Psychotic Disorders — MCQs
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Which of the following is NOT characteristic of Type I Schizophrenia?
A 25-year-old male patient presents with eccentric behavior for 3 years. He is unemployed and has difficulty with self-care, such as bathing and eating. He complains of auditory hallucinations and talking to himself when alone. On examination, he exhibits a flat affect, inappropriate emotions, and disorganized behavior, along with suicidal ideation. What is the most appropriate diagnosis?
What is the most common delusion seen in schizophrenia?
A 41-year-old woman believes that her management has fabricated negative reports about her competence and forged her signature on sensitive documents to undermine her. She has reported this to the police and requested security, yet she continues to attend work and manage her household. She is suffering from:
Schizophrenia is characterized by which of the following?
Which of the following is a true statement regarding Ganser's syndrome?
Acute organic psychosis may be associated with all of the following diseases EXCEPT?
A man hits his neighbour. The next day, he feels that the police are pursuing him and that his brain is being controlled by radio waves transmitted by his neighbour. What is the probable diagnosis?
What is the percentage of monozygotic twins who develop schizophrenia?
Schizophrenia with automutilism is called as?
Psychotic Disorders Indian Medical PG Practice Questions and MCQs
Question 231: Which of the following is NOT characteristic of Type I Schizophrenia?
- A. Positive symptoms
- B. CT, MRI shows enlarged ventricles (Correct Answer)
- C. Good prognosis
- D. None of the above
Explanation: This question tests your knowledge of **Crow’s Classification of Schizophrenia**, which divides the disorder into Type I and Type II based on clinical features, pathophysiology, and prognosis. ### **Explanation of the Correct Answer** **Option B** is the correct answer because **enlarged ventricles** (and other structural brain abnormalities like cortical atrophy) are characteristic of **Type II Schizophrenia**, not Type I. * **Type I (Positive Schizophrenia):** This is characterized by a "hyperdopaminergic" state. There are no significant structural changes on CT or MRI. Because the underlying pathology is biochemical (excess dopamine), these patients respond well to antipsychotics. * **Type II (Negative Schizophrenia):** This is characterized by "structural brain changes." Enlarged lateral ventricles and widened sulci are hallmark findings. These patients have a poor response to traditional neuroleptics. ### **Analysis of Incorrect Options** * **Option A (Positive symptoms):** This is a core feature of Type I. It includes hallucinations, delusions, and thought disorders. * **Option C (Good prognosis):** Type I is associated with an acute onset, preserved intellectual functions, and a good response to medication, leading to a generally better prognosis compared to Type II. ### **NEET-PG High-Yield Pearls: Crow’s Classification** | Feature | Type I (Positive) | Type II (Negative) | | :--- | :--- | :--- | | **Symptoms** | Hallucinations, Delusions | Apathy, Withdrawal, Poverty of speech | | **Pathology** | Increased Dopamine receptors | **Cell loss / Ventricular enlargement** | | **Response to Rx** | Good | Poor | | **Prognosis** | Reversible/Good | Irreversible/Poor | | **Intellect** | Preserved | Impaired | **Clinical Note:** In NEET-PG, remember that **Type II** is often associated with "the 5 A's": Affective flattening, Alogia, Avolition, Anhedonia, and Attention deficit.
Question 232: A 25-year-old male patient presents with eccentric behavior for 3 years. He is unemployed and has difficulty with self-care, such as bathing and eating. He complains of auditory hallucinations and talking to himself when alone. On examination, he exhibits a flat affect, inappropriate emotions, and disorganized behavior, along with suicidal ideation. What is the most appropriate diagnosis?
