Psychotic Disorders Practice Questions

Q: A young patient admitted to the hospital with acute psychosis believes his wife, who is present in the room, is a nurse masquerading as her. He states that this nurse previously gave him the wrong medication and now intends to harm him. What is the likely diagnosis?

Capgras syndrome. ### Explanation **1. Why Capgras Syndrome is Correct:** Capgras syndrome is a **delusional misidentification syndrome** characterized by the belief that a person familiar to the patient (usually a spouse or close relative) has been replaced by an **identical-looking impostor**. In this case, the patient recognizes his wife's physical appearance but denies her true identity, claiming she is a nurse "masquerading" as her. This often stems from a disconnection between the facial recognition area of the brain and the emotional processing center (amygdala), leading to a lack of "emotional warmth" upon seeing a loved one. **2. Analysis of Incorrect Options:** * **Fregoli Syndrome:** This is the "inverse" of Capgras. The patient believes that different strangers are actually a single familiar person in disguise. * **Delusion of Subjective Doubles:** The patient believes there is an exact physical double of *themselves* living an independent life. * **Othello Syndrome:** Also known as pathological jealousy, it is the delusional belief that one’s partner is being unfaithful, without any evidence. **3. High-Yield Clinical Pearls for NEET-PG:** * **Capgras Syndrome** is the most common delusional misidentification syndrome. * It is frequently associated with **Schizophrenia**, but can also occur in organic brain disorders like **Lewy Body Dementia** or right-hemisphere lesions. * **Key distinction:** In Capgras, the person looks the same but is a "stranger"; in Fregoli, the person looks like a stranger but is "familiar." * These syndromes are often categorized under **Monothematic Delusions**.

Q: Which of the following is the most specific indicator of psychosis?

Neologism. **Explanation:** The correct answer is **A. Neologism**. In psychiatry, **Neologism** refers to the coining of new words or the use of existing words in a completely private, idiosyncratic manner that has no recognized meaning to others. It is a hallmark of a **formal thought disorder** and is considered a "first-rank" or highly specific indicator of **Schizophrenia** and other psychotic disorders. While other speech disturbances occur in various conditions, neologisms are rarely seen outside of psychosis. **Analysis of Incorrect Options:** * **B. Incoherence (Word Salad):** While common in severe schizophrenia (disorganized type), it can also be seen in organic brain syndromes, delirium, or advanced dementia. It is less specific to primary psychosis than neologisms. * **C. Pressure of speech:** This is a characteristic feature of **Mania** (Bipolar Disorder). It refers to rapid, frantic, and unstoppable speech. While it can occur in psychotic mania, it is primarily a sign of psychomotor agitation rather than a specific indicator of psychosis itself. * **D. Perseveration:** This is the persistent repetition of a specific response (word, phrase, or gesture) despite the absence or cessation of a stimulus. It is most commonly associated with **organic brain diseases** (like frontal lobe damage) and dementias, making it non-specific for psychosis. **Clinical Pearls for NEET-PG:** * **Formal Thought Disorder (FTD):** Neologisms, Derailment (Knight’s move thinking), and Loosening of Associations are the most characteristic FTDs in Schizophrenia. * **Clang Association:** Choosing words based on sound (rhyming) rather than meaning; typically seen in Mania. * **Echolalia:** Senseless repetition of another person’s words; seen in Catatonia, Autism, and Dementia.

Q: What is an oneiroid state?

