Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 21: All of the following are findings in patients with schizophrenia except?

A. Lateral and third ventricle enlargement
B. Deficits in smooth-pursuit eye movements
C. Increased incidence of abnormally slow electroencephalogram tracings
D. Cerebellar dysfunction (Correct Answer)

Explanation: **Explanation:** Schizophrenia is a complex neurodevelopmental disorder characterized by structural, functional, and physiological brain abnormalities. While it involves widespread neural circuitry, **cerebellar dysfunction** is not a classic or diagnostic finding associated with the disease. **Why Option D is Correct:** The primary pathology in schizophrenia involves the **prefrontal cortex, basal ganglia, and limbic system**. While some recent research explores the "cerebellar-thalamo-cortical" circuit, clinical cerebellar signs (like ataxia or dysmetria) are not standard features of schizophrenia. **Analysis of Incorrect Options:** * **Option A (Ventricular Enlargement):** This is the most consistent structural finding on CT/MRI in schizophrenia. Patients frequently show **enlargement of the lateral and third ventricles** and reduced cortical volume (gray matter loss), particularly in the temporal and frontal lobes. * **Option B (Smooth-Pursuit Eye Movements):** Approximately 50–80% of patients (and 40% of their first-degree relatives) exhibit **saccadic intrusions** or "choppy" tracking instead of smooth pursuit. This is a high-yield physiological marker. * **Option C (EEG Changes):** Patients often show decreased alpha activity and an **increase in theta and delta (slow-wave) activity**. They also exhibit a decreased ability to filter sensory stimuli (P50 auditory gating deficit). **High-Yield Clinical Pearls for NEET-PG:** * **Most common finding on CT:** Lateral ventricular enlargement. * **Hypofrontality:** Decreased blood flow to the prefrontal cortex during executive tasks (seen on PET/fMRI). * **Neurological Soft Signs:** Patients often exhibit subtle impairments in coordination, stereognosis, and graphesthesia, but these are distinct from gross cerebellar dysfunction. * **Dopamine Hypothesis:** Schizophrenia is linked to *increased* dopamine in the mesolimbic pathway (positive symptoms) and *decreased* dopamine in the mesocortical pathway (negative symptoms).

Question 22: All are features of catatonia except?

A. Automatic obedience
B. Cataplexy (Correct Answer)
C. Catalepsy
D. Negativism

Explanation: **Explanation:** The correct answer is **Cataplexy** because it is a symptom of **Narcolepsy**, not Catatonia. Cataplexy is the sudden, temporary loss of muscle tone triggered by strong emotions (like laughter or anger) while the patient remains conscious. **Catatonia** is a neuropsychiatric syndrome characterized by motor abnormalities, often associated with schizophrenia, mood disorders, or general medical conditions. **Analysis of Options:** * **Automatic Obedience (Option A):** A catatonic feature where the patient follows all instructions mechanically and without question, even if they are harmful or illogical. * **Catalepsy (Option C):** A hallmark of catatonia involving "waxy flexibility" (*flexibilitas cerea*), where the patient maintains a fixed posture for long periods after being moved by an examiner. * **Negativism (Option D):** A catatonic state where the patient resists all instructions or performs the exact opposite of what is asked without an apparent motive. **High-Yield Clinical Pearls for NEET-PG:** 1. **Drug of Choice (DOC):** Benzodiazepines (specifically **Lorazepam**) are the first-line treatment for catatonia (the "Lorazepam Challenge Test"). 2. **Definitive Treatment:** If BZDs fail, **Electroconvulsive Therapy (ECT)** is the most effective treatment. 3. **Key Signs:** Other high-yield features include **Mannerisms** (purposeful movements), **Stereotypies** (non-purposeful repetitive movements), and **Echolalia/Echopraxia**. 4. **Distinction:** Do not confuse **Cataplexy** (Narcolepsy) with **Catalepsy** (Catatonia). This is a common "trap" in psychiatric exams.

Question 23: Which of the following is NOT diagnostic of schizophrenia?

