Psychotic Disorders Practice Questions

Q: Which of the following is NOT considered a first-rank symptom of schizophrenia?

Ambivalence. To answer this question correctly, it is essential to distinguish between **Kurt Schneider’s First-Rank Symptoms (FRS)** and **Eugen Bleuler’s "4 As"** of schizophrenia. ### **Why Ambivalence is the Correct Answer** **Ambivalence** is one of the "4 As" described by Eugen Bleuler as a fundamental (primary) symptom of schizophrenia. It refers to the coexistence of contradictory emotions or desires toward the same object or situation. While characteristic of the disorder, it is **not** part of Schneider’s First-Rank Symptoms, which focus more on specific types of hallucinations and delusions. ### **Explanation of Incorrect Options (First-Rank Symptoms)** Schneider’s FRS are highly suggestive of schizophrenia in the absence of organic brain disease. The incorrect options are all classic examples: * **Running Commentary:** A specific auditory hallucination where a voice describes the patient’s actions as they happen. * **Primary Delusion:** Also known as delusional perception, where a normal perception is suddenly given a private, idiosyncratic, and delusional meaning. * **Somatic Passivity:** The delusional belief that one’s body is being influenced or acted upon by an external force (a "made" sensation). ### **Clinical Pearls for NEET-PG** * **Bleuler’s 4 As:** **A**ffective flattening, **A**utism, **A**mbivalence, and **A**ssociative looseness. * **Schneider’s FRS Categories:** 1. **Auditory Hallucinations:** Thought echo (Gedankenlautwerden), third-person voices, and running commentary. 2. **Thought Interference:** Thought withdrawal, insertion, and broadcasting. 3. **Passivity Phenomena:** "Made" feelings, "made" impulses, and "made" acts. 4. **Delusional Perception.** * **High-Yield Note:** FRS are no longer required for a diagnosis in the **DSM-5**, as they were found to be less specific than previously thought, but they remain a favorite topic in NEET-PG exams.

Q: A psychotic disorder most commonly pertains to which of the following symptoms?

Delusions or hallucinations. **Explanation:** The hallmark of a **psychotic disorder** is the presence of **psychosis**, which is defined as a loss of contact with reality. In clinical psychiatry, the core features that define this state are **delusions** (fixed, false beliefs) and **hallucinations** (sensory perceptions in the absence of external stimuli). These symptoms represent a fundamental disturbance in the processing of reality and are the primary diagnostic criteria for disorders such as Schizophrenia, Delusional Disorder, and Brief Psychotic Disorder. **Analysis of Options:** * **A. Weeping or laughing:** These are disturbances of **affect or mood**. While they can occur in psychosis (e.g., inappropriate affect in schizophrenia), they are more characteristic of Mood Disorders (Depression/Bipolar) or Pseudobulbar affect. * **B. Agitation or retardation:** These are **psychomotor disturbances**. While common in severe psychosis, they are non-specific and are frequently seen in Major Depressive Disorder (Melancholic) or Catatonia. * **C. Obsessions or compulsions:** These are the defining features of **Obsessive-Compulsive Disorder (OCD)**. Unlike psychosis, patients with OCD usually maintain "insight"—they recognize their thoughts as irrational or products of their own mind. **NEET-PG High-Yield Pearls:** * **Schneider’s First Rank Symptoms (FRS):** A historical but high-yield list of symptoms (e.g., auditory hallucinations, thought withdrawal/insertion) used to diagnose Schizophrenia. * **Hallucination Type:** Auditory hallucinations (specifically third-person) are the most common in Schizophrenia, whereas visual hallucinations often suggest an organic/medical cause. * **Delusion Type:** Persecutory delusions are the most common type of delusion across psychotic disorders.

Q: Which subtype of schizophrenia carries the best prognosis?

