Psychotic Disorders Practice Questions

Q: A 25-year-old male complains of a visual hallucination of a transparent phantom of his own body. What is the most likely diagnosis?

Autoscopic psychosis. **Explanation:** The correct answer is **Autoscopic psychosis**. This is a rare phenomenological experience where an individual perceives a vision of their own body in external space. **1. Why Autoscopic Psychosis is Correct:** Autoscopy (from Greek *autos* "self" and *skopeo* "to look") refers to the experience of seeing a "double" or a phantom of oneself. In this condition, the patient sees a mirror image of themselves, which is often described as **transparent, colorless, or ghostly**. Unlike a reflection in a mirror, the phantom may mimic the patient’s movements or remain stationary. It is often associated with organic brain lesions (especially in the parieto-occipital region), epilepsy, or severe psychological stress. **2. Analysis of Incorrect Options:** * **Capgras Syndrome:** A delusional misidentification where the patient believes a close relative or friend has been replaced by an identical-looking **imposter**. * **Lycanthropy:** A rare delusion where the patient believes they are being transformed into an **animal** (traditionally a wolf). * **Cotard Syndrome:** Also known as "Walking Corpse Syndrome," it is a nihilistic delusion where the patient believes they are **dead**, rotting, or have lost their internal organs/blood. **3. Clinical Pearls for NEET-PG:** * **Heautoscopy:** A variation of autoscopy where the patient sees a double but is unsure which "self" is the real one (associated with vestibular dysfunction). * **Out-of-Body Experience (OBE):** The patient feels their consciousness has left their body and is looking down at their physical self from an elevated perspective. * **Fregoli Syndrome:** The delusional belief that different people are actually a single person in disguise.

Q: A 36-year-old individual has a firm belief that his wife is having an affair. He often sits alone, muttering to himself, and hears voices commenting about him. He was completely normal two weeks prior. What is the most likely diagnosis?

Acute psychosis. **Explanation:** The correct diagnosis is **Acute Psychosis** (specifically Acute and Transient Psychotic Disorder as per ICD-10, or Brief Psychotic Disorder as per DSM-5). **1. Why Acute Psychosis is correct:** The clinical presentation includes core psychotic symptoms: a **delusion** (belief of infidelity/delusional jealousy) and **auditory hallucinations** (voices commenting). The defining factor in this case is the **duration**. The patient was "completely normal two weeks prior," meaning the symptoms have lasted less than one month. In psychiatric classification, psychotic symptoms lasting more than one day but less than one month are categorized as Acute Psychotic Disorder. **2. Why other options are incorrect:** * **Schizophrenia:** Requires a minimum duration of **6 months** (DSM-5) or **1 month** (ICD-10) of continuous symptoms. A two-week duration is insufficient for this diagnosis. * **Delusional Disorder:** Characterized by non-bizarre delusions lasting at least 1 month. Crucially, in Delusional Disorder, prominent hallucinations (like the commenting voices seen here) are typically absent, and the patient’s functioning is not markedly impaired outside the delusion. * **Somatoform Disorder:** This involves physical symptoms (pain, fatigue) that suggest a medical condition but are not fully explained by one. It does not involve psychosis (delusions or hallucinations). **Clinical Pearls for NEET-PG:** * **Duration Criteria:** * 6 months: Schizophrenia. * **Prognosis:** Acute psychosis often has a sudden onset (within 2 weeks) and a good prognosis, frequently triggered by a stressful life event. * **Delusional Jealousy:** Also known as **Othello Syndrome**, it can be a feature of various psychotic disorders or chronic alcoholism.

Q: Microcephaly is related to which of the following conditions?

Schizophrenia. **Explanation:** **Correct Option: D. Schizophrenia** While Schizophrenia is primarily a psychiatric disorder, it is increasingly recognized as a neurodevelopmental condition. Neuroimaging and post-mortem studies have consistently demonstrated structural brain abnormalities in schizophrenic patients, including **reduced intracranial volume** and **decreased gray matter volume**. This reduction in brain size often manifests as a lower-than-average head circumference (microcephaly) compared to healthy controls, likely due to impaired neurogenesis or excessive synaptic pruning during development. **Analysis of Incorrect Options:** * **A. Alexander Disease:** This is a leukodystrophy caused by mutations in the *GFAP* gene. It typically presents with **macrocephaly** (megalencephaly) due to the accumulation of Rosenthal fibers and white matter destruction. * **B. Tuberous Sclerosis:** While it causes cortical tubers and subependymal nodules, it is not classically associated with microcephaly. In some cases, it can lead to obstructive hydrocephalus (due to SEGA), which would cause **macrocephaly**. * **C. Cowden Disease:** Part of the PTEN hamartoma tumor syndrome, this condition is a classic cause of **macrocephaly** (specifically megalencephaly) along with multiple hamartomas. **High-Yield Clinical Pearls for NEET-PG:** * **Macrocephaly (Megalencephaly) Differentials:** Alexander disease, Canavan disease, Cowden syndrome, Sotos syndrome, and Neurofibromatosis type 1. * **Microcephaly Differentials:** TORCH infections (especially Zika and CMV), Fetal Alcohol Syndrome, Down Syndrome, and Rett Syndrome. * **Schizophrenia Fact:** The most common structural finding on MRI in Schizophrenia is **enlargement of the lateral ventricles** (ventriculomegaly) secondary to decreased cortical volume.

