Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 391: 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?

A. A fixed, false belief that is resistant to reason or confrontation with actual fact (Correct Answer)
B. Perception of a stimulus that is not actually present
C. A false belief based on incorrect inference about external reality
D. A severe disturbance in mental abilities with confusion and altered consciousness

Explanation: ***A fixed, false belief that is resistant to reason or confrontation with actual fact*** - This definition precisely describes a **delusion**, which is a core feature of various psychotic disorders. - The husband's unwavering belief in his wife's infidelity despite contrary evidence is characteristic of a **delusion of jealousy** (also known as **Othello syndrome** or **morbid jealousy**). - In clinical practice, this would be diagnosed as **Delusional Disorder, Jealous Type** if it persists for at least 1 month and causes significant distress or impairment. - **Key features:** Fixed, false, unshakeable despite evidence to the contrary. *Perception of a stimulus that is not actually present* - This definition describes a **hallucination**, which is a sensory experience without an external stimulus (e.g., hearing voices, seeing things). - Hallucinations involve perception, whereas delusions involve belief systems. - Not applicable to this scenario as the husband has a false belief, not a false perception. *A false belief based on incorrect inference about external reality* - While this partially describes a delusion, it is **incomplete** as it misses the critical element of being **fixed and resistant to evidence**. - Delusions are not merely incorrect inferences but are held with **absolute conviction** despite clear contradictory evidence. - Many non-delusional beliefs could fit this description (e.g., cognitive distortions, misunderstandings). *A severe disturbance in mental abilities with confusion and altered consciousness* - This definition describes **delirium**, an acute confusional state with fluctuating consciousness and attention deficits. - Delirium typically has an organic cause (e.g., infection, medication, metabolic disturbance). - Not applicable to this scenario, which describes a chronic fixed belief without altered consciousness.

Question 392: Increased dopamine levels are associated with which of the following conditions?

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

Explanation: ***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.

Question 393: Poor prognostic factor for schizophrenia is?

A. Predominantly positive symptoms
B. Good social support
C. Acute onset
D. Insidious onset (Correct Answer)

Explanation: ***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.

Question 394: A patient inventing new words is a feature of?

A. Schizophrenia (Correct Answer)
B. Aphasia
C. Neurotic disorders
D. Obsessive-Compulsive Disorder (OCD)

Explanation: ***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.

Question 395: 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?

A. Somatic Symptom Disorder
B. Delusional Disorder (Correct Answer)
C. Illness Anxiety Disorder
D. Obsessive-Compulsive Disorder

Explanation: ***Delusional Disorder*** - This patient presents with a **fixed, false belief** (penis shrinkage and disappearance) that is not amenable to change in light of conflicting evidence, which is the hallmark of a **delusion**. - This is specifically a **somatic-type delusion** involving bodily functions or sensations. - The clinical presentation is characteristic of **Koro syndrome (genital retraction syndrome)**, a culture-bound syndrome where the patient has an intense fear that their genitalia are retracting and will disappear, leading to death. - Koro is classified under **Delusional Disorder, somatic type** in standard psychiatric classification, making this the most appropriate diagnosis among the given options. *Somatic Symptom Disorder* - Characterized by **distressing somatic symptoms** accompanied by excessive thoughts, feelings, or behaviors related to the symptoms, but without a fixed, false belief. - The patient here has a **delusion** (fixed false belief about genital disappearance), not merely excessive worry about somatic symptoms. - Patients with Somatic Symptom Disorder may be partially reassured; patients with delusions cannot be reassured. *Illness Anxiety Disorder* - Involves **preoccupation with having or acquiring a serious illness** despite absence or mildness of somatic symptoms. - Unlike a delusion, the fear in Illness Anxiety Disorder is **not a fixed, false belief** and patients can often be temporarily reassured. - The patient's belief about penis disappearance is a somatic delusion, not health anxiety. *Obsessive-Compulsive Disorder* - Distinguished by **obsessions** (recurrent, intrusive thoughts recognized as irrational) and/or **compulsions** (repetitive behaviors to neutralize anxiety). - The key difference: in OCD, patients have **insight** that their thoughts are irrational; in delusional disorder, there is **no insight** - the belief is held with conviction. - The patient's fixed belief about genital disappearance is a delusion, not an obsession with doubt.

