Psychotic Disorders Practice Questions

Q: Which of the following features is not typically considered a primary symptom of psychosis?

Panic attack. **Explanation:** Psychosis is a clinical syndrome characterized by a "loss of contact with reality." The core features of psychotic disorders include delusions, hallucinations, disorganized thinking (speech), and grossly disorganized or catatonic behavior. **Why Panic Attack is the correct answer:** A **Panic Attack** is an episode of intense fear accompanied by severe autonomic arousal (tachycardia, sweating, tremors). It is a hallmark of **Anxiety Disorders**, not Psychotic Disorders. In a panic attack, the individual’s reality testing remains intact; they are aware that their physical symptoms are a result of extreme anxiety, even if they fear they are dying. Therefore, it is not a primary symptom of psychosis. **Analysis of other options:** * **Delusion (B):** A fixed, false belief that is not amenable to change in light of conflicting evidence. It is a primary symptom of psychosis (disorder of thought content). * **Hallucination (C):** A perception in the absence of an external stimulus (e.g., hearing voices). It is a primary symptom of psychosis (disorder of perception). * **Hypochondriasis (D):** Now classified under Somatic Symptom Disorder (DSM-5), it involves a preoccupation with having a serious illness. While primarily a neurotic/somatic concern, it can reach **delusional intensity** (Somatic Delusion) in psychotic disorders, where the patient is unshakably convinced they have a disease despite medical reassurance. **High-Yield Clinical Pearls for NEET-PG:** * **Schneider’s First Rank Symptoms (FRS):** These are pathognomonic for Schizophrenia and include audible thoughts, voices arguing/commenting, and somatic passivity. * **Reality Testing:** The fundamental distinction between Neurosis (Anxiety/Depression) and Psychosis is the **loss of reality testing** in the latter. * **Formal Thought Disorder:** This refers to disorganized thinking (e.g., loosening of associations), which is a core objective sign of psychosis.

Q: A young woman develops a delusional belief that a famous film star is in love with her. Which of the following conditions best exemplifies this presentation?

Erotomania. **Explanation:** The clinical presentation described is a classic example of **Erotomania**, also known as **de Clérambault's Syndrome**. **1. Why Erotomania is correct:** Erotomania is a subtype of delusional disorder where the individual (typically a woman) develops a fixed, false belief that another person—usually of higher social status, such as a celebrity, politician, or employer—is deeply in love with them. Despite the lack of any real contact, the patient interprets neutral actions (like a TV anchor’s smile) as secret messages of affection. **2. Why other options are incorrect:** * **Persecutory delusion:** This is the most common type of delusion, where the individual believes they are being conspired against, cheated, or harassed. It does not involve themes of romantic love. * **Grandiose delusion:** The individual possesses an inflated sense of worth, power, knowledge, or identity (e.g., believing they are a deity or have a special relationship with a deity). While erotomania involves a "famous" person, the core theme is specifically romantic love, not personal omnipotence. * **Nymphomania:** This is an outdated term for hypersexuality in women. It refers to a high frequency of sexual desire or activity and is a behavioral/impulse control issue, not a delusional thought disorder. **High-Yield Clinical Pearls for NEET-PG:** * **De Clérambault's Syndrome:** Named after the French psychiatrist who first described it. * **Demographics:** More common in females, though males with the condition are more likely to exhibit stalking behavior or legal issues. * **Management:** Delusional disorders are notoriously difficult to treat; **Second-generation antipsychotics** (e.g., Risperidone) are the first-line pharmacological treatment, often combined with psychotherapy. * **Key Distinction:** In erotomania, the "lover" is usually the one who is supposedly pursuing the patient, not the other way around (initially).

Q: What is the most common type of hallucination experienced in schizophrenia?

