Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 401: What does the term 'Folie-à-deux' refer to?

A. Delusion of persecution
B. Sharing of delusion (Correct Answer)
C. Delusion of double
D. None of the options

Explanation: ***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be confused with **delusional misidentification syndromes** (like Capgras syndrome where a person believes someone has been replaced by an identical impostor), but this is a different concept from shared psychotic disorder.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.

Question 402: Which type of delusion is primarily associated with Cotard's syndrome?

A. Persecutory delusions
B. Religious delusions
C. Nihilistic delusions (Correct Answer)
D. Hypochondriacal delusions

Explanation: ***Nihilistic delusions*** - **Cotard's syndrome** is characterized by beliefs of **non-existence**, such as the patient being dead, not existing, or having lost their organs, which are typical of **nihilistic delusions**. - These delusions can also extend to the belief that the world or parts of it no longer exist. *Persecutory delusions* - These involve the belief that one is being **harassed, tricked, spied upon, or conspired against**, which is not the primary feature of Cotard's syndrome. - While they can co-occur with other psychiatric conditions, **persecutory themes** are distinct from the non-existence themes of Cotard's. *Religious delusions* - These delusions focus on **religious or spiritual themes**, such as believing one is a prophet or has a special relationship with a deity. - They are not a core component of Cotard's syndrome, which centers on themes of **death and non-existence**. *Hypochondriacal delusions* - These involve a preoccupation with the belief that one has a **serious, undiagnosed medical condition**, despite medical reassurance. - While Cotard's syndrome can involve bodily concerns, the belief in **non-existence of organs** or death goes beyond typical hypochondriacal fears of illness.

Question 403: Which of the following is the most common type of delusional misidentification syndrome?

A. Fregoli
B. Capgras (Correct Answer)
C. Cotard
D. Subjective double

Explanation: **Capgras** - **Capgras delusion** is a misidentification syndrome where an individual believes that a familiar person (e.g., a spouse, child, or parent) has been replaced by an identical imposter. - This delusion is often seen in psychiatric disorders like **schizophrenia** and neurological conditions such as **dementia**. *Fregoli* - **Fregoli delusion** involves the belief that different people are in fact a single person in disguise, who changes their appearance. - Unlike Capgras, where a familiar person is replaced, Fregoli focuses on the idea of a single persecutor or familiar individual appearing in various forms. *Cotard* - **Cotard delusion** is a rare mental illness in which the affected person holds the delusional belief that they are dead, do not exist, are rotting, or have lost their internal organs. - It does not involve the misidentification of other people but rather a nihilistic belief about one's own existence or body. *Subjective double* - The term "subjective double" is not a recognized classic delusion of misidentification in psychiatric diagnostic systems. - While concepts of "doubles" exist in various delusional states, this specific phrasing does not refer to a distinct, widely defined misidentification syndrome in the same way as Capgras or Fregoli.

Question 404: Which of the following statements is NOT true about type 1 schizophrenia?

A. It has a poor prognosis. (Correct Answer)
B. Intellect is usually maintained.
C. It is an acute illness.
D. It is characterized by negative symptoms.

Explanation: ***It has a poor prognosis.*** - This statement is **NOT true** about type 1 schizophrenia, making it the correct answer to this question. - Type 1 schizophrenia is generally associated with a **better prognosis** and good response to antipsychotic medication. - It is characterized by the prominence of **positive symptoms**, which tend to be more responsive to treatment. *It is an acute illness.* - This statement is **TRUE** about type 1 schizophrenia, so it is not the answer. - Type 1 schizophrenia is often characterized by an **acute onset** of symptoms, particularly positive symptoms. - This acute presentation differentiates it from type 2, which typically has a more insidious onset. *Intellect is usually maintained.* - This statement is **TRUE** about type 1 schizophrenia, so it is not the answer. - In type 1 schizophrenia, **cognitive function**, including intellect, is usually better preserved compared to type 2 schizophrenia. - While some cognitive deficits may occur, they are generally less severe and less pervasive than in type 2. *It is characterized by negative symptoms.* - This statement is **FALSE** about type 1 schizophrenia, but it is not the best answer because the prognosis statement is more definitively incorrect. - Type 1 schizophrenia is primarily characterized by the predominance of **positive symptoms**, such as hallucinations, delusions, and disorganized thought. - **Negative symptoms** (e.g., apathy, anhedonia, alogia, blunted affect) are the hallmark of type 2 schizophrenia.

Question 405: Which of the following is NOT considered one of Bleuler's fundamental symptoms of schizophrenia?

A. Loosening of associations
B. Affect disturbances
C. Autism
D. Delusions (Correct Answer)

Explanation: ***Delusions*** - **Delusions** are considered a **first-rank symptom** of schizophrenia according to Schneider, but not one of Bleuler's fundamental "4 A's". - Bleuler classified delusions as **accessory symptoms**, which are variable and not always present, unlike fundamental symptoms. *Loosening of associations* - This is one of Bleuler's **"4 A's"**, representing a disturbance in the logical flow of thought, leading to incoherent speech and fractured thinking. - Bleuler saw this as a core cognitive dysfunction in schizophrenia. *Affect disturbances* - This refers to **inappropriate affect** (e.g., laughing at a funeral) or **blunted/flattened affect**, which is another of Bleuler's "4 A's." - It signifies a disruption in the normal experience and expression of emotions. *Autism* - Bleuler's term **"autism"** (or autismus) refers to a pathological self-preoccupation, withdrawal from social interaction, and an immersion in one's own internal world. - This is also one of Bleuler's **"4 A's"**, highlighting a foundational disturbance in social engagement.

