Delusional disorder US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Delusional disorder. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Delusional disorder US Medical PG Question 1: A 55-year-old male was picked up by police in the public library for harassing the patrons and for public nudity. He displayed disorganized speech and believed that the books were the only way to his salvation. Identification was found on the man and his sister was called to provide more information. She described that he recently lost his house and got divorced within the same week although he seemed fine three days ago. The man was sedated with diazepam and chlorpromazine because he was very agitated. His labs returned normal and within three days, he appeared normal, had no recollection of the past several days, and discussed in detail how stressful the past two weeks of his life were. He was discharged the next day. Which of the following is the most appropriate diagnosis for this male?
- A. Brief psychotic disorder (Correct Answer)
- B. Schizotypal personality disorder
- C. Schizophreniform disorder
- D. Schizophrenia
- E. Schizoid personality disorder
Delusional disorder Explanation: ***Brief psychotic disorder***
- This patient exhibited characteristic symptoms such as **sudden onset of psychotic symptoms** (disorganized speech, delusions, public nudity) that lasted **less than one month** and were preceded by a **severe psychosocial stressor** (loss of house, divorce).
- The **full return to premorbid functioning** and lack of recollection after the episode further support brief psychotic disorder, distinguishing it from other chronic psychotic disorders.
*Schizotypal personality disorder*
- Characterized by a pervasive pattern of **social and interpersonal deficits**, cognitive or perceptual distortions, and eccentricities of behavior, which are usually **long-standing** and not episodic.
- While there may be odd beliefs or magical thinking, the dramatic and time-limited psychotic episode in the scenario is not typical of schizotypal personality disorder.
*Schizophreniform disorder*
- This disorder is diagnosed when psychotic symptoms (like those seen in schizophrenia) are present for **at least one month but less than six months**.
- Although the patient presented with psychotic symptoms, their rapid resolution within three days makes a diagnosis of schizophreniform disorder unlikely.
*Schizophrenia*
- Requires continuous signs of disturbance for **at least six months**, including at least one month of active-phase symptoms, along with significant impairment in social or occupational functioning.
- The rapid resolution of symptoms and return to baseline within days in this case immediately rules out schizophrenia, which is a chronic condition.
*Schizoid personality disorder*
- Characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of expression of emotions in interpersonal settings.
- This disorder does not involve psychotic symptoms, disorganized speech, or delusions of the intensity described in the patient's presentation.
Delusional disorder US Medical PG Question 2: A 45-year-old obese man is evaluated in a locked psychiatric facility. He was admitted to the unit after he was caught running through traffic naked while tearing out his hair. His urine toxicology screening was negative for illicit substances and after careful evaluation and additional history, provided by his parents, he was diagnosed with schizophrenia and was treated with aripiprazole. His symptoms did not improve after several dosage adjustments and he was placed on haloperidol, but this left him too lethargic and slow and he was placed on loxapine. After several dosage adjustments today, he is still quite confused. He describes giant spiders and robots that torture him in his room. He describes an incessant voice screaming at him to run away. He also strongly dislikes his current medication and would like to try something else. Which of the following is indicated in this patient?
- A. Haloperidol
- B. Olanzapine
- C. Chlorpromazine
- D. Fluphenazine
- E. Clozapine (Correct Answer)
Delusional disorder Explanation: ***Clozapine***
- This patient has **treatment-resistant schizophrenia**, indicated by a lack of response to multiple trials of antipsychotics, including aripiprazole (atypical), haloperidol (typical), and loxapine (atypical).
- **Clozapine** is the only antipsychotic proven effective for treatment-resistant schizophrenia, significantly reducing psychotic symptoms and suicidality.
*Haloperidol*
- Haloperidol is a **first-generation antipsychotic** that the patient has already tried and found to be too sedating and slow.
- Continuing with haloperidol would likely result in persistent side effects and inadequate symptom control given his prior negative experience.
*Olanzapine*
- Olanzapine is a **second-generation atypical antipsychotic**; however, it is not typically indicated as a first-line treatment for treatment-resistant schizophrenia after failure of multiple agents.
- While effective for schizophrenia, it would be less effective than clozapine in a patient who has failed several previous antipsychotic trials.
*Chlorpromazine*
- Chlorpromazine is a **first-generation antipsychotic** that carries a higher risk of sedation, extrapyramidal symptoms, and anticholinergic side effects.
