Psychotic Disorders Practice Questions

Q: What is the characteristic feature of catatonic schizophrenia?

All of the above. **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).

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

Auditory. **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).

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

Fluoxetine. **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.

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

Othello syndrome. **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.

Q: Which category of ICD codes is associated with schizophrenia?

F2. **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 1

What is the most common type of persistent delusional disorder?

Accepted Answer

Delusion of persecution

Answer

Somatic delusion

Answer

Delusion of jealousy

Answer

Delusion of grandeur

Question 2

What is the characteristic feature of catatonic schizophrenia?

Accepted Answer

All of the above

Answer

Stupor

Answer

Rigidity

Answer

Negativism

Question 3

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

Accepted Answer

Auditory

Answer

Visual

Answer

Olfactory

Answer

Tactile

Question 4

What is considered a good prognostic factor for schizophrenia?

Accepted Answer

Presence of depression

Answer

Blunted affect

Answer

Early onset

Answer

Male sex

Question 5

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?

Accepted Answer

Acute psychosis

Answer

Dementia

Answer

Delirium

Answer

Delusional disorder

Question 6

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

Accepted Answer

Acute onset

Answer

Middle age of onset

Answer

Family history of affective disorder

Answer

Gradual onset

Question 7

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

Accepted Answer

Fluoxetine

Answer

Clomipramine

Answer

Carbamazepine

Answer

Chlorpromazine

Question 8

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

Accepted Answer

Othello syndrome

Answer

Capgras syndrome

Answer

Hypochondrial paranomia

Answer

Declerambault's syndrome

Question 9

Which category of ICD codes is associated with schizophrenia?

Accepted Answer

F2

Answer

F0

Answer

F1

Answer

F3

Question 10

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

Accepted Answer

2-1-4-3

Answer

4-2-1-3

Answer

2-1-3-4

Answer

1-2-4-3

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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