Psychotic Disorders Practice Questions

Q: According to the DSM, what is the minimum period for which symptoms should be present before a diagnosis of schizophrenia can be made?

6 months. ### Explanation The diagnosis of **Schizophrenia** under DSM-5 criteria requires a continuous period of disturbance lasting for at least **6 months**. This 6-month period must include at least **1 month of active-phase symptoms** (e.g., delusions, hallucinations, disorganized speech) and may include periods of prodromal or residual symptoms. **Why the other options are incorrect:** * **1 month (Option B):** This is the minimum duration for the active-phase symptoms within a schizophrenia diagnosis. However, if the total duration of the illness is more than 1 month but **less than 6 months**, the correct diagnosis is **Schizophreniform Disorder**. * **3 weeks (Option C) & 4 months (Option A):** These timeframes do not correspond to specific DSM-5 diagnostic thresholds for psychotic disorders. If symptoms last less than 1 month, the diagnosis is **Brief Psychotic Disorder**. **High-Yield Clinical Pearls for NEET-PG:** * **Duration-based Hierarchy:** * 6 months: Schizophrenia. * **ICD-11 Difference:** Unlike the DSM-5, the ICD-11 requires a shorter duration of only **1 month** for the diagnosis of Schizophrenia. * **Prognosis:** Approximately one-third of patients with Schizophreniform Disorder recover, while two-thirds eventually progress to a diagnosis of Schizophrenia or Schizoaffective Disorder. * **Key Symptoms:** At least one of the "big three" (Delusions, Hallucinations, or Disorganized Speech) must be present for a diagnosis.

Q: Schizophrenia is characterized by which of the following?

Elation. **Explanation:** The question asks for the feature that is **NOT** characteristic of Schizophrenia (implied by the selection of "Elation" as the correct answer in this context). **1. Why "Elation" is the Correct Answer:** Elation is a state of extreme happiness, euphoria, and increased psychomotor activity, which is a hallmark feature of **Mania** (Bipolar Disorder), not Schizophrenia. While Schizophrenia involves disturbances in affect, it typically manifests as **blunted or flat affect**, or **inappropriate affect** (e.g., laughing at a funeral). Elation represents a primary mood disturbance, whereas Schizophrenia is primarily a thought disorder. **2. Analysis of Incorrect Options:** * **Delusion (Option A):** These are fixed, false beliefs. They are a "Positive Symptom" and a core diagnostic criterion for Schizophrenia (Schneider’s First Rank Symptoms). * **Auditory Hallucination (Option B):** Specifically, hearing voices (third-person or running commentary) is the most common type of hallucination in Schizophrenia. * **Catatonia (Option D):** This refers to a state of psychomotor disturbance (e.g., stupor, waxy flexibility, or mutism) that can occur in a specific subtype known as **Catatonic Schizophrenia**. **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts, voices arguing/commenting, somatic passivity, and delusional perception. * **Bleuler’s 4 A’s of Schizophrenia:** Ambivalence, Autism (social withdrawal), Affective flattening, and Association looseness. * **Dopamine Hypothesis:** Schizophrenia is associated with increased dopamine activity in the mesolimbic pathway. * **Prognosis:** "Good prognosis" factors include late onset, female sex, and presence of positive symptoms; "Poor prognosis" includes early onset, male sex, and negative symptoms.

Q: Fregoli's Syndrome is characterized by which of the following delusions?

Delusion of doubles. **Explanation:** **Fregoli’s Syndrome** is a rare neuropsychiatric condition classified as a **Delusional Misidentification Syndrome (DMS)**. In this syndrome, the patient holds a delusional belief that different people are actually a single person (usually a perceived persecutor) who is changing their appearance or wearing a disguise to follow them. It is termed a **"delusion of doubles"** because the patient identifies a familiar person in the bodies of various strangers. * **Option A (Correct):** It is a delusion of doubles where the patient over-identifies strangers as familiar people. This is the opposite of **Capgras Syndrome**, where a patient believes a familiar person has been replaced by an identical-looking impostor. * **Option B (Incorrect):** While Fregoli’s often has a paranoid flavor, "Delusion of persecution" is a broad category seen in Schizophrenia and is not the specific definition of this syndrome. * **Option C (Incorrect):** "Delusion of twins" is not a standard psychiatric term, though it is sometimes confused with the "Subjective Double" (the belief that a doppelgänger of oneself exists). * **Option D (Incorrect):** Delusion of parasites (Ekbom Syndrome) is the false belief that one is infested with small organisms. **Clinical Pearls for NEET-PG:** * **Capgras Syndrome:** Most common DMS; "Hypo-identification" (Familiar person = Stranger/Impostor). * **Fregoli Syndrome:** "Hyper-identification" (Stranger = Familiar person). * **Intermetamorphosis:** Belief that people swap identities with each other both physically and psychologically. * **Anatomical Association:** Often associated with lesions in the **right hemisphere** or bifrontal lobes, leading to a disconnection between visual recognition and emotional significance.