A dream-like state. **Explanation:** The term **Oneiroid state** (derived from the Greek word *oneiros*, meaning "dream") refers to a specific type of altered consciousness characterized by a **dream-like state** occurring while the patient is awake. 1. **Why Option B is correct:** In an oneiroid state, the patient experiences vivid, often kaleidoscopic hallucinations and scenic imagery, feeling as though they are living within a dream or a cinematic experience. Unlike typical delirium, the patient is often physically quiet but deeply immersed in an internal fantasy world. It is most commonly associated with **Oneiroid Schizophrenia**. 2. **Why the other options are incorrect:** * **Option A (Twilight state):** This is a condition of narrowed consciousness (often seen in epilepsy or hysteria) where the patient may perform complex actions but has subsequent amnesia. While similar, it lacks the specific "dream-like" hallucinatory depth of oneirophrenia. * **Option C (Heightened consciousness):** This refers to hyper-alertness, often seen in mania or under the influence of stimulants, which is the opposite of the clouded, dream-like immersion seen here. * **Option D (Organic stupor):** This involves a lack of psychomotor activity and responsiveness due to structural or metabolic brain damage, whereas the oneiroid state is primarily a functional psychotic phenomenon. **High-Yield Clinical Pearls for NEET-PG:** * **Mayer-Gross** is the psychiatrist associated with the description of the oneiroid state. * It is a key feature of **Oneirophrenia**, a sub-type of acute schizophrenia with a relatively good prognosis. * **Key distinction:** Unlike delirium (where disorientation is to the external environment), the oneiroid patient is disoriented because they are "lost" in an internal dream world.

Q: Schizophrenia is characterized by all the following positive symptoms, except:

Anhedonia. **Explanation:** In Schizophrenia, symptoms are broadly categorized into **Positive** and **Negative** symptoms. This distinction is crucial for both diagnosis and pharmacological management. **Why Anhedonia is the correct answer:** **Anhedonia** (the inability to experience pleasure from activities usually found enjoyable) is a classic **Negative symptom**. Negative symptoms represent a "loss" or "deficit" of normal functions. They are often more resistant to typical antipsychotics and are associated with a poorer long-term prognosis. Other negative symptoms include the "5 A’s": Affective flattening, Alogia (poverty of speech), Avolition (lack of motivation), Asociality, and Anhedonia. **Why the other options are incorrect:** Positive symptoms represent an "excess" or "distortion" of normal functions. * **A. Hallucinations:** These are sensory perceptions in the absence of external stimuli (most commonly auditory in Schizophrenia). * **B. Delusions:** These are fixed, false beliefs that are not amenable to change in light of conflicting evidence. * **C. Conceptual Disorganization:** This refers to thought disorder manifested through disorganized speech (e.g., derailment, incoherence, or tangentiality). **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** Primarily consist of positive symptoms (e.g., audible thoughts, somatic passivity, delusional perception). * **Dopamine Hypothesis:** Positive symptoms are associated with **hyperactivity** of dopamine in the **mesolimbic pathway**, while negative symptoms are linked to **hypoactivity** in the **mesocortical pathway**. * **Prognosis:** Presence of prominent positive symptoms generally predicts a better response to treatment compared to predominant negative symptoms.

Q: Bleuler's symptoms of schizophrenia include which of the following?

Automatism. **Explanation:** Eugen Bleuler, a Swiss psychiatrist, coined the term "Schizophrenia" and identified four fundamental symptoms (often called the **4 A’s**) that he believed were present in every case of the disorder. **The 4 A’s of Bleuler include:** 1. **A**ffective Disturbance (Inappropriate or blunted affect) 2. **A**utism (Social withdrawal and living in a private fantasy world) 3. **A**mbivalence (Coexisting opposing emotions/impulses toward the same object) 4. **A**ssociation Loosening (Fragmented thought processes/Formal thought disorder) **Analysis of Options:** * **Option B (Automatism) is the Correct Answer** in the context of this specific question format because it is **NOT** one of Bleuler’s 4 A’s. (Note: In NEET-PG, "include which of the following" questions sometimes ask for the "except" or the "odd one out" depending on the source; here, Automatism is the outlier). Automatism refers to involuntary motor activities and is more commonly associated with epilepsy or dissociative states. * **Options A, C, and D** are all primary (fundamental) symptoms described by Bleuler. **Clinical Pearls for NEET-PG:** * **Fundamental vs. Accessory Symptoms:** Bleuler categorized symptoms into Fundamental (the 4 A’s) and Accessory (Hallucinations and Delusions). He believed accessory symptoms were not essential for diagnosis. * **Schneider’s First Rank Symptoms (FRS):** Unlike Bleuler, Kurt Schneider focused on "First Rank Symptoms" (e.g., audible thoughts, somatic passivity, delusional perception) which were considered pathognomonic for schizophrenia. * **Historical Context:** Bleuler’s "Loosening of Association" is considered the hallmark of the schizophrenic thought disorder.