Catatonic. **Explanation:** The prognosis of schizophrenia is influenced by the age of onset, the nature of symptoms, and the speed of presentation. **Why Catatonic Schizophrenia is the Correct Answer:** Catatonic schizophrenia carries the **best prognosis** among all subtypes. This is primarily because it often presents with an **acute onset** and is frequently associated with identifiable precipitating stressors. From a clinical standpoint, catatonic symptoms (such as stupor, mutism, or excitement) show an excellent and rapid response to specific treatments, namely **Benzodiazepines (Lorazepam)** and **Electroconvulsive Therapy (ECT)**. **Analysis of Incorrect Options:** * **Paranoid Schizophrenia:** While it has a better prognosis than the hebephrenic type due to later age of onset and preserved cognitive function, it ranks second to the catatonic type. * **Hebephrenic (Disorganized) Schizophrenia:** This subtype carries the **worst prognosis**. It typically has an early (insidious) onset, significant personality deterioration, and poor emotional response (flat affect). * **Undifferentiated Schizophrenia:** This is a category for patients who do not fit clearly into other subtypes; its prognosis is generally intermediate but worse than the catatonic type. **NEET-PG High-Yield Pearls:** * **Best Prognosis:** Catatonic Subtype. * **Worst Prognosis:** Hebephrenic Subtype. * **Most Common Subtype:** Paranoid Subtype. * **Good Prognostic Factors:** Late onset, female sex, presence of mood symptoms (depression/anxiety), positive symptoms (hallucinations/delusions), and being married. * **Poor Prognostic Factors:** Early onset, male sex, negative symptoms (apathy/withdrawal), and a strong family history.

Q: Which of the following is not a Schneider's first-rank symptom of schizophrenia?

Delusion of self-reference. **Explanation:** Kurt Schneider identified a group of symptoms known as **First-Rank Symptoms (FRS)** which, in the absence of organic brain disease, were considered strongly suggestive of Schizophrenia. **Why "Delusion of self-reference" is the correct answer:** While delusions of reference (the belief that neutral events or coincidences have a special personal significance) are common in schizophrenia, they are **not** part of Schneider’s FRS. Schneider emphasized symptoms that involve a "blurring of boundaries" between the self and the environment. Delusions of reference are considered "Second-Rank Symptoms." **Analysis of Incorrect Options:** * **Passivity Phenomenon (Made Acts/Volition/Affect):** This is a core FRS where the patient feels their actions, feelings, or impulses are being controlled by an external force. * **Auditory Hallucinations:** Specifically, three types are FRS: **Third-person voices** (discussing the patient), **Running commentary** (narrating the patient's actions), and **Thought echo** (Gedankenlautwerden). * **Delusional Perception:** This is a two-stage process where a normal perception (e.g., seeing a red car) is suddenly given a private, idiosyncratic, and delusional meaning (e.g., "the red car means I am the chosen king"). This is a hallmark FRS. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for FRS (ABCD):** **A**uditory hallucinations (3 types), **B**roadcasting of thoughts, **C**ontrolled feelings/acts (Passivity), **D**elusional perception. * **Thought Alienation:** Includes Thought Insertion, Thought Withdrawal, and Thought Broadcasting. All are FRS. * **Current Status:** While historically significant, the DSM-5 has de-emphasized FRS because they lack diagnostic specificity (they can occur in bipolar disorder). * **Note:** Somatic passivity (feeling bodily sensations imposed by others) is also an FRS.

Q: Visual hallucinations are typically seen in which subtype of schizophrenia?

Hebephrenic schizophrenia. **Explanation:** **Hebephrenic Schizophrenia (Disorganized Schizophrenia)** is characterized by disorganized speech, disorganized behavior, and flat or inappropriate affect. While auditory hallucinations are the most common type across all schizophrenia subtypes, **visual hallucinations** are most frequently associated with the Hebephrenic subtype. This is often linked to the severe regression and primitive behavior seen in these patients, where sensory perceptions become highly fragmented. **Analysis of Options:** * **A. Hebephrenic Schizophrenia (Correct):** Patients often exhibit "silliness," shallow affect, and giggling. The hallucinations in this subtype are often fleeting, fragmentary, and more likely to involve visual elements compared to the Paranoid subtype. * **B. Residual Schizophrenia:** This stage occurs after at least one psychotic episode. It is characterized by "negative symptoms" (social withdrawal, emotional blunting) rather than active "positive symptoms" like hallucinations or delusions. * **C. Simple Schizophrenia:** This is a rare subtype characterized by the insidious development of negative symptoms without a history of overt psychotic symptoms (hallucinations or delusions). Therefore, visual hallucinations are absent by definition. **NEET-PG High-Yield Pearls:** * **Most common subtype overall:** Paranoid Schizophrenia (characterized by stable delusions and auditory hallucinations). * **Subtype with the best prognosis:** Paranoid Schizophrenia. * **Subtype with the worst prognosis:** Hebephrenic Schizophrenia (due to early onset and rapid cognitive decline). * **Schneider’s First Rank Symptoms (FRS):** These are diagnostic for schizophrenia but are **least** likely to be found in the Hebephrenic subtype. * **Visual Hallucinations:** If prominent, always rule out **Organic Brain Syndrome** (medical/toxic causes) first, as they are less common in functional psychoses than auditory ones.

