the more specific and accurate clinical diagnosis for this presentation. * **D. Obsessive Compulsive Disorder:** OCD involves intrusive thoughts (obsessions) recognized as the patient's own and repetitive behaviors (compulsions). It does not involve fixed false beliefs (delusions) or themes of persecution. **High-Yield Clinical Pearls for NEET-PG:** * **Delusion Type:** Persecutory is the most common subtype of PDD. * **Functioning:** "Encapsulated delusions" is a term often used for PDD because the delusion is walled off, leaving the rest of the personality intact. * **Age of Onset:** Usually middle to late adult life (unlike Schizophrenia, which typically starts in early adulthood). * **Treatment:** PDD is notoriously difficult to treat; **Atypical antipsychotics** are the first-line pharmacological treatment, though the patient often lacks insight and refuses medication.

Question 209: Catatonia is most commonly seen with which of the following psychiatric conditions?

A. Schizophrenia
B. Depression (Correct Answer)
C. Anxiety disorder
D. Obsessive-compulsive disorder

Explanation: **Explanation:** **1. Why Depression is the Correct Answer:** While catatonia was historically linked most closely with schizophrenia (Kahlbaum’s original description), modern epidemiological data and clinical practice show that it is most frequently associated with **Mood Disorders**. Among these, **Major Depressive Disorder (MDD)** is the single most common psychiatric condition where catatonia is observed. Approximately 20–25% of catatonic patients have an underlying primary mood disorder, whereas only about 10–15% have schizophrenia. **2. Analysis of Incorrect Options:** * **A. Schizophrenia:** Although "Catatonic Schizophrenia" is a well-known subtype in older classifications (ICD-10), it is statistically less common than mood-disorder-associated catatonia. In DSM-5, catatonia is now treated as a specifier that can be attached to any diagnosis, reflecting its prevalence in non-schizophrenic conditions. * **C. Anxiety Disorder:** While severe anxiety can lead to psychomotor agitation, it does not typically manifest as a full catatonic syndrome (stupor, waxy flexibility, mutism). * **D. Obsessive-Compulsive Disorder (OCD):** OCD is not a primary driver of catatonia. While some motor tics or compulsions may mimic catatonic movements, they do not meet the diagnostic criteria for catatonia. **3. NEET-PG High-Yield Pearls:** * **Most common cause overall:** Medical/Neurological conditions (always rule out organic causes first). * **Most common psychiatric cause:** Mood Disorders (Depression > Bipolar Disorder). * **Drug of Choice:** Benzodiazepines (specifically **Lorazepam**; the "Lorazepam Challenge Test" is used for diagnosis). * **Definitive Treatment for refractory cases:** Electroconvulsive Therapy (ECT). * **Key Signs:** Mutism, Stupor, Negativism, Waxy Flexibility, and Catalepsy.

Question 210: Which one of the following is NOT considered a first-rank symptom of schizophrenia?

A. Auditory hallucinations
B. Insertion of thoughts
C. Delusional perceptions
D. Compulsive acts that relieve tension (Correct Answer)

Explanation: The correct answer is **D. Compulsive acts that relieve tension.** ### Explanation **Schneider’s First-Rank Symptoms (FRS)** are a group of specific symptoms identified by Kurt Schneider in 1959 that, while not pathognomonic, carry high diagnostic weight for Schizophrenia in the absence of organic brain disease. **Compulsive acts that relieve tension** are characteristic of **Obsessive-Compulsive Disorder (OCD)**, not schizophrenia. In OCD, the patient feels an internal urge to perform an act to neutralize the anxiety caused by an obsession. While schizophrenia can involve "made acts" (the feeling that one's actions are controlled by an external force), the element of tension relief and the recognition of the act as one's own (ego-dystonic) are hallmarks of OCD. ### Why the other options are wrong: * **A. Auditory hallucinations:** Specifically, third-person hallucinations (voices arguing or commenting on the patient's behavior) and "Gedankenlautwerden" (thought echo) are core FRS. * **B. Insertion of thoughts:** This is a **Thought Alienation** phenomenon where the patient believes thoughts are being put into their mind by an external agency. * **C. Delusional perceptions:** This is a two-stage process where a normal perception is suddenly given a private, highly significant, and delusional meaning (e.g., "The traffic light turned red, so I knew I was the King of England"). ### NEET-PG High-Yield Pearls: * **Mnemonic for FRS (ABCD):** **A**uditory Hallucinations, **B**roadcasting of thoughts, **C**ontrolled feelings/acts (Passivity), **D**elusional Perception. * **Thought Alienation:** Includes Thought Insertion, Thought Withdrawal, and Thought Broadcasting. * **Passivity Phenomena:** Includes "Made" Volition, "Made" Affect, and "Made" Impulses. * **Note:** ICD-11 and DSM-5 have de-emphasized FRS because they are not specific to schizophrenia and can occur in bipolar affective disorder.

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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