Psychotic Disorders — MCQs
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Olfactory hallucinations are seen in which of the following conditions?
A 24-year-old occasional alcoholic presents with a change in behavior, including suspiciousness that people are conspiring against him, despite his father stating there is no apparent reason for his fears. He is also experiencing auditory hallucinations where voices comment on his actions. What is the most probable diagnosis?
The defect of conation is typically seen in which type of schizophrenia?
Delusion in which the person believes he is suffering from some serious illness is:
The unfamiliarity of familiar things is a phenomenon described as:
A 24-year-old unmarried male was brought by his family members with complaints of sudden onset of suspiciousness towards his family members and neighbors. He had stopped consuming home-cooked food, stating it was poisoned. He also exhibited restlessness and decreased sleep. What is the most likely diagnosis?
A delusion that nothing exists in this world is termed as:
Which of the following is a delusion of persecution?
All of the following are Schneider's first rank symptoms EXCEPT:
What does the term "Schizophrenia" mean?
Psychotic Disorders Indian Medical PG Practice Questions and MCQs
Question 211: Olfactory hallucinations are seen in which of the following conditions?
- A. Temporal lobe epilepsy
- B. Alzheimer's disease
- C. Mesial temporal sclerosis
- D. All of the above (Correct Answer)
Explanation: **Explanation:** Olfactory hallucinations (perceiving smells that are not present, usually unpleasant like burning rubber or sulfur) are clinically significant because they often point toward an **organic or neurological etiology** rather than a primary functional psychiatric disorder. 1. **Temporal Lobe Epilepsy (TLE):** This is the most classic cause. Olfactory hallucinations often serve as an **aura** (uncinate fits) originating from the uncus or the amygdala. 2. **Mesial Temporal Sclerosis (MTS):** As the most common cause of drug-resistant TLE, MTS involves scarring of the inner aspect of the temporal lobe. Since the olfactory cortex is located here, irritation or seizure activity in this region frequently triggers olfactory sensations. 3. **Alzheimer’s Disease:** While memory loss is primary, neurodegeneration in the entorhinal cortex and olfactory bulb occurs early in the disease process. This can manifest as both a loss of smell (anosmia) and, occasionally, olfactory hallucinations or distortions. **Why "All of the Above" is correct:** All three conditions involve pathology or electrical dysfunction within the **temporal lobe and limbic system**, which house the primary olfactory processing centers. **High-Yield Clinical Pearls for NEET-PG:** * **Uncinate Fits:** Specifically refers to olfactory hallucinations occurring as an aura in temporal lobe seizures. * **Schizophrenia vs. Organic:** While hallucinations in Schizophrenia are typically **auditory**, olfactory and gustatory hallucinations should first prompt a workup for **organic brain lesions** (e.g., tumors like Olfactory Groove Meningioma) or epilepsy. * **Foster Kennedy Syndrome:** A frontal lobe tumor causing ipsilateral anosmia, contralateral papilledema, and ipsilateral optic atrophy. * **Migraine:** Olfactory hallucinations (osmophobia/osmia) can also occur as a rare migraine aura.
Question 212: A 24-year-old occasional alcoholic presents with a change in behavior, including suspiciousness that people are conspiring against him, despite his father stating there is no apparent reason for his fears. He is also experiencing auditory hallucinations where voices comment on his actions. What is the most probable diagnosis?
