Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 341: What is the most common type of persistent delusional disorder?

A. Delusion of persecution (Correct Answer)
B. Somatic delusion
C. Delusion of jealousy
D. Delusion of grandeur

Explanation: **Explanation:** **Persistent Delusional Disorder (PDD)** is characterized by the presence of one or more non-bizarre delusions (situations that could occur in real life) lasting for at least one month, in the absence of other psychotic symptoms like prominent hallucinations or mood episodes. 1. **Why Option A is Correct:** **Delusion of persecution** is statistically the **most common subtype** of delusional disorder. In this type, the individual believes they are being conspired against, spied upon, followed, poisoned, or harassed. These patients often seek justice through legal actions or "police reports" and can occasionally become irritable or aggressive toward their perceived persecutors. 2. **Why Other Options are Incorrect:** * **Somatic Delusion (B):** Involves the conviction that the body is diseased, abnormal, or changed (e.g., infestation with parasites or foul odors). While significant, it is less frequent than persecutory types. * **Delusion of Jealousy (C):** Also known as **Othello Syndrome** or Conjugal Paranoia. It involves the false belief that a spouse or lover is unfaithful. It is more common in males but less prevalent than persecution. * **Delusion of Grandeur (D):** Also known as **Megalomania**, where the person believes they have extraordinary talent, fame, or a special relationship with a deity. This is more commonly associated with Bipolar Disorder (Manic phase) than PDD. **High-Yield Clinical Pearls for NEET-PG:** * **Erotomania (De Clerambault’s Syndrome):** A subtype where the patient believes a person of higher status (e.g., a celebrity) is in love with them. * **Fregoli Phenomenon:** The belief that different people are actually a single person in disguise. * **Capgras Syndrome:** The belief that a familiar person has been replaced by an identical impostor. * **Key Distinction:** Unlike Schizophrenia, in PDD, the patient’s **personality and social functioning** are relatively preserved outside the impact of the delusion.

Question 342: What is the characteristic feature of catatonic schizophrenia?

A. Stupor
B. Rigidity
C. Negativism
D. All of the above (Correct Answer)

Explanation: **Explanation:** Catatonic schizophrenia (now classified under the broader term "Schizophrenia with Catatonia" in DSM-5) is characterized by prominent **psychomotor disturbances**. These disturbances can manifest as either a marked decrease in reactivity to the environment or excessive, purposeless motor activity. The correct answer is **D (All of the above)** because: 1. **Stupor:** This refers to a state of akinesia (lack of movement) and mutism despite preserved consciousness and the ability to track objects with the eyes. 2. **Rigidity:** This involves maintaining a stiff posture against all efforts to be moved, often associated with "waxy flexibility" (catalepsy), where the patient stays in a position placed by the examiner. 3. **Negativism:** This is an active resistance to instructions or physical attempts to be moved. It can be "passive" (failing to cooperate) or "active" (doing the exact opposite of what is asked). **Why other options are not "more" correct:** Options A, B, and C are all individual components of the catatonic syndrome. Since all three are hallmark features frequently seen in these patients, selecting "All of the above" is the most accurate clinical description. **High-Yield Clinical Pearls for NEET-PG:** * **Waxy Flexibility (Catalepsy):** The most classic sign; the patient’s limbs can be molded like wax and held for long periods. * **Echolalia/Echopraxia:** Mimicking the speech or movements of the examiner. * **Ambitendency:** The patient makes alternating movements (e.g., reaching out to shake a hand but withdrawing). * **Drug of Choice:** **Lorazepam** (Benzodiazepines) is the first-line treatment (Lorazepam challenge test). * **Definitive Treatment:** **Electroconvulsive Therapy (ECT)** is highly effective for life-threatening catatonia (e.g., malignant catatonia).

Question 343: What is the most common type of hallucination experienced in schizophrenia?