Q: Folie à deux is a psychiatric syndrome in which symptoms of a delusionally biased belief system are shared by two or more individuals with unusually close social relationships. Which of the following conditions is most commonly associated with Folie à deux?

Paranoid disorder. **Explanation:** **Folie à deux**, also known as **Shared Psychotic Disorder** (ICD-10: Induced Delusional Disorder), is a rare syndrome where a delusion is transmitted from one individual (the primary/inducer) to another (the secondary/recipient) who are closely related. **Why Paranoid Disorder is Correct:** The core feature of Folie à deux is a **delusion**, most commonly of a **persecutory (paranoid)** nature. The "inducer" typically suffers from a chronic psychotic illness, most frequently **Delusional Disorder (Paranoid Disorder)** or Schizophrenia. The recipient, who is often suggestible or dependent, adopts the inducer’s paranoid belief system due to social isolation and a close emotional bond. **Why Other Options are Incorrect:** * **Obsessive-Compulsive Disorder (A):** Characterized by intrusive thoughts and repetitive behaviors, not fixed false beliefs (delusions). * **Hysteria (C):** Now termed Dissociative or Conversion disorders; these involve physical symptoms or memory loss triggered by psychological stress, not shared delusional systems. * **Neurasthenia (D):** An archaic term for a condition involving fatigue, headache, and irritability; it lacks psychotic features. **NEET-PG High-Yield Pearls:** * **Management:** The primary treatment for the "recipient" is **separation** from the inducer, which often leads to the disappearance of the shared delusion. The inducer requires standard antipsychotic therapy. * **Subtypes:** If more than two people are involved, it is called *folie à trois* (three), *folie à quatre* (four), or *folie à plusieurs* (many). * **Risk Factors:** Social isolation from the outside world is the most significant factor facilitating the transfer of the delusion.

Q: A delusional belief about having a subjective double is called:

Doppelganger. **Explanation:** The correct answer is **Doppelganger (Option A)**. This phenomenon, also known as the "phenomenon of the double," is a delusional belief where a person believes they have a subjective double who looks exactly like them and exists in the external world. Unlike other visual hallucinations, the patient does not necessarily see the double with their eyes but "knows" it exists, often perceiving it as an omen of bad luck or death. **Analysis of Options:** * **Autoscopy (Option B):** This is a visual hallucination where the individual sees an image of themselves in external space (an "out-of-body" experience). The key difference is that Autoscopy is a **perceptual** experience (seeing), whereas a Doppelganger is primarily a **delusional** belief or a sense of presence. * **Delusion of Misidentification (Option C):** This is a broad category of syndromes (like Capgras or Fregoli) where patients misidentify familiar people or places. While Doppelganger is technically a subtype, it specifically refers to the "subjective double" of the self, making Option A the most specific answer. * **Depersonalization (Option D):** This is a dissociative symptom where the individual feels detached from themselves, as if they are an outside observer of their own body or mental processes. There is no "double" involved; rather, the self feels "unreal." **High-Yield Clinical Pearls for NEET-PG:** * **Capgras Syndrome:** The belief that a familiar person has been replaced by an identical-looking impostor (the most common delusional misidentification). * **Fregoli Syndrome:** The belief that different people are actually a single person in disguise. * **Intermetamorphosis:** The belief that people have swapped identities with each other both physically and psychologically. * **Heautoscopy:** A variant of autoscopy where the person sees their double but is unsure which "self" is the real one.

Q: All are negative symptoms of schizophrenia, except:

Hallucination. To understand schizophrenia symptoms for NEET-PG, it is essential to distinguish between **Positive** and **Negative** symptoms using the framework of Crow’s Type I and Type II syndromes. ### **Explanation** **Positive symptoms** (Option B) represent an "excess" or distortion of normal function. **Hallucinations** (perception in the absence of external stimuli) and **Delusions** are the hallmark positive symptoms. These are typically associated with dopaminergic hyperactivity in the mesolimbic pathway and generally show a good response to typical antipsychotics. **Negative symptoms** (Options A, C, and D) represent a "loss" or deficit of normal functions. They are often associated with structural brain changes (e.g., ventricular enlargement) and dopaminergic hypoactivity in the mesocortical pathway. * **Anhedonia (Option A):** The inability to experience pleasure from activities usually found enjoyable. * **Alogia (Option C):** Poverty of speech or a reduction in the amount/content of spontaneous speech. * **Affective Flattening (Option D):** A restricted range of emotional expression, characterized by a lack of facial expression and poor eye contact. ### **High-Yield NEET-PG Pearls** * **The 5 A’s of Negative Symptoms:** **A**ffective flattening, **A**logia, **A**volition (lack of motivation), **A**nhedonia, and **A**ttentional impairment. * **Schneider’s First Rank Symptoms (FRS):** These are primarily **positive symptoms** (e.g., audible thoughts, somatic passivity, delusional perception). Note that negative symptoms are *not* part of Schneider’s FRS. * **Prognosis:** The presence of predominant negative symptoms is a predictor of **poor prognosis**, poor social functioning, and resistance to traditional antipsychotic treatment. * **Treatment:** While typical antipsychotics treat positive symptoms, **Atypical Antipsychotics** (e.g., Clozapine, Cariprazine) are preferred for managing negative symptoms.

