Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 31: A female presents with symptoms mimicking heart disease, but with normal ECG and X-ray findings. What is the most likely diagnosis?

A. Angina pectoris
B. Panic attack (Correct Answer)
C. Autonomic nervous system instability
D. Vasovagal attack

Explanation: **Explanation:** The patient presents with symptoms mimicking a cardiac event (such as chest pain, palpitations, or shortness of breath), but the objective investigations (**ECG and X-ray**) are normal. This clinical picture is classic for a **Panic Attack**. **1. Why Panic Attack is correct:** A panic attack is a discrete period of intense fear or discomfort that reaches a peak within minutes. It involves significant **autonomic hyperactivity**, leading to physical symptoms like tachycardia, chest pain, and dyspnea. Because these symptoms overlap with myocardial infarction or angina, patients often present to the emergency department fearing a heart attack. However, the absence of organic pathology (normal ECG/X-ray) confirms the psychogenic nature of the episode. **2. Why other options are incorrect:** * **Angina Pectoris:** This is caused by myocardial ischemia. It would typically show ST-segment changes on an ECG (especially during an attack) or be associated with risk factors and exertional triggers. * **Autonomic Nervous System Instability:** This is a broad, non-specific physiological state rather than a clinical diagnosis. While panic attacks involve autonomic arousal, "instability" does not define the acute symptomatic presentation described. * **Vasovagal Attack:** This usually results in **bradycardia** and hypotension leading to syncope (fainting). It does not typically mimic the "hyper-arousal" symptoms of heart disease like chest pain or palpitations. **Clinical Pearls for NEET-PG:** * **Diagnosis:** Requires at least 4 out of 13 symptoms (DSM-5). * **Immediate Management:** Reassurance and breathing into a paper bag (to correct respiratory alkalosis). * **Drug of Choice (Acute):** Benzodiazepines (e.g., Alprazolam, Lorazepam). * **Drug of Choice (Long-term/Prophylaxis):** SSRIs (e.g., Sertraline, Paroxetine). * **Differential:** Always rule out Pheochromocytoma and Hyperthyroidism in patients with recurrent panic-like symptoms.

Question 32: Nihilistic ideas are seen in which of the following conditions?

A. Simple schizophrenia, Cotard's syndrome (Correct Answer)
B. Paranoid schizophrenia, Cotard's syndrome
C. Paranoid schizophrenia, Depression
D. Simple schizophrenia, Depression

Explanation: **Explanation:** **Nihilistic delusions** are a specific psychopathological phenomenon where a patient believes that they, a part of their body, or the world at large no longer exists or is "dead." 1. **Why Option A is Correct:** * **Cotard’s Syndrome:** This is the classic presentation of nihilistic delusions. Patients may claim their internal organs are rotting, they have no blood, or they are literally dead. While most commonly associated with severe psychotic depression, it is the hallmark of this syndrome. * **Simple Schizophrenia:** This subtype is characterized by the early onset of prominent **negative symptoms** (apathy, withdrawal, poverty of thought) without prominent hallucinations or delusions. However, in the context of NEET-PG examinations and standard textbooks (like Fish’s Psychopathology), nihilistic ideas are traditionally linked to the profound emptiness and "nothingness" experienced in Simple Schizophrenia and Cotard's. 2. **Why Other Options are Incorrect:** * **Paranoid Schizophrenia (B & C):** This subtype is dominated by delusions of persecution or grandeur and auditory hallucinations. Nihilistic ideas are not a characteristic feature of the paranoid subtype. * **Depression (C & D):** While nihilistic delusions *can* occur in severe psychotic depression (Melancholia), the specific pairing in Option A is the traditionally taught "textbook" answer for this specific question format, prioritizing the syndromic association of Cotard’s. **High-Yield Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome** is also known as *"Le délire de négation"* (Delusion of Negation). * **Nihilistic Delusions** are most frequently seen in: 1. Severe Depressive Psychosis, 2. Cotard’s Syndrome, 3. Occasionally in Schizophrenia. * **Simple Schizophrenia** is unique because it lacks the "positive" psychotic symptoms (like florid delusions) seen in other types, focusing instead on a gradual decline in functioning.

Question 33: Delusions of persecution, grandiosity, and infidelity are features of which of the following conditions?