A. Auditory (Correct Answer)
B. Visual
C. Olfactory
D. Tactile

Explanation: **Explanation:** In the context of schizophrenia, **Auditory Hallucinations** are the most common and characteristic perceptual disturbances, occurring in approximately 70-80% of patients. These typically manifest as "voices" that may be derogatory, commanding, or conversational. Specifically, **third-person hallucinations** (voices discussing the patient among themselves) and **running commentaries** are considered Schneiderian First-Rank Symptoms (FRS), which carry high diagnostic weight for schizophrenia. **Analysis of Incorrect Options:** * **B. Visual Hallucinations:** While they can occur in schizophrenia, they are much less frequent than auditory ones. Their presence should always prompt a clinician to rule out **organic brain syndromes**, substance withdrawal (e.g., Delirium Tremens), or complex partial seizures. * **C. Olfactory Hallucinations:** These involve smelling non-existent odors (often unpleasant like burning rubber or sulfur). They are rare in schizophrenia and are most commonly associated with **Temporal Lobe Epilepsy** (uncinate fits). * **D. Tactile Hallucinations:** Also known as haptic hallucinations, these are uncommon in schizophrenia. They are classically associated with **cocaine intoxication** ("cocaine bugs" or Formication) and alcohol withdrawal. **Clinical Pearls for NEET-PG:** * **Most common subtype of Schizophrenia:** Paranoid Schizophrenia. * **Best Prognosis:** Paranoid Schizophrenia; **Worst Prognosis:** Hebephrenic (Disorganized) Schizophrenia. * **Functional Hallucination:** A real external stimulus triggers a simultaneous hallucination in the same sensory modality (e.g., hearing voices only when the tap is running). * **Reflex Hallucination:** A stimulus in one sensory modality triggers a hallucination in another (e.g., seeing a ghost when hearing a bell).

Question 344: What is considered a good prognostic factor for schizophrenia?

A. Blunted affect
B. Early onset
C. Presence of depression (Correct Answer)
D. Male sex

Explanation: ### Explanation The prognosis of Schizophrenia is influenced by various clinical, social, and demographic factors. In this question, the **presence of depression** (mood symptoms) is a well-recognized **good prognostic factor**. **1. Why "Presence of Depression" is correct:** Patients who exhibit significant affective symptoms (depression or anxiety) during the course of their illness generally have a better outcome. This is often because the presence of mood symptoms suggests a "Schizoaffective" picture or a more reactive process rather than a pure, deteriorating schizophrenic process. It is associated with better premorbid functioning and a higher likelihood of returning to baseline. **2. Why the other options are incorrect:** * **Blunted Affect (Option A):** This is a "Negative Symptom." Negative symptoms (apathy, alogia, anhedonia) are strongly associated with a **poor prognosis** as they are often resistant to antipsychotic treatment and lead to significant social decline. * **Early Onset (Option B):** Early age of onset (childhood or adolescence) is a **poor prognostic factor**. It usually correlates with more brain structural abnormalities and a more insidious, severe course of illness. * **Male Sex (Option D):** Statistically, **males have a poorer prognosis** than females. Females tend to have a later age of onset, better premorbid social functioning, and a better response to treatment (partially due to the protective effects of estrogen). ### NEET-PG High-Yield Pearls: Prognostic Factors in Schizophrenia | **Good Prognosis** | **Poor Prognosis** | | :--- | :--- | | Late onset | Early/Young onset | | Acute/Sudden onset | Insidious/Slow onset | | Obvious precipitating factors | No clear triggers | | **Presence of mood symptoms** | **Negative symptoms** (Blunted affect) | | Married / Good social support | Single/Divorced/Isolated | | Positive symptoms (Hallucinations/Delusions) | Male sex | | Female sex | Family history of Schizophrenia |

Question 345: A 20-year-old male presents with auditory hallucinations and aggressive behavior for the past 2 days. He also reports fever during the same period. His family states he has been muttering to himself and gesturing. There is no prior history of psychiatric illness. What is the most likely diagnosis?

