Psychotic Disorders — MCQs

A 30 year old unmarried woman from a low socioeconomic status family believes that a rich boy staying in her neighbourhood is in deep love with her. The boy clearly denies his love towards this lady. Still the lady insists that his denial is a secret affirmation of his love towards her. She makes desperate attempts to meet the boy despite resistance from her family. She also develops sadness at times when her effort to meet the boy does not materialize. She is able to maintain her daily routine. She however, remains preoccupied with the thoughts of this boy. She is likely to be suffering from :

Q364

Paranoid pseudocommunity was given by

Q365

All are first rank symptoms of schizophrenia, except:

Q366

Type of schizophrenia with intellectual disability:

Q367

Prognosis of schizophrenia is best, if:

Q368

Term 'schizophrenia' was coined by:

Q369

Which mental illness shows highest association with homicidal behavior?

Q370

Which of the following is associated with a poor prognosis in schizophrenia?

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 361: Negative symptoms of schizophrenia are all except:-

A. Apathy
B. Anhedonia
C. Over activity (Correct Answer)
D. Alogia

Explanation: ***Over activity*** - **Overactivity** is a manifestation of disorganized or positive symptoms in schizophrenia, such as **agitation** or purposeless movements, rather than a deficiency. - While it can occur in schizophrenia, it represents an excess or distortion of normal function, distinguishing it from **negative symptoms** which reflect a reduction or absence of typical behaviors. *Apathy* - **Apathy**, or avolition, is a core negative symptom characterized by a **lack of motivation** and an inability to initiate or persist in goal-directed activities. - Patients with apathy often show diminished interest in daily activities and personal care. *Anhedonia* - **Anhedonia** is a negative symptom defined by the **inability to experience pleasure** from activities that are usually enjoyable. - This can include a loss of interest in social interactions, hobbies, and other rewarding experiences. *Alogia* - **Alogia**, or poverty of speech, is a negative symptom characterized by a **reduction in the quantity and fluency of speech**. - Individuals with alogia may provide brief, empty responses and exhibit long pauses during conversation.

Question 362: A person of 35 years is having firm belief about infidelity involving the spouse. And he does not allow her to go out of home alone. He often locks his house, while going to the office. In spite of all this he is persistently suspicious about her character. The probable diagnosis is -

A. Schizophrenia
B. Othello syndrome (Correct Answer)
C. Clerambault's syndrome
D. Delusional parasitosis

Explanation: ***Othello syndrome*** - This syndrome is characterized by **delusional jealousy**, where an individual holds an unfounded yet firm belief that their partner is being unfaithful. - Also known as **morbid jealousy**, it represents a **monosymptomatic delusional disorder** specifically focused on infidelity, making it distinct from broader psychotic conditions. - The patient's actions, such as not allowing the spouse to leave alone and locking the house, are common **behavioral manifestations** of this strong belief, often leading to controlling and suspicious behavior. *Schizophrenia* - Schizophrenia involves a broader range of symptoms, including **hallucinations**, **disorganized speech**, and **negative symptoms**, which are not described here. - While delusions can occur in schizophrenia, the primary and isolated focus on infidelity without other psychotic features makes **Othello syndrome** a more specific diagnosis. *Clerambault's syndrome* - Also known as **erotomania**, this syndrome involves the delusional belief that another person, typically of higher status, is **in love with the individual**. - This is distinctly different from the described delusion of infidelity and **jealousy**. *Delusional parasitosis* - This is a rare psychotic disorder in which individuals have a **fixed, false belief** that they are infested with parasites despite no medical evidence. - The symptoms described are clearly related to infidelity and jealousy, not a belief in **parasitic infestation**.