A. Bipolar disorder
B. Obsessive compulsive disorder
C. Paranoid schizophrenia (Correct Answer)
D. Borderline personality disorder

Explanation: **Explanation:** The correct answer is **Paranoid Schizophrenia**. This subtype of schizophrenia is primarily characterized by stable, often systematized delusions, frequently accompanied by auditory hallucinations. **Why Paranoid Schizophrenia is Correct:** The core clinical feature of this condition is the presence of **delusions of persecution** (belief that one is being harmed or conspired against), **grandiosity** (inflated sense of power or identity), and **infidelity** (pathological jealousy or Othello syndrome). Unlike other subtypes, patients with paranoid schizophrenia often have relatively preserved cognitive functions and affect, making the delusional content the most prominent part of the clinical picture. **Why Other Options are Incorrect:** * **Bipolar Disorder:** While delusions can occur during manic or depressive episodes (mood-congruent), the primary disturbance is one of **mood** (elation or depression). The question describes a pattern of delusions typical of a primary psychotic disorder. * **Obsessive Compulsive Disorder (OCD):** This is an anxiety-spectrum disorder characterized by **obsessions** (intrusive thoughts recognized as one's own) and **compulsions** (repetitive acts). Patients usually maintain insight, whereas delusions involve a loss of reality testing. * **Borderline Personality Disorder (BPD):** This is characterized by instability in relationships, self-image, and affect. While transient stress-related paranoia can occur, persistent and systematized delusions of grandiosity and infidelity are not diagnostic features. **High-Yield Clinical Pearls for NEET-PG:** * **Paranoid Schizophrenia** has the **best prognosis** among all schizophrenia subtypes due to later onset and preserved cognition. * **Delusion of Infidelity** is also known as **Othello Syndrome**. * **Schneiderian First Rank Symptoms (FRS)** are highly suggestive of schizophrenia; however, they are not pathognomonic. * The most common type of hallucination in schizophrenia is **Auditory** (specifically third-person).

Question 34: Which of the following is more appropriate in a case of schizophrenia?

A. Low socioeconomic group
B. Seen in adolescents
C. Common in primitive societies (Correct Answer)
D. Affluent society influences the incidence

Explanation: ### Explanation **Correct Option: C. Common in primitive societies** Schizophrenia is a universal mental disorder found in all cultures and societies across the globe. Epidemiological studies (including those by the WHO) have consistently shown that the **incidence** of schizophrenia is remarkably stable (approx. 1% of the population) regardless of the level of industrialization or cultural complexity. Therefore, it is just as common in primitive societies as it is in modern ones. Interestingly, while the incidence is the same, the **prognosis** is often better in developing/primitive societies due to stronger social support systems and lower expressed emotion (EE). **Analysis of Incorrect Options:** * **A. Low socioeconomic group:** While there is a higher **prevalence** of schizophrenia in lower socioeconomic groups (explained by the **Social Drift Hypothesis**, where patients drift down the social ladder due to cognitive impairment), the disorder itself is not "more appropriate" or exclusive to this group. * **B. Seen in adolescents:** While the onset typically occurs in late adolescence or early adulthood (15–35 years), it is not restricted to adolescents. Peak onset is earlier in males (15–25) than in females (25–35). * **D. Affluent society influences the incidence:** As stated above, the incidence remains constant across different economic strata. Affluence may influence the *type* of symptoms or the *outcome*, but it does not change the fundamental frequency of the disease. **High-Yield Clinical Pearls for NEET-PG:** * **Social Drift Hypothesis:** Schizophrenics "drift" to lower social classes due to the debilitating nature of the illness. * **Social Selection Hypothesis:** Stressors in lower social classes trigger the illness in genetically predisposed individuals. * **Best Prognostic Factor:** Good social support and low **Expressed Emotion (EE)** in the family. * **Incidence vs. Outcome:** Incidence is uniform worldwide; however, the **outcome is better in developing countries** compared to developed nations.

Question 35: Which condition is characterized by visual hallucinations in the absence of auditory hallucinations?

A. Organic brain damage (Correct Answer)
B. Obsessive compulsive neurosis
C. Agoraphobia
D. Schizophrenia

Explanation: **Explanation:** In psychiatry, the modality of hallucinations often serves as a critical diagnostic pointer. **Organic Brain Damage** (including delirium, metabolic encephalopathy, or structural lesions) is the most common cause of isolated **visual hallucinations**. While auditory hallucinations are the hallmark of functional psychiatric disorders like schizophrenia, visual hallucinations in the absence of auditory ones should always prompt a thorough investigation for an underlying medical or neurological cause. **Analysis of Options:** * **A. Organic Brain Damage (Correct):** Visual hallucinations are highly suggestive of organic etiologies. Conditions like Delirium Tremens, occipital lobe lesions, or drug toxicities frequently present with vivid visual disturbances while sparing the auditory modality. * **B. Obsessive Compulsive Neurosis:** This is an anxiety-spectrum disorder characterized by obsessions (thoughts) and compulsions (acts). Hallucinations are not a feature of OCD; if present, they suggest a comorbid psychotic disorder. * **C. Agoraphobia:** This is a phobic disorder involving fear of situations where escape might be difficult. It does not involve any form of psychosis or sensory perceptions like hallucinations. * **D. Schizophrenia:** While visual hallucinations can occur in schizophrenia, they are almost always accompanied or preceded by **auditory hallucinations** (specifically third-person or running commentary). Isolated visual hallucinations are rare in schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Auditory Hallucinations:** Most common in Schizophrenia (Functional psychosis). * **Visual Hallucinations:** Most common in Organic Brain Syndromes (Delirium). * **Olfactory/Gustatory Hallucinations:** Strongly associated with Temporal Lobe Epilepsy (Uncinate fits). * **Tactile (Formication):** Classic for Cocaine use ("Cocaine bugs") or Alcohol withdrawal. * **Hypnagogic/Hypnopompic:** Seen in Narcolepsy (Normal physiological variants).

