Psychotic Disorders Practice Questions

Q: Which of the following is true for schizophrenia?

It is a disorder of thought. **Explanation:** **Why Option A is Correct:** Schizophrenia is fundamentally classified as a **disorder of thought**. It involves disturbances in the **form** (e.g., loosening of associations, neologisms), **content** (e.g., delusions), and **stream** of thought. While it also affects perception (hallucinations), emotion (blunted affect), and behavior, the core psychopathology lies in the fragmentation of thought processes and a loss of contact with reality. **Why Other Options are Incorrect:** * **Option B (Split Personality):** This is a common layman’s misconception. "Split personality" refers to **Dissociative Identity Disorder (DID)**. The "schizo" (split) in schizophrenia refers to a "split from reality" or a fragmentation of mental functions (the "Sejunction" theory by Wernicke), not multiple personalities. * **Option C & D (Emotional Turmoil/Childhood Trauma):** While psychosocial stressors and trauma can act as **triggers** or contributing factors in genetically predisposed individuals (Stress-Diathesis Model), they are not the primary cause. Schizophrenia is a complex **neurodevelopmental disorder** with strong genetic and biological underpinnings (e.g., Dopamine hypothesis). **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** These are diagnostic pillars and include audible thoughts (thought echo), voices arguing/commenting, and thought withdrawal/insertion/broadcast. * **Bleuler’s 4 A’s:** Fundamental symptoms include **A**ffective flattening, **A**mbivalence, **A**utism (social withdrawal), and **A**ssociation looseness. * **Neurobiology:** Associated with increased dopaminergic activity in the **mesolimbic pathway** (positive symptoms) and decreased activity in the **mesocortical pathway** (negative symptoms). * **Prognosis:** Good prognostic factors include late onset, female sex, presence of mood symptoms, and being married.

Q: Which is the first rank symptom described by Delusions?

Thought insertion. **Explanation:** **Kurt Schneider’s First Rank Symptoms (FRS)** are a group of specific symptoms used to diagnose Schizophrenia. These symptoms are characterized by a loss of ego boundaries, where the patient cannot distinguish between their own internal mental processes and external influences. **Why Thought Insertion is Correct:** Thought insertion is a classic **Delusion of Control/Passivity**. It is the belief that thoughts are being put into one’s mind by an external agency (e.g., "The government is planting ideas in my head via satellite"). Along with **thought withdrawal** and **thought broadcasting**, it forms the "Thought Alienation" triad, which is a core component of Schneider’s FRS. **Analysis of Incorrect Options:** * **A. Echolalia:** This is the automatic repetition of vocalizations made by another person. It is a feature of **Catatonia** or certain neurodevelopmental disorders, but it is not a First Rank Symptom. * **C. Autism:** In psychiatry, "Autistic thinking" (detachment from reality) is one of **Eugen Bleuler’s 4 A’s** of Schizophrenia, not a Schneiderian First Rank Symptom. * **D. Suicidal tendency:** While common in psychiatric disorders, this is a clinical risk factor and not a diagnostic symptom of any specific psychotic framework. **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s FRS Mnemonic (ABCD):** * **A**uditory Hallucinations (Third person, Running commentary, Echo/Gedankenlautwerden). * **B**eliefs (Delusional perception). * **C**ontrol (Passivity of affect, impulse, or volition). * **D**elusions of Thought (Insertion, Withdrawal, Broadcasting). * **Bleuler’s 4 A’s:** Ambivalence, Autism, Affective flattening, and Association looseness. * **Note:** FRS are no longer required for a diagnosis in DSM-5, but they remain highly relevant for exams and identifying "Schneiderian Schizophrenia."

Q: Which of the following is considered a Schneider's first-rank symptom?

Voices commenting on actions. **Explanation:** Kurt Schneider proposed **First-Rank Symptoms (FRS)** in 1959 to differentiate schizophrenia from other psychotic disorders. These symptoms are considered highly suggestive of schizophrenia in the absence of organic brain disease. **Why Option B is Correct:** **Voices commenting on one's actions** (Third-person auditory hallucinations) is one of the classic "Auditory Hallucinations" described by Schneider. In this symptom, the patient hears voices describing their movements or behaviors as they happen (e.g., "Now he is picking up the glass"). The other two specific auditory FRS are **voices arguing/discussing** and **thought echo** (Gedankenlautwerden). **Analysis of Incorrect Options:** * **A & C (Persecutory Delusion & Delusion of Guilt):** While these are common in schizophrenia and mood disorders, they are considered **Second-Rank Symptoms**. Schneider believed these delusions could occur in various psychiatric conditions and were not pathognomonic for schizophrenia. * **D (Incoherence):** This is a formal thought disorder. While it is a diagnostic criterion in DSM-5 and ICD-10, it is not part of Schneider’s original list of First-Rank Symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for FRS (ABCD):** * **A**uditory Hallucinations (Thought echo, 3rd person voices, running commentary). * **B**roadcasting of thoughts (and Thought Withdrawal/Insertion). * **C**ontrolled feelings/impulses/acts (Passivity phenomena/Made phenomena). * **D**elusional Perception (A normal perception followed by a private, highly significant, usually delusional conclusion). * **Note:** The presence of FRS is no longer mandatory for a diagnosis of schizophrenia in **DSM-5**, as they were found to be less specific than previously thought, though they remain high-yield for exams.

