Psychotic Disorders Practice Questions

Q: Delusion of doubles is found in which of the following conditions?

Capgras syndrome. **Explanation:** **Capgras syndrome** is a specific type of **delusional misidentification syndrome**. The core feature is the **"delusion of doubles,"** where a patient believes that a person close to them (usually a spouse or family member) has been replaced by an identical-looking impostor or a "double." This occurs despite the patient recognizing that the person looks exactly like the original, leading to a disconnect between visual recognition and emotional familiarity. **Analysis of Options:** * **Capgras Syndrome (Correct):** It is the classic example of a misidentification syndrome. It is often associated with lesions in the right hemisphere or a disconnection between the temporal cortex (face recognition) and the limbic system (emotional response). * **Schizoaffective Disorder:** While delusions can occur here, they are typically mood-congruent or incongruent general delusions, not the specific "delusion of doubles." * **Reactive Psychosis:** This refers to brief psychotic episodes triggered by extreme stress. While delusions may be present, they are usually transient and not specifically characterized by the Capgras phenomenon. * **Paranoid Schizophrenia:** Although Capgras syndrome can *occur* as a symptom within schizophrenia, the term "delusion of doubles" is the defining diagnostic hallmark of Capgras syndrome itself. **High-Yield Clinical Pearls for NEET-PG:** * **Fregoli Syndrome:** The opposite of Capgras; the patient believes different people are actually a single person in disguise. * **Cotard Syndrome:** The "walking corpse" delusion; the patient believes they are dead, rotting, or have lost their internal organs. * **Ekbom Syndrome:** Delusional parasitosis (belief that one is infested with insects). * **Othello Syndrome:** Delusional jealousy (morbid jealousy regarding a partner's fidelity).

Q: Which of the following is not associated with stuporous catatonia?

Increased speech production. **Explanation:** **Catatonia** is a neuropsychiatric syndrome characterized by a cluster of motor, emotional, and behavioral abnormalities. It is broadly classified into two types: **Stuporous (Retarded)** and **Excited**. **Why "Increased speech production" is the correct answer:** Stuporous catatonia is defined by a state of marked psychomotor retardation. The hallmark features include **mutism** (little to no verbal response) and **stupor** (no psychomotor activity; no active relation to the environment). Therefore, "increased speech production" (logorrhea or pressure of speech) is diametrically opposed to the clinical presentation of stuporous catatonia. Increased speech is instead a feature of **Excited Catatonia** or Manic episodes. **Analysis of incorrect options:** * **Echolalia & Echopraxia:** These are "automatic obedience" or "mimicry" phenomena. Echolalia is the pathological repetition of another's words, and echopraxia is the imitation of another's movements. Both are classic features of catatonia (ICD-10/DSM-5 criteria). * **Rigidity:** This refers to motoric immobility where the patient maintains a stiff posture against all efforts to be moved. It is a core motor sign of the stuporous subtype. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Benzodiazepines (specifically **Lorazepam**) are the first-line treatment (Lorazepam Challenge Test). * **Definitive Treatment:** Electroconvulsive Therapy (ECT) is highly effective, especially in malignant catatonia. * **Waxy Flexibility (Cerea Flexibilitas):** A classic sign where the patient maintains positions into which they are placed by the examiner. * **Gegenhalten (Paratonia):** Resistance to passive movement that is proportional to the strength of the stimulus. * **Malignant Catatonia:** A life-threatening form characterized by autonomic instability and hyperthermia (similar to Neuroleptic Malignant Syndrome).

Q: All of the following are positive features of Schizophrenia except?

Anhedonia. **Explanation:** In Schizophrenia, symptoms are broadly categorized into **Positive symptoms** (excess or distortion of normal functions) and **Negative symptoms** (diminution or loss of normal functions). **Why Anhedonia is the correct answer:** **Anhedonia** is defined as the inability to experience pleasure from activities usually found enjoyable. It is a classic **Negative symptom** of Schizophrenia, often grouped under the "5 A's" of negative symptoms (Affective flattening, Alogia, Anhedonia, Asociality, and Avolition). These symptoms are typically more resistant to traditional antipsychotic treatment and are associated with a poorer long-term prognosis. **Analysis of Incorrect Options:** * **Thought Disorder (A):** Specifically formal thought disorder (e.g., loosening of associations), is a **Positive symptom** representing a disorganized distortion of thinking. * **Visual Hallucination (C):** Hallucinations are sensory perceptions in the absence of external stimuli. They are hallmark **Positive symptoms**. While auditory hallucinations are most common in schizophrenia, visual ones also fall into this category. * **Delusion of Persecution (D):** Delusions are fixed, false beliefs. Persecutory delusions are the most common type in Schizophrenia and are classic **Positive symptoms**. **NEET-PG Clinical Pearls:** * **Positive Symptoms:** Mediated by increased dopamine in the **mesolimbic pathway**. They respond well to typical antipsychotics (D2 blockers). * **Negative Symptoms:** Mediated by decreased dopamine in the **mesocortical pathway**. They respond better to atypical antipsychotics (SDA). * **Schneider’s First Rank Symptoms (FRS):** These are all **Positive symptoms** (e.g., thought insertion, broadcasting, third-person hallucinations) used for diagnosis. Negative symptoms are *not* part of Schneider’s FRS.

Question 1

A female presents with symptoms mimicking heart disease, but with normal ECG and X-ray findings. What is the most likely diagnosis?

Accepted Answer

Panic attack

Answer

Angina pectoris

Answer

Autonomic nervous system instability

Answer

Vasovagal attack

Question 2

Nihilistic ideas are seen in which of the following conditions?

Accepted Answer

Simple schizophrenia, Cotard's syndrome

Answer

Paranoid schizophrenia, Cotard's syndrome

Answer

Paranoid schizophrenia, Depression

Answer

Simple schizophrenia, Depression

Question 3

Delusions of persecution, grandiosity, and infidelity are features of which of the following conditions?

Accepted Answer

Paranoid schizophrenia

Answer

Bipolar disorder

Answer

Obsessive compulsive disorder

Answer

Borderline personality disorder

Question 4

Which of the following is more appropriate in a case of schizophrenia?

Accepted Answer

Common in primitive societies

Answer

Low socioeconomic group

Answer

Seen in adolescents

Answer

Affluent society influences the incidence

Question 5

Which condition is characterized by visual hallucinations in the absence of auditory hallucinations?

Accepted Answer

Organic brain damage

Answer

Obsessive compulsive neurosis

Answer

Agoraphobia

Answer

Schizophrenia

Question 6

Delusion of doubles is found in which of the following conditions?

Accepted Answer

Capgras syndrome

Answer

Schizoaffective disorder

Answer

Reactive psychosis

Answer

Paranoid schizophrenia

Question 7

Schizophrenia is characterized by:

Accepted Answer

Delusion and hallucination

Answer

Tremor and delusion

Answer

Obsession and delusion

Answer

Autonomic disturbance

Question 8

Which of the following is not associated with stuporous catatonia?

Accepted Answer

Increased speech production

Answer

Echolalia

Answer

Echopraxia

Answer

Rigidity

Question 9

Catatonia is most commonly seen with which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Dissociative disorders

Answer

Anxiety disorders

Answer

Obsessive-compulsive disorder

Question 10

All of the following are positive features of Schizophrenia except?

Accepted Answer

Anhedonia

Answer

Thought disorder

Answer

Visual hallucination

Answer

Delusion of persecution

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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