Psychotic Disorders Practice Questions

Q: Term 'schizophrenia' was coined by:

Eugene Bleuler. ***Eugene Bleuler*** - The Swiss psychiatrist **Eugene Bleuler** was the first to use the term "schizophrenia" in **1908**, replacing **Kraepelin's** term **dementia praecox**. - He coined the term from Greek roots: "schizein" (to split) and "phren" (mind), referring to the **splitting of mental functions**. *Freud* - **Sigmund Freud** is known as the founder of **psychoanalysis** and developed theories on the unconscious mind, defense mechanisms, and psychosexual development. - While influential in psychiatry, he did not coin the term "schizophrenia." *Kraepelin* - **Emil Kraepelin** was a German psychiatrist who developed a classification system for mental disorders and described what he called **"dementia praecox,"** which is now largely equivalent to schizophrenia. - He systematized the understanding of the disorder but did not coin the term "schizophrenia" itself. *Schneider* - **Kurt Schneider** was a German psychiatrist known for his concept of **"first-rank symptoms"** of schizophrenia, which are considered highly characteristic of the disorder. - His contributions were significant in diagnosing schizophrenia, but he did not originate the term.

Q: Which of the following is associated with a poor prognosis in schizophrenia?

Disorganized schizophrenia (Hebephrenic type). ***Disorganized schizophrenia (Hebephrenic type)*** - This subtype is associated with a particularly **poor prognosis** due to its early onset (often during adolescence), significant **disorganization of thought and behavior**, and prominent negative symptoms. - Patients often experience persistent and severe functional impairment, making social and occupational integration very challenging. *Schizophrenia with catatonic features* - While catatonia can be a severe presentation, it is often responsive to treatment with **benzodiazepines** or **ECT**, leading to a potentially better short-term outcome compared to disorganized type. - Catatonic features can be episodic and do not uniformly predict long-term functional decline as stringently as sustained disorganization. *Residual schizophrenia* - This stage implies a progression from an active phase where positive symptoms have receded, and the individual primarily experiences **negative symptoms** or attenuated positive symptoms. - Patients in the residual phase have typically achieved some level of stability and functional adaptation, indicating a relatively better prognosis than the acutely disorganized type. *Paranoid schizophrenia* - This subtype is often considered to have a **better prognosis** than other types due to later onset, preservation of affective responses, and a relatively intact cognitive function. - Individuals with paranoid schizophrenia tend to respond better to treatment, maintain better social and occupational functioning, and have a more stable course of illness.

Q: A 45-year-old man is suspicious of others, believing that his coworkers are plotting against him, with no other psychotic symptoms. What is the most likely diagnosis?

Delusional disorder. ***Delusional disorder*** - This condition is characterized by the presence of **non-bizarre delusions** that persist for at least one month, in the absence of other prominent psychotic symptoms. The man's belief that his coworkers are plotting against him fits the criteria for a non-bizarre delusion. - The key here is the **absence of other psychotic symptoms** (e.g., hallucinations, disorganized speech), which differentiates it from other psychotic disorders like schizophrenia. *Schizophrenia* - Schizophrenia involves a broader range of psychotic symptoms, including **hallucinations, disorganized speech, negative symptoms**, or grossly disorganized behavior, in addition to delusions. - While delusions can be a feature, the isolated nature of the delusion without other prominent psychotic symptoms makes schizophrenia less likely. *Paranoid personality disorder* - Individuals with paranoid personality disorder have a pervasive **distrust and suspiciousness of others**, interpreting their motives as malevolent, but these beliefs are typically at the level of suspicion or preoccupation rather than fixed, unshakeable delusions. - The intensity and fixed nature of the belief described (coworkers *are* plotting against him) suggest a delusional level of conviction, transcending the level of personality trait. *Schizoid personality disorder* - This disorder is characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of emotional expression. - It does not typically involve suspiciousness or delusions, but rather a lack of interest in social interaction and emotional warmth.

