Psychotic Disorders Practice Questions

Q: Which type of schizophrenia is characterized by late onset and a good prognosis?

Paranoid schizophrenia. ### Explanation **Paranoid Schizophrenia** is the most common subtype and is characterized by the presence of prominent delusions (typically persecutory or grandiose) and auditory hallucinations. **Why it is the correct answer:** * **Late Onset:** Unlike other subtypes, it usually manifests in the late 20s or 30s. * **Good Prognosis:** It carries the best prognosis among all subtypes because the patient’s personality remains relatively preserved, and there is a significant absence of "negative symptoms" (apathy, withdrawal) and disorganized behavior/speech. These patients often have better cognitive functioning and social skills, leading to better treatment compliance and outcomes. **Analysis of Incorrect Options:** * **A. Simple Schizophrenia:** Characterized by early onset and an insidious progression of negative symptoms (apathy, social withdrawal) without prominent hallucinations or delusions. It has a **very poor prognosis**. * **B. Hebephrenic (Disorganized) Schizophrenia:** Features early onset (teens/early 20s), disorganized speech, and "flat" or inappropriate affect. It is associated with rapid personality deterioration and a **poor prognosis**. * **C. Catatonic Schizophrenia:** Characterized by psychomotor disturbances (stupor, waxy flexibility, or excitement). While it responds well to ECT and Lorazepam, it does not typically have the "late onset" profile characteristic of the paranoid type. **High-Yield NEET-PG Pearls:** * **Best Prognosis:** Paranoid Schizophrenia. * **Worst Prognosis:** Simple and Hebephrenic Schizophrenia. * **Schneider’s First Rank Symptoms (FRS):** Most commonly seen in Paranoid Schizophrenia. * **Prognostic Factors:** Good prognosis is associated with late onset, female sex, presence of precipitating factors, and acute onset. Poor prognosis is linked to early onset, insidious start, and negative symptoms.

Q: T.J. Crow proposed a classification of schizophrenia patients into type I and type II. Type II schizophrenia is characterized by all of the following, EXCEPT:

Disorganized behavior. **Explanation:** T.J. Crow’s classification (1980) divides schizophrenia into two distinct syndromes based on clinical features, treatment response, and underlying pathology. **Why "Disorganized Behavior" is the correct answer:** Disorganized behavior is considered a **positive symptom**. According to Crow’s classification, positive symptoms (like hallucinations, delusions, and thought disorders) are the hallmark of **Type I Schizophrenia**, not Type II. Type I is associated with dopaminergic hyperactivity and generally carries a better prognosis. **Analysis of Incorrect Options (Features of Type II):** * **A. Negative Symptoms:** Type II is primarily characterized by negative symptoms such as affective flattening, poverty of speech (alogia), and loss of drive (avolition). * **B. Poor response to medications:** Unlike Type I, which responds well to typical antipsychotics (D2 blockers), Type II patients typically show a **poor or partial response** to traditional medication. * **D. CT scan abnormalities:** Type II is associated with structural brain changes, most notably **ventricular enlargement** and cortical atrophy, suggesting a neurodegenerative component rather than just neurochemical dysfunction. **High-Yield Clinical Pearls for NEET-PG:** * **Type I (Positive):** "Dopamine Hypothesis" – Normal CT scan, good premorbid adjustment, reversible symptoms, good prognosis. * **Type II (Negative):** "Structural Hypothesis" – Abnormal CT (ventriculomegaly), poor premorbid adjustment, intellectual impairment, chronic course. * **Memory Aid:** Think of **Type I** as "Reactive/Chemical" and **Type II** as "Structural/Deficit."

Q: Who coined the term "Ambivalence"?

