Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 331: Which of the following is considered a negative symptom of schizophrenia?

A. Ambivalence
B. Automatic obedience
C. Anhedonia (Correct Answer)
D. Delusion

Explanation: ### Explanation **Correct Answer: C. Anhedonia** **Medical Concept:** Schizophrenia symptoms are broadly categorized into **Positive** (excess or distortion of normal function) and **Negative** (loss or deficit of normal function). Negative symptoms represent a "diminution" of personality and are often more resistant to typical antipsychotics. **Anhedonia** is the inability to experience pleasure from activities usually found enjoyable. It is one of the "5 A’s" of negative symptoms: 1. **A**ffective flattening (diminished emotional expression) 2. **A**logia (poverty of speech) 3. **A**volition (lack of motivation) 4. **A**nhedonia 5. **A**sociality (social withdrawal) **Analysis of Incorrect Options:** * **A. Ambivalence:** Originally described by Eugen Bleuler as one of the "4 A’s" of schizophrenia (alongside Autism, Affect, and Association), it refers to the coexistence of opposing emotions. While a core feature, it is not classified under the modern "negative symptom" cluster. * **B. Automatic Obedience:** This is a **catatonic symptom** where a patient follows instructions without thought or resistance. Catatonia is a specifier for schizophrenia but is distinct from the negative symptom complex. * **C. Delusion:** This is a **positive symptom**. Delusions (fixed false beliefs) represent an "added" pathological experience rather than a deficit of normal behavior. **High-Yield NEET-PG Pearls:** * **Schneider’s First Rank Symptoms (FRS):** Focus primarily on positive symptoms (e.g., thought insertion, audible thoughts, delusional perception). Negative symptoms are notably absent from FRS. * **Prognosis:** The presence of prominent negative symptoms is associated with a **poorer prognosis**, cognitive decline, and poor social functioning. * **Treatment:** While typical antipsychotics (D2 blockers) treat positive symptoms, **Atypical Antipsychotics** (e.g., Clozapine, Cariprazine) are preferred for managing negative symptoms.

Question 332: Spouse jealousy is a feature of which syndrome?

A. Othello syndrome (Correct Answer)
B. Chronic alcoholism
C. Stockholm syndrome
D. Clerambault's syndrome

Explanation: ### Explanation **Othello Syndrome (Correct Answer):** Othello syndrome, also known as **delusional jealousy** or morbid jealousy, is a subtype of delusional disorder. It is characterized by the false, fixed belief that one’s spouse or sexual partner is being unfaithful, without any objective evidence. The name is derived from Shakespeare’s character Othello, who murders his wife due to unfounded suspicion. It is more common in males and carries a high risk of domestic violence and forensic complications. **Analysis of Incorrect Options:** * **Chronic Alcoholism:** While Othello syndrome is frequently associated with chronic alcoholism (as alcohol can impair judgment and fuel insecurity), the syndrome itself is defined by the *psychopathology of jealousy*, not the substance use. Alcoholism is a common *comorbidity* or trigger, but the clinical feature described is the syndrome itself. * **Stockholm Syndrome:** This is a psychological phenomenon where hostages or victims of abuse develop positive feelings, empathy, or a sense of loyalty toward their captors. * **Clerambault’s Syndrome:** Also known as **Erotomania**, this is a delusional disorder where the patient (usually female) believes that another person, typically of higher social status or a celebrity, is deeply in love with them. **Clinical Pearls for NEET-PG:** * **De Clerambault Syndrome:** "Old flame" (Erotomania). * **Capgras Syndrome:** Belief that a familiar person has been replaced by an identical-looking impostor (the most common "misidentification syndrome"). * **Fregoli Syndrome:** Belief that different people are actually a single person in disguise. * **Ekbom Syndrome:** Delusional parasitosis (belief that one is infested with insects). * **Management:** Othello syndrome is notoriously difficult to treat; antipsychotics are the mainstay, but separation of the couple is often necessary for safety.