- A. Delirium tremens
- B. Alcohol-induced psychosis
- C. Schizophrenia (Correct Answer)
- D. Delusional disorder
Explanation: **Explanation:** The diagnosis is **Schizophrenia** based on the presence of characteristic "First Rank Symptoms" (FRS) and the patient’s age. **1. Why Schizophrenia is correct:** The patient exhibits two core diagnostic features of Schizophrenia according to ICD-11 and DSM-5: * **Persecutory Delusions:** Suspiciousness and the belief that people are conspiring against him (fixed false beliefs). * **Third-person Auditory Hallucinations:** Voices "commenting on his actions" are a classic Schneiderian First Rank Symptom, highly specific to schizophrenia. * **Demographics:** A 24-year-old male is in the peak age group for the onset of schizophrenia. **2. Why other options are incorrect:** * **Delirium Tremens:** This is a medical emergency characterized by autonomic hyperactivity (tachycardia, tremors, sweating) and clouded consciousness (disorientation) occurring 48–72 hours after alcohol withdrawal. This patient is an "occasional" drinker and lacks physical withdrawal signs. * **Alcohol-induced Psychosis:** While alcohol can cause hallucinations, they typically occur during or immediately after heavy intoxication or withdrawal. The presence of complex commentary hallucinations and the "occasional" nature of his drinking point toward a primary psychiatric disorder. * **Delusional Disorder:** This diagnosis is characterized by non-bizarre delusions *without* prominent hallucinations. The presence of auditory commentary voices excludes this diagnosis. **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Include audible thoughts (thought echo), voices arguing, voices commenting on one's actions, and thought withdrawal/insertion/broadcast. * **Duration Criteria:** For a diagnosis of Schizophrenia, symptoms must persist for at least **1 month** (ICD-11) or **6 months** (DSM-5). * **Prognosis:** Early onset (younger age) and being male are generally associated with a poorer prognosis in schizophrenia.
Question 213: The defect of conation is typically seen in which type of schizophrenia?
- A. Simple schizophrenia
- B. Hebephrenic schizophrenia
- C. Catatonic schizophrenia (Correct Answer)
- D. Paranoid schizophrenia
Explanation: **Explanation:** **Conation** refers to the mental faculty of purpose, desire, or the "will to act." It is the link between thought and physical movement. In **Catatonic Schizophrenia**, the primary pathology lies in the motor expression of this will. Patients exhibit profound disturbances in conation, manifesting as either extreme lack of movement (stupor, mutism, or negativism) or excessive, purposeless motor activity (catatonic excitement). The classic signs like waxy flexibility and posturing are direct results of this "defect of conation." **Analysis of Incorrect Options:** * **Simple Schizophrenia:** Characterized primarily by negative symptoms (apathy, social withdrawal, loss of drive) without prominent hallucinations or delusions. While there is a loss of volition, it lacks the specific motoric "conative" disturbances seen in catatonia. * **Hebephrenic (Disorganized) Schizophrenia:** Defined by disorganized speech, disorganized behavior, and flat or inappropriate affect. The primary defect is in **thought and affect**, not conation. * **Paranoid Schizophrenia:** Characterized by stable delusions and hallucinations. It is the most common type and usually has the best prognosis, but motor/conative symptoms are typically absent. **NEET-PG High-Yield Pearls:** * **Waxy Flexibility (Cerea Flexibilitas):** A hallmark of catatonia where the patient maintains positions in which they are placed by the examiner. * **Ambitendency:** A conative conflict where the patient makes a series of tentative, incomplete movements when asked to perform an action (e.g., reaching for a hand to shake but withdrawing). * **Treatment of Choice:** Benzodiazepines (Lorazepam) are the first-line treatment for catatonia; Electroconvulsive Therapy (ECT) is the most effective treatment for refractory cases.
Question 214: Delusion in which the person believes he is suffering from some serious illness is:
- A. Nihilistic delusion
- B. Delusion of persecution
- C. Cotard's delusion
- D. Hypochondriacal delusion (Correct Answer)
Explanation: ### Explanation **Correct Answer: D. Hypochondriacal delusion** **1. Why it is correct:** A **hypochondriacal delusion** is a fixed, false belief (not amenable to logic) that one is suffering from a serious physical disease (e.g., cancer, HIV, or heart failure) despite repeated medical reassurances and negative investigations. While *Hypochondriasis* (Illness Anxiety Disorder) involves a preoccupation or fear of having a disease, the **delusional** form is characterized by absolute conviction and is often seen in severe depression (psychotic depression) or schizophrenia. **2. Why other options are incorrect:** * **A. Nihilistic delusion:** This is the belief that oneself, a part of the body, or the world does not exist or is "dead/rotting." It is a core feature of severe depressive psychosis. * **B. Delusion of persecution:** The most common type of delusion in schizophrenia. The patient believes they are being conspired against, spied upon, or harmed by external forces (e.g., the police or neighbors). * **C. Cotard’s delusion:** This is an extreme form of nihilistic delusion where the patient claims they have lost their internal organs, soul, or are literally dead. It is often described as the "Walking Corpse Syndrome." **3. Clinical Pearls for NEET-PG:** * **Somatic Delusion vs. Hypochondriacal Delusion:** Somatic delusions often involve a specific bodily *function* (e.g., "infestation by parasites" or "emitting a foul odor"), whereas hypochondriacal delusions focus on the *diagnosis* of a serious medical illness. * **Monosymptomatic Hypochondriacal Psychosis:** A specific delusional disorder where the patient has a single hypochondriacal delusion (e.g., Ekbom syndrome/delusional parasitosis). * **Key Association:** Hypochondriacal delusions are a classic feature of **Involutional Melancholia** (severe depression in the elderly).
