Psychotic Disorders Practice Questions

Q: Delusion of infidelity is seen in which of the following syndromes?

Othello syndrome. **Explanation:** **1. Correct Option: Othello Syndrome (A)** Othello syndrome, also known as **pathological jealousy** or **morbid jealousy**, is characterized by a persistent and false belief (delusion) that one’s spouse or partner is being unfaithful. It is a form of delusional disorder (jealous type). Patients often go to extreme lengths to find "evidence" of infidelity, such as checking phone logs, stalking, or interrogating their partner. It is frequently associated with chronic alcoholism and carries a high risk of domestic violence. **2. Incorrect Options:** * **De Clérambault Syndrome (B):** Also known as **Erotomania**. The patient (usually female) holds a delusional belief that another person, typically of higher social status or a celebrity, is deeply in love with them. * **Magnan Syndrome (C):** This refers to **Cocaine-induced psychosis**, specifically characterized by tactile hallucinations known as "formication" or "cocaine bugs" (the sensation of insects crawling under the skin). * **Cotard Syndrome (D):** Also known as **Walking Corpse Syndrome** or **Nihilistic delusion**. The patient believes they are dead, do not exist, or that their internal organs have rotted away. It is most commonly seen in severe psychotic depression. **Clinical Pearls for NEET-PG:** * **Capgras Syndrome:** The belief that a familiar person has been replaced by an identical-looking impostor (the most common "misidentification syndrome"). * **Fregoli Syndrome:** The belief that different people are actually a single person in disguise. * **Ekbom Syndrome:** Delusional parasitosis (belief that one is infested with parasites). * **Othello Syndrome** is most strongly linked with **Alcohol Dependence Syndrome**.

Q: A 25-year-old university student had a fight with a neighbor. On the next day, while out, he felt that two men in police uniform were observing his movements. When he reached home in the evening, he was frightened and expressed that the police were after him and would arrest him. His symptoms represent which of the following?

Delusion of persecution. ### Explanation **1. Why "Delusion of Persecution" is correct:** A **delusion** is a fixed, false belief that is out of keeping with the patient’s social and cultural background and is held with absolute conviction despite contrary evidence. In this case, the student believes he is being followed and will be arrested by the police. This is a **Delusion of Persecution**, where the individual believes that harm is occurring or is going to occur, and that others (individuals or groups like the police) are intentionally targeting, spying on, or conspiring against them. **2. Why the other options are incorrect:** * **Ideas of Reference:** This involves the false belief that neutral, external events (like people talking in a corner or a news report) have a special personal significance. While the student felt observed (which can be a precursor), his firm conviction that they were "after him to arrest him" elevates this to a full-blown persecutory delusion. * **Passivity (Made Phenomena):** This is a Schneiderian First Rank Symptom (SFRS) where the patient feels their actions, impulses, or emotions are being controlled by an external agency. There is no evidence of loss of agency here. * **Thought Insertion:** This is the belief that thoughts are being put into one’s mind by an external force. This is a disorder of thought ownership, not content. **3. NEET-PG High-Yield Pearls:** * **Delusion of Persecution** is the most common type of delusion seen in **Schizophrenia**. * **Schneiderian First Rank Symptoms (SFRS):** Include thought insertion, withdrawal, broadcast, passivity, and third-person hallucinations. Note that persecutory delusions are *not* specific to SFRS but are common in psychosis. * **Differentiating Idea vs. Delusion:** An "idea" can be challenged or held with less conviction; a "delusion" is fixed and unshakable.

Q: Which of the following is not considered a first-rank symptom of Schizophrenia?

Delusion. **Explanation:** The concept of **First-Rank Symptoms (FRS)** was introduced by **Kurt Schneider** in 1959 to differentiate schizophrenia from other psychotic disorders. While delusions are a core feature of schizophrenia, only specific types of "bizarre" delusions are considered FRS. **Why "Delusion" is the correct answer:** General "Delusion" (Option C) is too broad. While Schneider included **Delusional Perception** (a two-stage process where a normal perception is given a private, delusional meaning) as an FRS, general delusions (like persecutory or grandiose delusions) are common in many other psychiatric conditions and are therefore not pathognomonic for schizophrenia. **Analysis of Incorrect Options (FRS Categories):** * **Thought Insertion (Option A):** Part of "Thought Alienation" (along with withdrawal and broadcasting), where the patient believes thoughts are being put into their mind by an external agency. * **Auditory Hallucinations (Option B):** Specifically, three types are FRS: voices arguing, voices commentating on one's actions, and "Gedankenlautwerden" (thought echo). * **Made Volition (Option C):** Part of "Passivity Phenomena" (Made acts, Made feelings, Made impulses), where the patient feels their actions or will are controlled by an external force. **Clinical Pearls for NEET-PG:** * **Mnemonic for FRS (ABCD):** **A**uditory hallucinations (3 types), **B**roadcasting of thoughts, **C**ontrolled feelings/impulses (Passivity), **D**elusional perception. * **Diagnostic Shift:** While historically significant, **DSM-5** has de-emphasized FRS; they are no longer required for diagnosis because they lack specificity (they can occur in Bipolar Disorder). * **Kurt Schneider** also described "Second-Rank Symptoms," which include emotional blunting and other types of hallucinations.

Q: Depressive delusions that the world and everything related to it cease to exist is called?