- It is unlikely to be more effective than haloperidol, which the patient already found too sedating and slow, and would not be the preferred choice for treatment-resistant schizophrenia.
*Fluphenazine*
- Fluphenazine is a **first-generation antipsychotic** with potent dopamine D2 receptor blockade, often leading to significant extrapyramidal side effects.
- Like other first-generation antipsychotics, it is not indicated as the next step for treatment-resistant schizophrenia after failure of multiple trials.
Delusional disorder US Medical PG Question 3: A 23-year-old man is brought to the emergency department by his girlfriend because of acute agitation and bizarre behavior. The girlfriend reports that, over the past 3 months, the patient has become withdrawn and stopped pursuing hobbies that he used to enjoy. One month ago, he lost his job because he stopped going to work. During this time, he has barely left his apartment because he believes that the FBI is spying on him and controlling his mind. He used to smoke marijuana occasionally in high school but quit 5 years ago. Physical and neurologic examinations show no abnormalities. On mental status examination, he is confused and suspicious with marked psychomotor agitation. His speech is disorganized and his affect is labile. Which of the following is the most likely diagnosis?
- A. Schizophreniform disorder (Correct Answer)
- B. Schizoid personality disorder
- C. Delusional disorder
- D. Schizoaffective disorder
- E. Brief psychotic disorder
Delusional disorder Explanation: **Correct: Schizophreniform disorder**
- This patient presents with ***psychotic symptoms*** (delusions, disorganized speech, agitation) and ***negative symptoms*** (withdrawal, anhedonia, loss of job), which have been present for approximately ***3 months***.
- The ***duration of symptoms (1-6 months)*** is the key differentiating factor for schizophreniform disorder compared to brief psychotic disorder (<1 month) or schizophrenia (>6 months).
- Meets DSM-5 criteria: psychotic symptoms with functional impairment lasting between 1 and 6 months.
*Incorrect: Schizoid personality disorder*
- Characterized by a pervasive pattern of ***detachment from social relationships*** and a restricted range of emotional expression, which are ***ego-syntonic*** and typically stable over time.
- This is a personality disorder with chronic traits, not an acute psychotic disorder.
- Does not include acute psychotic symptoms like delusions or disorganized speech.
*Incorrect: Delusional disorder*
- Defined by the presence of ***non-bizarre delusions*** for at least one month, without other significant psychotic symptoms or major functional impairment.
- This patient has ***bizarre delusions*** (FBI controlling his mind), ***disorganized speech***, ***psychomotor agitation***, and ***marked functional impairment***, which exceed the criteria for delusional disorder.
*Incorrect: Schizoaffective disorder*
- Requires the presence of a ***major mood episode*** (depressive or manic) concurrent with symptoms of schizophrenia, AND ***delusions or hallucinations for at least 2 weeks*** in the absence of a major mood episode.
- While the patient exhibits labile affect, there is no evidence of a distinct, prolonged major mood episode (major depression or mania) as required for schizoaffective disorder.
*Incorrect: Brief psychotic disorder*
- Characterized by the sudden onset of psychotic symptoms (delusions, hallucinations, disorganized speech or behavior) that last for ***at least one day but less than one month***, followed by full return to premorbid functioning.
- The patient's symptoms have been ongoing for approximately ***3 months***, which exceeds the duration criteria for brief psychotic disorder.
Delusional disorder US Medical PG Question 4: Two dizygotic twins present to the university clinic because they believe they are being poisoned through the school's cafeteria food. They have brought these concerns up in the past, but no other students or cafeteria staff support this belief. Both of them are average students with strong and weak subject areas as demonstrated by their course grade-books. They have no known medical conditions and are not known to abuse illicit substances. Which statement best describes the condition these patients have?
- A. A trial separation is likely to worsen symptoms.
- B. The disorder is its own disease entity in DSM-5.
- C. Antipsychotic medications are rarely beneficial.
- D. Can affect two or more closely related individuals. (Correct Answer)
- E. Cognitive behavioral therapy is a good first-line.
Delusional disorder Explanation: ***Can affect two or more closely related individuals.***
- The shared delusional belief in **folie à deux**, also known as **shared psychotic disorder**, typically occurs in two or more people who are closely associated.