- A. Paranoid schizophrenia
- B. Hebephrenic schizophrenia (Correct Answer)
- C. Catatonic schizophrenia
- D. Undifferentiated schizophrenia
Explanation: **Explanation:** The patient presents with the classic triad of **Hebephrenic Schizophrenia** (also known as Disorganized Schizophrenia): **disorganized behavior, disorganized speech/thought, and flat or inappropriate affect.** 1. **Why Hebephrenic Schizophrenia is correct:** This subtype typically has an early onset (ages 15–25) and a poor prognosis. Key features present in this case include **eccentric behavior**, poor self-care (hygiene), and **inappropriate emotional responses** (e.g., giggling or smiling without reason). The "disorganized" nature is evident in his inability to perform daily activities and his aimless behavior. While hallucinations are present, they are not the dominant feature compared to the emotional and behavioral disturbances. 2. **Why other options are incorrect:** * **Paranoid Schizophrenia:** Characterized by stable, persecutory delusions or auditory hallucinations. Affect and behavior are usually relatively preserved; the disorganized behavior seen here rules this out. * **Catatonic Schizophrenia:** Defined by prominent psychomotor disturbances such as stupor, mutism, waxy flexibility, or purposeless excitement. These features are absent in this patient. * **Undifferentiated Schizophrenia:** This is a "diagnosis of exclusion" used when symptoms meet the general criteria for schizophrenia but do not fit into the specific paranoid, hebephrenic, or catatonic categories. Since this patient fits the hebephrenic profile perfectly, this is not the best answer. **NEET-PG High-Yield Pearls:** * **Hebephrenic Schizophrenia** has the **worst prognosis** among all subtypes. * **Paranoid Schizophrenia** is the **most common** subtype and has the **best prognosis**. * In ICD-11 and DSM-5, these traditional subtypes have been largely removed in favor of a dimensional approach, but they remain high-yield for exam purposes. * **Schneider’s First Rank Symptoms (FRS)** are helpful for diagnosis but are not pathognomonic (they can occur in bipolar disorder).
Question 233: What is the most common delusion seen in schizophrenia?
- A. Persecution (Correct Answer)
- B. Grandiose
- C. Reference
- D. Nihilistic
Explanation: **Explanation:** **1. Why Persecution is Correct:** Delusions of persecution (or paranoid delusions) are the most frequently encountered subtype of delusions in patients with schizophrenia. In this state, the patient falsely believes that individuals, groups, or organizations are plotting against them, spying on them, or intending to cause them physical or mental harm. This is a hallmark feature of **Paranoid Schizophrenia**, which is the most common clinical subtype of the disorder worldwide. **2. Analysis of Incorrect Options:** * **B. Grandiose:** These involve beliefs of inflated self-worth, power, or special identity. While common in the manic phase of Bipolar Disorder, they are less frequent in schizophrenia than persecutory themes. * **C. Reference:** The belief that neutral environmental cues (e.g., a news anchor’s tie or a song on the radio) have a special personal meaning. While highly characteristic of schizophrenia, it is statistically less common than persecution. * **D. Nihilistic:** The belief that oneself, others, or the world does not exist. This is most classically associated with **Cotard Syndrome** and severe psychotic depression, rather than schizophrenia. **3. NEET-PG Clinical Pearls:** * **Most common type of Hallucination in Schizophrenia:** Auditory (specifically third-person hallucinations). * **Schneiderian First Rank Symptoms (FRS):** These are highly suggestive of schizophrenia and include thought insertion, withdrawal, broadcast, and "made" phenomena. * **Prognosis:** Paranoid schizophrenia (dominated by persecutory delusions) generally has a **better prognosis** compared to the hebephrenic (disorganized) subtype. * **Capgras Syndrome:** A specific "delusional misidentification" where the patient believes a familiar person has been replaced by an identical impostor.
Question 234: A 41-year-old woman believes that her management has fabricated negative reports about her competence and forged her signature on sensitive documents to undermine her. She has reported this to the police and requested security, yet she continues to attend work and manage her household. She is suffering from:
- A. Late onset Psychosis
- B. Paranoid Schizophrenia
- C. Persistent Delusional Disorder (Correct Answer)
- D. Obsessive Compulsive Disorder
Explanation: **Explanation:** The clinical presentation describes a patient with a well-systematized, non-bizarre delusion (persecutory type) that has not significantly impaired her global functioning. **Why Persistent Delusional Disorder (PDD) is correct:** The hallmark of PDD is the presence of one or more delusions for at least **one month** in the absence of other psychotic symptoms. Crucially, apart from the impact of the delusion, the patient’s **personality and social/occupational functioning remain preserved**. This patient continues to manage her household and attend work, which is characteristic of PDD and distinguishes it from Schizophrenia. **Why other options are incorrect:** * **Paranoid Schizophrenia:** While it involves persecutory delusions, it is typically accompanied by hallucinations, thought disorders, and a significant **decline in social and occupational functioning**. * **Late-onset Psychosis:** This is a broad term usually referring to psychosis starting after age 40 (often Very Late-Onset Schizophrenia-Like Psychosis after 60). While the age fits, PDD is the more specific ICD/DSM diagnosis for this clinical picture. * **Obsessive-Compulsive Disorder:** This involves intrusive thoughts (obsessions) recognized as the patient's own and repetitive behaviors (compulsions). The patient here has a fixed false belief (delusion), not an ego-dystonic obsession. **Clinical Pearls for NEET-PG:** * **Non-bizarre delusions:** Situations that could occur in real life (being followed, poisoned, or deceived). * **Functioning:** "Encapsulated" delusions—functioning is remarkably normal outside the delusional theme. * **Treatment:** PDD is notoriously difficult to treat; **Second-generation antipsychotics** are the first line, but the doctor-patient relationship is the most critical factor. * **Types of PDD:** Erotomanic (De Clerambault’s), Grandiose, Jealous (Othello syndrome), Persecutory (most common), and Somatic.