Auditory. **Explanation:** In the context of schizophrenia, **Auditory Hallucinations** are the most common and characteristic perceptual disturbances, occurring in approximately 70-80% of patients. These typically manifest as "voices" that may be derogatory, commanding, or conversational. Specifically, **third-person hallucinations** (voices discussing the patient among themselves) and **running commentaries** are considered Schneiderian First-Rank Symptoms (FRS), which carry high diagnostic weight for schizophrenia. **Analysis of Incorrect Options:** * **B. Visual Hallucinations:** While they can occur in schizophrenia, they are much less frequent than auditory ones. Their presence should always prompt a clinician to rule out **organic brain syndromes**, substance withdrawal (e.g., Delirium Tremens), or complex partial seizures. * **C. Olfactory Hallucinations:** These involve smelling non-existent odors (often unpleasant like burning rubber or sulfur). They are rare in schizophrenia and are most commonly associated with **Temporal Lobe Epilepsy** (uncinate fits). * **D. Tactile Hallucinations:** Also known as haptic hallucinations, these are uncommon in schizophrenia. They are classically associated with **cocaine intoxication** ("cocaine bugs" or Formication) and alcohol withdrawal. **Clinical Pearls for NEET-PG:** * **Most common subtype of Schizophrenia:** Paranoid Schizophrenia. * **Best Prognosis:** Paranoid Schizophrenia; **Worst Prognosis:** Hebephrenic (Disorganized) Schizophrenia. * **Functional Hallucination:** A real external stimulus triggers a simultaneous hallucination in the same sensory modality (e.g., hearing voices only when the tap is running). * **Reflex Hallucination:** A stimulus in one sensory modality triggers a hallucination in another (e.g., seeing a ghost when hearing a bell).

Q: What is Folie à deux?

Shared delusional disorder. **Explanation:** **Folie à deux** (literally "madness of two") is a rare clinical syndrome characterized by the transmission of delusional beliefs from one individual to another. In modern psychiatric classification (ICD-10), it is termed **Shared Psychotic Disorder** or **Induced Delusional Disorder**. 1. **Why Option B is Correct:** The disorder typically involves two people (usually family members with a close emotional bond) living in relative isolation. The **"primary" (inducer/dominant)** individual has a genuine psychotic disorder with stable delusions, which are then "passed on" to the **"secondary" (passive/submissive)** individual. A key diagnostic and therapeutic feature is that the secondary person’s delusions often resolve or significantly improve once they are separated from the primary individual. 2. **Why Other Options are Incorrect:** * **A. Obsessive-compulsive disorder:** Characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), not shared delusions. * **C. Hysteria:** An archaic term for Dissociative or Conversion disorders, involving physical symptoms without organic causes or emotional dissociation. * **D. Neurasthenia:** An older term (ICD-10) for a condition involving chronic fatigue, lassitude, and somatic complaints, often linked to stress. **Clinical Pearls for NEET-PG:** * **Treatment:** The first step in management is **separation** of the two individuals. The primary person usually requires antipsychotics, while the secondary may only need observation after separation. * **Variants:** If three people are involved, it is *Folie à trois*; if an entire family, it is *Folie à famille*. * **ICD-11 Update:** Under the newer ICD-11, this is categorized under "Induced Delusional Disorder."

Q: Infidelity and jealousy involving a spouse is the thought content of which disorder?

Othello syndrome. **Explanation:** The correct answer is **Othello Syndrome**, also known as **Morbid or Delusional Jealousy**. This is a psychotic disorder characterized by the unshakable, false belief that one’s spouse or sexual partner is being unfaithful. The patient often seeks "evidence" through stalking, checking belongings, or interrogation. It is clinically significant due to the high risk of domestic violence and homicide. **Analysis of Options:** * **Othello Syndrome (Correct):** Named after Shakespeare’s character, it involves a primary delusion of infidelity. It is frequently associated with chronic alcoholism and personality disorders. * **Capgras Syndrome:** A "delusional misidentification" syndrome where the patient believes a close relative or spouse has been replaced by an identical-looking impostor. * **De Clerambault’s Syndrome (Erotomania):** The delusional belief that a person (usually of higher social status or a celebrity) is deeply in love with the patient, despite little to no contact. * **Hypochondriacal Paranomia:** This is a distracter term; however, *Monomanic Hypochondriacal Psychosis* (like Ekbom syndrome/delusional parasitosis) involves fixed false beliefs regarding physical health or infestation, not infidelity. **NEET-PG High-Yield Pearls:** * **Othello Syndrome** is most commonly associated with **Alcohol Use Disorder**. * **Fregoli Syndrome** (the opposite of Capgras) is the belief that different people are actually a single person in disguise. * **Cotard Syndrome** is the "walking corpse" delusion (nihilistic delusions of being dead or rotting). * These are all categorized as **Delusional Disorders** (ICD-10/DSM-5), where the core symptom is a non-bizarre delusion lasting >1 month without prominent hallucinations.