Nihilistic delusion. ### Explanation **Correct Answer: C. Nihilistic delusion** **Understanding the Concept:** Nihilistic delusions (also known as **delusion of negation**) involve the false belief that oneself, others, or the entire world no longer exists, is dead, or is decomposing. Patients may claim their internal organs are missing or that the world has ended. This is a hallmark feature of **Cotard’s Syndrome**, which is most commonly associated with severe psychotic depression but can also occur in schizophrenia or organic brain states. **Analysis of Incorrect Options:** * **A. Persecutory delusion:** The most common type of delusion where the individual believes they are being conspired against, cheated, spied on, or harassed. It is typically seen in Schizophrenia and Delusional Disorder. * **B. Delusion of infidelity (Othello Syndrome):** A pathological jealousy where the person is convinced, without due cause, that their lover or spouse is unfaithful. * **C. Delusion of reference:** The false belief that insignificant remarks, events, or objects in the environment have personal meaning or significance (e.g., believing a news anchor is sending them a secret code). **High-Yield Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome:** Often described as the "Walking Corpse" syndrome; it is the extreme form of nihilistic delusion. * **Capgras Syndrome:** The belief that a familiar person has been replaced by an identical-looking impostor (an "illusion of doubles"). * **Fregoli Syndrome:** The belief that different people are actually a single person in disguise. * **Key Association:** While persecutory delusions are the most common overall, **nihilistic delusions are highly specific to severe depressive psychosis.**

Q: Which type of schizophrenia is characterized by late onset and a good prognosis?

Paranoid schizophrenia. ### Explanation **Paranoid Schizophrenia** is the most common subtype and is characterized by the presence of prominent delusions (typically persecutory or grandiose) and auditory hallucinations. **Why it is the correct answer:** * **Late Onset:** Unlike other subtypes, it usually manifests in the late 20s or 30s. * **Good Prognosis:** It carries the best prognosis among all subtypes because the patient’s personality remains relatively preserved, and there is a significant absence of "negative symptoms" (apathy, withdrawal) and disorganized behavior/speech. These patients often have better cognitive functioning and social skills, leading to better treatment compliance and outcomes. **Analysis of Incorrect Options:** * **A. Simple Schizophrenia:** Characterized by early onset and an insidious progression of negative symptoms (apathy, social withdrawal) without prominent hallucinations or delusions. It has a **very poor prognosis**. * **B. Hebephrenic (Disorganized) Schizophrenia:** Features early onset (teens/early 20s), disorganized speech, and "flat" or inappropriate affect. It is associated with rapid personality deterioration and a **poor prognosis**. * **C. Catatonic Schizophrenia:** Characterized by psychomotor disturbances (stupor, waxy flexibility, or excitement). While it responds well to ECT and Lorazepam, it does not typically have the "late onset" profile characteristic of the paranoid type. **High-Yield NEET-PG Pearls:** * **Best Prognosis:** Paranoid Schizophrenia. * **Worst Prognosis:** Simple and Hebephrenic Schizophrenia. * **Schneider’s First Rank Symptoms (FRS):** Most commonly seen in Paranoid Schizophrenia. * **Prognostic Factors:** Good prognosis is associated with late onset, female sex, presence of precipitating factors, and acute onset. Poor prognosis is linked to early onset, insidious start, and negative symptoms.

Question 1

Delusion of infidelity is seen in which of the following syndromes?

Accepted Answer

Othello syndrome

Answer

Dechlerambault syndrome

Answer

Magnan syndrome

Answer

Cotard syndrome

Question 2

What is considered a major psychosis?

Accepted Answer

Endogenous depression

Answer

Neurosis

Answer

Dementia

Answer

Reactive depression

Question 3

The "WurgStimme" sign refers to?

Accepted Answer

Speaking with an odd, muffled, or strangled voice, as seen in schizophrenia.

Answer

Speaking with an odd, muffled, or strangled voice, as seen in mania.

Answer

Areas of hair loss with broken hair, as seen in schizophrenia.

Answer

Areas of hair loss with broken hair, as seen in mania.

Question 4

A 25-year-old university student had a fight with a neighbor. On the next day, while out, he felt that two men in police uniform were observing his movements. When he reached home in the evening, he was frightened and expressed that the police were after him and would arrest him. His symptoms represent which of the following?

Accepted Answer

Delusion of persecution

Answer

Ideas of reference

Answer

Passivity

Answer

Thought insertion

Question 5

Which of the following is not considered a first-rank symptom of Schizophrenia?

Accepted Answer

Delusion

Answer

Thought insertion

Answer

Auditory hallucination

Answer

Made volition

Question 6

Depressive delusions that the world and everything related to it cease to exist is called?

Accepted Answer

Nihilistic delusion

Answer

Persecutory delusion

Answer

Delusion of infidelity

Answer

Delusion of reference

Question 7

Which of the following is an example of a bizarre delusion?

Accepted Answer

Delusion of persecution: "My brain is controlled by a microchip."

Answer

Delusion of infidelity: "My wife has an affair with another person."

Answer

Delusion of grandiosity: "I am the greatest person in the world."

Answer

Delusion of reference: "I am being prosecuted often."

Question 8

Which type of schizophrenia is characterized by late onset and a good prognosis?

Accepted Answer

Paranoid schizophrenia

Answer

Simple schizophrenia

Answer

Hebephrenic schizophrenia

Answer

Catatonic schizophrenia

Question 9

Which of the following statements regarding schizophrenia and delusional disorder is FALSE?

Accepted Answer

Socially inappropriate behavior is seen in delusional disorders.

Answer

Delusions and hallucinations are positive symptoms of schizophrenia.

Answer

Hallucinations are absent in delusional disorder.

Answer

Symptoms need to be present for at least 6 months to diagnose schizophrenia (according to DSM-5).

Question 10

What is the definition of treatment-resistant schizophrenia (TRS)?

Accepted Answer

Lack of response to two different antipsychotics at adequate doses for four weeks

Answer

Lack of response to one antipsychotic at an adequate dose for four weeks

Answer

Lack of response to one antipsychotic at an adequate dose for ten weeks

Answer

Lack of response to two same antipsychotics at adequate doses for four weeks

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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