Question 235: Schizophrenia is characterized by which of the following?
- A. Formal thought disorder
- B. Delusion of reference
- C. Waxy flexibility
- D. Altered sensorium (Correct Answer)
Explanation: ### Explanation **Correct Option: D. Altered sensorium** In the context of this specific question, the goal is to identify which feature is **NOT** typically a characteristic of Schizophrenia. Schizophrenia is fundamentally a disorder of **clear consciousness**. Patients are awake, alert, and oriented to time, place, and person. An **altered sensorium** (clouding of consciousness, disorientation, or delirium) suggests an **organic/medical etiology** (e.g., metabolic encephalopathy, drug toxicity, or intracranial pathology) rather than a primary functional psychotic disorder like Schizophrenia. If a patient presents with psychotic symptoms and an altered sensorium, the clinician must first rule out "Organic Psychosis." **Analysis of Incorrect Options:** * **A. Formal Thought Disorder (FTD):** This is a hallmark feature of Schizophrenia. It refers to a disturbance in the organization and flow of thought, manifesting as loosening of associations, word salad, or tangentiality. * **B. Delusion of Reference:** This is a common symptom where the patient falsely believes that random events, objects, or behaviors of others have a direct, personal significance (e.g., believing a news anchor is sending them coded messages). * **C. Waxy Flexibility:** A classic sign of **Catatonic Schizophrenia**, where a patient maintains a position for a long period after being placed in it by an examiner (like a lead pipe or wax). **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** These are high-yield diagnostic criteria including audible thoughts, voices arguing/commenting, somatic passivity, and delusional perception. * **The 4 A’s of Bleuler:** Ambivalence, Autism, Affective flattening, and Association looseness. * **Prognosis:** Good prognostic factors include late onset, female sex, presence of mood symptoms, and a clear precipitating factor. * **Rule of Thumb:** Always remember—**Psychosis + Altered Sensorium = Organic cause** until proven otherwise.
Question 236: Which of the following is a true statement regarding Ganser's syndrome?
- A. Involuntary nature of symptoms
- B. Absence of psychotic symptoms
- C. Absence of memory symptoms
- D. Tendency to give approximate answers (Correct Answer)
Explanation: **Ganser’s Syndrome**, also known as "Prisoner’s Psychosis," is a rare dissociative disorder traditionally classified under "Factitious Disorders" or "Dissociative Disorders" in modern psychiatry. ### **Explanation of the Correct Option** **D. Tendency to give approximate answers:** This is the hallmark feature of Ganser’s syndrome, known as **Vorbeireden** (talking past the point). Patients provide answers that are clearly incorrect but indicate that they have understood the question. For example, if asked how many legs a dog has, the patient might answer "five." This suggests the patient knows the correct answer but is intentionally (though often subconsciously) providing a near-miss response. ### **Analysis of Incorrect Options** * **A. Involuntary nature of symptoms:** While there is debate, Ganser’s is often associated with **voluntary** or factitious behavior, frequently seen in forensic settings where there is a clear secondary gain (e.g., avoiding trial or prison). * **B. Absence of psychotic symptoms:** This is incorrect because Ganser’s syndrome is characterized by a "psychosis-like" state that includes **hallucinations** and a clouded state of consciousness, though these are often inconsistent or "patchy." * **C. Absence of memory symptoms:** Incorrect. Patients typically present with **amnesia** for the duration of the episode, which is a core component of the dissociative nature of the syndrome. ### **NEET-PG High-Yield Pearls** * **Classic Tetrad:** 1. Approximate answers (Vorbeireden), 2. Clouding of consciousness, 3. Somatic conversion symptoms, and 4. Hallucinations. * **Demographics:** Most commonly seen in **males** and **prisoners**. * **ICD-10 Classification:** It is classified under **Dissociative Disorders (F44.8)**. * **Differential Diagnosis:** Must be distinguished from malingering (where the motive is purely conscious and external) and true schizophrenia.