A. Disorganized behavior
B. Suicidal attempt (Correct Answer)
C. Delusions
D. Catatonia

Explanation: To diagnose Schizophrenia according to the **DSM-5 criteria**, a patient must exhibit at least two of the following symptoms for a significant portion of time during a 1-month period (with continuous signs of disturbance for at least 6 months): 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Grossly disorganized or catatonic behavior 5. Negative symptoms (e.g., diminished emotional expression) **Explanation of the Correct Answer:** **B. Suicidal attempt:** While suicide is a major cause of premature death in patients with schizophrenia (approximately 5-10% lifetime risk), it is a **complication** or a co-morbid risk factor, not a diagnostic criterion. A suicide attempt alone does not define the presence of a psychotic disorder. **Explanation of Incorrect Options:** * **A. Disorganized behavior:** This is a core diagnostic criterion. It includes unpredictable agitation, childlike "silliness," or difficulties in performing activities of daily living. * **C. Delusions:** These are fixed, false beliefs and represent one of the "positive symptoms" essential for diagnosis. At least one of the symptoms must be delusions, hallucinations, or disorganized speech. * **D. Catatonia:** This refers to a state of motor abnormality (e.g., stupor, mutism, waxy flexibility). In DSM-5, catatonia is used as a specifier for schizophrenia rather than a subtype, but it remains a valid diagnostic feature. **High-Yield NEET-PG Pearls:** * **Schneider’s First Rank Symptoms (SFRS):** Historically used for diagnosis; includes audible thoughts, somatic passivity, and delusional perception. * **Prognosis:** Good prognostic factors include late onset, female sex, and presence of mood symptoms. * **Rule of Thirds:** 1/3 lead normal lives, 1/3 have moderate symptoms, 1/3 are significantly impaired.

Question 24: A man feels his neighbor is following him and planning to kill him. This history is suggestive of:

A. Delusion of reference
B. Delusion of persecution (Correct Answer)
C. Delusion of infidelity
D. Delusion of guilt

Explanation: ### Explanation The correct answer is **Delusion of persecution**. **1. Why the correct answer is right:** 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 evidence to the contrary. In **Delusion of Persecution**, the individual believes that they are being conspired against, spied on, followed, poisoned, or harassed. In this case, the patient’s belief that his neighbor is following him with the intent to kill him is a classic presentation of persecutory ideation, which is the most common type of delusion seen in Schizophrenia. **2. Why the incorrect options are wrong:** * **Delusion of Reference:** The patient falsely believes that insignificant remarks, events, or objects in the environment have personal meaning or significance (e.g., believing a news anchor is sending them secret messages). * **Delusion of Infidelity (Othello Syndrome):** The irrational belief that one’s partner is being unfaithful, often based on incorrect inferences from "evidence" like a disheveled bedsheet. * **Delusion of Guilt:** The patient feels they have committed a terrible sin or a crime and deserve punishment. This is most commonly seen in **Depressive Psychosis**. **3. Clinical Pearls for NEET-PG:** * **Most common delusion overall:** Delusion of Persecution. * **Erotomania (De Clerambault’s Syndrome):** Delusion that a person of higher status is in love with the patient. * **Capgras Syndrome:** The belief that a familiar person has been replaced by an identical impostor. * **Fregoli Syndrome:** The belief that different people are actually a single person in disguise. * **Nihilistic Delusion (Cotard’s Syndrome):** The belief that one is dead, non-existent, or their internal organs are rotting; typically seen in severe depression.

Question 25: A patient presents with altered behaviour, delusions, and hallucinations. What is the most likely diagnosis?

A. Psychotic disorder (Correct Answer)
B. Schizophrenia
C. Korsakoff's psychosis
D. Depression

Explanation: **Explanation:** The correct answer is **Psychotic disorder** because the question provides a broad clinical presentation characterized by the "positive symptoms" of psychosis—delusions and hallucinations—without specifying the duration, associated mood symptoms, or organic etiology. 1. **Why Psychotic Disorder is correct:** In clinical psychiatry, "Psychosis" is an umbrella term for a loss of contact with reality. Since the vignette does not mention the **duration** (e.g., >6 months for Schizophrenia) or **functional decline**, "Psychotic disorder" is the most accurate, generalized diagnosis for a patient presenting with these core features. 2. **Why other options are incorrect:** * **Schizophrenia:** Requires symptoms to persist for at least **6 months** (according to DSM-5) and usually involves significant social/occupational dysfunction and negative symptoms (e.g., apathy, withdrawal), which are not mentioned. * **Korsakoff’s Psychosis:** This is a chronic amnestic syndrome caused by Thiamine (B1) deficiency. Its hallmark is **confabulation** and severe anterograde amnesia, not primary delusions or hallucinations. * **Depression:** While "Psychotic Depression" exists, the primary feature must be a depressed mood or anhedonia. Without these, a mood disorder cannot be the primary diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Brief Psychotic Disorder:** Symptoms last >1 day but **<1 month**, with a full return to premorbid functioning. * **Schizophreniform Disorder:** Symptoms last **1 to 6 months**. * **Schizophrenia:** Symptoms last **>6 months**. * **Schneider’s First Rank Symptoms (SFRS):** High-yield indicators for Schizophrenia, including thought insertion, withdrawal, broadcast, and third-person hallucinations.