Q: A 45-year-old man with a history of schizophrenia presents with flat affect, alogia, and avolition. Which of the following best describes his symptoms?

Negative symptoms. ***Negative symptoms*** - **Flat affect**, **alogia** (poverty of speech), and **avolition** (lack of motivation) are classic examples of negative symptoms in schizophrenia. - These symptoms represent a **reduction or absence of normal functions** and are often more disabling and harder to treat than positive symptoms. *Positive symptoms* - These symptoms involve an **excess or distortion of normal functions**, such as **hallucinations**, **delusions**, and disorganized thought or behavior. - The patient's presentation of flat affect, alogia, and avolition does not include these exaggerated or distorted experiences. *Cognitive symptoms* - **Cognitive symptoms** involve difficulties with attention, memory, executive functions (e.g., planning, problem-solving), and processing speed. - While common in schizophrenia, the described symptoms (flat affect, alogia, avolition) do not primarily fall under the cognitive domain. *Affective symptoms* - **Affective symptoms** relate to disturbances in mood, such as **depression**, **anxiety**, or **irritability**. - While emotional blunting (flat affect) is a negative symptom, the term "affective symptoms" typically refers to broader mood disorders, which are not explicitly described here.

Q: A 45-year-old man believes that he has been receiving secret messages through the television for the past year. He is otherwise functioning well and has no other psychiatric symptoms. What is the most likely diagnosis?

Delusional disorder. ***Delusional disorder*** - The presence of a **fixed, false belief** (receiving secret messages) lasting over a month, without other significant psychiatric symptoms or functional impairment, is characteristic of **delusional disorder**. - In this case, the patient is "otherwise functioning well" and has "no other psychiatric symptoms," pointing away from more pervasive psychotic disorders. *Schizophrenia* - Schizophrenia typically involves a broader range of symptoms, including **disorganized thought and speech**, **negative symptoms** (e.g., flat affect, anhedonia), and significant functional impairment, none of which are described here. - While delusions are a core feature of schizophrenia, they are usually accompanied by other psychotic symptoms and a decline in overall functioning. *Major depressive disorder with psychotic features* - This diagnosis would require prominent symptoms of a **major depressive episode**, such as depressed mood, anhedonia, and vegetative symptoms, alongside psychotic features. - The patient is described as "otherwise functioning well" and having "no other psychiatric symptoms," ruling out a primary mood disorder. *Bipolar disorder* - Bipolar disorder involves episodes of both **mania/hypomania** and **depression**, often with psychotic features occurring during severe mood episodes. - The patient's presentation of isolated delusions without mood cycling or the full symptom constellation of either manic or depressive episodes does not fit bipolar disorder.

Q: Which of the following statements is not true regarding delusional disorder?

Usually false. ***Usually false*** ✓ Correct Answer - This statement is **NOT TRUE** because delusions are **by definition always false beliefs**, not "usually false" - Delusions are **fixed false beliefs** that are firmly held despite evidence to the contrary - Saying "usually false" suggests they could sometimes be true, which contradicts the fundamental definition of a delusion - A true belief, no matter how unusual, is **not a delusion** by psychiatric criteria *Held with some conviction* - This is TRUE - Delusional disorder is characterized by the presence of **non-bizarre delusions** held with strong conviction - Patients do not recognize their beliefs as problematic and will **defend their delusional ideas** when challenged *Not easily amenable to reasoning* - This is TRUE - A key feature of delusional disorder is the patient's **resistance to logical argument** or conflicting evidence - This inflexibility is a hallmark of **delusional thinking**, distinguishing it from overvalued ideas or obsessions *Occurs at a later age* - This is TRUE - Delusional disorder typically has a **later age of onset** compared to schizophrenia - Often appearing in **middle to late adulthood** (40-49 years), distinguishing it from disorders that manifest in late adolescence or early adulthood

Q: A 39-year-old male patient presents with waxy flexibility, negativism and rigidity. Most probable diagnosis is?