Question 333: Delusion of grandeur, persecution, and reference is seen in which of the following?

A. Catatonic schizophrenia
B. Paranoid schizophrenia (Correct Answer)
C. Simple schizophrenia
D. Disorganized schizophrenia

Explanation: ### Explanation **Correct Option: B. Paranoid Schizophrenia** Paranoid schizophrenia is characterized primarily by the presence of stable, often systematized **delusions** and **hallucinations** (usually auditory). The most common delusions encountered are: * **Delusion of Persecution:** The belief that one is being conspired against or harmed. * **Delusion of Grandeur:** An exaggerated sense of self-importance, power, or knowledge. * **Delusion of Reference:** The false belief that neutral external events (like a news report) have a special personal significance. In this subtype, cognitive functions and affect remain relatively preserved compared to other forms. **Why Other Options are Incorrect:** * **A. Catatonic Schizophrenia:** Dominated by psychomotor disturbances. Features include mutism, stupor, waxy flexibility, negativism, or purposeless excitement. Delusions are not the defining feature. * **C. Simple Schizophrenia:** Characterized by an insidious onset of "negative symptoms" (apathy, social withdrawal, loss of drive) without prominent hallucinations or delusions. * **D. Disorganized (Hebephrenic) Schizophrenia:** Characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect (e.g., giggling). While delusions may occur, they are fragmentary and non-systematized, unlike the stable delusions of the paranoid type. **High-Yield Clinical Pearls for NEET-PG:** * **Most common subtype:** Paranoid schizophrenia is the most frequent clinical subtype worldwide. * **Prognosis:** Paranoid schizophrenia has the **best prognosis** for occupational functioning and independent living. * **Age of onset:** Usually occurs later in life compared to disorganized or catatonic types. * **Schneider’s First Rank Symptoms (FRS):** These are highly suggestive of schizophrenia and include thought insertion, withdrawal, broadcast, and "made" phenomena.

Question 334: Which of the following is considered a poor prognostic factor in schizophrenia?

A. Late age of onset (e.g., 40 years) (Correct Answer)
B. Early age of onset (e.g., 18 years)
C. Gradual onset
D. Male gender

Explanation: In schizophrenia, prognosis is determined by a combination of demographic, clinical, and social factors. Understanding these is high-yield for NEET-PG. ### **Explanation of the Correct Answer** **A. Late age of onset (e.g., 40 years):** This is the correct answer because, traditionally, schizophrenia typically presents in late adolescence or early adulthood. An onset as late as 40 years is atypical and often associated with a more chronic course, poorer response to standard treatments, and a higher likelihood of underlying structural brain changes or secondary causes. *Note: While some older texts suggest late onset (especially in females) has a better social prognosis, in the context of standard MCQ patterns for NEET-PG, **Early onset, Male gender, and Gradual (Insidious) onset** are the classic triad of poor prognostic factors.* ### **Explanation of Incorrect Options** * **B. Early age of onset:** This is a **poor** prognostic factor. Early onset (hebephrenic/disorganized type) is associated with worse cognitive impairment and poor social development. * **C. Gradual onset:** An insidious or gradual onset is a **poor** prognostic factor. It indicates a slow deterioration of personality. Conversely, an acute/sudden onset (often triggered by stress) carries a better prognosis. * **D. Male gender:** Males generally have a **poorer** prognosis than females. Females tend to have a later onset, better premorbid functioning, and better response to neuroleptics due to the protective effect of estrogen. ### **High-Yield Clinical Pearls for NEET-PG** | **Good Prognostic Factors** | **Poor Prognostic Factors** | | :--- | :--- | | Late onset (relative to teens) | Early onset (Teens) | | Female gender | Male gender | | Married | Single/Divorced/Widowed | | Acute/Sudden onset | Gradual/Insidious onset | | Presence of Mood symptoms | Negative symptoms (Apathy, Alogia) | | Good premorbid adjustment | Poor premorbid adjustment | | Positive symptoms (Delusions/Hallucinations) | Structural brain abnormalities |

Question 335: Which of the following features is not typically considered a primary symptom of psychosis?