Question 237: Acute organic psychosis may be associated with all of the following diseases EXCEPT?
- A. Head injury
- B. Arteriosclerosis (Correct Answer)
- C. Meningitis
- D. Delirium tremens
Explanation: **Explanation:** The core concept in this question is the distinction between **Acute** and **Chronic** organic brain syndromes. **Why Arteriosclerosis is the Correct Answer:** Arteriosclerosis is a chronic, progressive degenerative process. In the brain, it leads to gradual vascular insufficiency, resulting in **Multi-infarct Dementia** or Chronic Organic Brain Syndrome. The onset of psychiatric symptoms (cognitive decline, personality changes) is insidious and long-term, rather than acute. Therefore, it is not typically associated with "Acute Organic Psychosis." **Analysis of Incorrect Options:** * **Head Injury:** Traumatic brain injury can cause sudden cerebral dysfunction, leading to acute post-traumatic psychosis or delirium. * **Meningitis:** Acute infections of the CNS cause rapid inflammation, often presenting with an acute organic brain syndrome characterized by clouding of consciousness, agitation, and hallucinations. * **Delirium Tremens:** This is a severe, acute manifestation of alcohol withdrawal. It is a medical emergency characterized by sudden onset of autonomic hyperactivity, vivid hallucinations, and global confusion (a classic example of acute organic psychosis). **NEET-PG High-Yield Pearls:** 1. **Acute Organic Brain Syndrome** is synonymous with **Delirium**. It is characterized by a fluctuating level of consciousness and is usually reversible. 2. **Chronic Organic Brain Syndrome** is synonymous with **Dementia**. It is characterized by a clear sensorium (conscious) but with permanent cognitive deficits. 3. **Visual Hallucinations** are the most common type of hallucination in organic psychoses (unlike Schizophrenia, where auditory hallucinations predominate). 4. Always rule out hypoglycemia, electrolyte imbalances, and infections in any patient presenting with sudden-onset psychosis.
Question 238: A man hits his neighbour. The next day, he feels that the police are pursuing him and that his brain is being controlled by radio waves transmitted by his neighbour. What is the probable diagnosis?
- A. Thought insertion
- B. Passivity feeling
- C. Delusion of persecution (Correct Answer)
- D. Obsessive-Compulsive Disorder
Explanation: ### Explanation The patient presents with two distinct psychotic symptoms: the belief that the police are pursuing him and the belief that his brain is being controlled by external radio waves. **Why "Delusion of Persecution" is the Correct Answer:** A **delusion** is a fixed, false belief that is out of keeping with the patient’s social and cultural background. **Delusion of persecution** is the most common type of delusion, where the individual believes they are being harassed, followed, or conspired against (in this case, by the police and the neighbor). While the patient also exhibits "delusions of control" (radio waves), the question asks for the *probable diagnosis* or the overarching theme of his presentation. Among the options provided, the belief that the police are pursuing him is a classic example of persecutory ideation. **Analysis of Incorrect Options:** * **Thought Insertion:** This is a specific type of thought alienation where the patient believes thoughts are being put into their mind by an external agency. While related to the "radio waves" description, it refers specifically to the *origin of thoughts*, not the general control of the brain or the pursuit by police. * **Passivity Feeling (Delusion of Control):** This involves the belief that one’s feelings, impulses, or actions are controlled by an external force (e.g., "made" volitional acts). While the radio wave description fits this category, "Delusion of Persecution" better encompasses the police pursuit aspect. * **Obsessive-Compulsive Disorder (OCD):** OCD involves ego-dystonic, repetitive thoughts (obsessions) and ritualistic behaviors (compulsions). The patient’s beliefs here are ego-syntonic (he believes them to be true) and lack the characteristic resistance seen in OCD. **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Both thought alienation and delusions of control are FRS for Schizophrenia. * **Persecutory Delusions:** These are the most frequent delusions in Schizophrenia but are also seen in Delusional Disorder and Manic episodes with psychotic features. * **Differentiating Delusion vs. Obsession:** The key is **insight**. In delusions, insight is absent; in obsessions, insight is usually preserved (the patient recognizes the thoughts as irrational).