A. Dementia
B. Acute psychosis (Correct Answer)
C. Delirium
D. Delusional disorder

Explanation: ### Explanation **1. Why Acute Psychosis is Correct:** The patient presents with classic **positive symptoms of psychosis** (auditory hallucinations, muttering, gesturing, and aggressive behavior) with an **acute onset** (2 days). In the context of NEET-PG, a sudden onset of psychotic symptoms (less than 1 month) in a young patient with no prior history is characteristic of **Brief Psychotic Disorder** (often referred to here as Acute Psychosis). While the patient has a fever, the primary presentation is behavioral and hallucinatory without the hallmark cognitive fluctuations of delirium. **2. Why the Other Options are Incorrect:** * **Delirium:** Although fever is present, delirium is primarily a disorder of **consciousness and attention** with a fluctuating course. The vignette emphasizes organized psychotic symptoms (hallucinations/muttering) rather than clouding of consciousness or disorientation. * **Dementia:** This is a chronic, progressive neurodegenerative condition characterized by significant cognitive decline (memory, executive function). A 2-day history in a 20-year-old completely rules this out. * **Delusional Disorder:** This diagnosis requires the presence of one or more delusions for at least **one month**. Hallucinations are typically absent or not prominent, and the patient’s behavior is usually not markedly odd or bizarre apart from the delusion. **3. Clinical Pearls for NEET-PG:** * **Duration Criteria (ICD/DSM):** * < 1 month: Brief Psychotic Disorder (Acute Psychosis). * 1–6 months: Schizophreniform Disorder. * \> 6 months: Schizophrenia. * **Organic vs. Functional:** Always rule out organic causes (like encephalitis or drug toxicity) when fever accompanies new-onset psychosis. However, if the question focuses on the psychiatric presentation, "Acute Psychosis" is the preferred term for rapid-onset symptoms. * **Prognosis:** Acute psychosis usually has a good prognosis, especially when triggered by a clear stressor.

Question 346: Which of the following is considered a poor prognostic factor in schizophrenia?

A. Acute onset (Correct Answer)
B. Middle age of onset
C. Family history of affective disorder
D. Gradual onset

Explanation: **Explanation:** In schizophrenia, prognosis is determined by the mode of onset, clinical features, and premorbid history. **Correct Answer: D. Gradual onset** *(Note: There appears to be a discrepancy in your prompt's marking. **Gradual (insidious) onset** is the poor prognostic factor, while **Acute onset** is actually a good prognostic factor.)* The underlying medical concept is that an **acute onset** (developing over days/weeks) is often triggered by an identifiable stressor and presents with florid positive symptoms, which tend to respond better to antipsychotics. Conversely, a **gradual/insidious onset** (developing over months/years) is associated with structural brain changes, negative symptoms (apathy, withdrawal), and a progressive decline in social functioning, leading to a poorer outcome. **Analysis of Options:** * **A. Acute onset:** A **good** prognostic factor. It suggests a reactive process rather than a deep-seated neurodevelopmental pathology. * **B. Middle age of onset:** A **good** prognostic factor. Late-onset schizophrenia (older age) typically has a better prognosis than early-onset (childhood/adolescence), as the individual has achieved more social and occupational milestones. * **C. Family history of affective disorder:** A **good** prognostic factor. Patients with a family history of mood disorders (like Bipolar or Depression) often have a more "cyclical" or episodic course rather than a chronic deteriorating one. **NEET-PG High-Yield Pearls:** * **Good Prognostic Factors:** Female sex, married status, presence of mood symptoms, positive symptoms (hallucinations/delusions), and clear precipitating stressors. * **Poor Prognostic Factors:** Male sex, single/divorced status, negative symptoms (5 A's: Affective flattening, Alogia, Anhedonia, Avolition, Attention deficit), early age of onset, and poor premorbid personality. * **Most common subtype** with the **best** prognosis: Paranoid Schizophrenia. * Subtype with the **worst** prognosis: Hebephrenic (Disorganized) Schizophrenia.

