Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 251: Who is credited with the concept of 'omission' in psychological conditioning?

A. Wernicke
B. Alois Alzheimer
C. Skinner (Correct Answer)
D. Prusiner

Explanation: **Explanation:** The concept of **'Omission'** (also known as Omission Training) is a procedure in **Operant Conditioning**, a theory developed by **B.F. Skinner**. In omission training, a specific response is discouraged by the removal of a pleasant stimulus (positive reinforcer) whenever the behavior occurs. This is clinically categorized as a form of **Negative Punishment**. The goal is to decrease the frequency of an unwanted behavior by ensuring the subject "misses out" on a reward. **Analysis of Options:** * **B.F. Skinner (Correct):** He pioneered Operant Conditioning, focusing on how consequences (reinforcement and punishment) shape behavior. Omission is one of the four basic contingencies of his theory. * **Wernicke (Incorrect):** Carl Wernicke is known for describing **Wernicke’s Encephalopathy** (triad of ataxia, ophthalmoplegia, and confusion) and **Wernicke’s Aphasia** (receptive aphasia due to lesions in the posterior superior temporal gyrus). * **Alois Alzheimer (Incorrect):** A neuropathologist credited with identifying the first published case of "presenile dementia," now known as **Alzheimer’s Disease**, characterized by amyloid plaques and neurofibrillary tangles. * **Prusiner (Incorrect):** Stanley Prusiner discovered **Prions**, the infectious proteins responsible for Transmissible Spongiform Encephalopathies like Creutzfeldt-Jakob Disease (CJD). **High-Yield Clinical Pearls for NEET-PG:** * **Positive Reinforcement:** Adding a reward to increase behavior. * **Negative Reinforcement:** Removing an aversive stimulus to increase behavior (e.g., taking an aspirin to remove a headache). * **Omission (Negative Punishment):** Removing a reward to decrease behavior (e.g., "Time-out" for a child). * **Classical Conditioning:** Developed by **Ivan Pavlov** (learning through association), whereas Operant Conditioning is learning through consequences.

Question 252: A teenager is diagnosed with schizophrenia. Which of the following is true for schizophrenia?

A. It is a disorder of thought (Correct Answer)
B. It causes split personality
C. It is due to emotional turmoil
D. It is due to childhood trauma

Explanation: **Explanation:** **Schizophrenia** is primarily defined as a **disorder of thought**, characterized by a fundamental distortion of thinking, perception, and affect. In psychiatry, it is classified as a psychotic disorder where the patient loses touch with reality. The core pathology involves disturbances in the **form** (e.g., loosening of associations), **content** (e.g., delusions), and **stream** of thought. **Analysis of Options:** * **Option A (Correct):** Schizophrenia involves "Formal Thought Disorder." Patients exhibit symptoms like delusions (fixed false beliefs) and disorganized thinking, which are hallmark features of the disease. * **Option B (Incorrect):** This is a common myth. "Split personality" refers to **Dissociative Identity Disorder (DID)**. The "schizo" in schizophrenia refers to a "split" between emotion, thought, and behavior (intra-psychic ataxia), not multiple personalities. * **Option C & D (Incorrect):** While stress and trauma can act as "triggers" in genetically predisposed individuals (Stress-Diathesis Model), they are not the primary causes. Schizophrenia is a **neurodevelopmental disorder** with strong genetic and biological components (e.g., Dopamine hypothesis). **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** High-yield diagnostic criteria including audible thoughts, somatic passivity, and delusional perception. * **Bleuler’s 4 A’s:** Ambivalence, Autism, Affective flattening, and Associative looseness. * **Neurobiology:** Associated with increased dopaminergic activity in the mesolimbic pathway (positive symptoms) and decreased activity in the mesocortical pathway (negative symptoms). * **Prognosis:** Better prognosis is associated with late onset, female sex, and presence of positive symptoms.

Question 253: The primary delusions are disorders of which of the following?

A. Thought (Correct Answer)
B. Perception
C. Loosening of association
D. Memory

Explanation: **Explanation:** **1. Why "Thought" is the correct answer:** Delusions are defined as fixed, false beliefs that are held with absolute conviction and are unshakable despite evidence to the contrary. In psychiatry, disorders are categorized into disorders of **form**, **stream**, and **content**. Delusions are the hallmark of **disorders of thought content**. A primary delusion (autochthonous delusion) arises suddenly and fully formed without any preceding mental event, representing a fundamental disturbance in the thinking process. **2. Why the other options are incorrect:** * **Perception:** Disorders of perception include hallucinations (sensory perception without external stimuli) and illusions (misinterpretation of real stimuli). While delusions can occur *in response* to perceptions (delusional perception), the delusion itself is a thought process. * **Loosening of Association:** This is a **disorder of the form of thought** (formal thought disorder), where the connection between successive ideas is lost, making speech incoherent. It is a structural issue, not a content issue like a delusion. * **Memory:** Disorders of memory include amnesia, paramnesia, and confabulation. While some delusions may involve past events (e.g., delusions of grandeur regarding past achievements), the core pathology is the belief system, not the retrieval of information. **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Delusional perception is a key FRS for Schizophrenia. * **Primary vs. Secondary:** Primary delusions (Apophany) are not preceded by other psychological symptoms, whereas secondary delusions (Delusional ideas) arise from underlying mood states or hallucinations. * **The "4 D's" of Delusion:** False **D**ogmatic belief, **D**eviant from culture, **D**istorted reality, and **D**ismissive of proof.

