Psychotic Disorders Practice Questions

Q: Schneider's first-rank symptoms include all of the following except?

Perplexity. **Explanation:** Kurt Schneider (1959) identified a group of symptoms known as **First-Rank Symptoms (FRS)** which, in the absence of organic brain disease, are highly suggestive of Schizophrenia. **Why Perplexity is the correct answer:** **Perplexity** is a state of cognitive uncertainty or confusion often seen in the early stages of psychosis (Trema phase) or in acute and transient psychotic disorders. While it is a common clinical feature, it is **not** part of Schneider’s original list of 11 First-Rank Symptoms. **Analysis of incorrect options (Included in FRS):** * **Delusional Perception (A):** A two-stage phenomenon where a normal perception is suddenly given a private, idiosyncratic, and delusional meaning (e.g., "The traffic light turned red, so I knew I was the King of England"). * **Thought Insertion (B):** A "thought alienation" symptom where the patient believes thoughts are being put into their mind by an external agency. * **Third-person Auditory Hallucinations (C):** Hearing voices talking about the patient in the third person or providing a running commentary on their actions. **High-Yield Clinical Pearls for NEET-PG:** * **The 11 FRS include:** 1. **Auditory Hallucinations:** Voices arguing, Voices commenting, Audible thoughts (Gedankenlautwerden). 2. **Thought Alienation:** Insertion, Withdrawal, Broadcasting. 3. **Made Phenomena (Passivity):** Made Volition (acts), Made Affect (feelings), Made Impulses. 4. **Delusional Perception.** 5. **Somatic Passivity** (bodily sensations imposed by external agency). * **Note:** FRS are no longer required for a diagnosis in DSM-5 or ICD-11, as they lack high specificity (they can occur in Bipolar Disorder). * **Mnemonic:** Remember the **"ABCD"** of FRS: **A**uditory hallucinations (3rd person), **B**roadcasting of thoughts, **C**ontrolled feelings/acts (Passivity), **D**elusional perception.

Q: Waxy flexibility is characteristic of which condition?

Stuporous catatonia. **Explanation:** **Waxy flexibility (Cerea Flexibilitas)** is a classic psychomotor symptom where a patient offers initial resistance to being moved, but then allows their limbs to be placed in a position which they then maintain for a prolonged period (like a lead pipe or warm wax). 1. **Why Stuporous Catatonia is correct:** Catatonia is a neuropsychiatric syndrome characterized by motor abnormalities. It is broadly divided into two types: **Stuporous (Retarded)** and **Excited**. Waxy flexibility is a hallmark of the stuporous subtype, along with mutism, posturing, and negativism. In this state, the patient is conscious but unresponsive to external stimuli, maintaining fixed, often uncomfortable positions. 2. **Why other options are incorrect:** * **Excitatory Catatonia:** This is characterized by purposeless, excessive motor activity, agitation, shouting, and impulsivity. While it is a form of catatonia, waxy flexibility is specifically a feature of the inhibited/stuporous state. * **Obsessive-Compulsive Disorder (OCD):** OCD involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions). It does not involve the gross psychomotor disturbances or muscular rigidity seen in catatonia. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Benzodiazepines (specifically **Lorazepam**) are the first-line treatment for catatonia (the "Lorazepam Challenge Test" is used for diagnosis). * **Definitive Treatment:** If BZDs fail or if the condition is life-threatening (Malignant Catatonia), **Electroconvulsive Therapy (ECT)** is the treatment of choice. * **Gegenhalten (Paratonia):** Often confused with waxy flexibility; it is a form of resistance where the patient resists passive movement with a force proportional to the stimulus. * **Mitmachen:** The patient moves their body in the direction of a slight push, despite being told to resist.

Q: Which of the following is considered a negative symptom of schizophrenia?

Ambivalence. **Explanation:** In Schizophrenia, symptoms are broadly categorized into **Positive** (excess or distortion of normal function) and **Negative** (loss or deficit of normal function). **Why Ambivalence is the Correct Answer:** Ambivalence refers to the simultaneous existence of contradictory emotions, ideas, or desires toward the same object or situation, leading to an inability to make decisions (avolition). It is one of the classic **"4 As" of Bleuler**, which are the fundamental symptoms of schizophrenia. Negative symptoms represent a "diminution" of normal emotional and behavioral states. Ambivalence reflects a deficit in goal-directed behavior and emotional integration, placing it firmly in the negative/deficit category. **Analysis of Incorrect Options:** * **A. Hallucination:** These are sensory perceptions in the absence of external stimuli. They represent an "added" abnormal experience, making them a hallmark **Positive symptom**. * **B. Delusion:** These are fixed, false beliefs held despite evidence to the contrary. Like hallucinations, they represent a distortion of thought content and are **Positive symptoms**. * **C. Motor Hyperactivity:** This is a feature of psychomotor agitation or catatonic excitement. Since it involves an "excess" of motor activity, it is classified as a **Positive/Disorganized symptom**. **NEET-PG High-Yield Pearls:** * **Bleuler’s 4 As:** Remember the mnemonic **A**ffective flattening, **A**utism, **A**mbivalence, and **A**ssociational looseness. * **Schneider’s First Rank Symptoms (FRS):** These focus primarily on positive symptoms (e.g., thought insertion, audible thoughts) and are used for diagnosis, but their absence does not rule out schizophrenia. * **Prognosis:** Negative symptoms (like apathy, anhedonia, and alogia) are generally more resistant to typical antipsychotics and are associated with a **poorer long-term prognosis** compared to positive symptoms.