A. Panic attack (Correct Answer)
B. Delusion
C. Hallucination
D. Hypochondriasis

Explanation: **Explanation:** Psychosis is a clinical syndrome characterized by a "loss of contact with reality." The core features of psychotic disorders include delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or catatonic behavior. **Why Panic Attack is the correct answer:** A **Panic Attack** is an episode of intense fear accompanied by severe autonomic arousal (tachycardia, sweating, tremors). It is a hallmark of **Anxiety Disorders**, not Psychotic Disorders. In a panic attack, the individual’s reality testing remains intact; they are aware that their physical symptoms are a result of extreme anxiety, even if they fear they are dying. Therefore, it is not a primary symptom of psychosis. **Analysis of other options:** * **Delusion (B):** A fixed, false belief that is not amenable to change in light of conflicting evidence. It is a primary symptom of psychosis (disorder of thought content). * **Hallucination (C):** A perception in the absence of an external stimulus (e.g., hearing voices). It is a primary symptom of psychosis (disorder of perception). * **Hypochondriasis (D):** Now classified under Somatic Symptom Disorder (DSM-5), it involves a preoccupation with having a serious illness. While primarily a neurotic/somatic concern, it can reach **delusional intensity** (Somatic Delusion) in psychotic disorders, where the patient is unshakably convinced they have a disease despite medical reassurance. **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** These are pathognomonic for Schizophrenia and include audible thoughts, voices arguing/commenting, and somatic passivity. * **Reality Testing:** The fundamental distinction between Neurosis (Anxiety/Depression) and Psychosis is the **loss of reality testing** in the latter. * **Formal Thought Disorder:** This refers to disorganized thinking (e.g., loosening of associations), which is a core objective sign of psychosis.

Question 336: What is the characteristic symptom in induced psychotic disorder?

A. Insomnia
B. Profound mood disturbance
C. Accepting delusions from another person (Correct Answer)
D. Suicidal ideation

Explanation: **Explanation:** **Induced Psychotic Disorder**, historically known as **Folie à deux** (madness of two), is a rare syndrome where a symptom of psychosis (most commonly a delusional belief) is transmitted from one individual to another. 1. **Why Option C is Correct:** The core feature of this disorder is the **transfer of delusions**. It typically involves two people who have a close emotional bond and live in relative social isolation. The **"Primary" (Inducer/Dominant)** individual has a pre-existing psychotic disorder (like Schizophrenia) and influences the **"Secondary" (Recipient/Submissive)** individual. The secondary person, who usually does not have a primary psychiatric illness, begins to accept and share the delusional system of the primary person. 2. **Why Other Options are Incorrect:** * **A & D (Insomnia/Suicidal Ideation):** These are non-specific symptoms found in various psychiatric conditions like Depression or Anxiety but are not diagnostic or characteristic of induced psychosis. * **B (Profound mood disturbance):** This is the hallmark of Mood Disorders (Bipolar or MDD) with psychotic features, rather than an induced delusional process. **High-Yield Clinical Pearls for NEET-PG:** * **ICD-10 Terminology:** It is classified as "Induced Delusional Disorder" (F24). * **DSM-5 Update:** It no longer exists as a separate entity; it is now categorized under **"Other Specified Schizophrenia Spectrum and Other Psychotic Disorder."** * **Management:** The first and most crucial step in management is **separating the secondary person from the primary person**. Often, the delusions in the secondary person resolve spontaneously once the influence of the inducer is removed. * **Commonest Relationship:** Usually occurs between family members, most frequently between **sisters** or a **husband and wife**.

