Psychotic Disorders Practice Questions

Q: Poor prognostic factor for schizophrenia is?

Insidious onset. ***Insidious onset*** - An **insidious onset** of schizophrenia, where symptoms develop gradually over time, is typically associated with a poorer prognosis. - This often leads to more severe and persistent symptoms, making treatment and recovery more challenging. *Acute onset* - An **acute onset** of schizophrenia, meaning symptoms appear suddenly and rapidly, is generally associated with a better prognosis. - Patients with acute onset are more likely to respond to treatment and achieve remission than those with insidious onset. *Good social support* - **Good social support** is a protective factor and is associated with a better prognosis in schizophrenia. - Individuals with strong social networks tend to have better adherence to treatment, reduced relapse rates, and improved overall functioning. *Predominantly positive symptoms* - While positive symptoms like **hallucinations** and **delusions** can be distressing, a predominance of these symptoms often indicates a better prognosis than a predominance of negative symptoms. - Positive symptoms tend to be more responsive to conventional antipsychotic medications, leading to better outcomes.

Q: Increased dopamine levels are associated with which of the following conditions?

Schizophrenia. ***Schizophrenia*** - The **dopamine hypothesis of schizophrenia** is the most well-established association with increased dopamine levels, particularly in the **mesolimbic pathway**, which contributes to positive symptoms such as **hallucinations** and **delusions**. - Antipsychotic medications, which are **dopamine D2 receptor antagonists**, effectively reduce these positive symptoms by blocking dopamine activity. - This is the **classic and primary answer** when considering increased dopamine levels in psychiatry. *Depression* - Depression is primarily associated with **decreased levels of monoamines**, including **serotonin**, **norepinephrine**, and **dopamine**. - Treatments for depression often aim to increase these neurotransmitter levels, not related to dopamine excess. *Mania* - Mania, a hallmark of **bipolar disorder**, is associated with **increased dopamine activity** along with elevated **norepinephrine** and **serotonin** levels. - While mania does involve dopamine elevation, **schizophrenia** remains the **primary and most established** condition associated with the dopamine hypothesis in psychiatric literature. - The distinction is that schizophrenia's pathophysiology is more centrally and specifically linked to dopamine dysregulation. *Delirium* - Delirium is a state of **acute brain failure** characterized by a fluctuating course and disturbances in attention and cognition. - While neurotransmitter imbalances, including dopamine, **acetylcholine deficiency**, and GABA alterations, can contribute to delirium, it is not primarily defined by increased dopamine as the main pathophysiological mechanism.

Q: A patient inventing new words is a feature of?

Schizophrenia. ***Schizophrenia*** - The invention of new words, known as **neologisms**, is a characteristic symptom of **thought disorder** in schizophrenia. - These words often have personal meaning to the patient but are unintelligible to others, reflecting disturbed communication. *Neurotic disorders* - These disorders, such as anxiety and phobias, primarily involve **distress and maladaptive coping mechanisms** but do not typically feature neologisms. - **Thought content** may be ruminative or anxious, but not disorganized to the extent of inventing new words. *Aphasia* - Aphasia is a **language disorder caused by brain damage** (e.g., stroke), resulting in difficulty with language production or comprehension. - While it can involve word-finding difficulties or paraphasias (word substitutions), it is distinctly different from the deliberate invention of new, non-existent words seen in psychosis. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by **recurrent, intrusive thoughts (obsessions)** and repetitive behaviors (compulsions). - It does not involve thought disorganization or the creation of neologisms; language remains structured, though often focused on obsessive themes.

Q: What is Capgras syndrome?