Q: What is true about late-onset schizophrenia?

Onset after 45 years. ### Explanation **1. Why Option A is Correct:** Schizophrenia typically presents in late adolescence or early adulthood. However, **Late-onset Schizophrenia** is defined as the onset of symptoms **after the age of 45**. It is more common in women and is often characterized by well-organized paranoid delusions and auditory hallucinations. **2. Analysis of Incorrect Options:** * **Option B (Onset between 25-30 years):** This is the typical age of onset for "early-onset" or "standard" schizophrenia (males: 15–25 years; females: 25–35 years). Onset after 60 years is specifically termed "Very-late-onset schizophrenia-like psychosis." * **Option C (Prognosis is poor):** This is incorrect. Late-onset schizophrenia generally has a **better prognosis** than early-onset forms. These patients usually have better premorbid social and occupational functioning, fewer negative symptoms (like apathy or withdrawal), and a better response to lower doses of antipsychotic medication. * **Option D (Olfactory hallucinations are common):** Auditory hallucinations remain the most common type in late-onset schizophrenia. Olfactory or gustatory hallucinations are rare and should always prompt an investigation into organic causes, such as temporal lobe epilepsy or tumors. **3. High-Yield Clinical Pearls for NEET-PG:** * **Gender Ratio:** Unlike early-onset schizophrenia (where M=F), late-onset is significantly more common in **females**. * **Symptom Profile:** Late-onset cases show **fewer negative symptoms** and less formal thought disorder compared to younger patients. * **Sensory Deficits:** There is a strong association between late-onset schizophrenia and **sensory impairments**, particularly hearing loss (presbycusis). * **Treatment:** Patients usually require **lower doses** of antipsychotics due to age-related changes in metabolism and increased sensitivity to extrapyramidal side effects.

Question 1

A 25-year-old male complains of a visual hallucination of a transparent phantom of his own body. What is the most likely diagnosis?

Accepted Answer

Autoscopic psychosis

Answer

Capgras syndrome

Answer

Lycanthropy

Answer

Cotard syndrome

Question 2

A 40-year-old male has recently started writing books. The content of his writing is incomprehensible, containing neologisms and a disjointed theme. He has become shy and self-absorbed, and when he speaks to people, he discusses metaphilosophical ideas. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

A genius writer

Answer

Delusional disorder

Question 3

A 36-year-old individual has a firm belief that his wife is having an affair. He often sits alone, muttering to himself, and hears voices commenting about him. He was completely normal two weeks prior. What is the most likely diagnosis?

Accepted Answer

Acute psychosis

Answer

Schizophrenia

Answer

Delusional disorder

Answer

Somatoform disorder

Question 4

Microcephaly is related to which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Alexander disease

Answer

Tuberous sclerosis

Answer

Cowden disease

Question 5

Folie à deux is a psychiatric syndrome in which symptoms of a delusionally biased belief system are shared by two or more individuals with unusually close social relationships. Which of the following conditions is most commonly associated with Folie à deux?

Accepted Answer

Paranoid disorder

Answer

Obsessive-Compulsive Disorder

Answer

Hysteria

Answer

Neurasthenia

Question 6

A delusional belief about having a subjective double is called:

Accepted Answer

Doppelganger

Answer

Autoscopy

Answer

Delusion of misidentification

Answer

Depersonalization

Question 7

Which of the following is a first-rank symptom in Schizophrenia?

Accepted Answer

Thought insertion

Answer

Delusions

Answer

Perceptional hallucinations

Answer

Word salad

Question 8

All are negative symptoms of schizophrenia, except:

Accepted Answer

Hallucination

Answer

Anhedonia

Answer

Alogia

Answer

Affective flattening

Question 9

Which of the following indicates a poor prognosis in Schizophrenia?

Accepted Answer

Insidious onset

Answer

Late age at onset

Answer

Family history of mania

Answer

Type I Schizophrenia

Question 10

What is true about late-onset schizophrenia?

Accepted Answer

Onset after 45 years

Answer

Onset between 25-30 years

Answer

Prognosis is poor

Answer

Olfactory hallucinations are common

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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