Psychotic Disorders Practice Questions

Q: Which of the following is considered a negative symptom of schizophrenia?

Ambivalence. **Explanation:** In Schizophrenia, symptoms are broadly categorized into **Positive** (excess or distortion of normal function) and **Negative** (loss or deficit of normal function). **Why Ambivalence is the Correct Answer:** Ambivalence refers to the simultaneous existence of contradictory emotions, ideas, or desires toward the same object or situation, leading to an inability to make decisions (avolition). It is one of the classic **"4 As" of Bleuler**, which are the fundamental symptoms of schizophrenia. Negative symptoms represent a "diminution" of normal emotional and behavioral states. Ambivalence reflects a deficit in goal-directed behavior and emotional integration, placing it firmly in the negative/deficit category. **Analysis of Incorrect Options:** * **A. Hallucination:** These are sensory perceptions in the absence of external stimuli. They represent an "added" abnormal experience, making them a hallmark **Positive symptom**. * **B. Delusion:** These are fixed, false beliefs held despite evidence to the contrary. Like hallucinations, they represent a distortion of thought content and are **Positive symptoms**. * **C. Motor Hyperactivity:** This is a feature of psychomotor agitation or catatonic excitement. Since it involves an "excess" of motor activity, it is classified as a **Positive/Disorganized symptom**. **NEET-PG High-Yield Pearls:** * **Bleuler’s 4 As:** Remember the mnemonic **A**ffective flattening, **A**utism, **A**mbivalence, and **A**ssociational looseness. * **Schneider’s First Rank Symptoms (FRS):** These focus primarily on positive symptoms (e.g., thought insertion, audible thoughts) and are used for diagnosis, but their absence does not rule out schizophrenia. * **Prognosis:** Negative symptoms (like apathy, anhedonia, and alogia) are generally more resistant to typical antipsychotics and are associated with a **poorer long-term prognosis** compared to positive symptoms.

Q: According to ICD-10 criteria, for how long must symptoms persist for the diagnosis of schizophrenia?

1 month. **Explanation:** The diagnosis of Schizophrenia requires a specific duration of symptoms to differentiate it from transient psychotic states. According to the **ICD-10** (International Classification of Diseases, 10th Revision), the characteristic symptoms (such as delusions, hallucinations, or thought disorder) must be present for a minimum period of **one month**. * **Why Option B is Correct:** ICD-10 criteria stipulate that at least one "very clear" symptom (from groups like thought echo, delusions of control, or persistent hallucinations) or two symptoms from less specific groups (like negative symptoms or catatonic behavior) must be present for **most of the time during a period of at least one month**. * **Why Option C is Incorrect:** A **6-month** duration is the requirement for Schizophrenia according to the **DSM-5** (Diagnostic and Statistical Manual of Mental Disorders). This is a frequent point of confusion in exams. * **Why Option D is Incorrect:** Symptoms lasting less than one month but more than a few days are often classified under **Acute and Transient Psychotic Disorders** (F23) in ICD-10. * **Why Option A is Incorrect:** Two months is not a standard diagnostic cutoff for schizophrenia in either major classification system. **High-Yield Clinical Pearls for NEET-PG:** 1. **ICD-10 vs. DSM-5:** Remember the "1 vs. 6" rule. ICD-10 = 1 month; DSM-5 = 6 months (which must include at least 1 month of active-phase symptoms). 2. **Schneider’s First Rank Symptoms (FRS):** These are highly suggestive of schizophrenia and are heavily weighted in the ICD-10 criteria. 3. **Prognosis:** Good prognostic factors include late onset, female sex, presence of mood symptoms, and being married. Poor prognosis is associated with insidious onset, young age, and prominent negative symptoms.

Q: A 37-year-old man reports that after a sudden financial loss, he had a bout of illness in which he felt sad and nervous and fearful, could not sleep or eat properly. He also began to hear voices telling him that he was useless and should kill himself. His symptoms stopped after approximately one week. He has had no similar episodes. Medical history includes no psychiatric conditions. Physical examination shows no abnormalities, and results of laboratory studies are within normal limits. Which of the following is the most likely diagnosis?