Question 215: The unfamiliarity of familiar things is a phenomenon described as:
- A. Déjà vu
- B. Jamais vu (Correct Answer)
- C. Déjà entendu
- D. Déjà pensée
Explanation: **Explanation:** The phenomenon described is **Jamais vu**, which is a disorder of memory and recognition characterized by a false sense of unfamiliarity. **1. Why Jamais vu is correct:** Jamais vu (French for "never seen") occurs when a person encounters a situation or person that is objectively familiar but feels completely strange or new. In psychiatry and neurology, it is considered a **paramnesia** (a distortion of memory). It is most commonly associated with **Temporal Lobe Epilepsy (TLE)** as an aura, but can also occur in migraines, fatigue, or schizophrenia. **2. Analysis of Incorrect Options:** * **A. Déjà vu:** This is the opposite of Jamais vu. It is the illusion of familiarity, where a person feels they have previously experienced a new, unfamiliar situation ("already seen"). * **C. Déjà entendu:** This refers to the illusion of auditory familiarity—the feeling that one has "already heard" something that is actually being heard for the first time. * **D. Déjà pensée:** This is the illusion that a new thought or idea has been "already thought" or experienced before. **3. Clinical Pearls for NEET-PG:** * **Phenomenology:** Both Déjà vu and Jamais vu are classified as **disturbances of memory** (specifically paramnesias) rather than perception. * **Localization:** These phenomena are highly suggestive of pathology in the **temporal lobe** (hippocampus/parahippocampal gyrus). * **Differential:** While they can occur in healthy individuals (especially during stress or sleep deprivation), frequent occurrences should prompt an evaluation for **Complex Partial Seizures**. * **Capgras Syndrome:** Do not confuse Jamais vu with Capgras syndrome (a delusional misidentification), where a patient believes a familiar person has been replaced by an identical impostor.
Question 216: A 24-year-old unmarried male was brought by his family members with complaints of sudden onset of suspiciousness towards his family members and neighbors. He had stopped consuming home-cooked food, stating it was poisoned. He also exhibited restlessness and decreased sleep. What is the most likely diagnosis?
- A. Acute mania
- B. Acute psychosis (Correct Answer)
- C. Delirium
- D. Post-traumatic stress disorder (PTSD)
Explanation: ### Explanation **Correct Option: B. Acute psychosis** The patient presents with a **sudden onset** of core psychotic symptoms: **delusions of persecution** (suspiciousness, belief that food is poisoned) and **behavioral disturbances** (restlessness, decreased sleep). In the context of NEET-PG, "Acute Psychosis" (often referred to as Brief Psychotic Disorder in DSM-5 or Acute and Transient Psychotic Disorder in ICD-10) is characterized by symptoms lasting less than one month, often triggered by stress, and a rapid return to premorbid functioning. The absence of long-term history or organic causes makes this the most likely diagnosis. **Why other options are incorrect:** * **A. Acute Mania:** While mania involves restlessness and decreased sleep, the primary features are elevated/irritable mood, grandiosity, and pressured speech. The clinical picture here is dominated by persecutory delusions rather than mood symptoms. * **C. Delirium:** This is an organic brain syndrome characterized by a **clouding of consciousness** and fluctuating levels of attention. The vignette does not mention disorientation, cognitive impairment, or an underlying medical illness. * **D. PTSD:** This requires a history of a traumatic event followed by intrusive symptoms (flashbacks/nightmares), avoidance, and hyperarousal. Suspiciousness about poisoned food is not a classic feature of PTSD. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** * < 1 month: Brief Psychotic Disorder (Acute Psychosis). * 1–6 months: Schizophreniform Disorder. * \> 6 months: Schizophrenia. * **Delusion of Persecution:** The most common type of delusion in psychiatric practice. * **First-line Treatment:** Atypical antipsychotics (e.g., Risperidone or Olanzapine) are generally the treatment of choice for acute psychotic episodes.
