Psychotic Disorders Practice Questions

Q: What does the term 'Folie-à-deux' refer to?

Sharing of delusion. ***Sharing of delusion*** - **Folie-à-deux**, also known as **shared psychotic disorder**, describes a rare psychiatric syndrome in which a **delusional belief** is transmitted from one individual to another. - It typically occurs between two people in a close relationship, where one individual (the primary case) develops a delusion and the other person (the secondary case) subsequently adopts the same delusion. *Delusion of persecution* - A **delusion of persecution** is a specific type of delusion where an individual believes they are being harmed, harassed, or conspired against by others. - While it can be the content of a shared delusion in folie-à-deux, the term itself refers to the *type* of delusion, not the *sharing* mechanism. *Delusion of double* - "Delusion of double" is not a standard term for folie-à-deux. - This phrase might be confused with **delusional misidentification syndromes** (like Capgras syndrome where a person believes someone has been replaced by an identical impostor), but this is a different concept from shared psychotic disorder. *None of the options* - This option is incorrect because "sharing of delusion" accurately defines folie-à-deux.

Q: The delusion that involves the belief that a familiar person has been replaced by someone else is known as?

Capgras syndrome. ***Capgras syndrome*** - This **delusional misidentification syndrome** is characterized by the belief that a familiar person (e.g., a spouse, child, or parent) has been replaced by an identical imposter. - It often occurs in individuals with **schizophrenia**, **dementia**, or following **brain injury**. *Cotard syndrome* - This syndrome involves a nihilistic delusion where the individual believes they are **dead**, do not exist, or have lost their organs or blood. - It is often associated with severe **depression**, psychosis, or neurological disorders. *Othello syndrome* - Also known as **delusional jealousy**, this involves the unfounded belief that one's partner is being unfaithful. - It is a **primary delusional disorder** but can also be seen in conditions like alcohol dependence or neurodegenerative diseases. *Fregoli syndrome* - This is another **delusional misidentification syndrome** where the person believes that different people are actually the same person in disguise. - It is the opposite of Capgras syndrome and may occur in **schizophrenia** or **organic brain disorders**.

Q: Which of the following is not a feature of psychosis?

Preserved contact with reality. ***Preserved contact with reality*** - Psychosis is fundamentally characterized by a **loss of contact with reality**, making this option a defining non-feature of the condition. - Individuals experiencing psychosis often have profound difficulties distinguishing between what is real and what is not. *Loss of insight* - **Lack of insight** into one's own mental illness is a hallmark feature of psychosis, meaning the affected individual may not recognize their thoughts or perceptions as abnormal. - This symptom contributes to the difficulty in engaging individuals with psychosis in treatment. *Presence of delusions* - **Delusions** are fixed, false beliefs that are resistant to reason or evidence, and they are a core positive symptom of psychosis. - These beliefs are often bizarre and can significantly impair an individual's functioning and perception of reality. *Personality disturbances* - While not a primary diagnostic criterion, **personality disturbances** can be associated with psychotic disorders. - Changes in personality, mood, and behavior may occur as a result of the psychotic experience or the underlying illness.

Q: Which type of delusion is primarily associated with Cotard's syndrome?

Nihilistic delusions. ***Nihilistic delusions*** - **Cotard's syndrome** is characterized by beliefs of **non-existence**, such as the patient being dead, not existing, or having lost their organs, which are typical of **nihilistic delusions**. - These delusions can also extend to the belief that the world or parts of it no longer exist. *Persecutory delusions* - These involve the belief that one is being **harassed, tricked, spied upon, or conspired against**, which is not the primary feature of Cotard's syndrome. - While they can co-occur with other psychiatric conditions, **persecutory themes** are distinct from the non-existence themes of Cotard's. *Religious delusions* - These delusions focus on **religious or spiritual themes**, such as believing one is a prophet or has a special relationship with a deity. - They are not a core component of Cotard's syndrome, which centers on themes of **death and non-existence**. *Hypochondriacal delusions* - These involve a preoccupation with the belief that one has a **serious, undiagnosed medical condition**, despite medical reassurance. - While Cotard's syndrome can involve bodily concerns, the belief in **non-existence of organs** or death goes beyond typical hypochondriacal fears of illness.

Q: Which of the following is considered a poor prognostic factor for schizophrenia?