Question 254: Which subtype of schizophrenia is characterized by early onset and a poor prognosis?

A. Catatonic
B. Hebephrenic (Correct Answer)
C. Paranoid
D. Schizoaffective

Explanation: **Explanation:** **Hebephrenic Schizophrenia** (also known as Disorganized Schizophrenia) is characterized by an **early onset** (typically between ages 15–25) and a **poor prognosis**. The clinical picture is dominated by disorganized speech, disorganized behavior, and flat or inappropriate affect (e.g., giggling without reason). Because of its early onset and insidious progression, it often leads to rapid personality deterioration and poor social functioning, making it the subtype with the least favorable outcome. **Analysis of Incorrect Options:** * **A. Catatonic:** Characterized by psychomotor disturbances (stupor, waxy flexibility, or excitement). It generally has a better prognosis than the hebephrenic type and often responds well to ECT and Benzodiazepines. * **C. Paranoid:** This is the most common subtype. It has a **later onset** and the **best prognosis** among all subtypes because the patient’s personality and cognitive functions remain relatively preserved. * **D. Schizoaffective:** This is a separate diagnostic category where symptoms of both schizophrenia and a mood disorder (manic or depressive) are present. It generally carries a better prognosis than pure schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognosis:** Paranoid Schizophrenia. * **Worst Prognosis:** Hebephrenic (Disorganized) Schizophrenia. * **Age of Onset:** Paranoid (Late 20s/30s) vs. Hebephrenic (Mid-teens/Early 20s). * **Residual Schizophrenia:** Characterized by a history of at least one psychotic episode but currently presenting only with "negative symptoms" (e.g., social withdrawal, emotional blunting). * **Simple Schizophrenia:** Notable for having an insidious onset of negative symptoms *without* a history of hallucinations or delusions.

Question 255: All of the following are associated with a better prognosis in schizophrenia except?

A. Late onset
B. Married status
C. Negative symptoms (Correct Answer)
D. Acute onset

Explanation: In schizophrenia, prognosis is determined by the clinical presentation, demographic factors, and the mode of onset. **Explanation of the Correct Answer:** **Option C (Negative Symptoms)** is associated with a **poor prognosis**. Negative symptoms (e.g., apathy, anhedonia, affective flattening, and poverty of speech) are often linked to structural brain changes (like ventricular enlargement), cognitive impairment, and a poor response to typical antipsychotics. These symptoms tend to be chronic and lead to significant social and occupational dysfunction. **Explanation of Incorrect Options:** * **A. Late onset:** Patients who develop schizophrenia later in life (typically females) tend to have better premorbid functioning and more mature coping mechanisms, leading to a better prognosis. * **B. Married status:** Being married is a proxy for good premorbid social adjustment and provides a strong social support system, both of which are positive prognostic indicators. * **D. Acute onset:** An abrupt onset (often triggered by a clear stressor) is associated with a better outcome compared to an insidious, slow onset, as it often responds more rapidly to treatment. **High-Yield Clinical Pearls for NEET-PG:** * **Good Prognostic Factors:** Female sex, positive symptoms (hallucinations/delusions), mood symptoms (depression/anxiety), and a family history of mood disorders. * **Poor Prognostic Factors:** Early onset (males), insidious onset, family history of schizophrenia, and frequent relapses. * **Key Fact:** The presence of **Positive Symptoms** (Type I Schizophrenia) generally predicts a better response to medication than **Negative Symptoms** (Type II Schizophrenia).

Question 256: Which of the following is NOT found in catatonic schizophrenia?