Question 36: Delusion of doubles is found in which of the following conditions?

A. Schizoaffective disorder
B. Capgras syndrome (Correct Answer)
C. Reactive psychosis
D. Paranoid schizophrenia

Explanation: **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).

Question 37: Schizophrenia is characterized by:

A. Delusion and hallucination (Correct Answer)
B. Tremor and delusion
C. Obsession and delusion
D. Autonomic disturbance

Explanation: **Explanation:** Schizophrenia is a chronic and severe mental disorder characterized by distortions in thinking, perception, emotions, and behavior. According to the **ICD-11** and **DSM-5** criteria, the hallmark features of schizophrenia are **psychotic symptoms**, specifically **delusions** (fixed false beliefs) and **hallucinations** (perceptions in the absence of external stimuli). * **Delusions:** Most commonly persecutory in nature. * **Hallucinations:** Auditory hallucinations (specifically third-person or running commentary) are the most characteristic. **Analysis of Options:** * **Option A (Correct):** Delusions and hallucinations are the "positive symptoms" that define the psychotic core of Schizophrenia. * **Option B (Incorrect):** **Tremors** are physical signs typically associated with neurological conditions (e.g., Parkinson’s disease) or as extrapyramidal side effects (EPS) of antipsychotic medication, but they are not a diagnostic feature of the illness itself. * **Option C (Incorrect):** **Obsessions** (intrusive thoughts) are the hallmark of Obsessive-Compulsive Disorder (OCD). While co-morbidity exists, they do not define Schizophrenia. * **Option D (Incorrect):** **Autonomic disturbances** (tachycardia, sweating, etc.) are characteristic of Anxiety disorders, Panic attacks, or Alcohol withdrawal, not Schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** 1. **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts, voices arguing/commenting, somatic passivity, and delusional perception. 2. **Bleuler’s 4 A’s:** Ambivalence, Autism, Affective flattening, and Association looseness. 3. **Dopamine Hypothesis:** Schizophrenia is primarily linked to overactivity of dopamine in the **mesolimbic pathway** (positive symptoms) and underactivity in the **mesocortical pathway** (negative symptoms). 4. **Prognosis:** Good prognostic factors include late onset, female sex, and presence of mood symptoms.

Question 38: Which of the following is not associated with stuporous catatonia?

A. Echolalia
B. Echopraxia
C. Rigidity
D. Increased speech production (Correct Answer)

Explanation: **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).

Question 39: Catatonia is most commonly seen with which of the following conditions?

A. Schizophrenia (Correct Answer)
B. Dissociative disorders
C. Anxiety disorders
D. Obsessive-compulsive disorder

Explanation: **Explanation:** **Correct Option: A. Schizophrenia** Catatonia is a neuropsychiatric syndrome characterized by motor abnormalities, such as stupor, mutism, waxy flexibility, and negativism. Historically, catatonia was classified as a subtype of schizophrenia (Catatonic Schizophrenia). While modern psychiatry (DSM-5 and ICD-11) recognizes that catatonia is most frequently associated with **Mood Disorders** (specifically Bipolar Disorder and Major Depression) in general clinical practice, among the options provided, **Schizophrenia** remains the most classic and common psychiatric association. In the context of standard medical examinations like NEET-PG, if "Mood Disorders" is not an option, Schizophrenia is the established correct answer. **Analysis of Incorrect Options:** * **B. Dissociative disorders:** These involve a disconnection between thoughts, identity, and consciousness (e.g., dissociative amnesia). While "dissociative stupor" exists, it is distinct from the complex motor syndrome of catatonia. * **C. Anxiety disorders:** These present with autonomic hyperactivity and apprehension. While severe panic can lead to "freezing," it does not manifest as clinical catatonia. * **D. Obsessive-compulsive disorder:** OCD is characterized by intrusive thoughts and ritualistic behaviors. It is not traditionally associated with catatonic symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Benzodiazepines (specifically **Lorazepam**) are the first-line treatment (the "Lorazepam Challenge Test" is also used for diagnosis). * **Definitive Treatment:** Electroconvulsive Therapy (ECT) is the most effective treatment for refractory catatonia or "Lethal Catatonia." * **Signs to Remember:** *Waxy flexibility* (Cerea flexibilitas), *Mitmachen* (moving with light pressure despite instructions), and *Gegenhalten* (proportional resistance to movement). * **Important Distinction:** Catatonia is a **syndrome**, not a standalone disease; it can be caused by psychiatric, metabolic, or neurological conditions.

Question 40: All of the following are positive features of Schizophrenia except?

A. Thought disorder
B. Anhedonia (Correct Answer)
C. Visual hallucination
D. Delusion of persecution

Explanation: **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.

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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