Belief that a loved one has been replaced by an impostor. ***Belief that a loved one has been replaced by an impostor*** - **Capgras syndrome** is a delusional misidentification syndrome where the affected individual believes that a close relative or loved one has been replaced by an identical-looking impostor. - This delusion can extend to pets or inanimate objects and is often associated with neurological conditions or psychiatric disorders like schizophrenia. *Belief of being loved by someone* - This describes **erotomania** (De Clerambault's syndrome), a delusion where an individual falsely believes that another person, often of higher status, is in love with them. - It is distinct from Capgras syndrome, which involves the belief in an impostor replacing a familiar person. *Belief that different people are the same person in disguise* - This describes **Fregoli syndrome**, another delusional misidentification syndrome where the patient believes that different people are actually a single person who changes appearance or is in disguise. - This is the opposite of Capgras syndrome - in Fregoli, multiple people are seen as one person; in Capgras, one person is seen as an impostor. *Belief of having a serious illness* - This describes **illness anxiety disorder** (formerly hypochondriasis) or a somatic symptom disorder, where a person is preoccupied with having or acquiring a serious illness despite minimal or no symptoms. - This is fundamentally different from the delusional misidentification seen in Capgras syndrome.

Q: What does the term 'Folie-à-deux' refer to?

Sharing of delusion. ***Sharing of delusion*** - **Folie-à-deux**, also known as **shared psychotic disorder**, describes a rare psychiatric syndrome in which a **delusional belief** is transmitted from one individual to another. - It typically occurs between two people in a close relationship, where one individual (the primary case) develops a delusion and the other person (the secondary case) subsequently adopts the same delusion. *Delusion of persecution* - A **delusion of persecution** is a specific type of delusion where an individual believes they are being harmed, harassed, or conspired against by others. - While it can be the content of a shared delusion in folie-à-deux, the term itself refers to the *type* of delusion, not the *sharing* mechanism. *Delusion of double* - "Delusion of double" is not a standard term for folie-à-deux. - This phrase might be confused with **delusional misidentification syndromes** (like Capgras syndrome where a person believes someone has been replaced by an identical impostor), but this is a different concept from shared psychotic disorder. *None of the options* - This option is incorrect because "sharing of delusion" accurately defines folie-à-deux.

Q: According to DSM-5 criteria, symptoms of brief psychotic disorder must resolve within what time period to differentiate it from longer-term psychotic conditions like schizophreniform disorder?

1 month. ***1 month*** - According to **DSM-5 criteria**, brief psychotic disorder is characterized by symptoms lasting more than **1 day** but less than **1 month**. - If psychotic symptoms persist for **1 month or longer**, it indicates a different diagnosis, such as schizophreniform disorder or schizophrenia, requiring further evaluation. *1 week* - While psychotic symptoms may be present for 1 week in brief psychotic disorder, this duration is within the disorder's diagnostic window but not its defining upper limit. - The key differentiator for brief psychotic disorder is that symptoms resolve within **1 month**. *2 weeks* - Similar to 1 week, 2 weeks is a duration that can occur within brief psychotic disorder, but it does not represent the minimum duration that distinguishes it from longer-term conditions. - The crucial threshold for duration in brief psychotic disorder is **less than 1 month**. *3 weeks* - Three weeks also falls within the diagnostic duration for brief psychotic disorder. - The essential criteria specify that psychotic symptoms must last **less than 1 month** to be classified as brief psychotic disorder.

Q: Which of the following is not considered a core diagnostic criterion for schizophrenia according to DSM-5?

Social withdrawal. ***Social withdrawal*** - While **social withdrawal** is a common clinical feature and often reflects negative symptoms in schizophrenia, it is **not specifically listed** as one of the **five core diagnostic criteria (Criterion A)** in DSM-5. - The five core symptom domains are: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behavior, and negative symptoms (diminished emotional expression or avolition). - Social withdrawal may be a manifestation of negative symptoms or part of **social/occupational dysfunction (Criterion B)**, but it is not itself a distinct core diagnostic criterion. *Catatonia* - **Catatonic behavior** (such as stupor, catalepsy, waxy flexibility, posturing, or mutism) is explicitly included as part of the **fourth core diagnostic criterion**: "Grossly disorganized or catatonic behavior." - This makes it one of the five primary symptom domains in **Criterion A** of DSM-5. - Note: "Catatonia" as a **specifier** (requiring 3+ out of 12 symptoms) is different from catatonic behavior as a core symptom. *Hallucinations* - **Hallucinations** (most commonly auditory, but can be visual, tactile, olfactory, or gustatory) are the **second core diagnostic criterion** in DSM-5. - At least **two of the five core symptoms** must be present, and hallucinations fulfill this requirement as a key **positive symptom**. *Disorganized speech* - **Disorganized speech** (formal thought disorder) is the **third core diagnostic criterion** for schizophrenia. - Characterized by **derailment, tangentiality, incoherence, or loose associations**, it reflects significant disruption in organized thinking and communication.