Q: According to ICD-10 criteria, for how long must symptoms persist for the diagnosis of schizophrenia?

1 month. **Explanation:** The diagnosis of Schizophrenia requires a specific duration of symptoms to differentiate it from transient psychotic states. According to the **ICD-10** (International Classification of Diseases, 10th Revision), the characteristic symptoms (such as delusions, hallucinations, or thought disorder) must be present for a minimum period of **one month**. * **Why Option B is Correct:** ICD-10 criteria stipulate that at least one "very clear" symptom (from groups like thought echo, delusions of control, or persistent hallucinations) or two symptoms from less specific groups (like negative symptoms or catatonic behavior) must be present for **most of the time during a period of at least one month**. * **Why Option C is Incorrect:** A **6-month** duration is the requirement for Schizophrenia according to the **DSM-5** (Diagnostic and Statistical Manual of Mental Disorders). This is a frequent point of confusion in exams. * **Why Option D is Incorrect:** Symptoms lasting less than one month but more than a few days are often classified under **Acute and Transient Psychotic Disorders** (F23) in ICD-10. * **Why Option A is Incorrect:** Two months is not a standard diagnostic cutoff for schizophrenia in either major classification system. **High-Yield Clinical Pearls for NEET-PG:** 1. **ICD-10 vs. DSM-5:** Remember the "1 vs. 6" rule. ICD-10 = 1 month; DSM-5 = 6 months (which must include at least 1 month of active-phase symptoms). 2. **Schneider’s First Rank Symptoms (FRS):** These are highly suggestive of schizophrenia and are heavily weighted in the ICD-10 criteria. 3. **Prognosis:** Good prognostic factors include late onset, female sex, presence of mood symptoms, and being married. Poor prognosis is associated with insidious onset, young age, and prominent negative symptoms.

Q: A 37-year-old man reports that after a sudden financial loss, he had a bout of illness in which he felt sad and nervous and fearful, could not sleep or eat properly. He also began to hear voices telling him that he was useless and should kill himself. His symptoms stopped after approximately one week. He has had no similar episodes. Medical history includes no psychiatric conditions. Physical examination shows no abnormalities, and results of laboratory studies are within normal limits. Which of the following is the most likely diagnosis?

Brief psychotic disorder. ### Explanation The correct diagnosis is **Brief Psychotic Disorder**. **1. Why Brief Psychotic Disorder is correct:** According to DSM-5/ICD criteria, Brief Psychotic Disorder is characterized by the sudden onset of at least one positive psychotic symptom (delusions, hallucinations, or disorganized speech/behavior). Crucially, the duration of the episode is **more than 1 day but less than 1 month**, with an eventual full return to the premorbid level of functioning. This patient’s symptoms (auditory hallucinations) lasted for **one week** and were preceded by a clear psychosocial stressor (financial loss), which is a common trigger. **2. Why the other options are incorrect:** * **Schizophreniform Disorder:** Requires the duration of symptoms to be **between 1 month and 6 months**. This patient’s symptoms lasted only one week. * **Schizophrenia:** Requires a continuous period of illness for **at least 6 months**, including at least one month of active-phase symptoms and significant functional decline. * **Schizo-affective Disorder:** Requires a period of illness where there is a major mood episode (manic or depressive) concurrent with symptoms of schizophrenia, preceded or followed by at least **2 weeks of delusions or hallucinations** in the absence of a major mood episode. **3. High-Yield Clinical Pearls for NEET-PG:** * **Duration-based differentiation is key:** * 6 months: Schizophrenia. * **Prognosis:** Brief Psychotic Disorder generally has a good prognosis, especially when triggered by a marked stressor (formerly called "Brief Reactive Psychosis"). * **Specifiers:** Always look for "with marked stressors" or "postpartum onset" in the history. * **Suicide Risk:** Even though the duration is short, the risk of suicide is high due to the sudden onset and nature of command hallucinations (as seen in this case).