Q: Auditory hallucination is common in which of the following conditions?

Schizophrenia. **Explanation:** **Schizophrenia** is the correct answer because **auditory hallucinations** (specifically third-person voices commenting or arguing) are a hallmark "First Rank Symptom" of the disorder. In psychiatry and neuroanatomy, schizophrenia is primarily associated with functional disturbances in the **superior temporal gyrus** (Heschl’s gyrus) and the dopaminergic pathways. While hallucinations can occur in various conditions, they are most consistently and characteristically auditory in schizophrenia. **Analysis of Incorrect Options:** * **Delirium Tremens:** This is a severe form of alcohol withdrawal characterized primarily by **visual hallucinations** (e.g., seeing animals or insects), autonomic hyperactivity, and clouded consciousness. * **Cocaine Bugs (Formication):** This is a specific type of **tactile hallucination** where the patient feels as if insects are crawling under their skin. It is a classic sign of stimulant withdrawal or toxicity. * **Temporal Lobe Epilepsy (TLE):** While TLE can cause sensory disturbances, it is more frequently associated with **olfactory hallucinations** (uncinate fits, often smelling burnt rubber) or complex partial seizures involving "déjà vu." **NEET-PG High-Yield Pearls:** * **Visual Hallucinations:** Most common in organic brain syndromes (Delirium, Head injury) and substance withdrawal. * **Gustatory/Olfactory Hallucinations:** Highly suggestive of organic pathology (e.g., Temporal lobe tumors or Epilepsy). * **Hypnagogic/Hypnopompic Hallucinations:** Occur while falling asleep or waking up; classically seen in **Narcolepsy**. * **Lilliputian Hallucinations:** Seeing people/objects as small; common in Alcohol Withdrawal.

Q: Generalized paresis of the insane is seen in which stage of syphilis?

Tertiary stage. **Explanation:** **Generalized Paresis of the Insane (GPI)**, also known as paretic neurosyphilis or dementia paralytica, is a chronic meningoencephalitis caused by the invasion of the brain parenchyma by *Treponema pallidum*. **Why Tertiary Stage is Correct:** Neurosyphilis is a manifestation of **Tertiary Syphilis**, occurring typically 10 to 25 years after the initial infection. GPI represents the "parenchymatous" form of neurosyphilis, characterized by a progressive decline in cognitive function, personality changes (classically megalomania/grandiosity), and neurological deficits. **Analysis of Incorrect Options:** * **Primary Stage:** Characterized by the appearance of a painless chancre at the site of inoculation. It is a localized infection. * **Secondary Stage:** Represents hematogenous dissemination, presenting with generalized lymphadenopathy, maculopapular rashes (palms and soles), and condyloma lata. While "asymptomatic" meningitis can occur here, GPI is not seen. * **Congenital Syphilis:** While neurosyphilis can occur in congenital cases (juvenile paresis), the classic description of "Generalized Paresis of the Insane" refers to the late-stage manifestation of acquired syphilis in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Psychiatric Symptoms:** Memory loss, irritability, and **grandiose delusions** are hallmark features. * **Physical Sign:** **Argyll Robertson Pupil** (Accommodation reflex present, Light reflex absent) is frequently associated. * **The "Paressis" Mnemonic:** **P**ersonality, **A**ffect, **R**eflexes (hyperreflexia), **E**ye (Argyll Robertson), **S**ensorium (illusions/hallucinations), **I**ntellect (dementia), **S**peech (slurred). * **Diagnosis:** CSF-VDRL is highly specific for neurosyphilis.