Q: Worst prognosis is seen in which type of schizophrenia?

Simple. **Explanation:** The prognosis of Schizophrenia is determined by the age of onset, the nature of symptoms (positive vs. negative), and the speed of progression. **Why Simple Schizophrenia is the Correct Answer:** Simple Schizophrenia (ICD-10) is characterized by the early and insidious onset of **negative symptoms** (apathy, withdrawal, loss of drive) without the presence of overt hallucinations or delusions. Because it lacks "florid" psychotic symptoms, it often goes undiagnosed for years. It has a chronic, downhill course with poor response to typical antipsychotics and a very high risk of social drift, making it the subtype with the **worst prognosis**. **Analysis of Incorrect Options:** * **Paranoid Schizophrenia:** This subtype has the **best prognosis**. It typically has a later age of onset, preserved cognitive function, and responds well to medication because it is dominated by positive symptoms (delusions/hallucinations). * **Catatonic Schizophrenia:** This has a **good prognosis** regarding recovery from individual episodes. It shows an excellent and rapid response to Benzodiazepines (Lorazepam) and Electroconvulsive Therapy (ECT). * **Hebephrenic (Disorganized) Schizophrenia:** This has a **poor prognosis** due to early onset and severe personality deterioration, but it is generally considered slightly better than Simple Schizophrenia because the symptoms are more recognizable, allowing for earlier intervention. **NEET-PG High-Yield Pearls:** * **Best Prognosis:** Paranoid Schizophrenia. * **Worst Prognosis:** Simple Schizophrenia (followed by Hebephrenic). * **Good Prognostic Factors:** Late onset, female sex, presence of precipitating factors, acute onset, and predominant positive symptoms. * **Poor Prognostic Factors:** Early onset, male sex, insidious onset, family history, and predominant negative symptoms.

Q: A 33-year-old male traveling by flight started fighting with an air hostess. The man alleged that the air hostess was his wife, but she had changed her face so she could not be identified. This history is consistent with which of the following syndromes?

Fregoli syndrome. ### Explanation The correct answer is **Fregoli syndrome**. **1. Why Fregoli Syndrome is Correct:** Fregoli syndrome is a **delusional misidentification syndrome** where the patient believes that a familiar person (often a perceived persecutor) is following them or present in their environment by taking on the physical appearance of strangers. In this case, the patient believes the air hostess (a stranger) is actually his wife (a familiar person) who has "changed her face." The core psychopathology is the belief that different people are actually a single person in disguise. **2. Why the Other Options are Incorrect:** * **Capgras Syndrome:** This is the "mirror image" of Fregoli. The patient believes a familiar person (e.g., a spouse) has been replaced by an **identical-looking impostor**. Here, the face is the same, but the identity is different. * **Othello Syndrome:** Also known as **pathological jealousy**, this is a delusion that one’s spouse or partner is being unfaithful. It does not involve misidentification of faces. * **de Clerembault Syndrome:** Also known as **Erotomania**, this is the delusion that another person, usually of higher social status or a celebrity, is deeply in love with the patient. **3. High-Yield Clinical Pearls for NEET-PG:** * **Delusional Misidentification Syndromes (DMS):** These are often associated with organic brain lesions (especially in the right hemisphere or bifrontal regions) or schizophrenia. * **Intermetamorphosis:** Another DMS where the patient believes people have swapped physical and psychological identities with each other. * **Syndrome of Subjective Doubles:** The belief that a physical double of oneself exists and is leading an independent life. * **Management:** Treatment typically involves atypical antipsychotics (e.g., Risperidone) and addressing any underlying neurological cause.

Q: A 45-year-old male admits himself to the hospital, stating that the nurse treating him is an imposter, and his wife has replaced her to kill him. What is the most likely diagnosis?