Question 239: What is the percentage of monozygotic twins who develop schizophrenia?
- A. 0.10%
- B. 1%
- C. 10%
- D. 50% (Correct Answer)
Explanation: ### Explanation The correct answer is **D. 50%**. Schizophrenia has a strong genetic component, and the risk of developing the disorder increases with the degree of genetic relatedness to an affected individual. Since **monozygotic (MZ) twins** share 100% of their genetic material, they have the highest concordance rate for schizophrenia, which is approximately **40% to 50%**. This high percentage underscores the significant role of genetics in the etiology of the disease. #### Analysis of Options: * **A. 0.10%:** This is significantly lower than the risk in the general population. * **B. 1%:** This represents the **lifetime prevalence** of schizophrenia in the **general population**. * **C. 10%:** This is the approximate risk for **first-degree relatives** (e.g., children of one affected parent or dizygotic/fraternal twins who share 50% of their genes). * **D. 50%:** This is the established concordance rate for monozygotic twins. Note that because it is not 100%, it also proves that environmental factors play a crucial role. #### High-Yield Clinical Pearls for NEET-PG: * **Highest Risk:** The highest risk of developing schizophrenia is in an individual with **two affected parents (approx. 40-46%)** or a **monozygotic twin (approx. 47-50%)**. * **Dizygotic (DZ) Twins:** The risk is approximately **12-15%**. * **Sibling Risk:** If one sibling is affected, the risk for another sibling is about **10%**. * **Second-degree relatives:** The risk drops to approximately **2-3%**. * **Key Concept:** If a question asks for the "most important factor" in the etiology of schizophrenia, the answer is **Genetics**.
Question 240: Schizophrenia with automutilism is called as?
- A. Von Gogh syndrome (Correct Answer)
- B. Lesch-Nyhan syndrome
- C. Pfropf's Schizophrenia
- D. Catatonia
Explanation: **Explanation:** **Van Gogh Syndrome** (Option A) refers to a condition where an individual performs self-mutilation (automutilism), often in the context of a psychotic disorder like Schizophrenia or severe personality disorders. It is named after the famous painter Vincent van Gogh, who famously cut off his own ear during a psychotic episode. In clinical psychiatry, it specifically describes patients who inflict major injuries upon themselves, such as amputation of ears, fingers, or genitals, usually driven by command hallucinations or delusions. **Why other options are incorrect:** * **Lesch-Nyhan Syndrome (Option B):** This is an X-linked recessive metabolic disorder caused by a deficiency of the enzyme HGPRT. While it involves severe self-mutilation (typically biting of lips and fingers), it is a biochemical/genetic disorder presenting in childhood, not a primary form of Schizophrenia. * **Pfropf’s Schizophrenia (Option C):** This term (also known as "Grafted Schizophrenia") refers to Schizophrenia that develops in an individual who already has a pre-existing Intellectual Disability (Mental Retardation). * **Catatonia (Option D):** This is a neuropsychiatric syndrome characterized by motor abnormalities (stupor, waxy flexibility, mutism) rather than active self-mutilation. **High-Yield Clinical Pearls for NEET-PG:** * **Diogenes Syndrome:** Characterized by extreme self-neglect, domestic squalor, and hoarding (often seen in the elderly). * **Othello Syndrome:** Pathological or delusional jealousy. * **Capgras Syndrome:** The delusion that a familiar person has been replaced by an identical-looking impostor. * **Fregoli Syndrome:** The delusion that different people are actually a single person in disguise.
Practice by Chapter
Schizophrenia: Epidemiology and Etiology
Practice Questions
Schizophrenia: Clinical Features
Practice Questions
Schizophrenia: Treatment
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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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