Brief psychotic disorder. ### Explanation The correct diagnosis is **Brief Psychotic Disorder**. **1. Why Brief Psychotic Disorder is correct:** According to DSM-5/ICD criteria, Brief Psychotic Disorder is characterized by the sudden onset of at least one positive psychotic symptom (delusions, hallucinations, or disorganized speech/behavior). Crucially, the duration of the episode is **more than 1 day but less than 1 month**, with an eventual full return to the premorbid level of functioning. This patient’s symptoms (auditory hallucinations) lasted for **one week** and were preceded by a clear psychosocial stressor (financial loss), which is a common trigger. **2. Why the other options are incorrect:** * **Schizophreniform Disorder:** Requires the duration of symptoms to be **between 1 month and 6 months**. This patient’s symptoms lasted only one week. * **Schizophrenia:** Requires a continuous period of illness for **at least 6 months**, including at least one month of active-phase symptoms and significant functional decline. * **Schizo-affective Disorder:** Requires a period of illness where there is a major mood episode (manic or depressive) concurrent with symptoms of schizophrenia, preceded or followed by at least **2 weeks of delusions or hallucinations** in the absence of a major mood episode. **3. High-Yield Clinical Pearls for NEET-PG:** * **Duration-based differentiation is key:** * 6 months: Schizophrenia. * **Prognosis:** Brief Psychotic Disorder generally has a good prognosis, especially when triggered by a marked stressor (formerly called "Brief Reactive Psychosis"). * **Specifiers:** Always look for "with marked stressors" or "postpartum onset" in the history. * **Suicide Risk:** Even though the duration is short, the risk of suicide is high due to the sudden onset and nature of command hallucinations (as seen in this case).

Q: Ambivalency and ambitendency are typically seen in which of the following conditions?

Obsessive-compulsive disorder. **Explanation:** The correct answer is **Obsessive-compulsive disorder (OCD)**. **Why OCD is correct:** In the context of OCD, **ambivalency** refers to the coexistence of opposing emotions or ideas toward the same object or situation, leading to profound indecisiveness (*folie du doute*). **Ambitendency** is the motor expression of this psychological conflict, where the patient manifests conflicting physical movements (e.g., reaching for an object but withdrawing the hand simultaneously). These features stem from the core pathology of OCD: the inability to reach a sense of "certainty" or "completion," leading to a state of constant doubt and repetitive, hesitant behavior. **Why other options are incorrect:** * **Schizophrenia:** While Eugen Bleuler originally described "Ambivalence" as one of the **4 As** of Schizophrenia, in modern clinical examinations (and specifically NEET-PG patterns), when ambivalency and ambitendency are paired together as a clinical presentation of pathological doubt and motor hesitation, **OCD** is the preferred answer. * **Substance Abuse:** Typically presents with intoxication, withdrawal, or craving symptoms, not the specific psychological-motor conflict of ambitendency. * **Alzheimer’s Disease:** Characterized by cognitive decline and memory loss; while patients may be confused, they do not typically exhibit the classic ambitendency seen in obsessive-compulsive states. **Clinical Pearls for NEET-PG:** * **Bleuler’s 4 As of Schizophrenia:** Ambivalence, Autism, Affective flattening, and Association looseness. * **Ambitendency vs. Mannerism:** Ambitendency is a conflict of movement; Mannerism is a goal-directed movement performed in an unusual/stilted way (seen in Schizophrenia). * **Folie du doute:** A classic term for the "doubting mania" seen in OCD patients that drives ambivalency.

Q: Delusion is a disorder of:

Content of thought. ### Explanation **1. Why Content of Thought is Correct:** Thought disorders are broadly classified into four categories: stream, form, possession, and content. **Delusion** is defined as a "fixed, false belief that is out of keeping with the patient’s social, cultural, and educational background, and is held with absolute conviction." Since it pertains to the **actual belief or the "what"** the patient is thinking, it is a disorder of the **Content of Thought**. Other examples include obsessions, phobias, and overvalued ideas. **2. Why Other Options are Incorrect:** * **Stream of Thought:** Refers to the **speed and quantity** of thoughts. Examples include *Flight of ideas* (mania), *Retardation* (depression), and *Pressure of speech*. * **Form of Thought:** Refers to the **logical connection** between ideas (the "how" of thinking). Examples include *Loosening of associations*, *Knight’s move thinking*, and *Circumstantiality*. This is also known as Formal Thought Disorder (FTD). * **Possession of Thought:** Refers to the patient’s sense of **ownership** over their thoughts. Examples include *Thought alienation* phenomena (Thought insertion, withdrawal, and broadcasting), which are pathognomonic for Schizophrenia (Schneiderian First Rank Symptoms). **3. Clinical Pearls for NEET-PG:** * **Primary Delusion (Autochthonous):** Arises "out of the blue" without a preceding mental event. It is a First Rank Symptom of Schizophrenia. * **Overvalued Idea:** A solitary, abnormal belief that is not as fixed as a delusion (the patient can entertain doubt). * **Most Common Delusion:** Delusion of Persecution (seen in Schizophrenia and Delusional Disorders). * **Delusion of Reference:** The false belief that neutral events (e.g., a news report) have special personal significance.

