Psychotic Disorders Practice Questions

Q: Which of the following is FALSE regarding delusional disorder?

Hallucinations are typically present.. **Explanation:** **Delusional Disorder** is characterized by the presence of one or more non-bizarre delusions (beliefs about situations that could occur in real life) lasting for at least **one month**. **Why Option D is the Correct (False) Statement:** In Delusional Disorder, **hallucinations are typically absent**. If they do occur, they are not prominent and are usually related to the delusional theme (e.g., the sensation of being infested with insects in the somatic subtype). A key diagnostic criterion is that the patient’s functioning is not markedly impaired, and behavior is not obviously odd or bizarre, which distinguishes it from Schizophrenia where hallucinations and disorganized behavior are hallmark features. **Analysis of Other Options:** * **Option A:** Delusion is indeed a **disorder of thought content**. It is defined as a fixed, false belief that is out of keeping with the patient’s social and cultural background and is held with absolute conviction despite contrary evidence. * **Option B:** By definition, a delusion is a **false belief**. * **Option C:** **Persecutory type** is clinically recognized as the most common subtype of delusional disorder, where the individual believes they are being conspired against, cheated, or harassed. **NEET-PG High-Yield Pearls:** * **Subtypes:** Erotomanic (De Clerambault’s Syndrome), Grandiose, Jealous (Othello Syndrome), Persecutory, and Somatic (e.g., Ekbom’s Syndrome/Monosymptomatic Hypochondriacal Psychosis). * **Age of Onset:** Usually middle to late life (older than Schizophrenia). * **Treatment:** Difficult to treat; **Atypical antipsychotics** are the first-line pharmacological treatment, though SSRIs may help in somatic types. Therapeutic alliance is crucial.

Q: All are true about Ganser's syndrome except:

Only found in prisoners. **Ganser’s Syndrome** (also known as "nonsense syndrome" or "prison psychosis") is a rare dissociative disorder characterized by the production of **approximate answers** (*vorbeireden*). ### Explanation of Options: * **Why Option C is the correct answer (The Exception):** While Ganser’s syndrome was historically described in prisoners awaiting trial (to achieve secondary gain like avoiding punishment), it is **not exclusively** found in them. It can occur in patients with severe personality disorders, organic brain syndromes, or following head trauma. * **Option A (Approximate answers):** This is the hallmark feature. The patient gives answers that are "near-misses" or slightly off, indicating they understand the question but provide a wrong answer (e.g., saying a dog has five legs or $2 + 2 = 5$). * **Option B (Clouding of consciousness):** Patients often appear disoriented or in a "twilight state," showing a decreased awareness of their surroundings. * **Option D (Hallucinations):** Visual or auditory hallucinations are common associated features, often contributing to the "pseudo-psychotic" presentation. ### High-Yield Clinical Pearls for NEET-PG: 1. **Classification:** Currently classified under **Dissociative Disorders** (ICD-10/DSM-5), though it shares features with Factitious Disorder. 2. **The Tetrad of Ganser’s:** * Approximate answers (*Vorbeireden*) * Clouding of consciousness * Somatic conversion symptoms * Hallucinations 3. **Recovery:** Typically, the syndrome has a sudden onset and a rapid recovery, often followed by **amnesia** for the episode. 4. **Differential Diagnosis:** Must be distinguished from **Malingering**, where the patient consciously and deliberately fakes symptoms for a specific external incentive.

Q: A patient presents with a 6-month history of odd behavior, including talking to himself and muttering loudly. There is a reported family history of a member who disappeared several years ago. What is the most likely diagnosis?