Fregoli syndrome. ### Explanation The correct answer is **Fregoli syndrome**. This is a delusional misidentification syndrome characterized by the belief that different people are actually a single person in disguise. **1. Why Fregoli Syndrome is Correct:** In this clinical scenario, the patient believes a familiar person (his wife) has taken on the appearance of a stranger (the nurse) to follow or harm him. This "hyper-identification" involves the belief that a familiar individual is physically disguised as someone else. It is often associated with paranoid schizophrenia or organic brain injury. **2. Analysis of Incorrect Options:** * **Capgras Syndrome:** This is the opposite of Fregoli. The patient believes a familiar person (e.g., a spouse) has been replaced by an identical-looking **imposter**. In the question, the patient believes the "imposter" is actually his wife in disguise, which points to Fregoli. * **Cotard Syndrome:** Also known as "Walking Corpse Syndrome," the patient suffers from nihilistic delusions, believing they are dead, rotting, or have lost their internal organs or soul. * **Alport Syndrome:** This is a genetic disorder (Type IV collagen defect) characterized by glomerulonephritis, end-stage kidney disease, and hearing loss. It is a renal/ENT condition, not a psychiatric disorder. **3. NEET-PG High-Yield Pearls:** * **Delusional Misidentification Syndromes (DMS):** These are often linked to a disconnection between the visual recognition system and the emotional processing system (amygdala). * **Intermetamorphosis:** A related syndrome where the patient believes people swap identities with each other both physically and psychologically. * **Reduplicative Paramnesia:** The delusional belief that a location has been duplicated or moved to another site. * **Management:** Primarily involves antipsychotics (e.g., Risperidone) and treating any underlying organic cause.

Question 1

A young patient admitted to the hospital with acute psychosis believes his wife, who is present in the room, is a nurse masquerading as her. He states that this nurse previously gave him the wrong medication and now intends to harm him. What is the likely diagnosis?

Accepted Answer

Capgras syndrome

Answer

Fregoli syndrome

Answer

Delusion of subjective doubles

Answer

Othello syndrome

Question 2

Marital discord is a known factor in the development of which of the following disorders?

Accepted Answer

Schizophrenia

Answer

Conduct disorder

Answer

Depression

Answer

Delusional disorder

Question 3

Which of the following is the most specific indicator of psychosis?

Accepted Answer

Neologism

Answer

Incoherence

Answer

Pressure of speech

Answer

Perseveration

Question 4

What is an oneiroid state?

Accepted Answer

A dream-like state

Answer

A twilight state

Answer

A heightened state of consciousness

Answer

An organic stupor or torpor

Question 5

Schizophrenia is characterized by all the following positive symptoms, except:

Accepted Answer

Anhedonia

Answer

Hallucinations

Answer

Delusions

Answer

Conceptual disorganization

Question 6

A patient with schizophrenia is on neuroleptics. Their psychotic symptoms have improved, but they have developed sadness, talk less, and remain in bed. Which of the following is LEAST likely to be the cause of these new symptoms?

Accepted Answer

Reaction to external stimuli

Answer

Parkinsonism

Answer

Major depression

Answer

Persisting negative symptoms of schizophrenia

Question 7

Bleuler's symptoms of schizophrenia include which of the following?

Accepted Answer

Automatism

Answer

Autism

Answer

Affect disturbance

Answer

Loosening of association

Question 8

Worst prognosis is seen in which type of schizophrenia?

Accepted Answer

Simple

Answer

Paranoid

Answer

Catatonic

Answer

Hebephrenic

Question 9

A 33-year-old male traveling by flight started fighting with an air hostess. The man alleged that the air hostess was his wife, but she had changed her face so she could not be identified. This history is consistent with which of the following syndromes?

Accepted Answer

Fregoli syndrome

Answer

Capgras syndrome

Answer

Othello syndrome

Answer

de Clerembault syndrome

Question 10

A 45-year-old male admits himself to the hospital, stating that the nurse treating him is an imposter, and his wife has replaced her to kill him. What is the most likely diagnosis?

Accepted Answer

Fregoli syndrome

Answer

Capgras syndrome

Answer

Cotard syndrome

Answer

Alport syndrome

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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