Q: Delusions in delirium are generally:

Transient. **Explanation:** Delirium is an acute neuropsychiatric syndrome characterized by a fluctuating course, altered consciousness, and global cognitive impairment. The correct answer is **Transient** because delusions in delirium are typically fleeting, poorly systematized, and fragmented. 1. **Why "Transient" is correct:** Unlike the fixed, well-organized delusions seen in Schizophrenia or Delusional Disorder, delusions in delirium lack stability. Because the patient’s level of consciousness and attention fluctuates throughout the day, their thought content remains disorganized and shifts rapidly. 2. **Why other options are incorrect:** * **Frightening:** While patients often experience fear due to visual hallucinations (zoopsia), the delusions themselves are not defined by being "frightening" as a diagnostic rule. * **Self-referential:** Ideas of reference are more characteristic of Schizophrenia or Mood Disorders with psychotic features. * **Nihilistic:** These are specific delusions (e.g., Cotard’s syndrome) where a patient believes they are dead or do not exist, typically associated with severe Psychotic Depression, not delirium. **High-Yield Clinical Pearls for NEET-PG:** * **Core Feature:** The hallmark of delirium is an **impairment of consciousness** (clouding of sensorium) and a **fluctuating** course (symptoms often worsen at night, known as "sundowning"). * **Hallucinations:** Visual hallucinations are much more common in delirium than auditory ones. * **EEG Finding:** Characteristically shows **generalized slowing** (except in Delirium Tremens, where there is low-voltage fast activity). * **Reversibility:** Delirium is usually secondary to an underlying medical condition (e.g., infection, electrolyte imbalance) and is reversible once the cause is treated.

Q: Which feature suggests schizophrenia rather than organic psychosis?

Third person auditory hallucination. **Explanation:** The distinction between functional psychosis (like Schizophrenia) and organic psychosis (due to medical conditions or substance use) is a high-yield topic in NEET-PG. **1. Why Option A is Correct:** **Third-person auditory hallucinations** (voices talking about the patient in the third person) and **running commentary** are considered **Schneiderian First Rank Symptoms (SFRS)**. These are highly characteristic of Schizophrenia. While not pathognomonic, their presence in a clear sensorium strongly points toward a functional psychotic disorder rather than an organic cause. **2. Why Incorrect Options are Wrong:** * **B. Split Personality:** This is a common layperson's misconception. "Split personality" refers to Dissociative Identity Disorder, not Schizophrenia. Schizophrenia involves a "splitting" of mental functions (thought, emotion, and behavior), not multiple identities. * **C. Visual Hallucinations:** These are the hallmark of **organic psychosis** (e.g., delirium, alcohol withdrawal, or head injury). While they can occur in schizophrenia, their presence should always prompt a clinician to rule out medical or neurological causes first. * **D. Altered Sensorium:** This refers to clouding of consciousness or disorientation. It is the defining feature of **Delirium (Organic Brain Syndrome)**. In Schizophrenia, the sensorium (orientation to time, place, and person) remains characteristically **clear**. **Clinical Pearls for NEET-PG:** * **Hallucinations:** Auditory = Most common in Schizophrenia; Visual/Tactile/Olfactory = Suggest Organic etiology. * **SFRS:** Includes audible thoughts (thought echo), voices arguing, voices commenting, and passivity phenomena. * **Age of Onset:** Schizophrenia typically starts in late teens to early 30s; new-onset psychosis in an elderly patient is almost always organic.

Q: Delusion of infidelity is seen in which of the following syndromes?

Othello syndrome. **Explanation:** **1. Correct Option: Othello Syndrome (A)** Othello syndrome, also known as **pathological jealousy** or **morbid jealousy**, is characterized by a persistent and false belief (delusion) that one’s spouse or partner is being unfaithful. It is a form of delusional disorder (jealous type). Patients often go to extreme lengths to find "evidence" of infidelity, such as checking phone logs, stalking, or interrogating their partner. It is frequently associated with chronic alcoholism and carries a high risk of domestic violence. **2. Incorrect Options:** * **De Clérambault Syndrome (B):** Also known as **Erotomania**. The patient (usually female) holds a delusional belief that another person, typically of higher social status or a celebrity, is deeply in love with them. * **Magnan Syndrome (C):** This refers to **Cocaine-induced psychosis**, specifically characterized by tactile hallucinations known as "formication" or "cocaine bugs" (the sensation of insects crawling under the skin). * **Cotard Syndrome (D):** Also known as **Walking Corpse Syndrome** or **Nihilistic delusion**. The patient believes they are dead, do not exist, or that their internal organs have rotted away. It is most commonly seen in severe psychotic depression. **Clinical Pearls for NEET-PG:** * **Capgras Syndrome:** The belief that a familiar person has been replaced by an identical-looking impostor (the most common "misidentification syndrome"). * **Fregoli Syndrome:** The belief that different people are actually a single person in disguise. * **Ekbom Syndrome:** Delusional parasitosis (belief that one is infested with parasites). * **Othello Syndrome** is most strongly linked with **Alcohol Dependence Syndrome**.

