Psychotic Disorders Practice Questions

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

Anhedonia. ### 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.

Q: Spouse jealousy is a feature of which syndrome?

Othello syndrome. ### 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.

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

Paranoid schizophrenia. ### 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.

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

Panic attack. **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.

Q: What is the characteristic symptom in induced psychotic disorder?

Accepting delusions from another person. **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**.

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

Negative symptoms. **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.

Q: 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?

Erotomania. **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).

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

Normal common knowledge. **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 1

Which of the following is considered a negative symptom of schizophrenia?

Accepted Answer

Anhedonia

Answer

Ambivalence

Answer

Automatic obedience

Answer

Delusion

Question 2

Spouse jealousy is a feature of which syndrome?

Accepted Answer

Othello syndrome

Answer

Chronic alcoholism

Answer

Stockholm syndrome

Answer

Clerambault's syndrome

Question 3

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

Accepted Answer

Paranoid schizophrenia

Answer

Catatonic schizophrenia

Answer

Simple schizophrenia

Answer

Disorganized schizophrenia

Question 4

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

Accepted Answer

Late age of onset (e.g., 40 years)

Answer

Early age of onset (e.g., 18 years)

Answer

Gradual onset

Answer

Male gender

Question 5

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

Accepted Answer

Panic attack

Answer

Delusion

Answer

Hallucination

Answer

Hypochondriasis

Question 6

What is the characteristic symptom in induced psychotic disorder?

Accepted Answer

Accepting delusions from another person

Answer

Insomnia

Answer

Profound mood disturbance

Answer

Suicidal ideation

Question 7

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

Accepted Answer

Negative symptoms

Answer

Late onset

Answer

Married

Answer

Acute onset

Question 8

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?

Accepted Answer

Erotomania

Answer

Persecutory delusion

Answer

Grandiose delusion

Answer

Nymphomania

Question 9

Which of the following is NOT seen in organic psychosis?

Accepted Answer

Normal common knowledge

Answer

Disorientation in place, time, and person

Answer

Clouding of consciousness

Answer

Hallucinations

Question 10

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?

Accepted Answer

Schizophrenia

Answer

Acute depression

Answer

Acute mania

Answer

Acute psychosis

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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