Q: Schneider's first-rank symptoms are typically seen in which of the following conditions?

Schizophrenia. **Explanation:** **Schneider’s First-Rank Symptoms (FRS)** were proposed by Kurt Schneider in 1959 as a set of specific clinical features that, in the absence of organic brain disease, are highly suggestive of **Schizophrenia**. While no longer considered pathognomonic (as they can occur in bipolar disorder), they remain a cornerstone of psychiatric history-taking and diagnosis. **Why Option D is Correct:** Schizophrenia is the primary condition associated with FRS. These symptoms are divided into four main categories: 1. **Auditory Hallucinations:** Specifically thought echo (Gedankenlautwerden), third-person voices (discussing the patient), and running commentary. 2. **Thought Interference:** Thought withdrawal, insertion, and broadcasting. 3. **Delusional Perception:** A normal perception is given a private, highly significant delusional meaning. 4. **Made Phenomena (Passivity):** Made affect, made impulses, and made acts (the feeling that one’s emotions or actions are controlled by an external force). **Why Other Options are Incorrect:** * **A & B (Delusion & Hallucination):** These are broad categories of psychopathology. While FRS includes specific types of delusions and hallucinations, not all delusions or hallucinations qualify as first-rank symptoms. * **C (Schizoid Personality):** This is a personality disorder characterized by social detachment and restricted emotional expression. It does not involve psychosis or FRS. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for FRS:** "ABCD" – **A**uditory hallucinations (3rd person), **B**roadcasting of thoughts, **C**ontrolled feelings/acts (Passivity), **D**elusional perception. * **Note:** FRS are **not** required for a diagnosis of Schizophrenia under DSM-5, but they remain high-yield for exam purposes. * **Kurt Schneider** also described "Second-Rank Symptoms," which include other hallucinations and emotional blunting, but these are less specific.

Question 1

Anhedonia seen in schizophrenia is linked to which of the following neurotransmitter abnormalities?

Accepted Answer

Norepinephrine

Answer

Serotonin

Answer

Glutamate

Answer

GABA

Question 2

Catatonic schizophrenia is associated with which of the following?

Accepted Answer

Motor symptoms

Answer

Paranoid thoughts

Answer

Suicidal behavior

Answer

Mental retardation

Question 3

A 50-year-old male presents with a 5-year history of persistent doubt regarding his wife's fidelity, despite evidence to the contrary. All other aspects of his life are normal. What is the most probable diagnosis?

Accepted Answer

Delusional disorder

Answer

Panic disorder

Answer

Depressive disorder

Answer

Phobia

Question 4

Which of the following is considered a negative symptom of schizophrenia?

Accepted Answer

Ambivalence

Answer

Hallucination

Answer

Delusion

Answer

Motor hyperactivity

Question 5

According to ICD-10 criteria, for how long must symptoms persist for the diagnosis of schizophrenia?

Accepted Answer

1 month

Answer

2 months

Answer

6 months

Answer

2 weeks

Question 6

A 37-year-old man reports that after a sudden financial loss, he had a bout of illness in which he felt sad and nervous and fearful, could not sleep or eat properly. He also began to hear voices telling him that he was useless and should kill himself. His symptoms stopped after approximately one week. He has had no similar episodes. Medical history includes no psychiatric conditions. Physical examination shows no abnormalities, and results of laboratory studies are within normal limits. Which of the following is the most likely diagnosis?

Accepted Answer

Brief psychotic disorder

Answer

Schizophreniform disorder

Answer

Schizo-affective disorder

Answer

Schizophrenia

Question 7

Ambivalency and ambitendency are typically seen in which of the following conditions?

Accepted Answer

Obsessive-compulsive disorder

Answer

Substance abuse

Answer

Alzheimer's disease

Answer

Schizophrenia

Question 8

All of the following are Schneider's first-rank symptoms except?

Accepted Answer

Elation

Answer

Hallucination

Answer

Delusion

Answer

Passivity phenomenon

Question 9

Delusion is a disorder of:

Accepted Answer

Content of thought

Answer

Stream of thought

Answer

Form of thought

Answer

Possession of thought

Question 10

Schneider's first-rank symptoms are typically seen in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Delusion

Answer

Hallucination

Answer

Schizoid personality

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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