Question 406: What is the medical term for the phenomenon where an individual perceives a double or duplicate of themselves?

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

Explanation: ***Autoscopy*** - **Autoscopy** is a dissociative phenomenon where an individual perceives a vision of their own body projected outside themselves. - It often involves the sensation of seeing a **double** or **duplicate** of oneself from a different spatial perspective. *Capgras syndrome* - **Capgras syndrome** is a delusional misidentification syndrome where a person believes that a close relative or friend has been replaced by an identical impostor. - It does not involve seeing oneself, but rather perceiving others as duplicates or impostors. *Fregoli delusion* - The **Fregoli delusion** is a rare delusional misidentification syndrome in which the affected person believes that different people are in fact a single person in disguise, shifting appearance or identity. - This involves seeing other people as disguised versions of a known individual, not seeing a double of oneself. *Cotard delusion* - **Cotard delusion** (also known as walking corpse syndrome) is a rare mental illness in which the affected person holds the delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. - This delusion specifically involves beliefs about one's own non-existence or loss of bodily parts, rather than seeing a double of oneself.

Question 407: Which of the following is considered a poor prognostic factor for schizophrenia?

A. Poor premorbid adjustment (Correct Answer)
B. Male sex
C. Presence of depression
D. Blunted affect

Explanation: **Poor premorbid adjustment** - **Poor premorbid adjustment**, indicated by difficulties in social, academic, or occupational functioning before the onset of psychosis, is a consistent predictor of a worse outcome in schizophrenia. - This suggests a more pervasive and entrenched neurodevelopmental vulnerability impacting the individual's ability to cope and integrate socially. *Blunted affect (negative symptom)* - While **blunted affect** is a negative symptom often associated with poorer outcomes than positive symptoms, it is typically considered a *symptom* of the illness rather than a primary prognostic *factor* like premorbid adjustment. - Its presence contributes to disability, but it is not as strong an independent prognostic indicator as the life trajectory prior to illness onset. *Male sex (generally poorer prognosis)* - **Male sex** is generally associated with an **earlier age of onset** and often a **more severe course** of schizophrenia. - However, compared to significant functional impairment before disease onset, it is not as strong an individual predictor of overall long-term prognosis. *Presence of depression (often associated with better outcomes)* - The **presence of depressive symptoms** in schizophrenia is often associated with a **better prognosis**. - This is because depressive features can sometimes indicate a more preserved capacity for emotional experience and insight, which can align with higher functioning.

Question 408: Visual hallucinations are typically seen in all of the following conditions except?

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

Explanation: **Depression** - While other forms of hallucinations can occur in severe depression with psychotic features (e.g., auditory), **visual hallucinations are rare**. - **Mood-congruent delusions** are more common in psychotic depression than visual hallucinations. *Delirium* - **Visual hallucinations** are a hallmark symptom of delirium, often described as polymorphic and vivid. - They are typically accompanied by **fluctuating consciousness** and cognitive impairment. *Schizophrenia* - Although **auditory hallucinations** are more common, visual hallucinations can occur in schizophrenia, particularly in advanced or severe cases. - These hallucinations are often well-formed, frequent, and can be **persecutory** or **bizarre** in nature. *Alcohol withdrawal* - **Alcohol withdrawal delirium** (delirium tremens) is characterized by prominent **visual hallucinations**, tactile hallucinations, and autonomic instability. - These hallucinations can be terrifying and are due to **CNS hyperexcitability**.

Question 409: 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?

A. 1 week
B. 3 weeks
C. 2 weeks
D. 1 month (Correct Answer)

Explanation: ***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.

Question 410: In stupor catatonia, all are seen except -

A. Mutism
B. Akinesia
C. Catalepsy
D. Agitation (Correct Answer)

Explanation: ***Agitation*** - **Stuporous catatonia** is characterized by a significant reduction or absence of motor activity and responsiveness, making **agitation**—increased motor activity—an unlikely feature. - In such a state, the patient is typically rigid, immobile, and unresponsive to external stimuli, which is the antithesis of agitation. *Catalepsy* - **Catalepsy** refers to a trance-like state with a loss of voluntary motion and active posturing, where the limbs maintain any position in which they are placed (waxy flexibility). - This is a hallmark feature of **catatonic stupor**, indicating a profound disturbance in motor control. *Mutism* - **Mutism** is the absence or profound reduction of speech, which is a common and defining feature of **catatonic stupor**. - Patients in a stuporous state typically do not speak or respond verbally to questions or commands. *Akinesia* - **Akinesia** is the absence of movement, or pronounced difficulty in initiating voluntary movements, which is a key component of **catatonic stupor**. - Patients exhibit severe motor retardation, often appearing frozen or rigid.

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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