Schizoaffective Disorder — MCQs
What is the minimum duration of symptoms required for the diagnosis of a manic episode?
An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
Which antipsychotic is preferred for treatment-resistant schizophrenia?
Which of the following conditions is characterized by intense depression and misery?
A 67-year-old lady is brought in by her six children, who say that she has become senile. Six months after her husband's death, she has become more religious and spiritual, and gives a lot of money in donation. She is occupied with too many activities and sleeps less. She now believes that she has a goal to change society. She does not like being brought to the hospital and is argumentative when questioned about her actions. The diagnosis is:
Which of the following is considered a poor prognostic factor for schizophrenia?
A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?
All of the following are true about bipolar disorder rapid cycling EXCEPT:
Type of schizophrenia with intellectual disability:
Schizoaffective Disorder Indian Medical PG Practice Questions and MCQs
Question 1: What is the minimum duration of symptoms required for the diagnosis of a manic episode?
- A. 1 week (Correct Answer)
- B. 3 weeks
- C. 2 weeks
- D. 4 weeks
Explanation: ***1 week*** - According to the **DSM-5 criteria**, a manic episode is defined by a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least **1 week** (or any duration if hospitalization is necessary). - This **duration criterion** helps differentiate true manic episodes from shorter mood fluctuations or other conditions. *3 weeks* - This duration is **not the diagnostic standard** for a manic episode as per the DSM-5 criteria. - While symptoms may persist for weeks, the **minimum threshold** is 1 week. *2 weeks* - This duration **exceeds the minimum** required for a manic episode and is **not the diagnostic standard**. - A 2-week period is more commonly associated with the duration criteria for a **major depressive episode**, which can cause confusion between the two conditions. *4 weeks* - This duration is **not the diagnostic standard** for a manic episode. - A 4-week period would far exceed the **minimum required duration** of 1 week, indicating a prolonged episode but not defining its diagnostic threshold.
Question 2: An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
- A. Olanzapine
- B. ECT (Correct Answer)
- C. Mirtazapine
- D. Clozapine
Explanation: ***ECT*** - **Electroconvulsive therapy (ECT)** is the **treatment of choice** for severe depression with **suicidal ideation** due to its rapid onset of action and high efficacy. - It is particularly indicated when there is an urgent need for symptom remission to prevent self-harm, as verbal therapies and medications take longer to exert their full effects. *Olanzapine* - **Olanzapine** is an **antipsychotic medication** with some antidepressant properties, but it is not the first-line treatment for severe depression with suicidal tendencies. - It is often used as an **adjunctive treatment** in treatment-resistant depression or in psychotic depression with delusions. *Mirtazapine* - **Mirtazapine** is an **antidepressant** that can be very effective in cases of major depressive disorder, especially when insomnia and appetite loss are prominent. - However, its onset of action is not as rapid as ECT, making it less suitable for situations requiring immediate intervention for **severe suicidal risk**. *Clozapine* - **Clozapine** is an **antipsychotic medication** primarily used for **treatment-resistant schizophrenia** and reducing suicidal behavior in schizophrenia. - It is highly effective but has significant side effects, including **agranulocytosis**, and is not a first-line treatment for major depressive disorder with suicidal tendencies.
Question 3: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
- A. Schizophrenia
- B. Major depressive disorder plus psychosis (Correct Answer)
- C. Schizoaffective disorder
- D. Schizotypal personality disorder
Explanation: ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.
Question 4: Which antipsychotic is preferred for treatment-resistant schizophrenia?
- A. Quetiapine
- B. Olanzapine
- C. Risperidone
- D. Clozapine (Correct Answer)
Explanation: ***Clozapine*** - **Clozapine** is the only antipsychotic with proven efficacy for **treatment-resistant schizophrenia**, defined as inadequate response to two different antipsychotics. - Its unique pharmacological profile, including strong antagonism of various **dopamine** and **serotonin receptors**, contributes to its superior efficacy in these cases. *Quetiapine* - While an effective antipsychotic for many, **quetiapine** is generally not considered the first-line or preferred agent for **treatment-resistant schizophrenia**. - It has a lower propensity for **extrapyramidal symptoms** but lacks the specific efficacy demonstrated by clozapine in refractory cases. *Olanzapine* - **Olanzapine** is a potent antipsychotic and can be effective for severe symptoms, but it does not have the same established efficacy for **treatment resistance** as clozapine. - Its use can be limited by significant metabolic side effects including **weight gain** and **glucose dysregulation**. *Risperidone* - **Risperidone** is a commonly used antipsychotic, but it is not indicated as the preferred treatment for **treatment-resistant schizophrenia**. - It can be effective for positive and negative symptoms but does not offer the same **superiority** in refractory cases as clozapine.