Question 347: What is the drug of choice for Obsessive-Compulsive Disorder (OCD)?

A. Clomipramine
B. Fluoxetine (Correct Answer)
C. Carbamazepine
D. Chlorpromazine

Explanation: **Explanation:** The drug of choice for **Obsessive-Compulsive Disorder (OCD)** is a **Selective Serotonin Reuptake Inhibitor (SSRI)**. Among the given options, **Fluoxetine** is the correct answer as it is a first-line SSRI used for this condition. **Why Fluoxetine is correct:** OCD is primarily linked to dysregulation in the serotonergic pathways of the brain. SSRIs like Fluoxetine, Sertraline, and Fluvoxamine are preferred as first-line treatments due to their favorable side-effect profile and high safety margin compared to older antidepressants. It is important to note that in OCD, SSRIs are typically required at **higher doses** and for a **longer duration** (10–12 weeks) to show a clinical response compared to their use in Depression. **Analysis of Incorrect Options:** * **Clomipramine (Option A):** This is a Tricyclic Antidepressant (TCA) and is actually the **most potent** anti-obsessional drug. However, it is considered a **second-line** treatment because of its significant side effects (anticholinergic effects, sedation, and cardiotoxicity). * **Carbamazepine (Option C):** This is an anticonvulsant and mood stabilizer used primarily in Bipolar Disorder and Trigeminal Neuralgia; it has no role in the primary management of OCD. * **Chlorpromazine (Option D):** This is a typical antipsychotic used for Schizophrenia. While antipsychotics can sometimes be used as *augmentation* in refractory OCD, they are never the drug of choice. **High-Yield NEET-PG Pearls:** * **First-line treatment:** SSRIs + Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP). * **Most effective drug:** Clomipramine (but not first-line due to safety). * **Neurosurgery for refractory OCD:** Anterior Capsulotomy or Cingulotomy. * **Deep Brain Stimulation (DBS) target:** Subthalamic nucleus or Internal capsule.

Question 348: Infidelity and jealousy involving a spouse is the thought content of which disorder?

A. Capgras syndrome
B. Othello syndrome (Correct Answer)
C. Hypochondrial paranomia
D. Declerambault's syndrome

Explanation: **Explanation:** The correct answer is **Othello Syndrome**, also known as **Morbid or Delusional Jealousy**. This is a psychotic disorder characterized by the unshakable, false belief that one’s spouse or sexual partner is being unfaithful. The patient often seeks "evidence" through stalking, checking belongings, or interrogation. It is clinically significant due to the high risk of domestic violence and homicide. **Analysis of Options:** * **Othello Syndrome (Correct):** Named after Shakespeare’s character, it involves a primary delusion of infidelity. It is frequently associated with chronic alcoholism and personality disorders. * **Capgras Syndrome:** A "delusional misidentification" syndrome where the patient believes a close relative or spouse has been replaced by an identical-looking impostor. * **De Clerambault’s Syndrome (Erotomania):** The delusional belief that a person (usually of higher social status or a celebrity) is deeply in love with the patient, despite little to no contact. * **Hypochondriacal Paranomia:** This is a distracter term; however, *Monomanic Hypochondriacal Psychosis* (like Ekbom syndrome/delusional parasitosis) involves fixed false beliefs regarding physical health or infestation, not infidelity. **NEET-PG High-Yield Pearls:** * **Othello Syndrome** is most commonly associated with **Alcohol Use Disorder**. * **Fregoli Syndrome** (the opposite of Capgras) is the belief that different people are actually a single person in disguise. * **Cotard Syndrome** is the "walking corpse" delusion (nihilistic delusions of being dead or rotting). * These are all categorized as **Delusional Disorders** (ICD-10/DSM-5), where the core symptom is a non-bizarre delusion lasting >1 month without prominent hallucinations.

Question 349: Which category of ICD codes is associated with schizophrenia?