Question 217: A delusion that nothing exists in this world is termed as:
- A. Delusion of influence
- B. Nihilistic delusion (Correct Answer)
- C. Delusion of self-reproach
- D. Erotomania
Explanation: **Explanation:** **Nihilistic delusion** (Option B) is a psychopathological conviction that oneself, others, or the world is non-existent, ending, or decaying. The term is derived from the Latin word *'nihil'* meaning 'nothing.' Patients may claim their internal organs are missing, they have no soul, or that the entire universe has ceased to exist. **Analysis of Options:** * **Delusion of influence (A):** The false belief that one’s thoughts, feelings, or actions are being controlled by an external force or agency (e.g., radio waves, aliens). * **Delusion of self-reproach (C):** Common in severe depression, where the patient feels excessive guilt or believes they have committed unpardonable sins or crimes. * **Erotomania (D):** Also known as **De Clérambault's syndrome**, it is the delusional belief that another person (usually of higher social status or a celebrity) is deeply in love with the patient. **Clinical Pearls for NEET-PG:** 1. **Cotard’s Syndrome:** This is a specific clinical triad consisting of nihilistic delusions, melancholic depression, and ideas of immortality (the belief that since they are already "dead," they cannot die). 2. **Diagnostic Association:** Nihilistic delusions are most commonly associated with **Psychotic Depression** (Severe Depressive Episode with Psychotic Symptoms) but can also occur in Schizophrenia. 3. **Schneiderian First Rank Symptoms (FRS):** While delusions of influence are FRS, nihilistic delusions are **not** considered FRS for Schizophrenia.
Question 218: Which of the following is a delusion of persecution?
- A. Delusion of jealousy
- B. Delusion of being cheated (Correct Answer)
- C. Delusion of a defective body part
- D. Delusion of love
Explanation: **Explanation:** **Delusion of persecution** is the most common type of delusion. It involves the false, fixed belief that one is being harmed, harassed, conspired against, or obstructed by others (individuals or groups). 1. **Why Option B is Correct:** The **delusion of being cheated**, spied upon, poisoned, or followed are all classic manifestations of persecutory delusions. The patient believes that external forces are intentionally acting to disadvantage or harm them. 2. **Analysis of Incorrect Options:** * **Option A (Delusion of Jealousy):** Also known as **Othello Syndrome**, this is the false belief that one’s spouse or partner is unfaithful. While it involves suspicion, it is categorized separately from general persecution. * **Option C (Delusion of a defective body part):** This is a **Somatic Delusion** (specifically Monosymptomatic Hypochondriacal Psychosis). The patient believes a part of their body is misshapen, malfunctioning, or emitting a foul odor. * **Option D (Delusion of Love):** Also known as **Erotomania** or **De Clerambault’s Syndrome**, this is the belief that another person (usually of higher social status) is in love with the patient. **High-Yield Clinical Pearls for NEET-PG:** * **Most common delusion in Schizophrenia:** Delusion of Persecution. * **Schneiderian First Rank Symptoms (FRS):** Delusional perception is a key FRS, but persecutory delusions are *not* pathognomonic for schizophrenia as they occur in various psychoses. * **Nihilistic Delusion (Cotard’s Syndrome):** Belief that one is dead, non-existent, or the world is ending; typically seen in severe agitated depression. * **Capgras Syndrome:** A "delusional misidentification" where the patient believes a familiar person has been replaced by an identical impostor.