Stuporous catatonia. ***Stuporous catatonia*** - **Waxy flexibility**, **negativism**, and **rigidity** are classic symptoms of catatonia, specifically indicating the stuporous presentation where there is a marked decrease in reactivity to the environment. - In this subtype, the patient often exhibits features such as **immobility**, mutism, and fixed postures, alongside the mentioned symptoms. *Excitatory catatonia* - Characterized by **psychomotor agitation**, restlessness, and sometimes violent behavior, which is contrary to the reduced reactivity seen in the patient. - Patients with excitatory catatonia may present with **purposeless motor activity** and impulsivity, along with other catatonic features. *Paranoid schizophrenia* - Primarily defined by prominent **delusions of persecution** or grandeur and **auditory hallucinations**. - While catatonic features can sometimes occur in schizophrenia, they are not the hallmark symptoms; the described features are more directly indicative of catatonia itself. *None of the options* - This is incorrect because the constellation of symptoms (waxy flexibility, negativism, rigidity) clearly points to a specific and well-recognized clinical syndrome, which is stuporous catatonia. - The symptoms provided are classic for a recognized psychiatric condition, making an "all of the above" or "none of the above" option unlikely if a specific diagnosis fits perfectly.

Q: Which of the following is not one of Eugene Bleuler's 4As?

Anhedonia. ***Anhedonia*** - **Anhedonia** is the inability to experience pleasure, often seen in major depressive disorder and schizophrenia, but it is not one of **Bleuler's original 4 As**. - **Bleuler's criteria** focused on fundamental symptoms of schizophrenia related to thought, feeling, and social interaction, not specifically the capacity for pleasure. *Autism* - **Autism** (Bleuler's concept of autism, referring to a withdrawal into a private world) is one of **Bleuler's 4 As**. - It describes the **self-absorption** and detachment from reality often observed in schizophrenia. *Affect* - **Affect** (specifically disturbance of affect, such as **blunted** or **inappropriate affect**) is one of **Bleuler's 4 As**. - This symptom refers to the **emotional responses** of an individual, which are often disorganized or mismatched with the context in schizophrenia. *Ambivalence* - **Ambivalence** (the coexistence of opposing thoughts, emotions, or attitudes toward the same object or situation) is one of **Bleuler's 4 As**. - It describes the **simultaneous presence of contradictory feelings** often seen in schizophrenia, such as loving and hating the same person at the same time.

Q: A woman firmly and persistently believes that her husband is cheating on her, despite any evidence to the contrary, and she disapproves of accepting any proof given in her husband's support. The other family members do not support her belief. This is an example of-

Delusion. ***Delusion*** - A **delusion** is a **fixed, false belief** that is not amenable to change in light of conflicting evidence. - The woman's persistent belief about her husband's infidelity, despite evidence to the contrary and disagreement from family members, fits the diagnostic criteria for a delusion. - This scenario specifically describes a **jealous delusion (Othello syndrome)**, where a person falsely believes their partner is unfaithful without any reasonable basis. - Key features: **firmly held**, **evidence-resistant**, **not shared by others** (non-bizarre delusion). *Illusion* - An **illusion** is a **misinterpretation of a real external stimulus**. - Example: Seeing a rope in dim light and thinking it's a snake. - In this case, there is no misperception of a real sensory stimulus; rather, it's a false belief held without basis in reality. *Hallucination* - A **hallucination** is a **sensory perception in the absence of an external stimulus**. - Examples include hearing voices when no one is speaking, or seeing objects that aren't present. - The woman is not experiencing false sensory perceptions; she is holding a fixed false belief about her husband's actions. *Perversion* - **Perversion** refers to a **deviation from what is considered normal**, often used in the context of sexual behavior or moral corruption. - This term does not describe a psychotic symptom or cognitive disorder like a delusion. - Not relevant to the clinical presentation of fixed false beliefs in psychiatric disorders.

Q: Catatonia is most commonly associated with which of the following mental disorders?