Question 26: All the following are characteristic of schizophrenia except:

A. Third person hallucination
B. Inappropriate emotions
C. Intermittent mood changes (Correct Answer)
D. Formal thought disorder

Explanation: **Explanation:** Schizophrenia is primarily a **disorder of thought and perception**, rather than a primary disorder of mood. **Why "Intermittent mood changes" is the correct answer:** Intermittent mood changes (fluctuating mania or depression) are characteristic of **Mood Disorders** (like Bipolar Disorder) or **Schizoaffective Disorder**, but they are not a diagnostic feature of Schizophrenia. While patients with schizophrenia may experience secondary depression or anxiety, the core clinical picture is dominated by cognitive and perceptual disturbances rather than episodic mood instability. **Analysis of Incorrect Options:** * **Third-person hallucinations:** These are "Schneiderian First Rank Symptoms" (FRS). Hearing voices talking about the patient in the third person or narrating the patient's actions is highly characteristic of schizophrenia. * **Inappropriate emotions:** Also known as **Incongruous Affect**, this is a hallmark of the Disorganized (Hebephrenic) subtype. The patient’s emotional expression does not match the situation (e.g., laughing while discussing a tragedy). * **Formal thought disorder:** This refers to a disorganized thinking process (e.g., loosening of associations, word salad, or neologisms). It is a core feature of schizophrenia, reflecting the "splitting" of psychic functions. **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts, voices arguing, voices commenting, somatic passivity, and delusional perception. * **Bleuler’s 4 A’s:** **A**ffective flattening, **A**utism (social withdrawal), **A**mbivalence, and **A**ssociation looseness. * **Prognosis:** Mood symptoms in a psychotic patient actually suggest a **better prognosis** compared to the "blunted affect" seen in chronic schizophrenia.

Question 27: Delusion of infidelity of a sexual partner is known as:

A. De Clerambault's syndrome
B. Couvade syndrome
C. Othello syndrome (Correct Answer)
D. Ekbom's syndrome

Explanation: **Explanation:** **Othello Syndrome** (also known as Morbid or Pathological Jealousy) is a type of delusional disorder where the central theme is the false belief that one’s spouse or sexual partner is being unfaithful. This delusion occurs without any adequate evidence and is often accompanied by stalking, excessive questioning, or checking the partner’s belongings. It is more common in males and is strongly associated with chronic alcoholism. **Analysis of Incorrect Options:** * **De Clerambault's Syndrome (Erotomania):** The delusion that another person, usually of higher social status or a celebrity, is deeply in love with the patient. * **Couvade Syndrome (Sympathetic Pregnancy):** A condition where the partner of a pregnant woman experiences similar pregnancy symptoms (e.g., weight gain, nausea, or sleep disturbances). This is not a delusional disorder. * **Ekbom's Syndrome (Delusional Parasitosis):** The firm, false belief that one is infested with small organisms like insects, lice, or worms. Patients often present with the "matchbox sign" (bringing skin debris in a container to prove the infestation). **NEET-PG High-Yield Pearls:** * **Othello Syndrome** carries a high risk of domestic violence and forensic significance (homicide/suicide). * **Capgras Syndrome:** The delusion that a familiar person has been replaced by an identical-looking impostor (an "illusion of doubles"). * **Fregoli Syndrome:** The delusion that different people are actually a single person in disguise. * **Cotard Syndrome:** The "walking corpse" delusion, where the patient believes they are dead, rotting, or have lost their internal organs.

Question 28: Echolalia is a recognized feature of which of the following conditions?