Q: Which of the following is NOT considered a first-rank symptom of schizophrenia?

Ambivalence. To answer this question correctly, it is essential to distinguish between **Kurt Schneider’s First-Rank Symptoms (FRS)** and **Eugen Bleuler’s "4 As"** of schizophrenia. ### **Why Ambivalence is the Correct Answer** **Ambivalence** is one of the "4 As" described by Eugen Bleuler as a fundamental (primary) symptom of schizophrenia. It refers to the coexistence of contradictory emotions or desires toward the same object or situation. While characteristic of the disorder, it is **not** part of Schneider’s First-Rank Symptoms, which focus more on specific types of hallucinations and delusions. ### **Explanation of Incorrect Options (First-Rank Symptoms)** Schneider’s FRS are highly suggestive of schizophrenia in the absence of organic brain disease. The incorrect options are all classic examples: * **Running Commentary:** A specific auditory hallucination where a voice describes the patient’s actions as they happen. * **Primary Delusion:** Also known as delusional perception, where a normal perception is suddenly given a private, idiosyncratic, and delusional meaning. * **Somatic Passivity:** The delusional belief that one’s body is being influenced or acted upon by an external force (a "made" sensation). ### **Clinical Pearls for NEET-PG** * **Bleuler’s 4 As:** **A**ffective flattening, **A**utism, **A**mbivalence, and **A**ssociative looseness. * **Schneider’s FRS Categories:** 1. **Auditory Hallucinations:** Thought echo (Gedankenlautwerden), third-person voices, and running commentary. 2. **Thought Interference:** Thought withdrawal, insertion, and broadcasting. 3. **Passivity Phenomena:** "Made" feelings, "made" impulses, and "made" acts. 4. **Delusional Perception.** * **High-Yield Note:** FRS are no longer required for a diagnosis in the **DSM-5**, as they were found to be less specific than previously thought, but they remain a favorite topic in NEET-PG exams.

Question 1

A 35-year-old woman who needs help with dressing and showering often giggles and laughs for no apparent reason. She spends most of her day rocking, muttering softly to herself, or looking at her reflection in a small mirror. What is the most likely diagnosis?

Accepted Answer

Schizophrenia, disorganized type

Answer

Schizophreniform disorder

Answer

Catatonia

Answer

Shared psychotic disorder

Question 2

Schneider's first-rank symptoms include all of the following except?

Accepted Answer

Perplexity

Answer

Delusional perception

Answer

Thought insertion

Answer

Third-person auditory hallucinations

Question 3

Waxy flexibility is characteristic of which condition?

Accepted Answer

Stuporous catatonia

Answer

Excitatory catatonia

Answer

Obsessive-Compulsive Disorder

Answer

All of the above

Question 4

Anhedonia seen in schizophrenia is linked to which of the following neurotransmitter abnormalities?

Accepted Answer

Norepinephrine

Answer

Serotonin

Answer

Glutamate

Answer

GABA

Question 5

A 50-year-old male presents with a 5-year history of persistent doubt regarding his wife's fidelity, despite evidence to the contrary. All other aspects of his life are normal. What is the most probable diagnosis?

Accepted Answer

Delusional disorder

Answer

Panic disorder

Answer

Depressive disorder

Answer

Phobia

Question 6

Which of the following is considered a negative symptom of schizophrenia?

Accepted Answer

Ambivalence

Answer

Hallucination

Answer

Delusion

Answer

Motor hyperactivity

Question 7

According to ICD-10 criteria, for how long must symptoms persist for the diagnosis of schizophrenia?

Accepted Answer

1 month

Answer

2 months

Answer

6 months

Answer

2 weeks

Question 8

A 37-year-old man reports that after a sudden financial loss, he had a bout of illness in which he felt sad and nervous and fearful, could not sleep or eat properly. He also began to hear voices telling him that he was useless and should kill himself. His symptoms stopped after approximately one week. He has had no similar episodes. Medical history includes no psychiatric conditions. Physical examination shows no abnormalities, and results of laboratory studies are within normal limits. Which of the following is the most likely diagnosis?

Accepted Answer

Brief psychotic disorder

Answer

Schizophreniform disorder

Answer

Schizo-affective disorder

Answer

Schizophrenia

Question 9

A 16-year-old boy does not attend school due to the fear of being harmed by schoolmates. He believes his classmates laugh at and talk about him. He is also scared of going to the market. He is most likely suffering from which of the following disorders?

Accepted Answer

Schizophrenia

Answer

Anxiety neurosis

Answer

Adjustment reaction

Answer

Manic depressive psychosis

Question 10

Which of the following is NOT considered a first-rank symptom of schizophrenia?

Accepted Answer

Ambivalence

Answer

Running commentary

Answer

Primary delusion

Answer

Somatic passivity

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?