Question 363: A 30 year old unmarried woman from a low socioeconomic status family believes that a rich boy staying in her neighbourhood is in deep love with her. The boy clearly denies his love towards this lady. Still the lady insists that his denial is a secret affirmation of his love towards her. She makes desperate attempts to meet the boy despite resistance from her family. She also develops sadness at times when her effort to meet the boy does not materialize. She is able to maintain her daily routine. She however, remains preoccupied with the thoughts of this boy. She is likely to be suffering from :

A. Depression
B. Delusional disorder (Correct Answer)
C. Schizophrenia
D. Mania

Explanation: ***Delusional disorder*** - The central feature of delusional disorder is the presence of one or more **non-bizarre delusions** for at least one month, without other psychotic symptoms or significant impairment in functioning. In this case, the woman's fixed belief that the rich boy is in love with her, despite clear evidence to the contrary, fits the description of an **erotomanic delusion**. - She is able to maintain a **normal daily routine** and her sadness is a reaction to her efforts to meet the boy not materialising, rather than a pervasive mood disorder, which is consistent with delusional disorder where functioning is often not markedly impaired outside the delusion's specific impact. *Depression* - While the patient experiences sadness, this is episodic and directly related to her inability to pursue her delusion, not a pervasive **depressed mood** with associated neurovegetative symptoms (e.g., significant changes in sleep, appetite, energy, concentration, or feelings of worthlessness/guilt). - The presence of a **fixed, false belief** (delusion) as the primary pathology is not characteristic of depression, although psychotic features can occur in severe depression, they would be accompanied by clear depressive symptoms. *Schizophrenia* - Schizophrenia typically involves a broader range of symptoms, including **hallucinations**, **disorganized speech**, **negative symptoms**, and significant **functional impairment**. These are not described in the patient's presentation. - The patient's delusions in schizophrenia are often **bizarre** (i.e., clearly implausible and not understandable to same-culture peers) and are accompanied by other characteristic symptoms, which are absent here. *Mania* - Mania is characterized by an elevated, expansive, or irritable mood, along with increased energy and goal-directed activity, often accompanied by **grandiosity**, **decreased need for sleep**, **talkativeness**, **flight of ideas**, and **reckless behavior**. - While the patient's persistent pursuit of the boy might seem driven, it lacks the broad constellation of manic symptoms, and her sadness further differentiates her presentation from a manic episode.

Question 364: Paranoid pseudocommunity was given by

A. Norman Cameron (Correct Answer)
B. Benedict Morel
C. Kurt Schneider
D. Eugene Bleuler

Explanation: ***Norman Cameron*** - **Norman Cameron** coined the term **"paranoid pseudocommunity"** to describe how individuals with **paranoid delusions** construct explanations involving others to make sense of their perceived persecution. - This concept highlights the social and interactive aspects of delusion formation, where an individual falsely believes a group of people is conspiring against them. *Benedict Morel* - **Benedict Morel** introduced the term **"démence précoce"** (precocious dementia) in 1856, which was an early concept related to what later became known as schizophrenia. - His work focused on the idea of hereditary degeneration leading to mental illness, rather than specific paranoid phenomena. *Kurt Schneider* - **Kurt Schneider** is known for his **"first-rank symptoms"** of schizophrenia, which are specific psychotic phenomena often considered diagnostic of the disorder. - These symptoms include thought broadcasting, auditory hallucinations (like voices discussing the patient in the third person), and delusions of control. *Eugene Bleuler* - **Eugene Bleuler** coined the term **"schizophrenia"** in 1908, replacing Morel's "démence précoce." - He described the fundamental symptoms of schizophrenia as the **"four A's"** – affective blunting, autism, ambivalence, and disturbances of association.

Question 365: All are first rank symptoms of schizophrenia, except:

A. Audible thoughts
B. Thought broadcasting
C. Voice arguing or discussing or both
D. Perplexity (Correct Answer)

Explanation: ***Perplexity*** - **Perplexity** is a state of severe confusion, bewilderment, or puzzlement, which can be seen in various psychiatric conditions but is not specifically classified as a **first-rank symptom of schizophrenia** by Kurt Schneider. - While it may be present in schizophrenia, it is a non-specific symptom, meaning it can occur in conditions other than schizophrenia. *Audible thoughts* - **Audible thoughts** (Gedankenlautwerden in German) refers to the patient hearing their own thoughts spoken aloud, often as if by another voice. - This is considered a **first-rank symptom** as described by Kurt Schneider, highly indicative of schizophrenia. *Thought broadcasting* - **Thought broadcasting** is the delusional belief that one's thoughts are escaping from their mind and are somehow accessible to others. - This symptom is also a **first-rank symptom** of schizophrenia according to Schneider's criteria. *Voice arguing or discussing or both* - **Voices arguing or discussing** are a specific type of auditory hallucination where two or more voices are perceived to be talking to each other, often about the patient. - This phenomenon is considered a classic **first-rank symptom** of schizophrenia.

