Psychotic Disorders Practice Questions

Q: A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?

Delusional disorder. ***Delusional disorder*** - This diagnosis fits the scenario as the patient holds a **false, fixed belief** (daughter wanting to kill him) that is not amenable to change in light of conflicting evidence. - The delusion is **non-bizarre** and relates to situations that can occur in real life, consistent with delusional disorder, and there are no other significant psychotic symptoms or impairment in functioning. *Cotard syndrome* - This is a rare syndrome characterized by **nihilistic delusions** (e.g., belief that one is dead, does not exist, or that organs have putrefied). - The patient's delusion in the question is persecutory, not nihilistic. *Illusions* - **Illusions** are misinterpretations of real external stimuli (e.g., seeing a coat in the dark and believing it's a person). - The patient's belief is a **false belief** without an external stimulus being misinterpreted. *Hallucinations* - **Hallucinations** are sensory experiences that occur in the absence of an external stimulus (e.g., hearing voices when no one is speaking). - The patient's presentation is characterized by a **fixed false belief**, not primarily by sensory perceptions without external stimuli.

Q: Neologism is seen in:

Schizophrenia. ***Schizophrenia*** - **Neologisms** are newly coined words that have meaning only to the person who invents them, and they are a characteristic **thought disorder** symptom often observed in schizophrenia. - This symptom reflects the **disorganized thinking** and **impaired communication** typical of the disorder. *Mania* - While individuals in a manic episode may exhibit **rapid speech**, **flight of ideas**, and **pressured speech**, they typically do not create entirely new words (neologisms). - Their speech is usually characterized by **excessive quantity** and quick topic changes, rather than word invention. *Depression* - Depression is associated with **poverty of speech**, **slowed thought processes**, and a focus on negative themes. - **Neologisms** are not a feature of depressive episodes. *Dysphasia* - **Dysphasia** (or aphasia) refers to an impairment in the production or comprehension of language due to brain injury, such as stroke. - While speech may be **disrupted** or **grammatically incorrect**, it primarily involves difficulty using existing words correctly rather than producing entirely new ones.

Q: Negative symptoms of schizophrenia are all except:-

Over activity. ***Over activity*** - **Overactivity** is a manifestation of disorganized or positive symptoms in schizophrenia, such as **agitation** or purposeless movements, rather than a deficiency. - While it can occur in schizophrenia, it represents an excess or distortion of normal function, distinguishing it from **negative symptoms** which reflect a reduction or absence of typical behaviors. *Apathy* - **Apathy**, or avolition, is a core negative symptom characterized by a **lack of motivation** and an inability to initiate or persist in goal-directed activities. - Patients with apathy often show diminished interest in daily activities and personal care. *Anhedonia* - **Anhedonia** is a negative symptom defined by the **inability to experience pleasure** from activities that are usually enjoyable. - This can include a loss of interest in social interactions, hobbies, and other rewarding experiences. *Alogia* - **Alogia**, or poverty of speech, is a negative symptom characterized by a **reduction in the quantity and fluency of speech**. - Individuals with alogia may provide brief, empty responses and exhibit long pauses during conversation.

Q: A person of 35 years is having firm belief about infidelity involving the spouse. And he does not allow her to go out of home alone. He often locks his house, while going to the office. In spite of all this he is persistently suspicious about her character. The probable diagnosis is -

Othello syndrome. ***Othello syndrome*** - This syndrome is characterized by **delusional jealousy**, where an individual holds an unfounded yet firm belief that their partner is being unfaithful. - Also known as **morbid jealousy**, it represents a **monosymptomatic delusional disorder** specifically focused on infidelity, making it distinct from broader psychotic conditions. - The patient's actions, such as not allowing the spouse to leave alone and locking the house, are common **behavioral manifestations** of this strong belief, often leading to controlling and suspicious behavior. *Schizophrenia* - Schizophrenia involves a broader range of symptoms, including **hallucinations**, **disorganized speech**, and **negative symptoms**, which are not described here. - While delusions can occur in schizophrenia, the primary and isolated focus on infidelity without other psychotic features makes **Othello syndrome** a more specific diagnosis. *Clerambault's syndrome* - Also known as **erotomania**, this syndrome involves the delusional belief that another person, typically of higher status, is **in love with the individual**. - This is distinctly different from the described delusion of infidelity and **jealousy**. *Delusional parasitosis* - This is a rare psychotic disorder in which individuals have a **fixed, false belief** that they are infested with parasites despite no medical evidence. - The symptoms described are clearly related to infidelity and jealousy, not a belief in **parasitic infestation**.