Poor premorbid adjustment. **Poor premorbid adjustment** - **Poor premorbid adjustment**, indicated by difficulties in social, academic, or occupational functioning before the onset of psychosis, is a consistent predictor of a worse outcome in schizophrenia. - This suggests a more pervasive and entrenched neurodevelopmental vulnerability impacting the individual's ability to cope and integrate socially. *Blunted affect (negative symptom)* - While **blunted affect** is a negative symptom often associated with poorer outcomes than positive symptoms, it is typically considered a *symptom* of the illness rather than a primary prognostic *factor* like premorbid adjustment. - Its presence contributes to disability, but it is not as strong an independent prognostic indicator as the life trajectory prior to illness onset. *Male sex (generally poorer prognosis)* - **Male sex** is generally associated with an **earlier age of onset** and often a **more severe course** of schizophrenia. - However, compared to significant functional impairment before disease onset, it is not as strong an individual predictor of overall long-term prognosis. *Presence of depression (often associated with better outcomes)* - The **presence of depressive symptoms** in schizophrenia is often associated with a **better prognosis**. - This is because depressive features can sometimes indicate a more preserved capacity for emotional experience and insight, which can align with higher functioning.

Q: In stupor catatonia, all are seen except -

Agitation. ***Agitation*** - **Stuporous catatonia** is characterized by a significant reduction or absence of motor activity and responsiveness, making **agitation**—increased motor activity—an unlikely feature. - In such a state, the patient is typically rigid, immobile, and unresponsive to external stimuli, which is the antithesis of agitation. *Catalepsy* - **Catalepsy** refers to a trance-like state with a loss of voluntary motion and active posturing, where the limbs maintain any position in which they are placed (waxy flexibility). - This is a hallmark feature of **catatonic stupor**, indicating a profound disturbance in motor control. *Mutism* - **Mutism** is the absence or profound reduction of speech, which is a common and defining feature of **catatonic stupor**. - Patients in a stuporous state typically do not speak or respond verbally to questions or commands. *Akinesia* - **Akinesia** is the absence of movement, or pronounced difficulty in initiating voluntary movements, which is a key component of **catatonic stupor**. - Patients exhibit severe motor retardation, often appearing frozen or rigid.

Q: Which of the following is considered a poor prognostic factor for schizophrenia?

Early onset. ***Early onset*** - An **earlier age of onset** (e.g., childhood or early adolescence) for schizophrenia is consistently associated with a **worse long-term prognosis**, including more severe symptoms, greater functional impairment, and a lower likelihood of full recovery. - This is thought to be due to the greater developmental disruption caused by the illness when it begins at a younger age. *Presence of depression* - While depression is common in schizophrenia, it is generally considered to be a **treatable co-occurring condition** rather than a primary poor prognostic factor for the core psychotic disorder itself. - Effective treatment for depression can actually **improve overall quality of life** and adherence to antipsychotic medication. *Presence of stressor* - The presence of a significant psychosocial stressor at the onset of schizophrenia is often associated with a **better prognosis**, as it suggests a more reactive and potentially remitting course. - This indicates that the illness might be more environmentally triggered and less intrinsically severe. *Female sex* - **Female sex** is typically associated with a **somewhat better prognosis** in schizophrenia, with a later age of onset and potentially less severe symptoms compared to males. - This may be influenced by hormonal factors and differences in social support networks.

Q: In which socioeconomic strata is schizophrenia most commonly observed?

Low. ***Low*** - Epidemiological studies consistently show a **higher prevalence of schizophrenia** in individuals from **lower socioeconomic strata**. - This association is explained by the "**social drift**" hypothesis, where individuals with schizophrenia experience a decline in social class due to the chronic and disabling nature of the illness, or the "**social causation**" hypothesis, which posits that adverse social conditions contribute to the development of the disorder. *Middle* - While individuals from all socioeconomic backgrounds can develop schizophrenia, it is **less common** compared to the lowest strata. - The middle socioeconomic group generally experiences **better access to resources** and support systems, which may mitigate some risk factors. *Upper* - Schizophrenia is **least common** in the upper socioeconomic strata. - Individuals in this group typically have **greater financial stability**, better living conditions, and access to high-quality healthcare, which might protect against environmental stressors. *Upper middle* - Similar to the middle and upper strata, the upper-middle class experiences a **lower prevalence of schizophrenia** compared to the low socioeconomic group. - This group often benefits from **good educational opportunities** and stable employment, reducing some of the psychosocial stressors associated with the disorder.