- In this case, the **dizygotic twins** sharing the same delusional belief about being poisoned from cafeteria food fits this pattern.
*A trial separation is likely to worsen symptoms.*
- **Separating the individuals** involved in **folie à deux** is often a crucial step in treatment, as it can help break the cycle of shared delusion and allow for individual therapy.
- Separation typically IMPROVES rather than worsens symptoms by removing the reinforcement of the shared delusion.
*The disorder is its own disease entity in DSM-5.*
- In the **DSM-5**, **folie à deux** is no longer considered a separate diagnostic category.
- Instead, it is classified under **Other Specified Schizophrenia Spectrum and Other Psychotic Disorder** or **Unspecified Schizophrenia Spectrum and Other Psychotic Disorder**, with the specific context of shared delusion noted.
*Antipsychotic medications are rarely beneficial.*
- **Antipsychotics** are actually commonly used in treating folie à deux, particularly for the **primary individual** who initially developed the delusion.
- They can be an important component of treatment, often combined with separation and psychotherapy.
*Cognitive behavioral therapy is a good first-line.*
- **Cognitive Behavioral Therapy (CBT)** can be beneficial, particularly after separation, to help individuals challenge and reframe their delusional beliefs.
- However, the **first-line intervention** for shared psychotic disorder is **separation of the involved individuals**, followed by individual therapy (which may include CBT) and medication as needed.
Delusional disorder US Medical PG Question 5: A 22-year-old man is brought to the emergency department by his father because he is having bizarre thoughts. The patient says that he is being haunted by aliens from outer space. The father is worried as his son has had these symptoms for the past 7 months and lately, it seems to be getting worse. He has become more self-obsessed and does not seem to have any interest in his favorite activities. He has no plans to harm himself or others but spends a lot of time and energy building ‘defenses’ in and around his room as he is absolutely sure that aliens will come to get him soon. His blood pressure is 121/79 mm Hg, pulse 86/min, respiratory rate 15/min, temperature 36.8°C (98.2°F). Which of the following is correct regarding the patient’s symptoms?
- A. It would benefit from psychosurgery.
- B. He has a fixed false belief. (Correct Answer)
- C. It is best treated with cognitive behavioral therapy alone.
- D. It is a negative symptom.
- E. It falls under the disorganized thinking domain.
Delusional disorder Explanation: ***He has a fixed false belief.***
- The patient's conviction that he is being haunted by aliens, despite evidence to the contrary and the distress it causes, constitutes a **delusion**.
- A delusion is by definition a **fixed, false belief** that is not in keeping with the individual's cultural background.
*It would benefit from psychosurgery.*
- Psychosurgery, such as lobotomy, is an extreme and rarely used intervention for **severe, refractory mental disorders**, typically only after all other treatments have failed and with significant ethical considerations.
- While the patient's symptoms are impairing, **first-line treatments** for psychotic disorders involve antipsychotic medications and psychotherapy, not psychosurgery.
*It is best treated with cognitive behavioral therapy alone.*
- While CBT for psychosis (CBTp) can be a useful **adjunct** in managing delusions and reducing distress, it is **not sufficient as monotherapy** for active, severe psychotic symptoms.
- The primary intervention for profound delusions like those described is **antipsychotic medication**, with CBT added as an adjunctive treatment to help improve functioning and coping.
- CBT alone would be inadequate for someone with such fixed, impairing delusions actively building defenses against perceived threats.
*It is a negative symptom.*
- Negative symptoms of psychosis include features like **anhedonia** (lack of pleasure), **alogia** (poverty of speech), **avolition** (lack of motivation), and affective flattening.
- The patient's bizarre belief in aliens is a **positive symptom** as it represents an *addition* to normal experience, rather than a *reduction* or *absence* of normal functions.
- Note: The patient's decreased interest in activities suggests negative symptoms are also present, but the question asks about "the patient's symptoms" in context of the delusion described.
*It falls under the disorganized thinking domain.*
- Disorganized thinking or speech involves patterns like **loose associations, tangentiality, incoherence**, or word salad, where the logical connections between thoughts are lost.
- While the content of the patient's thoughts is bizarre, the core issue described is the *belief itself* (a delusion, which is a **positive symptom**), rather than disordered *thought processes* or the way he expresses them.
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