Q: A 25-year-old university student had a fight with a neighbor. On the next day, while out, he felt that two men in police uniform were observing his movements. When he reached home in the evening, he was frightened and expressed that the police were after him and would arrest him. His symptoms represent which of the following?

Delusion of persecution. ### Explanation **1. Why "Delusion of Persecution" is correct:** A **delusion** is 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. In this case, the student believes he is being followed and will be arrested by the police. This is a **Delusion of Persecution**, where the individual believes that harm is occurring or is going to occur, and that others (individuals or groups like the police) are intentionally targeting, spying on, or conspiring against them. **2. Why the other options are incorrect:** * **Ideas of Reference:** This involves the false belief that neutral, external events (like people talking in a corner or a news report) have a special personal significance. While the student felt observed (which can be a precursor), his firm conviction that they were "after him to arrest him" elevates this to a full-blown persecutory delusion. * **Passivity (Made Phenomena):** This is a Schneiderian First Rank Symptom (SFRS) where the patient feels their actions, impulses, or emotions are being controlled by an external agency. There is no evidence of loss of agency here. * **Thought Insertion:** This is the belief that thoughts are being put into one’s mind by an external force. This is a disorder of thought ownership, not content. **3. NEET-PG High-Yield Pearls:** * **Delusion of Persecution** is the most common type of delusion seen in **Schizophrenia**. * **Schneiderian First Rank Symptoms (SFRS):** Include thought insertion, withdrawal, broadcast, passivity, and third-person hallucinations. Note that persecutory delusions are *not* specific to SFRS but are common in psychosis. * **Differentiating Idea vs. Delusion:** An "idea" can be challenged or held with less conviction; a "delusion" is fixed and unshakable.

Question 1

Which of the following is true for schizophrenia?

Accepted Answer

It is a disorder of thought

Answer

It is split personality

Answer

It is due to emotional turmoil

Answer

It is due to childhood trauma

Question 2

Which is the first rank symptom described by Delusions?

Accepted Answer

Thought insertion

Answer

Echolalia

Answer

Autism

Answer

Suicidal tendency

Question 3

Which of the following is considered a Schneider's first-rank symptom?

Accepted Answer

Voices commenting on actions

Answer

Persecutory delusion

Answer

Delusion of guilt

Answer

Incoherence

Question 4

A 40-year-old man has recently started writing books. The content of his writing is incoherent, using neologisms and tangential themes, making it unintelligible to others. What is the likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Genius writer

Answer

Delusional disorder

Question 5

Delusions in delirium are generally:

Accepted Answer

Transient

Answer

Frightening

Answer

Self-referential

Answer

Nihilistic

Question 6

Which feature suggests schizophrenia rather than organic psychosis?

Accepted Answer

Third person auditory hallucination

Answer

Split personality

Answer

Visual hallucination

Answer

Altered sensorium

Question 7

Delusion of infidelity is seen in which of the following syndromes?

Accepted Answer

Othello syndrome

Answer

Dechlerambault syndrome

Answer

Magnan syndrome

Answer

Cotard syndrome

Question 8

A 25-year-old university student had a fight with a neighbor. On the next day, while out, he felt that two men in police uniform were observing his movements. When he reached home in the evening, he was frightened and expressed that the police were after him and would arrest him. His symptoms represent which of the following?

Accepted Answer

Delusion of persecution

Answer

Ideas of reference

Answer

Passivity

Answer

Thought insertion

Question 9

A 25-year-old female complains that her jawline is too long, a perception not shared by her husband or family members. She has consulted multiple plastic surgeons who have not recommended any surgical modification. What condition is she most likely suffering from?

Accepted Answer

Delusional Disorder

Answer

Body Dysmorphic Disorder

Answer

Hypochondriasis

Answer

Somatization Disorder

Question 10

Which of the following is an example of a bizarre delusion?

Accepted Answer

Delusion of persecution: "My brain is controlled by a microchip."

Answer

Delusion of infidelity: "My wife has an affair with another person."

Answer

Delusion of grandiosity: "I am the greatest person in the world."

Answer

Delusion of reference: "I am being prosecuted often."

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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