Psychotic Disorders — MCQs

Psychotic Disorders Indian Medical PG Practice Questions and MCQs

Question 421: A perception experienced in the absence of an external stimulus in clear consciousness is called:

A. Delusion
B. Hallucination (Correct Answer)
C. Illusion
D. Pseudohallucination

Explanation: ***Hallucination*** - A **hallucination** is defined as a perception occurring in the absence of any external stimulus, experienced in clear consciousness - The individual believes the perception is real and typically cannot distinguish it from genuine sensory input - Can occur in any sensory modality: auditory, visual, tactile, olfactory, or gustatory - Key feature: NO external stimulus present, yet perception occurs *Delusion* - A **delusion** is a fixed, false belief that is not amenable to change despite conflicting evidence - This is a disorder of *thought content*, not perception - Does not involve sensory experiences but rather irrational beliefs *Illusion* - An **illusion** is a misinterpretation or distortion of a real external stimulus - The key difference from hallucination is the *presence* of an actual external stimulus - Example: mistaking a shadow for a person, or hearing wind as voices *Pseudohallucination* - A **pseudohallucination** is a perception where the individual recognizes it as unreal or internally generated - The person has insight that the perception is not from the external environment - Unlike true hallucinations, these are perceived as subjective experiences

Question 422: Characteristic hallucination of schizophrenia is -

A. Auditory hallucinations criticizing the patient
B. Auditory hallucinations talking to patient
C. Auditory hallucinations commanding the patient
D. Auditory hallucinations giving running commentary (Correct Answer)

Explanation: **Auditory hallucinations giving running commentary** - **Third-person auditory hallucinations**, such as *running commentaries* or *voices discussing the patient in the third person*, are considered highly characteristic of **schizophrenia**, particularly a **first-rank symptom**. - These types of hallucinations are distinct from simple voices and often involve multiple voices or a narrative describing the patient's actions or thoughts. *Auditory hallucinations commanding the patient* - While *command hallucinations* can occur in **schizophrenia**, they are not considered as diagnostically characteristic as *third-person commentaries or discussions*. - *Command hallucinations* can also be seen in other psychiatric conditions, including **bipolar disorder** and **severe depression**. *Auditory hallucinations criticizing the patient* - *Critical or pejorative hallucinations* can be present in **schizophrenia**, but they are not as specific to the diagnosis as third-person voices. - These types of hallucinations can also be a feature of **mood disorders** with psychotic features. *Auditory hallucinations talking to patient* - *Second-person auditory hallucinations* where voices speak directly *to* the patient are common in many psychotic disorders, including **schizophrenia**. - However, they lack the specific classic feature of *third-person commentary* or discussion, which is more indicative of **schizophrenia**.

Question 423: A 60-year-old man is brought to a psychiatrist with a 10-year history of persecutory delusions, including the belief that his neighbors conspire against him and that his wife has been replaced by a double. He is well-groomed, alert, and occasionally consumes alcohol. What is the likely diagnosis?

A. Paranoid personality disorder
B. Alcohol withdrawal
C. Conversion disorder
D. Delusional disorder (Correct Answer)

Explanation: ***Delusional disorder*** - This patient presents with **chronic delusions** (persecutory belief about neighbors, Capgras delusion regarding wife being replaced by a double) that have persisted for over 1 month (10 years in this case), with relatively preserved functioning. - The belief that his wife has been replaced by a double is a **Capgras delusion**, a type of delusional misidentification syndrome that can occur in delusional disorder. - Despite the presence of delusions, he remains **well-groomed and alert**, indicating preserved functioning, which is characteristic of **delusional disorder**. - The 10-year duration and absence of prominent hallucinations, negative symptoms, or significant functional decline differentiate this from schizophrenia. *Paranoid personality disorder* - Characterized by pervasive **distrust and suspiciousness** of others, but does not involve **fixed delusions** like belief in conspiracy or delusional misidentification. - Personality disorders involve enduring patterns of thinking and behavior, not discrete psychotic symptoms. - The intensity and conviction of the beliefs described (especially Capgras delusion) exceed what would be seen in a personality disorder. *Alcohol withdrawal* - Typically presents as an **acute syndrome** following cessation or reduction of heavy, prolonged alcohol use, with symptoms like **tremors, autonomic hyperactivity, hallucinations, and seizures**. - The patient has a **10-year history of stable delusions**, not an acute presentation. - "Occasional" alcohol consumption does not suggest alcohol dependence or risk of withdrawal syndrome. *Conversion disorder* - Involves **neurological symptoms** (e.g., paralysis, blindness, non-epileptic seizures) that are inconsistent with recognized neurological diseases and are often related to psychological stressors. - This patient presents with **psychotic symptoms (delusions)**, not unexplained neurological deficits. - No motor or sensory symptoms are described in the case.

Question 424: Schizophrenia with the worst prognosis is which of the following?

