Psychotic Disorders Practice Questions

Q: General Paresis of the Insane is associated with which condition?

Tertiary Syphilis. **Explanation:** **General Paresis of the Insane (GPI)**, also known as paretic neurosyphilis, is a chronic meningoencephalitis caused by the direct invasion of the brain parenchyma by *Treponema pallidum*. It is a late-stage manifestation of **Tertiary Syphilis**, typically occurring 10–25 years after the initial infection. **Why Tertiary Syphilis is correct:** GPI is characterized by a "constellation of neuropsychiatric symptoms." Clinically, it presents with the **"4 Ps"**: **P**ersonality changes, **P**aresis (weakness), **P**upillary abnormalities (Argyll Robertson pupil), and **P**sychosis (classically **grandiose delusions**). It leads to progressive cognitive decline and frontal lobe syndrome. **Why other options are incorrect:** * **Miliary Tuberculosis:** While TB can cause meningitis or tuberculomas, it does not lead to the specific parenchymal degenerative pattern seen in GPI. * **Vitamin B12 Deficiency:** This causes Subacute Combined Degeneration (SCD) of the spinal cord and "megaloblastic madness" (psychosis/dementia), but it is a nutritional deficiency, not an infectious process. * **Autoimmune Encephalitis:** Conditions like Anti-NMDA receptor encephalitis present with acute psychosis and seizures, but they are mediated by antibodies rather than treponemal infection. **High-Yield Clinical Pearls for NEET-PG:** * **Argyll Robertson Pupil:** The classic sign in neurosyphilis—pupils accommodate but do not react to light ("Prostitute’s Pupil"). * **Diagnosis:** CSF-VDRL is highly specific (though less sensitive); FTA-ABS is often used for confirmation. * **Treatment:** Intravenous Penicillin G is the gold standard. * **Historical Note:** GPI was one of the first psychiatric conditions for which a biological cause was identified.

Q: Loss of insight is seen in which of the following conditions?

Schizophrenia. ### Explanation The core concept tested here is the distinction between **Psychosis** and **Neurosis**, specifically regarding the presence or absence of **insight**. **1. Why Schizophrenia is Correct:** Schizophrenia is a prototype of **Psychotic Disorders**. In psychosis, there is a gross impairment in reality testing. The patient is unable to distinguish between subjective experiences (like hallucinations or delusions) and objective reality. Consequently, they lack **insight**—the awareness that their symptoms are part of a mental illness. They typically do not believe they are ill and may refuse treatment. **2. Why the Other Options are Incorrect:** * **Hysteria (Dissociative/Conversion Disorders):** Classified under neurotic/stress-related disorders. While patients may exhibit dramatic physical symptoms without an organic cause, they generally maintain a connection with reality and do not suffer from a primary loss of insight into the fact that something is "wrong" with them. * **Anxiety Disorders:** Patients are acutely aware of their symptoms (palpitations, fear, apprehension). They recognize their distress as abnormal and often seek help voluntarily. * **Obsessive-Compulsive Neurosis (OCD):** A hallmark of OCD is that the patient recognizes their obsessions as **ego-dystonic** (irrational and originating from their own mind). This preservation of insight is what causes the significant distress and struggle against the thoughts. **Clinical Pearls for NEET-PG:** * **Insight Scale:** Insight is not "all-or-none" but is measured on a 6-point scale (ASIST scale). * **Ego-syntonic vs. Ego-dystonic:** Psychotic symptoms (Schizophrenia) are usually *ego-syntonic* (accepted by the ego), whereas neurotic symptoms (OCD) are *ego-dystonic* (rejected by the ego). * **Judgment:** Along with insight, **social and test judgment** are typically impaired in Schizophrenia but preserved in Neuroses.

Q: The procedure shown below is used in all of the following illnesses except:

Dissociative disorder. ***Dissociative disorder*** - **ECT is not indicated** for dissociative disorders as they are primarily treated with **psychotherapy** and **trauma-focused interventions**. - Dissociative disorders involve disruptions in **consciousness, memory, identity**, and do not respond to **neurobiological interventions** like ECT. *Catatonic schizophrenia* - **ECT is highly effective** for catatonic symptoms, especially **catatonic stupor** and **malignant catatonia**. - Provides rapid relief when **antipsychotics** fail or when **life-threatening complications** like hyperthermia occur. *Treatment-resistant major depressive disorder* - **ECT is the gold standard** for severe depression that fails to respond to **multiple antidepressant trials**. - Shows **response rates of 70-90%** in treatment-resistant cases and is particularly effective for **psychotic depression**. *Severe mania* - **ECT is indicated** for severe manic episodes, especially with **psychotic features** or **catatonic symptoms**. - Used when **mood stabilizers** are ineffective or contraindicated, providing rapid **mood stabilization**.