Question 396: What is Capgras syndrome?

A. Belief that a loved one has been replaced by an impostor (Correct Answer)
B. Belief of being loved by someone
C. Belief of having a serious illness
D. Belief that different people are the same person in disguise

Explanation: ***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.

Question 397: Which of the following is not a feature of psychosis?

A. Loss of insight
B. Preserved contact with reality (Correct Answer)
C. Personality disturbances
D. Presence of delusions

Explanation: ***Preserved contact with reality*** - Psychosis is fundamentally characterized by a **loss of contact with reality**, making this option a defining non-feature of the condition. - Individuals experiencing psychosis often have profound difficulties distinguishing between what is real and what is not. *Loss of insight* - **Lack of insight** into one's own mental illness is a hallmark feature of psychosis, meaning the affected individual may not recognize their thoughts or perceptions as abnormal. - This symptom contributes to the difficulty in engaging individuals with psychosis in treatment. *Presence of delusions* - **Delusions** are fixed, false beliefs that are resistant to reason or evidence, and they are a core positive symptom of psychosis. - These beliefs are often bizarre and can significantly impair an individual's functioning and perception of reality. *Personality disturbances* - While not a primary diagnostic criterion, **personality disturbances** can be associated with psychotic disorders. - Changes in personality, mood, and behavior may occur as a result of the psychotic experience or the underlying illness.

Question 398: Waxy flexibility is a feature of ?

A. Catatonia (Correct Answer)
B. Echolalia
C. Stereotypy
D. Mannerisms

Explanation: ***Catatonia*** - **Waxy flexibility** (or catalepsy) is a classic symptom of **catatonia**, where an individual's limbs can be **placed in any position by the examiner and remain in that position for an extended period**, as if molded from wax. - It reflects a severe psychomotor disturbance, often seen in conditions like **schizophrenia** or **mood disorders** with catatonic features. *Echolalia* - **Echolalia** refers to the **involuntary repetition of another person's spoken words**, typically without understanding. - It is a symptom of thought disorder or communication difficulties, not a state of motor rigidity. *Stereotypy* - **Stereotypy** involves **repetitive, seemingly purposeless movements or utterances** (e.g., body rocking, hand flapping). - While repetitive, it does not involve maintaining a fixed posture imposed by another, as seen in waxy flexibility. *Mannerisms* - **Mannerisms** are **habitual, idiosyncratic gestures or behaviors** that may appear odd but are often voluntary and goal-directed (e.g., an exaggerated bow before speaking). - They are distinct from the involuntary, often rigid, posturing characteristic of waxy flexibility.

Question 399: The delusion that involves the belief that a familiar person has been replaced by someone else is known as?

A. Capgras syndrome (Correct Answer)
B. Cotard syndrome
C. Othello syndrome
D. Fregoli syndrome

Explanation: ***Capgras syndrome*** - This **delusional misidentification syndrome** is characterized by the belief that a familiar person (e.g., a spouse, child, or parent) has been replaced by an identical imposter. - It often occurs in individuals with **schizophrenia**, **dementia**, or following **brain injury**. *Cotard syndrome* - This syndrome involves a nihilistic delusion where the individual believes they are **dead**, do not exist, or have lost their organs or blood. - It is often associated with severe **depression**, psychosis, or neurological disorders. *Othello syndrome* - Also known as **delusional jealousy**, this involves the unfounded belief that one's partner is being unfaithful. - It is a **primary delusional disorder** but can also be seen in conditions like alcohol dependence or neurodegenerative diseases. *Fregoli syndrome* - This is another **delusional misidentification syndrome** where the person believes that different people are actually the same person in disguise. - It is the opposite of Capgras syndrome and may occur in **schizophrenia** or **organic brain disorders**.

Question 400: Which of the following is not considered a core diagnostic criterion for schizophrenia according to DSM-5?

A. Catatonia
B. Hallucinations
C. Disorganized speech
D. Social withdrawal (Correct Answer)

Explanation: ***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.

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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