Question 366: Type of schizophrenia with intellectual disability:

A. Catatonic schizophrenia
B. Pfropf schizophrenia (Correct Answer)
C. Paranoid schizophrenia
D. Hebephrenic schizophrenia

Explanation: ***Pfropf schizophrenia*** - **Pfropf schizophrenia** is a historical term specifically used to describe a form of schizophrenia that develops in individuals with **pre-existing intellectual disability** (formerly termed mental retardation). - The term "Pfropf" is derived from German, meaning "grafted" or "engrafted," referring to schizophrenia being "grafted onto" pre-existing intellectual disability. - This term distinguishes it from other types of schizophrenia where intellectual disability is not a primary defining characteristic. - While this classification is largely historical (modern DSM-5 has removed schizophrenia subtypes), it remains relevant for older examination questions. *Catatonic schizophrenia* - Characterized primarily by prominent **psychomotor disturbances**, which can include stupor, catalepsy, waxy flexibility, mutism, and negativism. - While intellectual disability might coexist, it is not a defining feature of the catatonic subtype itself. *Paranoid schizophrenia* - Marked by the prominence of **delusions**, typically persecutory or grandiose, and **auditory hallucinations**. - Intellectual disability is not a core diagnostic criterion or a defining characteristic of this subtype. *Hebephrenic schizophrenia* - Also known as **disorganized schizophrenia**, this type is characterized by marked **disorganization of thought processes**, flat or inappropriate affect, and bizarre behavior. - While it often presents early and can lead to significant functional impairment, intellectual disability is not a defining feature; rather, the primary disturbance is in thought and emotion.

Question 367: Prognosis of schizophrenia is best, if:

A. Acute onset (Correct Answer)
B. Negative symptoms
C. Insidious onset
D. Family history is positive

Explanation: ***Acute onset*** - An **acute onset** of schizophrenia is associated with a better prognosis, as it often indicates a more favorable response to treatment and less pervasive deterioration of daily functioning. - This typically suggests that the individual had a relatively intact baseline level of functioning before the emergence of psychotic symptoms. *Negative symptoms* - The presence of prominent **negative symptoms** (e.g., avolition, anhedonia, alogia) is usually associated with a poorer prognosis in schizophrenia. - Negative symptoms are generally harder to treat and often lead to greater functional impairment and disability. *Insidious onset* - An **insidious onset** of schizophrenia, where symptoms develop gradually over time, is typically linked to a poorer prognosis. - This often implies more severe and persistent neurodevelopmental abnormalities and a less robust response to interventions. *Family history is positive* - A **positive family history** of schizophrenia indicates a higher genetic predisposition but does not directly predict the individual's prognosis. - While genetics play a role in susceptibility, the course and outcome of the illness are influenced by many other factors, including symptom presentation and treatment adherence.

Question 368: Term 'schizophrenia' was coined by:

A. Freud
B. Kraepelin
C. Eugene Bleuler (Correct Answer)
D. Schneider

Explanation: ***Eugene Bleuler*** - The Swiss psychiatrist **Eugene Bleuler** was the first to use the term "schizophrenia" in **1908**, replacing **Kraepelin's** term **dementia praecox**. - He coined the term from Greek roots: "schizein" (to split) and "phren" (mind), referring to the **splitting of mental functions**. *Freud* - **Sigmund Freud** is known as the founder of **psychoanalysis** and developed theories on the unconscious mind, defense mechanisms, and psychosexual development. - While influential in psychiatry, he did not coin the term "schizophrenia." *Kraepelin* - **Emil Kraepelin** was a German psychiatrist who developed a classification system for mental disorders and described what he called **"dementia praecox,"** which is now largely equivalent to schizophrenia. - He systematized the understanding of the disorder but did not coin the term "schizophrenia" itself. *Schneider* - **Kurt Schneider** was a German psychiatrist known for his concept of **"first-rank symptoms"** of schizophrenia, which are considered highly characteristic of the disorder. - His contributions were significant in diagnosing schizophrenia, but he did not originate the term.