Q: Bleuler's symptoms of schizophrenia include which of the following?

Automatism. **Explanation:** Eugen Bleuler, a Swiss psychiatrist, coined the term "Schizophrenia" and identified four fundamental symptoms (often called the **4 A’s**) that he believed were present in every case of the disorder. **The 4 A’s of Bleuler include:** 1. **A**ffective Disturbance (Inappropriate or blunted affect) 2. **A**utism (Social withdrawal and living in a private fantasy world) 3. **A**mbivalence (Coexisting opposing emotions/impulses toward the same object) 4. **A**ssociation Loosening (Fragmented thought processes/Formal thought disorder) **Analysis of Options:** * **Option B (Automatism) is the Correct Answer** in the context of this specific question format because it is **NOT** one of Bleuler’s 4 A’s. (Note: In NEET-PG, "include which of the following" questions sometimes ask for the "except" or the "odd one out" depending on the source; here, Automatism is the outlier). Automatism refers to involuntary motor activities and is more commonly associated with epilepsy or dissociative states. * **Options A, C, and D** are all primary (fundamental) symptoms described by Bleuler. **Clinical Pearls for NEET-PG:** * **Fundamental vs. Accessory Symptoms:** Bleuler categorized symptoms into Fundamental (the 4 A’s) and Accessory (Hallucinations and Delusions). He believed accessory symptoms were not essential for diagnosis. * **Schneider’s First Rank Symptoms (FRS):** Unlike Bleuler, Kurt Schneider focused on "First Rank Symptoms" (e.g., audible thoughts, somatic passivity, delusional perception) which were considered pathognomonic for schizophrenia. * **Historical Context:** Bleuler’s "Loosening of Association" is considered the hallmark of the schizophrenic thought disorder.

Q: Worst prognosis is seen in which type of schizophrenia?

Simple. **Explanation:** The prognosis of Schizophrenia is determined by the age of onset, the nature of symptoms (positive vs. negative), and the speed of progression. **Why Simple Schizophrenia is the Correct Answer:** Simple Schizophrenia (ICD-10) is characterized by the early and insidious onset of **negative symptoms** (apathy, withdrawal, loss of drive) without the presence of overt hallucinations or delusions. Because it lacks "florid" psychotic symptoms, it often goes undiagnosed for years. It has a chronic, downhill course with poor response to typical antipsychotics and a very high risk of social drift, making it the subtype with the **worst prognosis**. **Analysis of Incorrect Options:** * **Paranoid Schizophrenia:** This subtype has the **best prognosis**. It typically has a later age of onset, preserved cognitive function, and responds well to medication because it is dominated by positive symptoms (delusions/hallucinations). * **Catatonic Schizophrenia:** This has a **good prognosis** regarding recovery from individual episodes. It shows an excellent and rapid response to Benzodiazepines (Lorazepam) and Electroconvulsive Therapy (ECT). * **Hebephrenic (Disorganized) Schizophrenia:** This has a **poor prognosis** due to early onset and severe personality deterioration, but it is generally considered slightly better than Simple Schizophrenia because the symptoms are more recognizable, allowing for earlier intervention. **NEET-PG High-Yield Pearls:** * **Best Prognosis:** Paranoid Schizophrenia. * **Worst Prognosis:** Simple Schizophrenia (followed by Hebephrenic). * **Good Prognostic Factors:** Late onset, female sex, presence of precipitating factors, acute onset, and predominant positive symptoms. * **Poor Prognostic Factors:** Early onset, male sex, insidious onset, family history, and predominant negative symptoms.

Q: A 33-year-old male traveling by flight started fighting with an air hostess. The man alleged that the air hostess was his wife, but she had changed her face so she could not be identified. This history is consistent with which of the following syndromes?

Fregoli syndrome. ### Explanation The correct answer is **Fregoli syndrome**. **1. Why Fregoli Syndrome is Correct:** Fregoli syndrome is a **delusional misidentification syndrome** where the patient believes that a familiar person (often a perceived persecutor) is following them or present in their environment by taking on the physical appearance of strangers. In this case, the patient believes the air hostess (a stranger) is actually his wife (a familiar person) who has "changed her face." The core psychopathology is the belief that different people are actually a single person in disguise. **2. Why the Other Options are Incorrect:** * **Capgras Syndrome:** This is the "mirror image" of Fregoli. The patient believes a familiar person (e.g., a spouse) has been replaced by an **identical-looking impostor**. Here, the face is the same, but the identity is different. * **Othello Syndrome:** Also known as **pathological jealousy**, this is a delusion that one’s spouse or partner is being unfaithful. It does not involve misidentification of faces. * **de Clerembault Syndrome:** Also known as **Erotomania**, this is the delusion that another person, usually of higher social status or a celebrity, is deeply in love with the patient. **3. High-Yield Clinical Pearls for NEET-PG:** * **Delusional Misidentification Syndromes (DMS):** These are often associated with organic brain lesions (especially in the right hemisphere or bifrontal regions) or schizophrenia. * **Intermetamorphosis:** Another DMS where the patient believes people have swapped physical and psychological identities with each other. * **Syndrome of Subjective Doubles:** The belief that a physical double of oneself exists and is leading an independent life. * **Management:** Treatment typically involves atypical antipsychotics (e.g., Risperidone) and addressing any underlying neurological cause.