Question 5: Which of the following conditions is characterized by intense depression and misery?
- A. Schizophrenia
- B. Major depressive disorder (Correct Answer)
- C. Mania
- D. Melancholia
Explanation: ***Major depressive disorder*** - This condition is primarily defined by a period of at least two weeks of **depressed mood** or **loss of interest or pleasure** (anhedonia). - Patients often experience profound **feelings of sadness, hopelessness, and misery**, along with other symptoms like changes in sleep, appetite, energy, and concentration. - **MDD is the primary diagnostic category** for conditions characterized by intense depression and misery. *Schizophrenia* - Schizophrenia is characterized by **psychotic symptoms** such as hallucinations, delusions, disorganized thought, and negative symptoms. - While people with schizophrenia might experience periods of low mood, the primary defining features are not intense depression and misery, but rather a **break from reality**. *Mania* - Mania is characterized by an **elevated or irritable mood**, increased energy, and hyperactivity, which are the opposite of depression. - Symptoms include **racing thoughts, decreased need for sleep, grandiosity, and impulsive behavior**, not intense depression. *Melancholia* - Melancholia is a **specifier for major depressive disorder**, not a standalone condition in DSM-5/ICD-11. - While melancholia describes a **particularly severe form** of depression with profound despondency, it is a **subtype or qualifier** applied to MDD, not a separate diagnostic entity. - **The question asks for a "condition"** - MDD is the primary condition, while melancholic features describe characteristics within that condition.
Question 6: A 67-year-old lady is brought in by her six children, who say that she has become senile. Six months after her husband's death, she has become more religious and spiritual, and gives a lot of money in donation. She is occupied with too many activities and sleeps less. She now believes that she has a goal to change society. She does not like being brought to the hospital and is argumentative when questioned about her actions. The diagnosis is:
- A. Depression
- B. Impulse control disorder
- C. Mania (Correct Answer)
- D. Schizophrenia
Explanation: ***Mania*** - The patient exhibits classic symptoms of **mania**: increased religiosity, excessive donations, overactivity, reduced sleep, and a **grandiose belief** ("goal to change society"). - Her **argumentativeness** and resistance to evaluation are consistent with the **lack of insight** often seen in manic episodes. *Depression* - While the death of her husband could trigger depression, her symptoms of **increased energy**, reduced sleep, and grandiosity are **contrary to typical depression** (low mood, anhedonia, fatigue). - Depression usually involves feelings of **worthlessness and guilt**, not an inflated sense of self-importance or mission. *Impulse control disorder* - This category usually involves specific problematic behaviors (e.g., gambling, kleptomania) driven by an **irresistible urge**, often preceded by tension and followed by relief. - The patient's broader constellation of symptoms, including grandiosity and reduced sleep, points to a more pervasive mood disturbance rather than a single maladaptive impulse. *Schizophrenia* - Schizophrenia is characterized by **psychosis**, including prominent hallucinations, delusions (often bizarre), disorganization in thought and speech, and negative symptoms. - While she has a **grandiose delusion**, the overall clinical picture, especially the prominent mood and energy changes, is much more indicative of a **manic episode**.
Question 7: Which of the following is considered a poor prognostic factor for schizophrenia?
- A. Poor premorbid adjustment (Correct Answer)
- B. Male sex
- C. Presence of depression
- D. Blunted affect
Explanation: **Poor premorbid adjustment** - **Poor premorbid adjustment**, indicated by difficulties in social, academic, or occupational functioning before the onset of psychosis, is a consistent predictor of a worse outcome in schizophrenia. - This suggests a more pervasive and entrenched neurodevelopmental vulnerability impacting the individual's ability to cope and integrate socially. *Blunted affect (negative symptom)* - While **blunted affect** is a negative symptom often associated with poorer outcomes than positive symptoms, it is typically considered a *symptom* of the illness rather than a primary prognostic *factor* like premorbid adjustment. - Its presence contributes to disability, but it is not as strong an independent prognostic indicator as the life trajectory prior to illness onset. *Male sex (generally poorer prognosis)* - **Male sex** is generally associated with an **earlier age of onset** and often a **more severe course** of schizophrenia. - However, compared to significant functional impairment before disease onset, it is not as strong an individual predictor of overall long-term prognosis. *Presence of depression (often associated with better outcomes)* - The **presence of depressive symptoms** in schizophrenia is often associated with a **better prognosis**. - This is because depressive features can sometimes indicate a more preserved capacity for emotional experience and insight, which can align with higher functioning.