Q: Catatonia is a type of:

Schizophrenia. **Explanation:** **Catatonia** is a clinical syndrome characterized by a constellation of psychomotor disturbances, including motoric immobility (stupor), excessive motor activity, mutism, negativism, and posturing. Historically and traditionally in medical examinations like NEET-PG, Catatonia is classified as a subtype of **Schizophrenia** (Catatonic Schizophrenia). 1. **Why Schizophrenia is correct:** In the ICD-10 classification (still widely used for exam patterns), Catatonic Schizophrenia is one of the primary subtypes. It is characterized by prominent psychomotor disturbances that may alternate between extremes such as hyperkinesis and stupor, or automatic obedience and negativism. 2. **Why other options are incorrect:** * **Phobia:** This is an anxiety disorder characterized by irrational fear; it does not involve the gross motor disturbances seen in catatonia. * **Depression:** While catatonia can *occur* as a specifier in severe mood disorders (Catatonic Depression), it is not a "type" of depression itself. * **OCD:** This is characterized by obsessions and compulsions; it lacks the diagnostic motor features of catatonia. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Cause:** Although traditionally linked to Schizophrenia, the most common underlying cause of catatonia in modern clinical practice is actually **Mood Disorders** (specifically Bipolar Disorder). * **Drug of Choice:** The first-line treatment for Catatonia is **Lorazepam** (Benzodiazepines). This is known as the "Lorazepam Challenge Test." * **Definitive Treatment:** If medications fail, **Electroconvulsive Therapy (ECT)** is the most effective treatment. * **Key Signs:** Look for *Waxy Flexibility* (Cerea Flexibilitas), *Negativism*, and *Echolalia/Echopraxia* in clinical vignettes.

Q: Which of the following symptoms is likely to be of organic origin?

Prominent visual hallucination. **Explanation:** In psychiatry, distinguishing between **Functional Psychosis** (e.g., Schizophrenia) and **Organic Psychosis** (e.g., Delirium, metabolic encephalopathy, or brain lesions) is a critical clinical skill. **Why Option D is correct:** **Visual hallucinations** are the hallmark of organic brain syndromes. While they can occur in functional disorders, their presence—especially when prominent, vivid, or occurring in a clear sensorium—should immediately raise suspicion of an underlying medical cause, such as substance withdrawal (Delirium Tremens), epilepsy, or neurotoxicity. **Analysis of Incorrect Options:** * **A. Delusion of Guilt:** This is a classic feature of **Psychotic Depression** (Functional). Patients believe they have committed unforgivable sins or are responsible for disasters. * **B. Auditory Hallucinations:** These are the most common type of hallucinations in functional psychiatric disorders, particularly **Schizophrenia** (specifically Schneiderian First Rank Symptoms). * **C. Formal Thought Disorder (FTD):** Characterized by disorganized thinking (e.g., loosening of associations), FTD is a core feature of **Schizophrenia** and is rarely the primary presentation of an organic condition. **High-Yield Clinical Pearls for NEET-PG:** * **Visual Hallucinations = Organic** until proven otherwise. * **Auditory Hallucinations = Functional** (Schizophrenia) until proven otherwise. * **Olfactory/Gustatory Hallucinations:** Strongly associated with **Temporal Lobe Epilepsy** (Uncinate fits). * **Tactile (Formication) Hallucinations:** Classically seen in **Cocaine** use (Cocaine bugs) or Alcohol withdrawal. * **Clouding of consciousness** is the most reliable indicator of an organic etiology (Delirium).

Q: In Schizophrenia, which subtype is associated with early onset and poor prognosis?

Hebephrenic Schizophrenia. **Explanation:** **Hebephrenic Schizophrenia** (also known as Disorganized Schizophrenia) is characterized by an **early onset** (typically between ages 15–25) and a **poor prognosis**. The clinical picture is dominated by disorganized speech, disorganized behavior, and flat or inappropriate affect (e.g., giggling without reason). The poor prognosis is attributed to the early onset, insidious progression, and the rapid development of "negative symptoms" and cognitive decline. **Analysis of Incorrect Options:** * **Simple Schizophrenia:** While it has an insidious onset and a very poor prognosis due to the absence of positive symptoms (hallucinations/delusions), it is characterized primarily by a slow decline in functioning and social withdrawal rather than the classic disorganized features of Hebephrenia. * **Catatonic Schizophrenia:** This subtype is characterized by psychomotor disturbances (stupor, waxy flexibility, or excitement). It generally has a **good prognosis** as it often responds rapidly to Benzodiazepines (Lorazepam) or Electroconvulsive Therapy (ECT). * **Paranoid Schizophrenia:** This is the most common subtype. It has a **late onset** (usually late 20s or 30s) and the **best prognosis** among all subtypes because the personality remains relatively preserved and patients respond well to antipsychotics. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognosis:** Paranoid Schizophrenia. * **Worst Prognosis:** Hebephrenic Schizophrenia. * **Most Common Subtype:** Paranoid Schizophrenia. * **Schneiderian First Rank Symptoms (SFRS):** These are diagnostic for schizophrenia but do not carry prognostic value. * **Prognostic Factors:** Acute onset, late age of onset, and presence of positive symptoms (hallucinations/delusions) indicate a **good prognosis**; insidious onset, early age, and negative symptoms indicate a **poor prognosis**.