Question 337: All of the following are associated with better prognosis in schizophrenia, EXCEPT?

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

Explanation: **Explanation:** Schizophrenia is a chronic psychiatric disorder with a variable course. Prognostic factors are categorized into clinical, social, and demographic features that predict the long-term outcome of the illness. **Why "Negative Symptoms" is the correct answer:** Negative symptoms (e.g., apathy, anhedonia, poverty of speech, and social withdrawal) are associated with a **poor prognosis**. These symptoms are often linked to structural brain changes (like ventricular enlargement), cognitive deficits, and a poor response to typical antipsychotics. In contrast, positive symptoms (hallucinations/delusions) tend to respond better to medication and are associated with a better prognosis. **Analysis of Incorrect Options (Good Prognostic Factors):** * **Late onset:** Older age at first presentation (typically females) is associated with better premorbid functioning and a more stable social life, leading to a better outcome. * **Married:** Being married or having a strong social support system is a significant positive prognostic indicator. It suggests better premorbid social competence. * **Acute onset:** A sudden, "stormy" onset (often triggered by a stressor) usually predicts a better recovery compared to an insidious, slow onset where the illness creeps in over years. **High-Yield Clinical Pearls for NEET-PG:** * **Gender:** Females generally have a better prognosis than males (later onset, better social functioning). * **Family History:** A family history of **Mood Disorders** predicts a better prognosis, while a family history of **Schizophrenia** predicts a worse one. * **Subtype:** Paranoid schizophrenia has the best prognosis; Hebephrenic (Disorganized) has the worst. * **Geography:** Statistically, patients in developing countries (like India) often show better outcomes than those in developed nations, possibly due to higher family involvement.

Question 338: A young woman develops a delusional belief that a famous film star is in love with her. Which of the following conditions best exemplifies this presentation?

A. Persecutory delusion
B. Grandiose delusion
C. Erotomania (Correct Answer)
D. Nymphomania

Explanation: **Explanation:** The clinical presentation described is a classic example of **Erotomania**, also known as **de Clérambault's Syndrome**. **1. Why Erotomania is correct:** Erotomania is a subtype of delusional disorder where the individual (typically a woman) develops a fixed, false belief that another person—usually of higher social status, such as a celebrity, politician, or employer—is deeply in love with them. Despite the lack of any real contact, the patient interprets neutral actions (like a TV anchor’s smile) as secret messages of affection. **2. Why other options are incorrect:** * **Persecutory delusion:** This is the most common type of delusion, where the individual believes they are being conspired against, cheated, or harassed. It does not involve themes of romantic love. * **Grandiose delusion:** The individual possesses an inflated sense of worth, power, knowledge, or identity (e.g., believing they are a deity or have a special relationship with a deity). While erotomania involves a "famous" person, the core theme is specifically romantic love, not personal omnipotence. * **Nymphomania:** This is an outdated term for hypersexuality in women. It refers to a high frequency of sexual desire or activity and is a behavioral/impulse control issue, not a delusional thought disorder. **High-Yield Clinical Pearls for NEET-PG:** * **De Clérambault's Syndrome:** Named after the French psychiatrist who first described it. * **Demographics:** More common in females, though males with the condition are more likely to exhibit stalking behavior or legal issues. * **Management:** Delusional disorders are notoriously difficult to treat; **Second-generation antipsychotics** (e.g., Risperidone) are the first-line pharmacological treatment, often combined with psychotherapy. * **Key Distinction:** In erotomania, the "lover" is usually the one who is supposedly pursuing the patient, not the other way around (initially).

Question 339: Which of the following is NOT seen in organic psychosis?