Schizophrenia. **Explanation:** The clinical presentation of odd behavior, talking to oneself (soliloquy), and muttering (hallucinatory behavior) for a duration of **6 months** points directly toward **Schizophrenia**. According to ICD-11 and DSM-5 criteria, a diagnosis of Schizophrenia requires continuous signs of the disturbance for at least 6 months (DSM-5) or persistent symptoms for at least one month (ICD-11), involving positive symptoms like hallucinations or disorganized speech. The mention of a family member who "disappeared" is a classic NEET-PG examiner’s hint toward a family history of psychiatric illness or "vagrancy," which is common in untreated schizophrenia. **Why other options are incorrect:** * **Conversion Disorder:** Presents with neurological symptoms (paralysis, seizures, blindness) that cannot be explained by a neurological disease, usually triggered by a stressor. It does not involve psychosis. * **Major Depression:** While it can have psychotic features, the primary symptom must be a persistent low mood or anhedonia. "Odd behavior" and soliloquy without mood symptoms favor a primary psychotic disorder. * **Delusional Disorder:** Characterized by non-bizarre delusions (e.g., being followed) lasting at least one month. Hallucinations are typically absent or not prominent, and the patient’s behavior is generally not "odd" or disorganized apart from the delusion. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** 6 months = Schizophrenia. * **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts, voices arguing/commenting, and thought withdrawal/insertion. * **Prognosis:** Good prognostic factors include late onset, female sex, and presence of a precipitating stressor. Poor prognosis is associated with early (insidious) onset and negative symptoms.

Q: Auditory hallucinations, features of affect, and delusion of persecution occur in which of the following conditions?

Schizophrenia. **Explanation:** The correct answer is **Schizophrenia**. This condition is a chronic psychotic disorder characterized by a constellation of symptoms often categorized into positive, negative, and cognitive domains. 1. **Why Schizophrenia is correct:** * **Auditory Hallucinations:** These are the most common type of hallucinations in Schizophrenia, particularly "third-person" hallucinations (voices arguing or commenting). * **Delusion of Persecution:** This is the most common subtype of delusion in Schizophrenia, where the patient believes they are being conspired against or harmed. * **Features of Affect:** Schizophrenia frequently involves disturbances in affect, such as blunted (diminished emotional expression), flat, or inappropriate affect (e.g., laughing at a sad event). 2. **Why other options are incorrect:** * **Depression:** While psychotic depression exists, the primary features are low mood, anhedonia, and "mood-congruent" delusions (e.g., guilt or poverty), rather than the classic triad mentioned. * **Hysteria (Dissociative/Conversion Disorder):** This typically presents with physical symptoms (motor or sensory loss) without an organic cause or dissociative amnesia, not primary psychotic symptoms. * **Anxiety Neurosis:** This involves excessive worry, panic, or phobias. Patients maintain a firm grip on reality (no delusions or hallucinations). **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts, voices arguing/commenting, somatic passivity, and delusional perception. These are highly suggestive of Schizophrenia. * **The 4 A’s of Bleuler:** Ambivalence, Autism (social withdrawal), Affective flattening, and Association looseness. * **Prognosis:** Persecutory delusions and auditory hallucinations are "positive symptoms," which generally respond better to antipsychotics than "negative symptoms" like apathy or alogia.

Q: Who coined the term schizophrenia?

Eugen Bleuler. **Explanation:** The term **Schizophrenia** was coined by the Swiss psychiatrist **Eugen Bleuler** in **1908**. He derived the name from the Greek words *schizo* (split) and *phren* (mind). Bleuler’s primary contribution was shifting the focus from the "inevitable decline" of the patient to the "splitting" of various psychic functions (fragmentation of thought processes). He is also famous for describing the **"4 As"** of schizophrenia: Autism, Ambivalence, Affective flattening, and Associative looseness. **Analysis of Incorrect Options:** * **Emil Kraepelin:** He is known for the earlier classification of the disorder, which he called **Dementia Praecox** (premature dementia). He believed the illness was a progressive, deteriorating brain disease. * **Sigmund Freud:** The father of psychoanalysis. While he theorized about the unconscious mind and defense mechanisms, he did not name schizophrenia and believed it was difficult to treat with traditional psychoanalysis. * **Erich Muir:** This is a distractor name and is not associated with any major historical milestones in psychiatric nomenclature. **High-Yield Clinical Pearls for NEET-PG:** * **Kurt Schneider:** Coined the **"First Rank Symptoms" (FRS)**, which are diagnostic criteria focusing on hallucinations and delusions (e.g., thought insertion, broadcasting). * **Benedict Morel:** First used the term *démence précoce* in 1852. * **Bleuler’s 4 As:** Remember them as the "Fundamental Symptoms," whereas hallucinations and delusions were considered "Accessory Symptoms" by him.