Q: Paranoid pseudocommunity was given by

Norman Cameron. ***Norman Cameron*** - **Norman Cameron** coined the term **"paranoid pseudocommunity"** to describe how individuals with **paranoid delusions** construct explanations involving others to make sense of their perceived persecution. - This concept highlights the social and interactive aspects of delusion formation, where an individual falsely believes a group of people is conspiring against them. *Benedict Morel* - **Benedict Morel** introduced the term **"démence précoce"** (precocious dementia) in 1856, which was an early concept related to what later became known as schizophrenia. - His work focused on the idea of hereditary degeneration leading to mental illness, rather than specific paranoid phenomena. *Kurt Schneider* - **Kurt Schneider** is known for his **"first-rank symptoms"** of schizophrenia, which are specific psychotic phenomena often considered diagnostic of the disorder. - These symptoms include thought broadcasting, auditory hallucinations (like voices discussing the patient in the third person), and delusions of control. *Eugene Bleuler* - **Eugene Bleuler** coined the term **"schizophrenia"** in 1908, replacing Morel's "démence précoce." - He described the fundamental symptoms of schizophrenia as the **"four A's"** – affective blunting, autism, ambivalence, and disturbances of association.

Q: All are first rank symptoms of schizophrenia, except:

Perplexity. ***Perplexity*** - **Perplexity** is a state of severe confusion, bewilderment, or puzzlement, which can be seen in various psychiatric conditions but is not specifically classified as a **first-rank symptom of schizophrenia** by Kurt Schneider. - While it may be present in schizophrenia, it is a non-specific symptom, meaning it can occur in conditions other than schizophrenia. *Audible thoughts* - **Audible thoughts** (Gedankenlautwerden in German) refers to the patient hearing their own thoughts spoken aloud, often as if by another voice. - This is considered a **first-rank symptom** as described by Kurt Schneider, highly indicative of schizophrenia. *Thought broadcasting* - **Thought broadcasting** is the delusional belief that one's thoughts are escaping from their mind and are somehow accessible to others. - This symptom is also a **first-rank symptom** of schizophrenia according to Schneider's criteria. *Voice arguing or discussing or both* - **Voices arguing or discussing** are a specific type of auditory hallucination where two or more voices are perceived to be talking to each other, often about the patient. - This phenomenon is considered a classic **first-rank symptom** of schizophrenia.

Q: Type of schizophrenia with intellectual disability:

Pfropf schizophrenia. ***Pfropf schizophrenia*** - **Pfropf schizophrenia** is a historical term specifically used to describe a form of schizophrenia that develops in individuals with **pre-existing intellectual disability** (formerly termed mental retardation). - The term "Pfropf" is derived from German, meaning "grafted" or "engrafted," referring to schizophrenia being "grafted onto" pre-existing intellectual disability. - This term distinguishes it from other types of schizophrenia where intellectual disability is not a primary defining characteristic. - While this classification is largely historical (modern DSM-5 has removed schizophrenia subtypes), it remains relevant for older examination questions. *Catatonic schizophrenia* - Characterized primarily by prominent **psychomotor disturbances**, which can include stupor, catalepsy, waxy flexibility, mutism, and negativism. - While intellectual disability might coexist, it is not a defining feature of the catatonic subtype itself. *Paranoid schizophrenia* - Marked by the prominence of **delusions**, typically persecutory or grandiose, and **auditory hallucinations**. - Intellectual disability is not a core diagnostic criterion or a defining characteristic of this subtype. *Hebephrenic schizophrenia* - Also known as **disorganized schizophrenia**, this type is characterized by marked **disorganization of thought processes**, flat or inappropriate affect, and bizarre behavior. - While it often presents early and can lead to significant functional impairment, intellectual disability is not a defining feature; rather, the primary disturbance is in thought and emotion.