A. Disorganized type (Correct Answer)
B. Catatonic type
C. Paranoid type
D. Undifferentiated type

Explanation: ***Disorganized type*** - This subtype, also known as **hebephrenic schizophrenia**, is characterized by prominent **disorganized speech**, **behavior**, and **flat or inappropriate affect**. - The combination of severe thought disorder and affective disturbance typically leads to a **poorer long-term outcome** and **greater functional impairment**. *Catatonic type* - Characterized by prominent psychomotor disturbances, such as **stupor**, **catalepsy**, **waxy flexibility**, mutism, or excessive motor activity. - While acute episodes can be severe, the long-term prognosis is generally considered better than the disorganized type, especially if treatment is initiated early. *Paranoid type* - This subtype is characterized by prominent **delusions** (often persecutory or grandiose) and **auditory hallucinations**, with relatively preserved cognitive function and affect. - Patients with paranoid schizophrenia often have a **better prognosis** and are more likely to achieve functional recovery compared to disorganized type. *Undifferentiated type* - This diagnosis is given when the criteria for the paranoid, disorganized, or catatonic types are not met, but prominent **positive (e.g., delusions, hallucinations)** and **negative (e.g., avolition, anhedonia)** symptoms of schizophrenia are present. - The prognosis varies widely and is not inherently worse than the disorganized type; it simply indicates that the clinical picture doesn't fit neatly into other defined subtypes.

Question 425: Which type of schizophrenia is characterized by prominent psychomotor disturbances such as waxy flexibility, stupor, or catatonic excitement?

A. Simple schizophrenia
B. Hebephrenic schizophrenia
C. Catatonic schizophrenia (Correct Answer)
D. None of the options

Explanation: ***Catatonic schizophrenia*** - **Catatonic schizophrenia** is distinguished by prominent **psychomotor disturbances**, including **waxy flexibility** (the ability to be molded into positions that are then maintained). - Other features include **stupor**, **posturing**, **echolalia**, **mutism**, and **negativism**, along with periods of excessive, purposeless motor activity. *Simple schizophrenia* - This type is characterized by a gradual and insidious onset of **negative symptoms**, such as apathy, anhedonia, and social withdrawal. - It lacks prominent positive symptoms like hallucinations, delusions, or the distinctive psychomotor symptoms seen in catatonia. *Hebephrenic schizophrenia* - Also known as **disorganized schizophrenia**, it is characterized by prominent **disorganized speech** and behavior, as well as flat or inappropriate affect. - While there may be some motor abnormalities, they do not typically manifest as the specific psychomotor features like waxy flexibility or stupor. *None of the options* - This option is incorrect because catatonic schizophrenia precisely describes the symptoms of increased psychomotor activity and waxy flexibility. - These features are classic diagnostic criteria for catatonic presentations within the schizophrenia spectrum.

Question 426: A patient presents with fixed, false beliefs about their partner's fidelity. What is the most likely diagnosis?

A. Schizophrenia
B. Brief psychotic disorder
C. Delusional Disorder (Correct Answer)
D. Adjustment disorder

Explanation: ***Delusional Disorder*** - This condition is characterized by the presence of **non-bizarre delusions** (plausible in real life) that persist for at least one month, often involving themes such as jealousy, persecution, or grandiosity. - The patient's fixed, false beliefs about their partner's fidelity are a classic example of a **delusion of jealousy** (Othello syndrome). - According to DSM-5, the diagnosis requires the presence of delusions for at least one month, with no other symptoms of schizophrenia, and relatively preserved functioning apart from the impact of the delusion. *Schizophrenia* - Schizophrenia involves a broader range of psychotic symptoms, including **bizarre delusions**, hallucinations, disorganized thinking, and negative symptoms. - While delusions are present in schizophrenia, the absence of other symptoms like prominent **hallucinations** or disorganized speech makes this diagnosis less likely. *Brief psychotic disorder* - Brief psychotic disorder is characterized by the sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech) that last for **at least one day but less than one month**. - The key differentiator here is the **duration**: if symptoms persist beyond one month with only delusions present, delusional disorder is more appropriate. *Adjustment disorder* - Adjustment disorder is a stress-related condition characterized by emotional or behavioral symptoms that develop in response to a clearly identifiable stressor. - The symptoms are typically reactive and *do not involve psychotic features* like fixed, false beliefs (delusions).

Question 427: Doppelganger is a term used to describe which medical phenomenon?

A. Shadow following person
B. Feeling of double of oneself (Correct Answer)
C. Identification of stranger as familiar
D. None of the options

Explanation: ***Feeling of double of oneself*** - **Doppelganger** (also called **autoscopy** or **heautoscopy**) refers to the experience of seeing or sensing one's own double or duplicate - This is the **correct definition** of the term doppelganger in medical terminology - Associated with **neurological conditions** (temporal lobe epilepsy, brain lesions, migraine) and **psychiatric conditions** (schizophrenia, dissociative states) - The person perceives their duplicate as a separate entity, which may appear visually or be sensed as a presence *Shadow following person* - This is not a recognized medical or psychiatric phenomenon - Does not describe the autoscopic experience of seeing one's own double - Not related to the definition of doppelganger *Identification of stranger as familiar* - This more closely describes **Fregoli delusion**, where a person believes that different people are actually a single person in disguise - Could also relate to other delusional misidentification syndromes - **Not doppelganger**, which specifically involves seeing one's own double, not misidentifying others - Note: **Capgras syndrome** is the opposite—believing a familiar person has been replaced by an imposter *None of the options* - Incorrect because "Feeling of double of oneself" accurately describes the doppelganger phenomenon