Q: According to DSM-5 criteria, symptoms of brief psychotic disorder must resolve within what time period to differentiate it from longer-term psychotic conditions like schizophreniform disorder?

1 month. ***1 month*** - According to **DSM-5 criteria**, brief psychotic disorder is characterized by symptoms lasting more than **1 day** but less than **1 month**. - If psychotic symptoms persist for **1 month or longer**, it indicates a different diagnosis, such as schizophreniform disorder or schizophrenia, requiring further evaluation. *1 week* - While psychotic symptoms may be present for 1 week in brief psychotic disorder, this duration is within the disorder's diagnostic window but not its defining upper limit. - The key differentiator for brief psychotic disorder is that symptoms resolve within **1 month**. *2 weeks* - Similar to 1 week, 2 weeks is a duration that can occur within brief psychotic disorder, but it does not represent the minimum duration that distinguishes it from longer-term conditions. - The crucial threshold for duration in brief psychotic disorder is **less than 1 month**. *3 weeks* - Three weeks also falls within the diagnostic duration for brief psychotic disorder. - The essential criteria specify that psychotic symptoms must last **less than 1 month** to be classified as brief psychotic disorder.

Q: Waxy flexibility is a feature of ?

Catatonia. ***Catatonia*** - **Waxy flexibility** (or catalepsy) is a classic symptom of **catatonia**, where an individual's limbs can be **placed in any position by the examiner and remain in that position for an extended period**, as if molded from wax. - It reflects a severe psychomotor disturbance, often seen in conditions like **schizophrenia** or **mood disorders** with catatonic features. *Echolalia* - **Echolalia** refers to the **involuntary repetition of another person's spoken words**, typically without understanding. - It is a symptom of thought disorder or communication difficulties, not a state of motor rigidity. *Stereotypy* - **Stereotypy** involves **repetitive, seemingly purposeless movements or utterances** (e.g., body rocking, hand flapping). - While repetitive, it does not involve maintaining a fixed posture imposed by another, as seen in waxy flexibility. *Mannerisms* - **Mannerisms** are **habitual, idiosyncratic gestures or behaviors** that may appear odd but are often voluntary and goal-directed (e.g., an exaggerated bow before speaking). - They are distinct from the involuntary, often rigid, posturing characteristic of waxy flexibility.

Question 1

What does the term 'Folie-à-deux' refer to?

Accepted Answer

Sharing of delusion

Answer

Delusion of persecution

Answer

Delusion of double

Answer

None of the options

Question 2

The delusion that involves the belief that a familiar person has been replaced by someone else is known as?

Accepted Answer

Capgras syndrome

Answer

Cotard syndrome

Answer

Othello syndrome

Answer

Fregoli syndrome

Question 3

Which of the following is not a feature of psychosis?

Accepted Answer

Preserved contact with reality

Answer

Loss of insight

Answer

Personality disturbances

Answer

Presence of delusions

Question 4

Which type of delusion is primarily associated with Cotard's syndrome?

Accepted Answer

Nihilistic delusions

Answer

Persecutory delusions

Answer

Religious delusions

Answer

Hypochondriacal delusions

Question 5

Which of the following is considered a poor prognostic factor for schizophrenia?

Accepted Answer

Poor premorbid adjustment

Answer

Male sex

Answer

Presence of depression

Answer

Blunted affect

Question 6

In stupor catatonia, all are seen except -

Accepted Answer

Agitation

Answer

Mutism

Answer

Akinesia

Answer

Catalepsy

Question 7

Which of the following is considered a poor prognostic factor for schizophrenia?

Accepted Answer

Early onset

Answer

Presence of depression

Answer

Presence of stressor

Answer

Female sex

Question 8

In which socioeconomic strata is schizophrenia most commonly observed?

Accepted Answer

Low

Answer

Middle

Answer

Upper

Answer

Upper middle

Question 9

According to DSM-5 criteria, symptoms of brief psychotic disorder must resolve within what time period to differentiate it from longer-term psychotic conditions like schizophreniform disorder?

Accepted Answer

1 month

Answer

1 week

Answer

3 weeks

Answer

2 weeks

Question 10

Waxy flexibility is a feature of ?

Accepted Answer

Catatonia

Answer

Echolalia

Answer

Stereotypy

Answer

Mannerisms

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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