Q: A 45-year-old male admits himself to the hospital, stating that the nurse treating him is an imposter, and his wife has replaced her to kill him. What is the most likely diagnosis?

Fregoli syndrome. ### Explanation The correct answer is **Fregoli syndrome**. This is a delusional misidentification syndrome characterized by the belief that different people are actually a single person in disguise. **1. Why Fregoli Syndrome is Correct:** In this clinical scenario, the patient believes a familiar person (his wife) has taken on the appearance of a stranger (the nurse) to follow or harm him. This "hyper-identification" involves the belief that a familiar individual is physically disguised as someone else. It is often associated with paranoid schizophrenia or organic brain injury. **2. Analysis of Incorrect Options:** * **Capgras Syndrome:** This is the opposite of Fregoli. The patient believes a familiar person (e.g., a spouse) has been replaced by an identical-looking **imposter**. In the question, the patient believes the "imposter" is actually his wife in disguise, which points to Fregoli. * **Cotard Syndrome:** Also known as "Walking Corpse Syndrome," the patient suffers from nihilistic delusions, believing they are dead, rotting, or have lost their internal organs or soul. * **Alport Syndrome:** This is a genetic disorder (Type IV collagen defect) characterized by glomerulonephritis, end-stage kidney disease, and hearing loss. It is a renal/ENT condition, not a psychiatric disorder. **3. NEET-PG High-Yield Pearls:** * **Delusional Misidentification Syndromes (DMS):** These are often linked to a disconnection between the visual recognition system and the emotional processing system (amygdala). * **Intermetamorphosis:** A related syndrome where the patient believes people swap identities with each other both physically and psychologically. * **Reduplicative Paramnesia:** The delusional belief that a location has been duplicated or moved to another site. * **Management:** Primarily involves antipsychotics (e.g., Risperidone) and treating any underlying organic cause.

Question 1

General Paresis of the Insane is associated with which condition?

Accepted Answer

Tertiary Syphilis

Answer

Miliary tuberculosis

Answer

Vitamin B12 deficiency

Answer

Autoimmune encephalitis

Question 2

All of the following are features of hallucination EXCEPT:

Accepted Answer

It occurs in the absence of a perceptual stimulus

Answer

Depends on the will of the observer and is under voluntary control

Answer

Occur in inner subjective space

Answer

It is vivid like sensory perception

Question 3

Loss of insight is seen in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Hysteria

Answer

Anxiety

Answer

Obsessive-Compulsive neurosis

Question 4

Somatic passivity is a feature of which of the following conditions?

Accepted Answer

Paranoid Schizophrenia

Answer

Depressive illness

Answer

Hypochondriasis

Answer

Panic disorder

Question 5

A patient with schizophrenia is on neuroleptics. Their psychotic symptoms have improved, but they have developed sadness, talk less, and remain in bed. Which of the following is LEAST likely to be the cause of these new symptoms?

Accepted Answer

Reaction to external stimuli

Answer

Parkinsonism

Answer

Major depression

Answer

Persisting negative symptoms of schizophrenia

Question 6

The procedure shown below is used in all of the following illnesses except:

Accepted Answer

Dissociative disorder

Answer

Catatonic schizophrenia

Answer

Treatment-resistant major depressive disorder

Answer

Severe mania

Question 7

Bleuler's symptoms of schizophrenia include which of the following?

Accepted Answer

Automatism

Answer

Autism

Answer

Affect disturbance

Answer

Loosening of association

Question 8

Worst prognosis is seen in which type of schizophrenia?

Accepted Answer

Simple

Answer

Paranoid

Answer

Catatonic

Answer

Hebephrenic

Question 9

A 33-year-old male traveling by flight started fighting with an air hostess. The man alleged that the air hostess was his wife, but she had changed her face so she could not be identified. This history is consistent with which of the following syndromes?

Accepted Answer

Fregoli syndrome

Answer

Capgras syndrome

Answer

Othello syndrome

Answer

de Clerembault syndrome

Question 10

A 45-year-old male admits himself to the hospital, stating that the nurse treating him is an imposter, and his wife has replaced her to kill him. What is the most likely diagnosis?

Accepted Answer

Fregoli syndrome

Answer

Capgras syndrome

Answer

Cotard syndrome

Answer

Alport syndrome

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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