Schizophrenia. ***Schizophrenia*** - Catatonia is a severe neuropsychiatric syndrome characterized by profound psychomotor disturbance. It is **most commonly associated with schizophrenia and other psychotic disorders**. - Catatonia in schizophrenia can present with symptoms like **immobility**, **mutism**, **waxy flexibility**, **posturing**, **negativism**, and **stupor**. - Approximately **10-35%** of patients with schizophrenia may exhibit catatonic features during their illness, making it the most frequent psychiatric association. - DSM-5 recognizes catatonia as a specifier that can occur with schizophrenia spectrum disorders, where it remains most prevalent. *Major Depressive Disorder* - While catatonia can occur in mood disorders including major depressive disorder, it is **less common** than in schizophrenia and psychotic disorders. - When catatonia occurs in MDD, it indicates a **severe episode** and requires urgent treatment, often with benzodiazepines or ECT. - Catatonia in mood disorders accounts for a significant but smaller proportion of cases compared to psychotic disorders. *Specific Phobia* - **Specific phobias** are anxiety disorders characterized by an intense, irrational fear of a specific object or situation. - They do not involve **psychomotor disturbances** or other symptoms associated with catatonia. *Obsessive-Compulsive Disorder* - **Obsessive-compulsive disorder (OCD)** is characterized by recurrent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - OCD does not present with **catatonic symptoms**; its motor features (compulsions) are driven by anxiety reduction, not the profound psychomotor dysfunction seen in catatonia.

Question 1

Term 'schizophrenia' was coined by:

Accepted Answer

Eugene Bleuler

Answer

Freud

Answer

Kraepelin

Answer

Schneider

Question 2

Which of the following is associated with a poor prognosis in schizophrenia?

Accepted Answer

Disorganized schizophrenia (Hebephrenic type)

Answer

Schizophrenia with catatonic features

Answer

Residual schizophrenia

Answer

Paranoid schizophrenia

Question 3

A 45-year-old man is suspicious of others, believing that his coworkers are plotting against him, with no other psychotic symptoms. What is the most likely diagnosis?

Accepted Answer

Delusional disorder

Answer

Schizophrenia

Answer

Paranoid personality disorder

Answer

Schizoid personality disorder

Question 4

A 45-year-old man with a history of schizophrenia presents with flat affect, alogia, and avolition. Which of the following best describes his symptoms?

Accepted Answer

Negative symptoms

Answer

Positive symptoms

Answer

Cognitive symptoms

Answer

Affective symptoms

Question 5

A 45-year-old man believes that he has been receiving secret messages through the television for the past year. He is otherwise functioning well and has no other psychiatric symptoms. What is the most likely diagnosis?

Accepted Answer

Delusional disorder

Answer

Schizophrenia

Answer

Major depressive disorder with psychotic features

Answer

Bipolar disorder

Question 6

Which of the following statements is not true regarding delusional disorder?

Accepted Answer

Usually false

Answer

Held with some conviction

Answer

Not easily amenable to reasoning

Answer

Occurs at a later age

Question 7

A 39-year-old male patient presents with waxy flexibility, negativism and rigidity. Most probable diagnosis is?

Accepted Answer

Stuporous catatonia

Answer

None of the options

Answer

Paranoid schizophrenia

Answer

Excitatory catatonia

Question 8

Which of the following is not one of Eugene Bleuler's 4As?

Accepted Answer

Anhedonia

Answer

Autism

Answer

Ambivalence

Answer

Affect

Question 9

A woman firmly and persistently believes that her husband is cheating on her, despite any evidence to the contrary, and she disapproves of accepting any proof given in her husband's support. The other family members do not support her belief. This is an example of-

Accepted Answer

Delusion

Answer

Illusion

Answer

Hallucination

Answer

Perversion

Question 10

Catatonia is most commonly associated with which of the following mental disorders?

Accepted Answer

Schizophrenia

Answer

Major Depressive Disorder

Answer

Specific Phobia

Answer

Obsessive-Compulsive Disorder

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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