Question 219: All of the following are Schneider's first rank symptoms EXCEPT:
- A. Running commentary
- B. Primary delusion
- C. Thought insertion
- D. Delusion of guilt (Correct Answer)
Explanation: **Explanation:** Kurt Schneider’s **First Rank Symptoms (FRS)** are a group of specific auditory hallucinations and delusions that, while not pathognomonic, are highly suggestive of **Schizophrenia** in the absence of organic brain disease. **Why "Delusion of Guilt" is the correct answer:** Delusion of guilt is a **Second Rank Symptom**. It is more commonly associated with **Severe Depressive Episodes with Psychotic Features** (Melancholic Depression) rather than being a core diagnostic feature of Schizophrenia. **Analysis of Incorrect Options:** * **Running Commentary (Option A):** A classic FRS where the patient hears voices describing their actions as they happen (e.g., "He is now opening the door"). * **Primary Delusion (Option B):** Also known as an **Autochthonous delusion**, this is a "bolt from the blue" belief that arises without any preceding sensory event. It is a hallmark FRS. * **Thought Insertion (Option C):** A "Passivity Phenomenon" where the patient believes thoughts are being put into their mind by an external agency. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for FRS (ABCD):** * **A**uditory Hallucinations (Third person, Running commentary, Echo/Gedankenlautwerden). * **B**roadcasting of thoughts (and Insertion/Withdrawal). * **C**ontrolled feelings/impulses (Passivity/Made phenomena). * **D**elusional Perception (Attributing a private, abnormal meaning to a normal perception). * **ICD-11/DSM-5 Update:** While historically vital, FRS have been de-emphasized in recent diagnostic criteria because they lack high specificity (they can occur in bipolar disorder). * **Somatic Passivity:** The belief that bodily sensations are being imposed by an external force is also an FRS.
Question 220: What does the term "Schizophrenia" mean?
- A. Split mind (Correct Answer)
- B. Split mood
- C. Split thoughts
- D. Split associations
Explanation: **Explanation:** The term **"Schizophrenia"** was coined in 1908 by the Swiss psychiatrist **Eugen Bleuler**. It is derived from the Greek words *schizein* (to split) and *phren* (mind). 1. **Why "Split Mind" is correct:** Bleuler used this term to describe a "splitting" or fragmentation of various mental functions (such as thought, emotion, and behavior) that normally work together harmoniously. It does **not** refer to a "split personality" (Dissociative Identity Disorder), but rather a lack of integration between cognitive processes and emotional expression. 2. **Why other options are incorrect:** * **Split mood:** Mood disturbances are primary to Bipolar Disorder or Schizoaffective Disorder, not the defining etymology of Schizophrenia. * **Split thoughts:** While "formal thought disorder" is a hallmark of the disease, the term specifically encompasses the entire "mind" (*phren*), not just the thought process. * **Split associations:** While Bleuler described "loosening of associations" as a core symptom, the literal translation of the name remains "split mind." **High-Yield Clinical Pearls for NEET-PG:** * **Historical Context:** Before Bleuler, **Emil Kraepelin** called this condition *Dementia Praecox* (premature dementia), focusing on its early onset and deteriorating course. * **Bleuler’s 4 A’s (Primary Symptoms):** 1. **A**mbivalence 2. **A**utism (social withdrawal) 3. **A**ffective flattening 4. **A**ssociative looseness * **Kurt Schneider’s First Rank Symptoms (FRS):** These are diagnostic criteria focusing on hallucinations and delusions (e.g., thought insertion, broadcasting, and third-person auditory hallucinations). * **Prognosis:** Schizophrenia generally follows the **"Rule of Thirds"** (one-third recover significantly, one-third have moderate disability, one-third remain severely impaired).
Practice by Chapter
Schizophrenia: Epidemiology and Etiology
Practice Questions
Schizophrenia: Clinical Features
Practice Questions
Schizophrenia: Treatment
Practice Questions
Schizoaffective Disorder
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Delusional Disorders
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Brief Psychotic Disorder
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Substance-Induced Psychotic Disorders
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Psychosis in Medical Conditions
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First Episode Psychosis
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Treatment-Resistant Psychosis
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Rehabilitation in Psychotic Disorders
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Outcome and Prognosis
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