Eugen Bleuler. **Explanation:** The term **Ambivalence** was coined by the Swiss psychiatrist **Eugen Bleuler** in 1911. Ambivalence refers to the simultaneous existence of contradictory feelings (such as love and hate), attitudes, or wishes toward the same object, person, or situation. Bleuler is most famous for defining the **"4 As" of Schizophrenia**, which are considered the primary (fundamental) symptoms of the disorder: 1. **Ambivalence** 2. **Autism** (Social withdrawal/internalized world) 3. **Affective Incongruity** (Inappropriate emotional response) 4. **Association Looseness** (Disordered thought process) **Analysis of Incorrect Options:** * **Hippocrates:** Known as the "Father of Medicine," he proposed the Humoral Theory (imbalance of black bile, yellow bile, blood, and phlegm) to explain mental illness but did not define modern psychiatric terminology. * **Emil Kraepelin:** Often called the founder of modern scientific psychiatry, he is best known for the **"Kraepelinian Dichotomy,"** which distinguished between *Dementia Praecox* (now Schizophrenia) and Manic-Depressive Psychosis. * **Sigmund Freud:** The founder of Psychoanalysis. While he extensively utilized the concept of ambivalence in his theories regarding the unconscious and the Oedipus complex, he was not the one who coined the term. **High-Yield NEET-PG Pearls:** * **Eugen Bleuler** also coined the term **"Schizophrenia"** (replacing Kraepelin’s *Dementia Praecox*) and **"Autism."** * **Kurt Schneider** later proposed the **"First Rank Symptoms" (FRS)** of Schizophrenia, which are different from Bleuler’s 4 As and focus on hallucinations and delusions. * Bleuler’s symptoms are considered "fundamental," while Schneider’s are "diagnostic" in many traditional frameworks.

Q: An elderly patient presents with auditory hallucinations and a delusion that unknown people are conspiring against him and commenting on his actions. What is the most likely diagnosis?

Schizophrenia. **Explanation:** The correct diagnosis is **Schizophrenia**. According to ICD and DSM criteria, the presence of **auditory hallucinations** (specifically running commentary) combined with **delusions of persecution** (conspiracy) are hallmark "First Rank Symptoms" (FRS) of Schizophrenia. While Schizophrenia typically has an onset in early adulthood, it can present in the elderly (Late-onset Schizophrenia, usually after age 45), often characterized by more prominent persecutory delusions and sensory hallucinations with fewer negative symptoms. **Why other options are incorrect:** * **Dementia:** While elderly patients with dementia (like Alzheimer’s) can have delusions, the primary deficit is cognitive decline (memory loss, disorientation). Hallucinations in dementia are more commonly visual rather than complex auditory commentary. * **Delusional Disorder:** This diagnosis is characterized by non-bizarre delusions *without* prominent hallucinations. The presence of auditory hallucinations (commenting on actions) effectively rules out pure Delusional Disorder. * **Acute Psychosis:** This term usually refers to symptoms lasting less than one month. Given the complexity of the symptoms (conspiracy + commentary), Schizophrenia is the more specific and likely clinical diagnosis in a standard board-style question unless a very short duration is explicitly mentioned. **Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Include audible thoughts (thought echo), voices arguing, voices commenting on one's action, and delusions of control/passivity. * **Late-onset Schizophrenia:** More common in females and often associated with sensory deficits (hearing/vision loss). * **Treatment:** Low-dose atypical antipsychotics are the mainstay, but one must always rule out organic causes (delirium/electrolyte imbalance) in elderly psychiatric presentations.

Q: If both parents are diagnosed with schizophrenia, what is the estimated probability of their offspring developing the condition?

40%. **Explanation:** The risk of developing schizophrenia is heavily influenced by genetic factors. In the general population, the lifetime prevalence is approximately **1%**. However, this risk increases significantly as the degree of genetic relatedness to an affected individual increases. When **both parents** have schizophrenia, the risk to the offspring is approximately **40% to 46%**. This represents the highest risk among all familial categories, second only to monozygotic (identical) twins. In the context of standard medical examinations like NEET-PG, **40%** is the most commonly cited and accepted figure based on Kallmann’s landmark studies and Kaplan & Sadock’s Synopsis of Psychiatry. **Analysis of Options:** * **A (4%):** This is the approximate risk for a second-degree relative (e.g., a grandchild or nephew/niece) of an individual with schizophrenia. * **B (14%):** This is the approximate risk when only **one parent** or one non-twin sibling is affected (ranging from 10% to 15%). * **D (50%):** While 40-46% is close to 50%, the latter is generally reserved for the risk in **Monozygotic twins (47-50%)**. A child of two affected parents has a slightly lower risk than an identical twin because the twin shares 100% of the DNA and a more similar intrauterine environment. **High-Yield Clinical Pearls for NEET-PG:** * **General Population:** 1% * **One Parent affected:** 12–15% * **Dizygotic (Fraternal) Twins:** 12–15% (same as a sibling) * **Both Parents affected:** 40–46% * **Monozygotic (Identical) Twins:** 47–50% * **Note:** Schizophrenia is a **polygenic** disorder; no single gene is responsible. The most common environmental risk factor cited is cannabis use or obstetric complications.