A. Waxy flexibility
B. Automatic obedience
C. Somatic passivity (Correct Answer)
D. Gegenhalten

Explanation: **Explanation:** The correct answer is **Somatic Passivity** because it is a **First Rank Symptom (FRS)** of Schizophrenia, specifically a disorder of the "experience of self" or "delusion of control," rather than a motor (catatonic) symptom. **1. Why Somatic Passivity is the correct answer:** Somatic passivity involves the patient’s belief that their body is being influenced or acted upon by an external agency (e.g., "aliens are sending electrical currents into my limbs"). While it is a hallmark of Schizophrenia (Schneiderian FRS), it is a **perceptual/delusional phenomenon**, not a motor sign of catatonia. **2. Analysis of Incorrect Options (Catatonic Features):** * **Waxy Flexibility (Cerea Flexibilitas):** A classic catatonic sign where the patient’s limbs can be molded into a position and held there for a long duration, resisting gravity. * **Automatic Obedience:** The patient follows every instruction from the examiner in a robot-like fashion, regardless of the nature of the request. * **Gegenhalten (Paratonia):** A form of "oppositional" negativism where the patient offers a resistance to passive movement that increases proportionally to the force applied by the examiner. **Clinical Pearls for NEET-PG:** * **Catatonia** is no longer considered a subtype of Schizophrenia in DSM-5; it is now a specifier that can occur across various psychiatric and medical conditions. * **Drug of Choice (DOC):** Lorazepam (Benzodiazepines) is the first-line treatment for catatonia (Lorazepam Challenge Test). * **Definitive Treatment:** Electroconvulsive Therapy (ECT) is highly effective if medications fail or if the condition is life-threatening (Malignant Catatonia). * **Ambitendence:** A catatonic sign where the patient makes conflicting movements (e.g., starts to shake hands but pulls back repeatedly).

Question 257: Which of the following symptoms of schizophrenia responds quickly to treatment with medication?

A. Apathy
B. Auditory Hallucinations (Correct Answer)
C. Poverty of thought content
D. Anhedonia

Explanation: In schizophrenia, symptoms are broadly categorized into **Positive symptoms** (excess or distortion of normal function) and **Negative symptoms** (diminution or loss of normal function). **Why Auditory Hallucinations is correct:** Auditory hallucinations are a hallmark **positive symptom**. The pathophysiology of positive symptoms is primarily linked to **dopaminergic hyperactivity** in the **mesolimbic pathway** [1]. Antipsychotic medications (both typical and atypical) work by blocking D2 receptors in this pathway. Because these medications directly target the neurochemical imbalance responsible for positive symptoms, patients often show a relatively rapid response (usually within days to a few weeks) regarding hallucinations and delusions [3]. **Why the other options are incorrect:** * **Apathy (A), Poverty of thought content (C), and Anhedonia (D)** are all **Negative symptoms** [3]. * Negative symptoms are associated with **dopaminergic hypoactivity** in the **mesocortical pathway** and structural brain changes (like ventricular enlargement) [1]. * These symptoms are notoriously resistant to conventional antipsychotics. While atypical antipsychotics (SGAs) may offer slight improvement due to serotonin-dopamine antagonism, negative symptoms generally persist long-term and respond much more slowly, if at all, compared to positive symptoms [2]. **NEET-PG High-Yield Pearls:** * **Schneider’s First Rank Symptoms (FRS):** Auditory hallucinations (specifically third-person or running commentary) are key FRS [3]. * **Prognosis:** The presence of predominant positive symptoms is a **good prognostic factor**, as they respond well to medication. Predominant negative symptoms indicate a **poor prognosis** [2]. * **Pathway Mnemonic:** **M**esolimbic = **M**adness (Positive symptoms); **M**esocortical = **M**ud/Muffled (Negative symptoms/Cognitive dulling).

Question 258: What is the duration required for the diagnosis of acute and transient psychosis?

A. 1 week
B. 2 weeks (Correct Answer)
C. 1 month
D. 6 months

Explanation: ### Explanation The diagnosis of **Acute and Transient Psychotic Disorder (ATPD)** is primarily defined by its rapid onset and short duration. According to the **ICD-10** classification (commonly followed in Indian medical curricula and NEET-PG), the symptoms must resolve completely within a specific timeframe. **1. Why Option B is Correct:** In ICD-10, for a diagnosis of ATPD (F23), the symptoms (such as delusions, hallucinations, or disorganized speech) must have an acute onset (within 2 weeks or less) and, most importantly, the duration of the episode **must not exceed 1 month**. However, the specific diagnostic requirement for the "acute" phase and the typical resolution period emphasized in exams for this category is **2 weeks**. If symptoms persist beyond 1 month, the diagnosis must be changed (usually to Schizophrenia or Persistent Delusional Disorder). **2. Why Other Options are Incorrect:** * **Option A (1 week):** While symptoms can resolve in a week, this is not the formal diagnostic threshold for the category. * **Option C (1 month):** This is the upper limit for ATPD in ICD-10. In **DSM-5**, this same timeframe (1 day to 1 month) defines **Brief Psychotic Disorder**. * **Option D (6 months):** This is the minimum duration required for a diagnosis of **Schizophrenia** according to DSM-5. In ICD-10, Schizophrenia requires only 1 month of symptoms. **Clinical Pearls for NEET-PG:** * **ICD-10 vs. DSM-5:** Remember that ICD-10 uses the term "Acute and Transient Psychotic Disorder," while DSM-5 uses "Brief Psychotic Disorder." * **Polymorphic Symptoms:** ATPD is often characterized by "polymorphic" features—rapidly changing, unstable emotional states and shifting hallucinations/delusions. * **Prognosis:** ATPD generally has a good prognosis and is often associated with an acute stressful event (Brief Reactive Psychosis). * **Key Timeframes:** * < 1 month: Brief Psychotic Disorder (DSM) / ATPD (ICD). * 1–6 months: Schizophreniform Disorder (DSM). * \> 6 months: Schizophrenia (DSM).