A. Catatonic schizophrenia (Correct Answer)
B. Anorexia nervosa
C. Alzheimer's disease
D. All of the above

Explanation: **Explanation:** **Echolalia** is defined as the involuntary, parrot-like repetition of words or phrases spoken by another person. It is a classic feature of **Catatonic Schizophrenia**, where it is often accompanied by **echopraxia** (mimicking movements). These "echo phenomena" are part of the motor and behavioral disturbances seen in catatonia, reflecting a lack of ego boundaries and automatic obedience. **Analysis of Options:** * **A. Catatonic Schizophrenia (Correct):** It is one of the hallmark features of catatonia. Other features include stupor, waxy flexibility (cerea flexibilitas), mutism, and negativism. * **B. Anorexia Nervosa:** This is an eating disorder characterized by a distorted body image and self-starvation. It does not involve motor or speech mimicry. * **C. Alzheimer’s Disease:** While advanced dementia can involve repetitive speech (palilalia), echolalia is not a diagnostic or characteristic feature of Alzheimer’s. It is more commonly associated with frontal lobe pathologies or specific neurodevelopmental disorders like Autism. **High-Yield Clinical Pearls for NEET-PG:** * **Echo Phenomena:** Echolalia (speech) and Echopraxia (actions) are frequently tested together as features of catatonia. * **Differential Diagnosis:** Apart from catatonia, echolalia is commonly seen in **Autism Spectrum Disorder (ASD)**, **Tourette’s Syndrome**, and **Pick’s Disease** (Frontotemporal Dementia). * **Management:** The first-line treatment for catatonic features (including echolalia) is **Benzodiazepines (Lorazepam)**. If unresponsive, **Electroconvulsive Therapy (ECT)** is the treatment of choice.

Question 29: Which of the following illnesses is related to being expressed emotionally?

A. Depression
B. Schizophrenia (Correct Answer)
C. Mania
D. Somatoform disorder

Explanation: **Explanation** The concept of **Expressed Emotion (EE)** is a critical psychosocial factor primarily studied in the context of **Schizophrenia**. It refers to the quality of the family environment and the attitudes of caregivers toward a patient with a mental disorder. **Why Schizophrenia is the Correct Answer:** Expressed Emotion is a robust predictor of **relapse** in Schizophrenia. It consists of three main components: 1. **Critical Comments:** Negative remarks about the patient’s behavior. 2. **Hostility:** General animosity or rejection of the patient as a person. 3. **Emotional Over-involvement (EOI):** Overprotective, intrusive, or self-sacrificing behaviors. High EE in a household creates a stressful environment that acts as a "trigger," significantly increasing the risk of psychotic symptom exacerbation and re-hospitalization. **Analysis of Incorrect Options:** * **Depression & Mania (Mood Disorders):** While family dynamics affect all psychiatric illnesses, the specific clinical construct of "Expressed Emotion" was historically developed and validated as a primary prognostic indicator for Schizophrenia (Brown et al., 1950s). * **Somatoform Disorder:** These disorders are characterized by physical symptoms without organic cause. While psychological stress is a factor, EE is not the defining psychosocial metric used for relapse prediction in these cases. **NEET-PG High-Yield Pearls:** * **Best Predictor of Relapse:** High Expressed Emotion is considered the single most important psychosocial predictor of relapse in Schizophrenia. * **Management:** Family Intervention Therapy (FIT) aims to reduce high EE to improve long-term outcomes. * **Measurement:** The "Gold Standard" for measuring EE is the **Camberwell Family Interview (CFI)**.

Question 30: Erotomanic delusion is seen in which syndrome?

A. de Clerambault's syndrome (Correct Answer)
B. Cotard syndrome
C. Couvade syndrome
D. Othello syndrome

Explanation: **Explanation:** **1. Correct Answer: A. de Clerambault's syndrome** Erotomanic delusion (also known as de Clerambault's syndrome) is a type of delusional disorder where the patient—typically a female—holds a fixed, false belief that another person, usually of higher social status or a celebrity, is deeply in love with them. The patient often believes the "suitor" is communicating their love through subtle signs, glances, or coded messages. **2. Analysis of Incorrect Options:** * **B. Cotard syndrome:** Also known as "Walking Corpse Syndrome," it is a nihilistic delusion where the patient believes they are dead, do not exist, or that their internal organs have rotted away. It is often seen in severe psychotic depression. * **C. Couvade syndrome:** This is a "sympathetic pregnancy" where the partner of an expectant mother experiences pregnancy-related symptoms (e.g., weight gain, nausea, morning sickness). It is not a psychotic disorder. * **D. Othello syndrome:** Also known as "Pathological Jealousy," it is a delusion that one’s spouse or partner is being unfaithful without any evidence. It is frequently associated with chronic alcoholism. **3. NEET-PG High-Yield Pearls:** * **Capgras Syndrome:** The delusion that a familiar person has been replaced by an identical-looking impostor (an "illusion of doubles"). * **Fregoli Syndrome:** The delusion that different people are actually a single person in disguise. * **Ekbom Syndrome:** Delusional parasitosis (belief that one is infested with insects). * **Folies à deux:** A shared psychotic disorder where a delusion is transmitted from one person to another.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free