Question 8: A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?
- A. Cotard syndrome
- B. Delusional disorder (Correct Answer)
- C. Illusions
- D. Hallucinations
Explanation: ***Delusional disorder*** - This diagnosis fits the scenario as the patient holds a **false, fixed belief** (daughter wanting to kill him) that is not amenable to change in light of conflicting evidence. - The delusion is **non-bizarre** and relates to situations that can occur in real life, consistent with delusional disorder, and there are no other significant psychotic symptoms or impairment in functioning. *Cotard syndrome* - This is a rare syndrome characterized by **nihilistic delusions** (e.g., belief that one is dead, does not exist, or that organs have putrefied). - The patient's delusion in the question is persecutory, not nihilistic. *Illusions* - **Illusions** are misinterpretations of real external stimuli (e.g., seeing a coat in the dark and believing it's a person). - The patient's belief is a **false belief** without an external stimulus being misinterpreted. *Hallucinations* - **Hallucinations** are sensory experiences that occur in the absence of an external stimulus (e.g., hearing voices when no one is speaking). - The patient's presentation is characterized by a **fixed false belief**, not primarily by sensory perceptions without external stimuli.
Question 9: All of the following are true about bipolar disorder rapid cycling EXCEPT:
- A. Associated with hypothyroidism
- B. More common in males (Correct Answer)
- C. Often worsened by antidepressants
- D. Defined by ≥4 mood episodes per year
Explanation: ***More common in males*** - **Rapid cycling** in bipolar disorder is actually **more common in females** than in males. - While overall prevalence of bipolar disorder is similar between sexes, rapid cycling and mixed features tend to be more frequent in women. *Defined by ≥4 mood episodes per year* - This is the correct definition of **rapid cycling** in bipolar disorder according to diagnostic criteria (DSM-5). - These episodes can be of major depressive, manic, hypomanic, or mixed types. *Often worsened by antidepressants* - **Antidepressants** can sometimes **induce mania** or **accelerate cycling** in vulnerable individuals with bipolar disorder. - This risk is particularly elevated in rapid cycling presentations, leading to caution in their use. *Associated with hypothyroidism* - There is a recognized association between **hypothyroidism** and **rapid cycling** in bipolar disorder. - Treating underlying thyroid dysfunction can sometimes help stabilize mood in these patients.
Question 10: Type of schizophrenia with intellectual disability:
- A. Catatonic schizophrenia
- B. Pfropf schizophrenia (Correct Answer)
- C. Paranoid schizophrenia
- D. Hebephrenic schizophrenia
Explanation: ***Pfropf schizophrenia*** - **Pfropf schizophrenia** is a historical term specifically used to describe a form of schizophrenia that develops in individuals with **pre-existing intellectual disability** (formerly termed mental retardation). - The term "Pfropf" is derived from German, meaning "grafted" or "engrafted," referring to schizophrenia being "grafted onto" pre-existing intellectual disability. - This term distinguishes it from other types of schizophrenia where intellectual disability is not a primary defining characteristic. - While this classification is largely historical (modern DSM-5 has removed schizophrenia subtypes), it remains relevant for older examination questions. *Catatonic schizophrenia* - Characterized primarily by prominent **psychomotor disturbances**, which can include stupor, catalepsy, waxy flexibility, mutism, and negativism. - While intellectual disability might coexist, it is not a defining feature of the catatonic subtype itself. *Paranoid schizophrenia* - Marked by the prominence of **delusions**, typically persecutory or grandiose, and **auditory hallucinations**. - Intellectual disability is not a core diagnostic criterion or a defining characteristic of this subtype. *Hebephrenic schizophrenia* - Also known as **disorganized schizophrenia**, this type is characterized by marked **disorganization of thought processes**, flat or inappropriate affect, and bizarre behavior. - While it often presents early and can lead to significant functional impairment, intellectual disability is not a defining feature; rather, the primary disturbance is in thought and emotion.
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