Q: Which of the following is NOT a clinical manifestation of Schizophrenia?

Altered sensorium. **Explanation:** The correct answer is **B. Altered sensorium**. In psychiatry, **sensorium** refers to the state of consciousness and orientation (to time, place, and person). Schizophrenia is primarily a disorder of **thought, perception, and affect**, occurring in a state of **clear consciousness**. If a patient presents with psychotic symptoms (like delusions or hallucinations) alongside an altered sensorium or clouded consciousness, the clinician must first rule out **Organic Brain Syndromes** (e.g., Delirium) or substance-induced psychosis rather than a primary functional psychotic disorder like Schizophrenia. **Analysis of Incorrect Options:** * **A. Delusion:** These are fixed, false beliefs not amenable to change despite conflicting evidence. They are a "Positive Symptom" and a hallmark feature of Schizophrenia (e.g., delusions of persecution or reference). * **C. Auditory Hallucinations:** These are the most common type of hallucinations in Schizophrenia. Specifically, "Schneiderian First Rank Symptoms" like third-person voices commenting on the patient's actions are highly characteristic. * **D. Catatonia:** This is a state of psychomotor disturbance that can manifest as stupor, mutism, posturing, or waxy flexibility. While it can occur in mood disorders or medical conditions, it remains a recognized clinical subtype/specifier of Schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Includes thought insertion, withdrawal, broadcast, and made phenomena. Their presence strongly suggests Schizophrenia but is not pathognomonic. * **Bleuler’s 4 A’s:** Fundamental symptoms of Schizophrenia—**A**ffective flattening, **A**mbivalence, **A**utism (social withdrawal), and **A**ssociative looseness. * **Visual Hallucinations:** If prominent, always suspect an organic cause (e.g., tumors, epilepsy, or drugs) rather than Schizophrenia.

Question 1

Which of the following is NOT considered a first-rank symptom of schizophrenia?

Accepted Answer

Ambivalence

Answer

Running commentary

Answer

Primary delusion

Answer

Somatic passivity

Question 2

A psychotic disorder most commonly pertains to which of the following symptoms?

Accepted Answer

Delusions or hallucinations

Answer

Weeping or laughing

Answer

Agitation or retardation

Answer

Obsessions or compulsions

Question 3

What is a bad prognostic factor for Schizophrenia?

Accepted Answer

Late onset of disease

Answer

Catatonia

Answer

Presence of depression

Answer

Absence of family history

Question 4

Which subtype of schizophrenia carries the best prognosis?

Accepted Answer

Catatonic

Answer

Undifferentiated

Answer

Paranoid

Answer

Hebephrenic

Question 5

Which of the following is not a Schneider's first-rank symptom of schizophrenia?

Accepted Answer

Delusion of self-reference

Answer

Passivity phenomenon

Answer

Auditory hallucinations

Answer

Delusional perception

Question 6

Visual hallucinations are typically seen in which subtype of schizophrenia?

Accepted Answer

Hebephrenic schizophrenia

Answer

Residual schizophrenia

Answer

Simple schizophrenia

Answer

All of the above

Question 7

Catatonia is a type of:

Accepted Answer

Schizophrenia

Answer

Phobia

Answer

Depression

Answer

OCD

Question 8

Which of the following symptoms is likely to be of organic origin?

Accepted Answer

Prominent visual hallucination

Answer

Delusion of guilt

Answer

Auditory hallucinations

Answer

Formal thought disorder

Question 9

In Schizophrenia, which subtype is associated with early onset and poor prognosis?

Accepted Answer

Hebephrenic Schizophrenia

Answer

Simple Schizophrenia

Answer

Catatonic Schizophrenia

Answer

Paranoid Schizophrenia

Question 10

Which of the following is NOT a clinical manifestation of Schizophrenia?

Accepted Answer

Altered sensorium

Answer

Delusion

Answer

Auditory hallucinations

Answer

Catatonia

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?