Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 411: In which socioeconomic strata is schizophrenia most commonly observed?

A. Middle
B. Upper
C. Low (Correct Answer)
D. Upper middle

Explanation: ***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 412: Which of the following is considered a poor prognostic factor for schizophrenia?

A. Presence of depression
B. Presence of stressor
C. Early onset (Correct Answer)
D. Female sex

Explanation: ***Early onset*** - An **earlier age of onset** (e.g., childhood or early adolescence) for schizophrenia is consistently associated with a **worse long-term prognosis**, including more severe symptoms, greater functional impairment, and a lower likelihood of full recovery. - This is thought to be due to the greater developmental disruption caused by the illness when it begins at a younger age. *Presence of depression* - While depression is common in schizophrenia, it is generally considered to be a **treatable co-occurring condition** rather than a primary poor prognostic factor for the core psychotic disorder itself. - Effective treatment for depression can actually **improve overall quality of life** and adherence to antipsychotic medication. *Presence of stressor* - The presence of a significant psychosocial stressor at the onset of schizophrenia is often associated with a **better prognosis**, as it suggests a more reactive and potentially remitting course. - This indicates that the illness might be more environmentally triggered and less intrinsically severe. *Female sex* - **Female sex** is typically associated with a **somewhat better prognosis** in schizophrenia, with a later age of onset and potentially less severe symptoms compared to males. - This may be influenced by hormonal factors and differences in social support networks.

Question 413: Which of the following is a negative symptom of schizophrenia?

A. Hallucination
B. Delusion
C. Motor hyperactivity
D. Alogia (poverty of speech) (Correct Answer)

Explanation: ***Alogia (poverty of speech)*** - **Alogia** refers to a reduction in the **fluency and productivity of speech**, which is a classic **negative symptom** of schizophrenia indicating a *loss* or *absence* of normal functions. - Negative symptoms are characterized by deficits in normal emotional responses or other thought processes. *Hallucination* - **Hallucinations** are perceptual experiences that occur in the absence of an external stimulus, most commonly **auditory** in schizophrenia. - They are considered **positive symptoms** because they represent an *addition* or *distortion* of normal functions. *Delusion* - A **delusion** is a fixed, false belief that is not amenable to change in light of conflicting evidence, such as **persecutory** or **grandiose delusions**. - Delusions are also categorized as **positive symptoms** as they involve an *exaggeration* or *distortion* of normal thought content. *Motor hyperactivity* - **Motor hyperactivity** involves excessive or uncontrolled body movements and is not a typical symptom of schizophrenia. - While schizophrenia can involve **psychomotor agitation**, this is distinct from generalized hyperactivity and is not a core negative symptom.

Question 414: According to current diagnostic criteria (DSM-5), which of the following represents a valid diagnostic formulation for schizophrenia?

A. Schizophrenia with prominent delusions
B. Disorganized schizophrenia
C. Schizophrenia with catatonic features (Correct Answer)
D. Schizophrenia is not classified into subtypes in current diagnostic systems

Explanation: ***Schizophrenia with catatonic features*** - This is the **correct answer** as current diagnostic systems like the **DSM-5** removed traditional subtype classifications for schizophrenia but retained **specifiers** to describe prominent clinical features. - When **catatonic symptoms** are present (catalepsy, waxy flexibility, mutism, negativism, posturing, mannerisms, stereotypy, agitation, grimacing, echolalia, echopraxia), they are documented using the **"with catatonic features" specifier**. - This approach allows clinicians to describe the clinical presentation without rigid subtyping. *Disorganized schizophrenia* - This was a **subtype of schizophrenia** in previous diagnostic manuals (DSM-IV-TR) characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect. - It is **no longer recognized** as a distinct subtype in **DSM-5** because the subtype system lacked stability over time and had limited clinical utility. - These symptoms are now assessed dimensionally as part of the broader schizophrenia diagnosis. *Schizophrenia with prominent delusions* - While **delusions** are a core positive symptom and diagnostic criterion for schizophrenia, "prominent delusions" is **not a recognized specifier** in current diagnostic systems. - Previous "paranoid type" schizophrenia (characterized by prominent delusions/hallucinations) was removed in DSM-5. - Delusion types and content are described in the clinical formulation but not as formal specifiers. *Schizophrenia is not classified into subtypes in current diagnostic systems* - This statement is **partially correct** but not the best answer to the question asked. - While traditional subtypes (paranoid, disorganized, catatonic, undifferentiated, residual) were removed in **DSM-5**, the diagnostic system still uses **specifiers** to capture important clinical features. - Available specifiers include: with catatonia, first episode vs. multiple episodes, acute vs. in partial/full remission, with severity ratings, etc. - Therefore, while there are no subtypes, diagnostic formulations still include important qualifiers.