Q: Erotomania is seen in:

Delusional disorder. ***Delusional disorder*** - Erotomania (De Clérambault's syndrome) is **classically a subtype of delusional disorder** known as **erotomanic type** in DSM-5. - Characterized by a **non-bizarre delusion** that another person, usually of higher social status, is in love with the individual. - The delusion persists despite clear evidence to the contrary and is the **primary psychiatric diagnosis** for erotomania. - Patients may engage in behaviors like following, attempting contact, or surveillance of the object of their delusion. *Bipolar mania* - While **psychotic features can occur** in severe manic episodes, they typically involve **grandiose delusions** about one's own abilities, power, wealth, or special identity. - Erotomania is **not a characteristic or common psychotic feature** of bipolar mania. - Manic psychosis more commonly presents with mood-congruent grandiose delusions rather than erotomanic delusions. *Obsessive compulsive disorder* - Characterized by **obsessions** (intrusive, unwanted thoughts) and **compulsions** (repetitive behaviors performed to reduce anxiety). - These thoughts are **ego-dystonic** and recognized as excessive or irrational by the patient. - Erotomania is a **fixed delusional belief** without insight, fundamentally different from OCD phenomenology. *Mania without psychotic features* - By definition involves elevated mood, increased energy, and decreased need for sleep **without delusions or hallucinations**. - Erotomania is a **delusional belief**, indicating presence of psychotic features. - This diagnosis would exclude any presentation with erotomanic delusions.

Q: Prognosis of schizophrenia is best, if:

Acute onset. ***Acute onset*** - An **acute onset** of schizophrenia is associated with a better prognosis, as it often indicates a more favorable response to treatment and less pervasive deterioration of daily functioning. - This typically suggests that the individual had a relatively intact baseline level of functioning before the emergence of psychotic symptoms. *Negative symptoms* - The presence of prominent **negative symptoms** (e.g., avolition, anhedonia, alogia) is usually associated with a poorer prognosis in schizophrenia. - Negative symptoms are generally harder to treat and often lead to greater functional impairment and disability. *Insidious onset* - An **insidious onset** of schizophrenia, where symptoms develop gradually over time, is typically linked to a poorer prognosis. - This often implies more severe and persistent neurodevelopmental abnormalities and a less robust response to interventions. *Family history is positive* - A **positive family history** of schizophrenia indicates a higher genetic predisposition but does not directly predict the individual's prognosis. - While genetics play a role in susceptibility, the course and outcome of the illness are influenced by many other factors, including symptom presentation and treatment adherence.

Question 1

A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?

Accepted Answer

Delusional disorder

Answer

Cotard syndrome

Answer

Illusions

Answer

Hallucinations

Question 2

Neologism is seen in:

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Depression

Answer

Dysphasia

Question 3

Negative symptoms of schizophrenia are all except:-

Accepted Answer

Over activity

Answer

Apathy

Answer

Anhedonia

Answer

Alogia

Question 4

A person of 35 years is having firm belief about infidelity involving the spouse. And he does not allow her to go out of home alone. He often locks his house, while going to the office. In spite of all this he is persistently suspicious about her character. The probable diagnosis is -

Accepted Answer

Othello syndrome

Answer

Schizophrenia

Answer

Clerambault's syndrome

Answer

Delusional parasitosis

Question 5

A 30 year old unmarried woman from a low socioeconomic status family believes that a rich boy staying in her neighbourhood is in deep love with her. The boy clearly denies his love towards this lady. Still the lady insists that his denial is a secret affirmation of his love towards her. She makes desperate attempts to meet the boy despite resistance from her family. She also develops sadness at times when her effort to meet the boy does not materialize. She is able to maintain her daily routine. She however, remains preoccupied with the thoughts of this boy. She is likely to be suffering from :

Accepted Answer

Delusional disorder

Answer

Depression

Answer

Schizophrenia

Answer

Mania

Question 6

Paranoid pseudocommunity was given by

Accepted Answer

Norman Cameron

Answer

Benedict Morel

Answer

Kurt Schneider

Answer

Eugene Bleuler

Question 7

All are first rank symptoms of schizophrenia, except:

Accepted Answer

Perplexity

Answer

Audible thoughts

Answer

Thought broadcasting

Answer

Voice arguing or discussing or both

Question 8

Type of schizophrenia with intellectual disability:

Accepted Answer

Pfropf schizophrenia

Answer

Catatonic schizophrenia

Answer

Paranoid schizophrenia

Answer

Hebephrenic schizophrenia

Question 9

Erotomania is seen in:

Accepted Answer

Delusional disorder

Answer

Obsessive compulsive disorder

Answer

Bipolar mania

Answer

Mania without psychotic features

Question 10

Prognosis of schizophrenia is best, if:

Accepted Answer

Acute onset

Answer

Negative symptoms

Answer

Insidious onset

Answer

Family history is positive

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?