Q: Which of the following is a delusion?

Othello syndrome. **Explanation:** The correct answer is **Othello syndrome**. In psychiatry, a **delusion** 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 evidence to the contrary. **1. Why Othello Syndrome is correct:** Othello syndrome, also known as **Morbid Jealousy** or Conjugal Paranoia, is a type of delusional disorder where the individual is unshakably convinced that their spouse or sexual partner is being unfaithful. This belief is maintained without any objective evidence and often leads to dangerous behaviors like stalking or violence. **2. Analysis of other options:** * **De Clerambault's syndrome:** Also known as **Erotomania**, this is a delusional disorder where the patient believes that another person (usually of higher social status or a celebrity) is in love with them. While this is also a delusion, the question asks "Which of the following is a delusion?" and in many standardized NEET-PG keys, Othello syndrome is the primary example used for "Delusional Disorder—Jealous type." *Note: In some contexts, both A and B are delusions; however, if forced to choose the "most" classic example in older MCQ patterns, Othello is frequently cited.* * **Pyromania:** This is an **Impulse Control Disorder**, not a delusion. It involves a repetitive failure to resist impulses to set fires, accompanied by tension before the act and relief/gratification afterward. **High-Yield Clinical Pearls for NEET-PG:** * **Capgras Syndrome:** Delusion of doubles (believing a familiar person has been replaced by an identical impostor). * **Fregoli Syndrome:** Delusion that different people are actually a single person in disguise. * **Ekbom Syndrome:** Delusional parasitosis (belief that one is infested with insects). * **Cotard Syndrome:** Nihilistic delusion (belief that one is dead, rotting, or does not exist).

Question 1

Which type of schizophrenia is characterized by late onset and a good prognosis?

Accepted Answer

Paranoid schizophrenia

Answer

Simple schizophrenia

Answer

Hebephrenic schizophrenia

Answer

Catatonic schizophrenia

Question 2

Which of the following statements regarding schizophrenia and delusional disorder is FALSE?

Accepted Answer

Socially inappropriate behavior is seen in delusional disorders.

Answer

Delusions and hallucinations are positive symptoms of schizophrenia.

Answer

Hallucinations are absent in delusional disorder.

Answer

Symptoms need to be present for at least 6 months to diagnose schizophrenia (according to DSM-5).

Question 3

What is the definition of treatment-resistant schizophrenia (TRS)?

Accepted Answer

Lack of response to two different antipsychotics at adequate doses for four weeks

Answer

Lack of response to one antipsychotic at an adequate dose for four weeks

Answer

Lack of response to one antipsychotic at an adequate dose for ten weeks

Answer

Lack of response to two same antipsychotics at adequate doses for four weeks

Question 4

T.J. Crow proposed a classification of schizophrenia patients into type I and type II. Type II schizophrenia is characterized by all of the following, EXCEPT:

Accepted Answer

Disorganized behavior

Answer

Negative symptoms

Answer

Poor response to medications

Answer

CT scan abnormalities

Question 5

Who coined the term "Ambivalence"?

Accepted Answer

Eugen Bleuler

Answer

Hippocrates

Answer

Kraeplin

Answer

Sigmund Freud

Question 6

An elderly patient presents with auditory hallucinations and a delusion that unknown people are conspiring against him and commenting on his actions. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Dementia

Answer

Delusional disorder

Answer

Acute psychosis

Question 7

A 42-year-old man, employed by a company for 2 years, believes his fellow employees have conspired to get him fired. He suspects his phone is tapped and that he is followed home, frequently checking his residence for surveillance. He denies auditory hallucinations and has no other symptoms. What is the most appropriate diagnosis?

Accepted Answer

Delusional disorder (paranoid type)

Answer

Paranoid schizophrenia

Answer

Catatonic schizophrenia

Answer

Paranoid personality disorder

Question 8

Which of the following is a characteristic clinical manifestation of schizophrenia?

Accepted Answer

Formal thought disorder

Answer

Delusions

Answer

Auditory hallucinations

Answer

Visual hallucinations

Question 9

If both parents are diagnosed with schizophrenia, what is the estimated probability of their offspring developing the condition?

Accepted Answer

40%

Answer

4%

Answer

14%

Answer

50%

Question 10

Which of the following is a delusion?

Accepted Answer

Othello syndrome

Answer

De Clerambault's syndrome

Answer

Pyromania

Answer

None of the above

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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