Question 415: The syndrome characterized by an elaborate delusion that the patient is passionately loved by another person is also known as:

A. Ekbom's syndrome
B. De Clérambault's syndrome (Correct Answer)
C. Othello syndrome
D. Querulous paranoia

Explanation: ***De Clérambault's syndrome*** - Also known as **erotomania**, this syndrome is characterized by the delusional belief that one is passionately loved by another person, often someone of higher social status. - Patients with this syndrome may go to great lengths to communicate with or even stalk the object of their delusion, interpreting any response as confirmation of their belief. *Ekbom's syndrome* - Also known as **delusional parasitosis**, where the patient believes they are infested with parasites (insects, worms, etc.), despite no medical evidence. - This often leads to self-mutilation as they try to remove the perceived parasites. *Othello syndrome* - This is a delusional disorder characterized by the **delusional belief of infidelity** by a spouse or partner, without any substantiating evidence. - It often leads to obsessive surveillance, accusations, and controlling behaviors, driven by intense jealousy. *Querulous paranoia* - This term refers to a type of paranoia where individuals feel that they have been **treated unjustly or wronged** and relentlessly seek to rectify these perceived injustices. - They are often seen as litigious or constantly complaining, characterized by a persistent and intense sense of grievance and a tendency to challenge authority or established systems.

Question 416: The worldwide lifetime prevalence of schizophrenia is best estimated as?

A. 1% (Correct Answer)
B. 2.50%
C. 5%
D. 10%

Explanation: ***1%*** - This value represents the widely accepted **lifetime prevalence** of schizophrenia across diverse populations and cultures. - While exact figures can vary slightly based on study methodology (0.7-1.0%), **1%** is the standard estimate provided in most psychiatric textbooks and epidemiological studies. - This means approximately 1 in 100 people will develop schizophrenia during their lifetime. *2.50%* - This figure is generally too high for the global lifetime prevalence of schizophrenia. - While other mental health conditions (such as depression or anxiety disorders) may have higher prevalence rates, schizophrenia is typically less common. *5%* - This percentage significantly overestimates the prevalence of schizophrenia. - Such a high rate would indicate a far more common disorder than observed clinically and epidemiologically. *10%* - A 10% lifetime prevalence rate for schizophrenia is exceptionally high and not supported by global epidemiological data. - This figure would imply that schizophrenia is one of the most common psychiatric disorders, which is not the case.

Question 417: Which of the following is NOT considered one of Schneider's first-rank symptoms?

A. Auditory hallucinations
B. Thought insertion
C. Passivity phenomenon
D. Elation (Correct Answer)

Explanation: ***Elation*** - **Elation** is a mood state characterized by intense joy, excitement, and a sense of well-being, commonly associated with bipolar disorder or mania. - It is **not** included in Schneider's first-rank symptoms, which are specific psychotic phenomena strongly suggestive of schizophrenia. *Auditory hallucinations* - **Auditory hallucinations** are a core first-rank symptom, specifically including: - **Voices commenting** on one's actions - **Voices arguing** or discussing the patient in the third person - **Thought echo** (audible thoughts) - These specific types of auditory hallucinations are highly indicative in Schneider's criteria for schizophrenia. *Thought insertion* - **Thought insertion** is a classic first-rank symptom where the patient believes that thoughts are being put into their mind by an external force or agency. - Along with **thought withdrawal** (thoughts being removed) and **thought broadcasting** (thoughts being made known to others), this belongs to the category of **disorders of thought possession**. - These are pathognomonic features in Schneider's framework. *Passivity phenomenon* - **Passivity phenomena** (also known as experiences of influence or control) involve the feeling that one's body, movements, emotions, or impulses are being controlled by an external force. - These include **made feelings**, **made impulses**, **made acts**, and **somatic passivity**, all of which are classic first-rank symptoms. - The patient experiences their will or actions as being taken over by an alien force.