Q: A 60-year-old male suffering from auditory hallucinations states that people living upstairs are talking about him and conspiring against him. He filed a police complaint against them, but the allegations were proven to be false. What is the most likely diagnosis?

Schizophrenia. ### Explanation **Correct Answer: D. Schizophrenia** The patient presents with two core psychotic symptoms: **Auditory hallucinations** (hearing voices talking about him) and **Delusions of persecution** (conspiring against him). According to ICD-10 and DSM-5 criteria, the presence of persistent hallucinations accompanied by delusions is a hallmark of Schizophrenia. While the age of onset (60 years) is late, "Late-onset Schizophrenia" (onset after age 40) frequently presents with prominent persecutory delusions and sensory hallucinations, often directed at neighbors or people in the environment. **Why other options are incorrect:** * **A. Depression:** While psychotic depression exists, the primary feature must be a pervasive low mood, anhedonia, or suicidal ideation. There is no mention of mood symptoms here. * **B. Dementia:** Although delusions can occur in dementia, the primary deficit must be cognitive decline (memory loss, executive dysfunction). The vignette focuses purely on psychotic symptoms. * **C. Delusional Disorder:** This is the most common distractor. In Delusional Disorder, the patient has non-bizarre delusions, but **prominent auditory hallucinations are absent**. Since this patient has clear auditory hallucinations, it points toward Schizophrenia. **NEET-PG High-Yield Pearls:** * **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts (thought echo), voices arguing, and voices commenting. These are highly suggestive of Schizophrenia. * **Late-onset Schizophrenia:** More common in females and often characterized by paranoid themes and better preservation of affect compared to early-onset. * **Diagnostic Duration:** For a diagnosis of Schizophrenia, symptoms should generally be present for at least 1 month (ICD-10) or 6 months (DSM-5). * **Key Distinction:** Delusional Disorder = Delusions ONLY; Schizophrenia = Delusions + Hallucinations + Disorganized behavior/speech.

Question 1

According to the DSM, what is the minimum period for which symptoms should be present before a diagnosis of schizophrenia can be made?

Accepted Answer

6 months

Answer

4 months

Answer

1 month

Answer

3 weeks

Question 2

Catatonic features are seen in schizophrenia. In which other conditions are catatonic features also seen?

Accepted Answer

Severe depression and personality disorder

Answer

Severe depression and conversion disorder

Answer

Severe depression

Answer

Conversion disorder and personality disorder

Question 3

Schizophrenia is characterized by which of the following?

Accepted Answer

Elation

Answer

Delusion

Answer

Auditory Hallucination

Answer

Catatonia

Question 4

Fregoli's Syndrome is characterized by which of the following delusions?

Accepted Answer

Delusion of doubles

Answer

Delusion of persecution

Answer

Delusion of twins

Answer

Delusion of parasites

Question 5

A 25-year-old housewife presented to the psychiatry outpatient department complaining that her nose was longer than usual. She felt that her husband did not like her because of this perceived deformity and had developed a relationship with the neighboring girl. Furthermore, she complained that people made fun of her. It was not possible to convince her that there was no deformity. What do her symptoms suggest?

Accepted Answer

Delusion

Answer

Depression

Answer

Hallucination

Answer

Depersonalization

Question 6

Auditory hallucination is common in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Delirium tremens

Answer

Cocaine bugs

Answer

Temporal lobe epilepsy

Question 7

Generalized paresis of the insane is seen in which stage of syphilis?

Accepted Answer

Tertiary stage

Answer

Primary stage

Answer

Secondary stage

Answer

Congenital syphilis

Question 8

Which of the following is NOT an environmental risk factor for schizophrenia?

Accepted Answer

Higher socioeconomic status

Answer

Cannabis use

Answer

Migration

Answer

Obstetric complications

Question 9

A 60-year-old male suffering from auditory hallucinations states that people living upstairs are talking about him and conspiring against him. He filed a police complaint against them, but the allegations were proven to be false. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Depression

Answer

Dementia

Answer

Delusional disorder

Question 10

A 23-year-old engineering student presents with a history of gradual onset of suspiciousness, muttering and smiling without clear reason, decreased socialization, violent outbursts, and lack of interest in studies for 8 months. Mental status examination reveals a blunt affect, thought broadcast, relatively preserved cognition, and impaired judgment and insight. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Delusional disorder

Answer

Depression

Answer

Anxiety disorder

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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