Q: What is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?

D. Somatic passivity. ***Somatic passivity***- This symptom describes the delusional belief that one's **bodily sensations**, movements, or actions (e.g., movements of the limbs, feelings in the body) are being controlled or imposed upon by an **external agency** or force.- It is considered one of **Schneider's First-Rank Symptoms** (FRS) of **schizophrenia**, highlighting profound disturbances in self-boundaries and agency.*Delusion of nihilism*- This delusion, often seen in severe depression or psychosis (e.g., **Cotard's syndrome**), is the belief that one is dead, does not exist, or that parts of the body or the world do not exist.- It does not involve the feeling of **external control** or influence over existing bodily movements or sensations.*Delusion of reference*- This is the belief that otherwise innocuous or neutral events, objects, or people's actions in the environment have a particular and unusual meaning specifically **referring to oneself**.- It relates to interpreting the environment (e.g., hearing a radio broadcast talking *about* them), not the feeling of bodily movements being **controlled by external forces**.*Othello syndrome*- Also known as **morbid jealousy** or **delusional jealousy**, this is a specific type of delusional disorder characterized by the fixed, unfounded belief that one's partner is being **unfaithful**.- It is focused strictly on relationships and fidelity and has no association with beliefs of external control over **somatic functions**.

Question 1

Which of the following features is not typically considered a primary symptom of psychosis?

Accepted Answer

Panic attack

Answer

Delusion

Answer

Hallucination

Answer

Hypochondriasis

Question 2

A young woman develops a delusional belief that a famous film star is in love with her. Which of the following conditions best exemplifies this presentation?

Accepted Answer

Erotomania

Answer

Persecutory delusion

Answer

Grandiose delusion

Answer

Nymphomania

Question 3

A 22-year-old, unmarried man is suffering from sudden onset of third person hallucination for the past 12 days. He is suspicious of his relatives and close friends and is having reduced appetite and improper sleep. What is he most likely suffering from?

Accepted Answer

Schizophrenia

Answer

Acute depression

Answer

Acute mania

Answer

Acute psychosis

Question 4

What is the most common type of persistent delusional disorder?

Accepted Answer

Delusion of persecution

Answer

Somatic delusion

Answer

Delusion of jealousy

Answer

Delusion of grandeur

Question 5

What is the most common type of hallucination experienced in schizophrenia?

Accepted Answer

Auditory

Answer

Visual

Answer

Olfactory

Answer

Tactile

Question 6

A 20-year-old male presents with auditory hallucinations and aggressive behavior for the past 2 days. He also reports fever during the same period. His family states he has been muttering to himself and gesturing. There is no prior history of psychiatric illness. What is the most likely diagnosis?

Accepted Answer

Acute psychosis

Answer

Dementia

Answer

Delirium

Answer

Delusional disorder

Question 7

What is Folie à deux?

Accepted Answer

Shared delusional disorder

Answer

Obsessive-compulsive disorder

Answer

Hysteria

Answer

Neurasthenia

Question 8

Infidelity and jealousy involving a spouse is the thought content of which disorder?

Accepted Answer

Othello syndrome

Answer

Capgras syndrome

Answer

Hypochondrial paranomia

Answer

Declerambault's syndrome

Question 9

Arrange the following subtypes of schizophrenia in order of prognosis, with the best prognosis first and the worst prognosis last: 1. Paranoid schizophrenia 2. Catatonic schizophrenia 3. Simple schizophrenia 4. Disorganised schizophrenia

Accepted Answer

2-1-4-3

Answer

4-2-1-3

Answer

2-1-3-4

Answer

1-2-4-3

Question 10

What is the diagnosis for a patient who believes their bodily sensations or movements are controlled or influenced by an external agency?

Accepted Answer

D. Somatic passivity

Answer

C. Othello syndrome

Answer

A. Delusion of nihilism

Answer

B. Delusion of reference

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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