Q: In which socioeconomic strata is schizophrenia most commonly observed?

Low. ***Low*** - Epidemiological studies consistently show a **higher prevalence of schizophrenia** in individuals from **lower socioeconomic strata**. - This association is explained by the "**social drift**" hypothesis, where individuals with schizophrenia experience a decline in social class due to the chronic and disabling nature of the illness, or the "**social causation**" hypothesis, which posits that adverse social conditions contribute to the development of the disorder. *Middle* - While individuals from all socioeconomic backgrounds can develop schizophrenia, it is **less common** compared to the lowest strata. - The middle socioeconomic group generally experiences **better access to resources** and support systems, which may mitigate some risk factors. *Upper* - Schizophrenia is **least common** in the upper socioeconomic strata. - Individuals in this group typically have **greater financial stability**, better living conditions, and access to high-quality healthcare, which might protect against environmental stressors. *Upper middle* - Similar to the middle and upper strata, the upper-middle class experiences a **lower prevalence of schizophrenia** compared to the low socioeconomic group. - This group often benefits from **good educational opportunities** and stable employment, reducing some of the psychosocial stressors associated with the disorder.

Question 1

Poor prognostic factor for schizophrenia is?

Accepted Answer

Insidious onset

Answer

Predominantly positive symptoms

Answer

Good social support

Answer

Acute onset

Question 2

A husband believes that his wife is having an affair with another man despite no evidence to support this belief. What term best describes this belief?

Accepted Answer

A fixed, false belief that is resistant to reason or confrontation with actual fact

Answer

Perception of a stimulus that is not actually present

Answer

A false belief based on incorrect inference about external reality

Answer

A severe disturbance in mental abilities with confusion and altered consciousness

Question 3

Increased dopamine levels are associated with which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Depression

Answer

Mania

Answer

Delirium

Question 4

A 25-year-old male believes that his penis is decreasing in size every day and that it will eventually disappear, leading to his death. What is the most likely diagnosis?

Accepted Answer

Delusional Disorder

Answer

Somatic Symptom Disorder

Answer

Illness Anxiety Disorder

Answer

Obsessive-Compulsive Disorder

Question 5

A patient inventing new words is a feature of?

Accepted Answer

Schizophrenia

Answer

Aphasia

Answer

Neurotic disorders

Answer

Obsessive-Compulsive Disorder (OCD)

Question 6

What is Capgras syndrome?

Accepted Answer

Belief that a loved one has been replaced by an impostor

Answer

Belief of being loved by someone

Answer

Belief of having a serious illness

Answer

Belief that different people are the same person in disguise

Question 7

What does the term 'Folie-à-deux' refer to?

Accepted Answer

Sharing of delusion

Answer

Delusion of persecution

Answer

Delusion of double

Answer

None of the options

Question 8

According to DSM-5 criteria, symptoms of brief psychotic disorder must resolve within what time period to differentiate it from longer-term psychotic conditions like schizophreniform disorder?

Accepted Answer

1 month

Answer

1 week

Answer

3 weeks

Answer

2 weeks

Question 9

Which of the following is not considered a core diagnostic criterion for schizophrenia according to DSM-5?

Accepted Answer

Social withdrawal

Answer

Catatonia

Answer

Hallucinations

Answer

Disorganized speech

Question 10

In which socioeconomic strata is schizophrenia most commonly observed?

Accepted Answer

Low

Answer

Middle

Answer

Upper

Answer

Upper middle

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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