Q: Which of the following is the most common cause of premature death in schizophrenia?

Suicide. **Explanation:** **Schizophrenia** is associated with a significantly reduced life expectancy (approximately 10–20 years less than the general population). While cardiovascular disease is the leading cause of natural death, **suicide** is the most common cause of **premature (unnatural) death**. 1. **Why Suicide is Correct:** Approximately **5–10%** of patients with schizophrenia die by suicide. The risk is highest during the early stages of the illness, following a recent discharge from the hospital, or during periods of "post-psychotic depression." High-risk factors include being young, male, having high premorbid IQ (awareness of the illness), and command hallucinations. 2. **Why Incorrect Options are Wrong:** * **Homicide:** While there is a common stigma associating schizophrenia with violence, patients are more likely to be victims than perpetrators. Homicide is a very rare cause of death compared to suicide. * **Toxicity of Antipsychotic Drugs:** While side effects like Neuroleptic Malignant Syndrome (NMS) or agranulocytosis (from Clozapine) can be fatal, they are statistically rare due to modern monitoring protocols. * **Hospital-Acquired Infection:** Though patients may have poorer self-care, infections are not the leading cause of mortality in the era of antibiotics and community-based care. **High-Yield Clinical Pearls for NEET-PG:** * **Leading cause of death overall:** Cardiovascular disease (due to metabolic syndrome and lifestyle). * **Leading cause of premature/unnatural death:** Suicide. * **Risk Window:** The first year after diagnosis and the period immediately following psychiatric discharge are the highest risk periods for suicide. * **Protective Factor:** Effective treatment with **Clozapine** is the only antipsychotic proven to specifically reduce the risk of suicidal behavior in schizophrenia.

Q: A 46-year-old male presents with sudden blankness of thought and accuses you of stealing his thoughts. What is the most likely diagnosis?

Thought withdrawal. ### Explanation The patient is experiencing **Thought Withdrawal**, a classic **delusion of thought possession**. In this phenomenon, the patient experiences a sudden cessation of thought and attributes this "blankness" to an external agency or person (in this case, the doctor) physically removing or "stealing" the thoughts from their mind. This is a **First Rank Symptom (FRS)** of Schizophrenia as described by Kurt Schneider. **Analysis of Options:** * **Thought Withdrawal (Correct):** The key differentiator here is the **external attribution**. The patient doesn't just lose their train of thought; they believe it was taken by someone else. * **Thought Block:** This is a formal thought disorder where the patient experiences a sudden, involuntary stop in the flow of thought. While the patient feels "blank," they do *not* necessarily attribute it to an external force stealing the thought. * **Neologism:** This refers to the coining of new words that have no recognized meaning to others, often seen in schizophrenia. It is a disorder of the *content/form* of thought, not possession. * **Perseveration:** This is the inappropriate persistence or repetition of a response (word, phrase, or gesture) beyond the point of relevance, often associated with organic brain disease or schizophrenia. **Clinical Pearls for NEET-PG:** * **Schneiderian First Rank Symptoms (FRS):** Include thought withdrawal, thought insertion, and thought broadcasting. * **Passivity Phenomena:** Thought withdrawal is a type of passivity where the patient feels they are no longer the master of their own mental processes. * **Differential:** While thought blocking can occur in high anxiety, **thought withdrawal** is almost pathognomonic for Schizophrenia.