A. F0
B. F1
C. F2 (Correct Answer)
D. F3

Explanation: **Explanation:** In the **ICD-10 (International Classification of Diseases, 10th Revision)**, Chapter V (F) is dedicated to Mental and Behavioral Disorders. The correct answer is **F2**, as this block specifically covers **Schizophrenia, schizotypal, and delusional disorders**. * **F20–F29 (Schizophrenia and related disorders):** This category includes Schizophrenia (F20), Schizotypal disorder (F21), Persistent delusional disorders (F22), and Schizoaffective disorders (F25). These are characterized by fundamental distortions in thinking, perception, and affects that are inappropriate or blunted. **Analysis of Incorrect Options:** * **F0 (Organic Mental Disorders):** Includes symptomatic mental disorders like Dementia (Alzheimer’s, Vascular) and Delirium due to known physiological conditions. * **F1 (Mental and Behavioral Disorders due to Psychoactive Substance Use):** Covers disorders resulting from the use of alcohol, opioids, cannabinoids, and stimulants. * **F3 (Mood [Affective] Disorders):** Includes Manic episodes, Bipolar Affective Disorder (BPAD), and Depressive episodes. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** According to ICD-10, symptoms of schizophrenia must be present for at least **1 month**. (Note: DSM-5 requires 6 months of continuous signs of disturbance). * **First-Rank Symptoms (FRS):** Kurt Schneider’s FRS (e.g., auditory hallucinations, thought withdrawal/insertion) are central to the ICD-10 diagnosis of Schizophrenia. * **Most Common Subtype:** Paranoid Schizophrenia (F20.0) is the most common clinical subtype worldwide. * **F4 block:** Covers Neurotic, stress-related, and somatoform disorders (e.g., OCD, Phobias).

Question 350: Arrange the following subtypes of schizophrenia in order of prognosis, with the best prognosis first and the worst prognosis last: 1. Paranoid schizophrenia 2. Catatonic schizophrenia 3. Simple schizophrenia 4. Disorganised schizophrenia

A. 4-2-1-3
B. 2-1-3-4
C. 2-1-4-3 (Correct Answer)
D. 1-2-4-3

Explanation: ### Explanation The prognosis of schizophrenia subtypes is primarily determined by the age of onset, the nature of symptoms (positive vs. negative), and the level of cognitive/functional impairment. **1. Why Option C (2-1-4-3) is Correct:** * **Catatonic Schizophrenia (Best Prognosis):** It typically has an acute onset and responds remarkably well to treatment, including Benzodiazepines and Electroconvulsive Therapy (ECT). * **Paranoid Schizophrenia:** Characterized by positive symptoms (delusions/hallucinations) with preserved cognitive function and later age of onset. While it has a good prognosis compared to others, it ranks below Catatonic due to the risk of chronicity. * **Disorganised (Hebephrenic) Schizophrenia:** Features early onset, poor premorbid personality, and prominent negative symptoms/thought disorder. It has a poor prognosis due to rapid emotional and cognitive deterioration. * **Simple Schizophrenia (Worst Prognosis):** Characterized by an insidious onset of negative symptoms without overt delusions or hallucinations. It is highly resistant to treatment and leads to severe social drift. **2. Why Other Options are Incorrect:** * **Option A & B:** Incorrectly place Disorganised or Simple schizophrenia ahead of Paranoid/Catatonic. These subtypes are inherently more chronic and less responsive to medication. * **Option D:** Places Paranoid ahead of Catatonic. While Paranoid has a good prognosis, the dramatic and rapid recovery seen in Catatonic schizophrenia (especially with ECT) gives it the clinical edge in prognostic ranking. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognostic Factors:** Late onset, female sex, presence of precipitating factors, acute onset, and positive symptoms. * **Worst Prognostic Factors:** Early onset (Hebephrenic), insidious onset (Simple), male sex, and family history of schizophrenia. * **Note:** In ICD-11 and DSM-5, these classic subtypes have been largely removed in favor of a dimensional approach, but they remain high-yield for competitive exams.

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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