Question 428: A patient with complaints of a deformed nose, despite reassurances from multiple plastic surgeons that there is no deformity, is most probably suffering from:

A. Somatization disorder
B. Delusional disorder (Correct Answer)
C. OCD
D. Hypochondriasis

Explanation: ***Body Dysmorphic Disorder (BDD) / Delusional Disorder (Somatic Type)*** - This is a **classic presentation of Body Dysmorphic Disorder (BDD)** characterized by preoccupation with a perceived defect in physical appearance that is **not observable or appears slight to others** - The nose is the **most common site of concern** in BDD - Patients typically seek reassurance from multiple specialists (plastic surgeons, dermatologists) despite objective evidence of no deformity - When the belief is held with **delusional intensity** (as in this case with multiple reassurances ignored), it can be classified as **delusional disorder, somatic type** - BDD is classified under Obsessive-Compulsive and Related Disorders in DSM-5 *Somatization disorder* - Involves **multiple medically unexplained physical symptoms** affecting various body systems over several years - Not characterized by a singular, fixed belief about a specific perceived physical defect - Patients present with numerous somatic complaints, not focused preoccupation with appearance *Hypochondriasis (Illness Anxiety Disorder)* - Characterized by **preoccupation with having or acquiring a serious illness** based on misinterpretation of bodily symptoms - The focus is on disease/illness, not appearance or physical defects - Different from concern about a perceived cosmetic deformity *OCD* - Involves **recurrent, intrusive thoughts (obsessions)** and **repetitive behaviors (compulsions)** performed to reduce anxiety - While BDD can have obsessive quality, this patient shows a fixed belief about deformity rather than ego-dystonic obsessions - No mention of compulsive rituals or behaviors in this case

Question 429: The primary disturbance in schizophrenia is:

A. Hallucination
B. Illusion
C. Formal Thought Disorder (Correct Answer)
D. Psychomotor Retardation

Explanation: ***Formal Thought Disorder*** - **Formal thought disorder** is considered the primary disturbance in schizophrenia, affecting the structure and organization of thought, leading to symptoms like **loosening of associations**, **tangentiality**, and **word salad**. - It underlies many of the other symptomatic manifestations of schizophrenia, influencing perception, belief, and behavior. *Hallucination* - **Hallucinations** are perceptual disturbances that occur in the absence of an external stimulus, most commonly auditory in schizophrenia. - While prominent in schizophrenia, hallucinations are a *symptom* arising from the underlying thought disorder, not the primary disturbance itself. *Illusion* - An **illusion** is a misinterpretation of an actual external stimulus. - Illusions are much less common in schizophrenia compared to hallucinations and are not considered a primary or defining feature of the disorder. *Psychomotor Retardation* - **Psychomotor retardation** involves a generalized slowing of physical and emotional reactions, and can be seen in conditions like depression or catatonia. - While it can occur in some forms of schizophrenia (e.g., catatonic type), it is not the primary or universal disturbance characterizing the disorder as a whole.

Question 430: Which of the following hallucinations is pathognomonic of schizophrenia?

A. Auditory hallucinations commanding the patient
B. Auditory hallucinations giving running commentary (Correct Answer)
C. Auditory hallucinations criticizing the patient
D. Auditory hallucinations talking to patient

Explanation: ***Auditory hallucinations giving running commentary*** - **Third-person auditory hallucinations**, particularly those giving a continuous descriptive commentary on the patient's actions, thoughts, or movements, are considered **pathognomonic of schizophrenia** within Schneider's first-rank symptoms. - These are distinguished from other types of auditory hallucinations by their specific content and the perspective from which they are perceived, indicating a fundamental disruption in self-perception and reality testing. *Auditory hallucinations commanding the patient* - **Command hallucinations** involve voices instructing the patient to perform specific actions and can occur in various psychiatric conditions, including other psychoses, mood disorders with psychotic features, and even non-psychotic states. - While significant and potentially dangerous, they are **not unique to schizophrenia** and therefore not pathognomonic. *Auditory hallucinations criticizing the patient* - **Critical auditory hallucinations** involve voices that demean, scold, or negatively evaluate the patient, contributing to distress and low self-esteem. - These are also **nonspecific** and can be found in a range of mental health conditions, including depression with psychotic features and bipolar disorder. *Auditory hallucinations talking to patient* - **Second-person auditory hallucinations**, where voices communicate directly with the patient in a conversational manner, are common in various psychotic disorders. - They are a general feature of psychosis and **do not specifically indicate schizophrenia** over other conditions; the *content* and *form* of the hallucination are crucial for differential diagnosis.

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

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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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