Psychotic Disorders Practice Questions

Q: Which of the following is NOT characteristic of Type I Schizophrenia?

CT, MRI shows enlarged ventricles. 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.

Q: What is the most common delusion seen in schizophrenia?

Persecution. **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.

Q: Which of the following is a true statement regarding Ganser's syndrome?

Tendency to give approximate answers. **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.

Q: Acute organic psychosis may be associated with all of the following diseases EXCEPT?

Arteriosclerosis. **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.

Q: What is the percentage of monozygotic twins who develop schizophrenia?

50%. ### 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**.

Q: Schizophrenia with automutilism is called as?

Von Gogh syndrome. **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.

Question 1

Which of the following is NOT characteristic of Type I Schizophrenia?

Accepted Answer

CT, MRI shows enlarged ventricles

Answer

Positive symptoms

Answer

Good prognosis

Answer

None of the above

Question 2

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?

Accepted Answer

Hebephrenic schizophrenia

Answer

Paranoid schizophrenia

Answer

Catatonic schizophrenia

Answer

Undifferentiated schizophrenia

Question 3

What is the most common delusion seen in schizophrenia?

Accepted Answer

Persecution

Answer

Grandiose

Answer

Reference

Answer

Nihilistic

Question 4

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:

Accepted Answer

Persistent Delusional Disorder

Answer

Late onset Psychosis

Answer

Paranoid Schizophrenia

Answer

Obsessive Compulsive Disorder

Question 5

Schizophrenia is characterized by which of the following?

Accepted Answer

Altered sensorium

Answer

Formal thought disorder

Answer

Delusion of reference

Answer

Waxy flexibility

Question 6

Which of the following is a true statement regarding Ganser's syndrome?

Accepted Answer

Tendency to give approximate answers

Answer

Involuntary nature of symptoms

Answer

Absence of psychotic symptoms

Answer

Absence of memory symptoms

Question 7

Acute organic psychosis may be associated with all of the following diseases EXCEPT?

Accepted Answer

Arteriosclerosis

Answer

Head injury

Answer

Meningitis

Answer

Delirium tremens

Question 8

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?

Accepted Answer

Delusion of persecution

Answer

Thought insertion

Answer

Passivity feeling

Answer

Obsessive-Compulsive Disorder

Question 9

What is the percentage of monozygotic twins who develop schizophrenia?

Accepted Answer

50%

Answer

0.10%

Answer

1%

Answer

10%

Question 10

Schizophrenia with automutilism is called as?

Accepted Answer

Von Gogh syndrome

Answer

Lesch-Nyhan syndrome

Answer

Pfropf's Schizophrenia

Answer

Catatonia

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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