Question 259: All of the following are considered as first rank symptoms of Schizophrenia EXCEPT?

A. Thought broadcast
B. Third person auditory hallucination
C. Somatic passivity
D. Anhedonia (Correct Answer)

Explanation: **Explanation:** The correct answer is **Anhedonia**. **Kurt Schneider** defined **First Rank Symptoms (FRS)** in 1959 to differentiate schizophrenia from other psychotic disorders. These symptoms are considered pathognomonic for schizophrenia in the absence of organic brain disease. **Anhedonia** (the inability to feel pleasure) is a **Negative Symptom** of schizophrenia, not a First Rank Symptom. Negative symptoms are more commonly associated with chronic schizophrenia and poor prognosis but lack the diagnostic specificity of FRS. **Analysis of Options:** * **Thought Broadcast (Option A):** This is a "Thought Alienation" symptom where the patient believes their private thoughts are being transmitted to others via external media (radio, TV, or air). It is a classic FRS. * **Third Person Auditory Hallucination (Option B):** This involves hearing voices talking *about* the patient in the third person or voices providing a running commentary on the patient's actions. This is a hallmark FRS. * **Somatic Passivity (Option C):** This is a "Made Phenomenon" where the patient believes their body is being acted upon by an external force, often involving strange physical sensations imposed from outside. It is a core FRS. **Clinical Pearls for NEET-PG:** * **Mnemonic for FRS (ABCD):** **A**uditory hallucinations (3rd person/commentary), **B**roadcasting of thoughts, **C**ontrolled feelings/impulses (Passivity), **D**elusional Perception. * **ICD-11 & DSM-5 Update:** While historically significant, the diagnostic importance of FRS has been de-emphasized in newer classifications (DSM-5) because they are not entirely specific to schizophrenia (can occur in Bipolar Disorder). * **Negative Symptoms (The 5 A's):** Anhedonia, Affective flattening, Alogia, Avolition, and Asociality. These are *not* Schneiderian FRS.

Question 260: What is Othello syndrome?

A. Delusion of persecution
B. Delusion of grandeur
C. Delusion of infidelity (Correct Answer)
D. Delusion of doubles

Explanation: **Explanation:** **Othello Syndrome**, also known as **Conjugal Paranoia** or **Morbid Jealousy**, is a subtype of delusional disorder characterized by the **delusion of infidelity** (Option C). The patient is unshakably convinced, without any logical proof, that their spouse or sexual partner is being unfaithful. The name is derived from Shakespeare’s character Othello, who murders his wife Desdemona due to unfounded suspicion of adultery. **Analysis of Options:** * **Option A: Delusion of Persecution:** This is the most common type of delusion, where the individual believes they are being conspired against, cheated, or harassed. It is a hallmark of Paranoid Schizophrenia. * **Option B: Delusion of Grandeur:** The false belief that one possesses superior powers, wealth, or importance. This is typically seen in the Manic phase of Bipolar Disorder. * **Option D: Delusion of Doubles:** Also known as **Capgras Syndrome**, this is a "delusional misidentification" where the patient believes a person close to them has been replaced by an identical-looking impostor. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Othello syndrome is strongly associated with **Chronic Alcoholism** and may also occur in organic brain disorders or Parkinson’s disease (often linked to dopamine agonist therapy). * **Risk of Violence:** It is clinically significant because it carries a high risk of domestic violence, stalking, and even homicide. * **Gender:** Historically reported more in males, though it can affect both genders. * **Management:** Treatment involves antipsychotics and addressing underlying substance abuse, though it is often resistant to therapy.

Practice by Chapter

Schizophrenia: Epidemiology and Etiology

Practice Questions

Schizophrenia: Clinical Features

Practice Questions

Schizophrenia: Treatment

Practice Questions

Schizoaffective Disorder

Practice Questions

Delusional Disorders

Practice Questions

Brief Psychotic Disorder

Practice Questions

Substance-Induced Psychotic Disorders

Practice Questions

Psychosis in Medical Conditions

Practice Questions

First Episode Psychosis

Practice Questions

Treatment-Resistant Psychosis

Practice Questions

Rehabilitation in Psychotic Disorders

Practice Questions

Outcome and Prognosis

Practice Questions

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