Question 418: Delusions of control, persecution, and self-reference are seen in:

A. Delusional disorder
B. Schizophrenia (Correct Answer)
C. Bipolar disorder
D. Generalized anxiety disorder

Explanation: ***Schizophrenia*** - Hallmarks of **schizophrenia** (particularly presentations with predominantly positive symptoms) include bizarre and highly organized delusions, such as **delusions of control**, persecution, and self-reference, often accompanied by auditory hallucinations. - These symptoms disrupt daily functioning and are typically chronic, distinguishing it from other delusional disorders by its pervasive impact and additional psychotic features. - Note: The term "paranoid schizophrenia" is outdated (DSM-5, ICD-11); current classification uses "schizophrenia" with symptom specifiers. *Delusional disorder* - Characterized by **non-bizarre delusions**, meaning they could conceivably occur in real life, such as being followed or poisoned. - Lacks other symptoms of psychosis seen in schizophrenia, like hallucinations, disorganized speech, or negative symptoms. - Delusions are typically more circumscribed and less bizarre than in schizophrenia. *Bipolar disorder* - Primarily defined by episodes of **mania** and **depression**, with mood swings being the dominant feature. - Psychotic symptoms, if present, are usually **mood-congruent** and occur during severe manic or depressive episodes, not as persistent, bizarre delusions. *Generalized anxiety disorder* - Involves **persistent and excessive worry** about various aspects of life, accompanied by physical symptoms like restlessness, fatigue, and difficulty concentrating. - Does not involve delusions or other psychotic symptoms; the anxiety is rooted in reality-based concerns, however exaggerated.

Question 419: Which class of drugs is primarily used for the treatment of schizophrenia?

A. Mood stabilizers
B. Antihistamines
C. Antipsychotic medications (Correct Answer)
D. Antidepressants

Explanation: ***Antipsychotic medications*** - **Antipsychotic medications** primarily target **dopamine receptors** in the brain, which are implicated in the positive symptoms of schizophrenia like **hallucinations** and **delusions**. - They also have effects on other neurotransmitter systems, such as **serotonin**, contributing to their efficacy in managing negative and cognitive symptoms. *Mood stabilizers* - **Mood stabilizers** are primarily used for conditions characterized by extreme mood swings, such as **bipolar disorder**. - While they may be used adjunctively in some cases of schizophrenia to manage mood symptoms, they are not the primary treatment class. *Antihistamines* - **Antihistamines** are primarily used to treat **allergic reactions**, **insomnia**, or **nausea**. - They do not address the core neurochemical imbalances associated with schizophrenia and are not indicated for its treatment. *Antidepressants* - **Antidepressants** are primarily used to treat **depressive disorders** by modulating neurotransmitters like serotonin and norepinephrine. - While depression can co-occur with schizophrenia, antidepressants are not the primary treatment for the psychotic symptoms of schizophrenia and may even exacerbate psychosis in some individuals.

Question 420: Which of the following is considered the prototypical major psychotic disorder?

A. Bipolar disorder with psychotic features
B. Delusional disorder
C. Schizophrenia (Correct Answer)
D. Schizoaffective disorder

Explanation: ***Schizophrenia*** - Schizophrenia is often considered the **prototypical major psychotic disorder** due to its characteristic presentation of **positive symptoms** (hallucinations, delusions, disorganized thought), **negative symptoms** (avolition, anhedonia), and **cognitive deficits**. - It is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves, leading to significant functional impairment. *Bipolar disorder with psychotic features* - This disorder primarily involves **mood disturbances** (manic and depressive episodes), with psychotic symptoms occurring specifically during severe mood episodes. - While it can involve psychosis, the **mood dysregulation** is the defining feature, differentiating it from disorders where psychosis is primary. *Delusional disorder* - Delusional disorder is characterized by the presence of **non-bizarre delusions** for at least one month, without the other prominent psychotic symptoms (e.g., hallucinations, disorganized speech) common in schizophrenia. - The **relative absence of other positive and negative symptoms** distinguishes it from schizophrenia. *Schizoaffective disorder* - Schizoaffective disorder involves a continuous period during which there is an uninterrupted illness where a **major mood episode (manic or depressive) is concurrent with Criterion A of schizophrenia**, and delusions or hallucinations have been present for at least two weeks in the absence of a major mood episode. - Its diagnosis requires the co-occurrence of prominent **mood episodes** with psychotic symptoms, distinguishing it from schizophrenia where psychosis is the core feature without necessarily prominent mood episodes.

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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