Question 369: Which mental illness shows highest association with homicidal behavior?

A. Bipolar disorder
B. Paranoid schizophrenia
C. Depression
D. Antisocial personality (Correct Answer)

Explanation: ***Antisocial personality*** - Individuals with **antisocial personality disorder** exhibit a pervasive pattern of disregard for and violation of the rights of others, often leading to aggressive and homicidal behaviors. - Key features include **lack of empathy**, impulsivity, deceitfulness, and a failure to conform to social norms regarding lawful behaviors, which are strong predictors of violence. *Bipolar disorder* - While individuals with bipolar disorder can experience episodes of heightened irritability and impulsivity, particularly during **manic episodes**, their association with homicidal behavior is significantly lower than that of antisocial personality disorder. - Violence in bipolar disorder is often reactive and situation-dependent, rather than the planned, predatory aggression seen in antisocial personality. *Paranoid schizophrenia* - Although **psychotic symptoms** such as delusions and hallucinations can sometimes be associated with violent acts, particularly when the delusions involve a perceived threat, the overall risk of homicidal behavior in schizophrenia is relatively low and often overstated. - Violence in schizophrenia is more frequently directed towards oneself or is an act of self-defense reacting to perceived threats rather than planned aggression toward others. *Depression* - Depression is primarily associated with **internalized aggression** and a significant risk of suicide, rather than outward-directed violence or homicidal behavior. - While severe depression can lead to irritability or a lack of self-control, it is not a direct or strong predictor of homicide.

Question 370: Which of the following is associated with a poor prognosis in schizophrenia?

A. Disorganized schizophrenia (Hebephrenic type) (Correct Answer)
B. Schizophrenia with catatonic features
C. Residual schizophrenia
D. Paranoid schizophrenia

Explanation: ***Disorganized schizophrenia (Hebephrenic type)*** - This subtype is associated with a particularly **poor prognosis** due to its early onset (often during adolescence), significant **disorganization of thought and behavior**, and prominent negative symptoms. - Patients often experience persistent and severe functional impairment, making social and occupational integration very challenging. *Schizophrenia with catatonic features* - While catatonia can be a severe presentation, it is often responsive to treatment with **benzodiazepines** or **ECT**, leading to a potentially better short-term outcome compared to disorganized type. - Catatonic features can be episodic and do not uniformly predict long-term functional decline as stringently as sustained disorganization. *Residual schizophrenia* - This stage implies a progression from an active phase where positive symptoms have receded, and the individual primarily experiences **negative symptoms** or attenuated positive symptoms. - Patients in the residual phase have typically achieved some level of stability and functional adaptation, indicating a relatively better prognosis than the acutely disorganized type. *Paranoid schizophrenia* - This subtype is often considered to have a **better prognosis** than other types due to later onset, preservation of affective responses, and a relatively intact cognitive function. - Individuals with paranoid schizophrenia tend to respond better to treatment, maintain better social and occupational functioning, and have a more stable course of illness.

Practice by Chapter

Schizophrenia: Epidemiology and Etiology

Practice Questions

Schizophrenia: Clinical Features

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Schizophrenia: Treatment

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Schizoaffective Disorder

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Delusional Disorders

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Brief Psychotic Disorder

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Substance-Induced Psychotic Disorders

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Psychosis in Medical Conditions

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First Episode Psychosis

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Treatment-Resistant Psychosis

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Rehabilitation in Psychotic Disorders

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Outcome and Prognosis

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