Q: Which of the following is NOT a feature of catatonic schizophrenia?

Deep tendon reflexes are increased. ### Explanation **Catatonic Schizophrenia** is a subtype of schizophrenia (though classified under "Catatonia associated with another mental disorder" in DSM-5) characterized by prominent psychomotor disturbances. These disturbances can range from marked unresponsiveness to excessive, purposeless motor activity. **Why Option D is correct:** Catatonia is a **psychomotor syndrome**, not a primary neurological lesion of the Upper Motor Neuron (UMN) or Lower Motor Neuron (LMN) tracts. Therefore, **Deep Tendon Reflexes (DTRs) remain normal**. Increased reflexes (hyperreflexia) would suggest an organic neurological pathology (like a pyramidal tract lesion) rather than a psychiatric catatonic state. **Why the other options are incorrect:** * **A. Mutism:** This is a classic "negative" motor feature where the patient provides little to no verbal response despite being conscious. * **B. Echolalia:** This is a "command" or "automatic" feature where the patient mimics the examiner's words. Its counterpart is **Echopraxia** (mimicking movements). * **C. Waxy Flexibility (Cerea Flexibilitas):** A hallmark sign where the patient’s limbs can be molded into a position by the examiner, which the patient then maintains for a prolonged period (like a wax figure). **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** Lorazepam (Benzodiazepines) is the first-line treatment (the "Lorazepam Challenge Test" is also diagnostic). * **Most Effective Treatment:** Electroconvulsive Therapy (ECT) is highly effective, especially if the patient is stuporous or not eating. * **Negativism:** Motivation-less resistance to all instructions or physical attempts to be moved. * **Ambitendence:** The patient appears stuck in a "hesitation" loop (e.g., reaching for a hand to shake but withdrawing repeatedly). * **Catalepsy:** Passive induction of a posture held against gravity.

Question 1

The least likely good prognostic factor in a patient with Schizophrenia is?

Accepted Answer

Premorbid personality issues

Answer

Acute onset

Answer

Female gender

Answer

History of mood disorder in the family

Question 2

Which of the following is FALSE regarding delusional disorder?

Accepted Answer

Hallucinations are typically present.

Answer

Delusion is a disorder of thought content.

Answer

The patient holds a false belief.

Answer

Delusions of persecution are the most common subtype.

Question 3

What is a delusion?

Accepted Answer

None

Answer

Comprehensible

Answer

Reasonable

Answer

Both

Question 4

All are true about Ganser's syndrome except:

Accepted Answer

Only found in prisoners

Answer

Approximate answers

Answer

Apparent clouding of consciousness

Answer

Hallucinations

Question 5

A patient presents with a 6-month history of odd behavior, including talking to himself and muttering loudly. There is a reported family history of a member who disappeared several years ago. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Conversion disorder

Answer

Major depression

Answer

Delusional disorder

Question 6

Auditory hallucinations, features of affect, and delusion of persecution occur in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Depression

Answer

Hysteria

Answer

Anxiety neurosis

Question 7

Who coined the term schizophrenia?

Accepted Answer

Eugen Bleuler

Answer

Erich Muir

Answer

Sigmund Freud

Answer

Emil Kraepelin

Question 8

Which of the following is the most common cause of premature death in schizophrenia?

Accepted Answer

Suicide

Answer

Homicide

Answer

Toxicity of antipsychotic drug

Answer

Hospital acquired infection

Question 9

A 46-year-old male presents with sudden blankness of thought and accuses you of stealing his thoughts. What is the most likely diagnosis?

Accepted Answer

Thought withdrawal

Answer

Thought block

Answer

Neologism

Answer

Perseveration

Question 10

Which of the following is NOT a feature of catatonic schizophrenia?

Accepted Answer

Deep tendon reflexes are increased

Answer

Mutism

Answer

Echolalia

Answer

Waxy flexibility

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?