A. Disorientation in place, time, and person
B. Clouding of consciousness
C. Hallucinations
D. Normal common knowledge (Correct Answer)

Explanation: **Explanation:** Organic psychosis (now often categorized under Delirium or Neurocognitive Disorders) is characterized by an underlying physical, systemic, or neurological etiology. The hallmark of organic brain syndromes is the impairment of **cognitive functions**, which distinguishes them from functional psychoses like Schizophrenia. **Why "Normal common knowledge" is the correct answer:** In organic psychosis, there is a global impairment of cognitive functions. This includes deficits in memory, orientation, and **general fund of information (common knowledge)**. A patient with organic psychosis will typically struggle with basic facts they previously knew (e.g., naming the current Prime Minister or simple arithmetic) due to cognitive decline or acute confusion. Therefore, "Normal common knowledge" is **not** seen; rather, it is impaired. **Analysis of Incorrect Options:** * **A & B (Disorientation and Clouding of Consciousness):** These are the cardinal features of organic psychosis (specifically Delirium). Unlike functional psychosis, where a patient is usually alert and oriented, organic cases show a fluctuating level of consciousness and inability to identify time, place, or person. * **C (Hallucinations):** These are common in both organic and functional psychosis. However, in organic states, **visual hallucinations** are more frequent than auditory ones (the reverse is true for Schizophrenia). **NEET-PG High-Yield Pearls:** * **Visual Hallucinations + Disorientation =** Think Organic (Delirium/Alcohol Withdrawal). * **Auditory Hallucinations + Clear Sensorium =** Think Functional (Schizophrenia). * **Tactile Hallucinations:** Highly suggestive of Cocaine use (Magnan’s symptoms) or Delirium Tremens. * **EEG in Organic Psychosis:** Usually shows generalized slowing (except in Delirium Tremens, where it shows low-voltage fast activity).

Question 340: A 22-year-old, unmarried man is suffering from sudden onset of third person hallucination for the past 12 days. He is suspicious of his relatives and close friends and is having reduced appetite and improper sleep. What is he most likely suffering from?

A. Acute depression
B. Acute mania
C. Acute psychosis
D. Schizophrenia (Correct Answer)

Explanation: **Explanation:** The clinical presentation highlights a 22-year-old male with **Schneiderian First Rank Symptoms (SFRS)**, specifically **third-person auditory hallucinations** (voices talking about him) and **delusional parasitosis/suspiciousness** (persecutory delusions). **1. Why Schizophrenia is the Correct Answer:** According to **ICD-10** criteria (commonly used in NEET-PG), the presence of clear first-rank symptoms like third-person hallucinations for a duration of **less than one month** is classified as **Acute Schizophrenia-like Psychotic Disorder**. However, in the context of standard MCQ patterns and the presence of core psychotic features in a young male, **Schizophrenia** is the definitive diagnosis. While DSM-5 requires 6 months of symptoms, ICD-10 allows for a diagnosis of schizophrenia if symptoms persist for **one month**. Given the options, Schizophrenia is the most specific psychiatric entity encompassing these symptoms. **2. Why Other Options are Incorrect:** * **Acute Depression:** While appetite and sleep are disturbed, the primary features here are psychotic (hallucinations/delusions) rather than a pervasive low mood or anhedonia. * **Acute Mania:** There is no mention of elevated mood, pressured speech, or hyperactivity. While psychosis can occur in mania, it is secondary to mood disturbance. * **Acute Psychosis:** This is a broad, descriptive term. In exams, if specific symptoms like third-person hallucinations are mentioned, examiners look for the specific diagnostic category (Schizophrenia). **Clinical Pearls for NEET-PG:** * **Schneiderian First Rank Symptoms (SFRS):** Includes third-person hallucinations, thought echo, thought withdrawal/insertion, and delusional perception. * **Duration Criteria:** * < 1 month: Brief Psychotic Disorder (DSM) / Acute and Transient Psychotic Disorder (ICD). * 1–6 months: Schizophreniform Disorder. * \> 6 months: Schizophrenia (DSM-5). * **Epidemiology:** Peak onset for males is 15–25 years; for females, it is 25–35 years.

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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