Psychotic Disorders Practice Questions

Q: A person has a false belief that he owns a lot of property and that someone he knows is trying to take it away from him. Which of the following best describes the type of delusions he is experiencing?

Delusion of grandeur and persecution. ***Delusion of grandeur and persecution***- The belief in owning a lot of property reflects **delusion of grandeur**, which is characterized by an exaggerated belief in one's wealth, importance, or abilities.- The belief that someone is trying to take their property away indicates a **delusion of persecution**, where the individual feels threatened or believes others are conspiring to harm them.*Delusion of grandeur and reference*- This option correctly identifies **delusion of grandeur** (owning vast property), but incorrectly identifies the second component.- **Delusion of reference** refers to the erroneous belief that common events, objects, or people have a specific, usually negative, meaning directed towards oneself (e.g., people on TV are talking about them). The patient is directly targeted, indicating persecution.*Delusion of nihilism*- Neither of the patient's described beliefs fit **delusion of nihilism** (Cotard syndrome), which is the false conviction that one's self, parts of the body, or the entire world do not exist.- This patient exhibits high self-importance (**grandeur**) and being targeted (**persecution**), not beliefs related to non-existence.*Delusion of grandeur and nihilism*- While **delusion of grandeur** is present, the patient's worry about someone stealing property is a persecutory type of delusion, not a **delusion of nihilism**.- The themes of persecution and grandeur found here are inconsistent with the theme of non-existence or loss of existence central to **nihilistic delusions**.

Q: A patient shows flat affect. What does it indicate?

Negative symptom. ***Correct: Negative symptom*** Flat affect refers to the **reduction** or **absence** of emotional expression, which is defined as a deficit in normal function or experience. Along with **alogia** (poverty of speech), **avolition** (lack of motivation), and **anhedonia** (inability to feel pleasure), flat affect is a core component of the **negative symptom** cluster, particularly in **schizophrenia**. Negative symptoms represent deficits or diminutions in normal emotional, motivational, and social functioning. *Incorrect: Positive symptom* Positive symptoms involve the **presence** or **addition** of abnormal mental phenomena, such as **hallucinations** (perceptual disturbances), **delusions** (fixed false beliefs), or **disorganized behavior**. Flat affect represents a **diminution** of normal emotional expression and is therefore categorized as a negative symptom, opposite to the addition of phenomena seen in positive symptoms. *Incorrect: Affect symptom* While flat affect is fundamentally related to the expression of **affect** (emotion), "affect symptom" is not a standard clinical classification used in psychiatric diagnostic systems. Psychiatric symptoms are primarily categorized into **positive**, **negative**, and **cognitive** domains for diagnostic and treatment purposes, particularly in disorders like schizophrenia. *Incorrect: Cognitive symptom* Cognitive symptoms relate to deficits in **executive function**, **attention**, **working memory**, and **processing speed**. These involve difficulties with thinking, concentration, and mental organization. Flat affect is categorized as an **emotional expression deficit** (negative symptom), which is distinct from the primary cognitive processing difficulties related to thought and memory.

Q: You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

Schizophrenia. ***Schizophrenia***- The presence of prominent **auditory hallucinations** and **command hallucinations** lasting for 7 months fulfills the diagnostic criteria for Schizophrenia (continuous signs of disturbance for at least 6 months).- The symptoms described (hearing aliens commanding violence) represent **positive symptoms** of psychosis and are often associated with poor insight and significant functional decline characteristic of this disorder.*Mania*- Mania requires a sustained period of abnormally and persistently elevated, expansive, or irritable **mood**, and increased goal-directed activity or energy, which is not the primary complaint here.- Psychotic features in Mania are usually **mood-congruent** (e.g., grandiose delusions about immense power), whereas these command hallucinations are non-mood-congruent.*Delusional disorder*- This disorder is characterized by the presence of one or more **non-bizarre delusions** lasting >1 month, but prominent hallucinations are specifically excluded.- The patient is experiencing persistent and prominent **auditory hallucinations**, making schizophrenia a more appropriate diagnosis.*Brief psychotic disorder*- This diagnosis is reserved for psychotic symptoms (delusions, hallucinations, disorganized speech) that last for a period of **less than one month**.- Since the patient's symptoms have persisted for **7 months**, the duration clearly rules out brief psychotic disorder.

Q: A 22-year-old male presents with a 6-month history of hearing voices commenting on his actions, social withdrawal, and belief that his thoughts are being broadcast to others. He has poor self-care and blunted affect. What is the most likely diagnosis?

Schizophrenia. ***Schizophrenia*** - The patient presents with **Schneiderian first-rank symptoms**: third-person auditory hallucinations (voices commenting on his actions) and **thought broadcasting** (belief that thoughts are being broadcast to others). - Duration of **6 months** meets the DSM-5 criterion for schizophrenia (continuous signs for at least 6 months). - Prominent **negative symptoms** including blunted affect, social withdrawal, and poor self-care with functional decline. - The combination of positive symptoms, negative symptoms, and duration establishes the diagnosis of schizophrenia. *Delusional disorder* - Characterized by fixed, non-bizarre delusions lasting at least **1 month** without other prominent psychotic symptoms. - **Hallucinations are absent or not prominent** in delusional disorder, whereas this patient has clear auditory hallucinations. - Functioning is relatively preserved except in areas directly affected by the delusion; this patient shows significant functional decline. *Brief psychotic disorder* - Requires symptom duration of **less than 1 month** with eventual return to premorbid functioning. - This patient has a **6-month history**, which far exceeds the duration criterion for brief psychotic disorder. - The chronicity and progressive nature rule out this diagnosis. *Schizoaffective disorder* - Requires concurrent presence of **major mood episode** (major depression or mania) meeting full criteria along with schizophrenia symptoms. - Must have delusions or hallucinations for at least **2 weeks in the absence of mood symptoms**. - This patient shows **no evidence of mood episodes** (neither depression nor mania) in the clinical presentation, ruling out schizoaffective disorder.

Q: A man reports that he is receiving orders from God to follow white birds in a specific direction. What is the most appropriate description of this symptom?

Passivity phenomenon. ***Passivity phenomenon*** - This symptom describes **delusions of control** (also called **made acts** or **passivity of volition**), which is a type of **passivity phenomenon**. - The patient believes that an **external force (God) is giving orders** and directing their actions (following white birds in a specific direction). - This represents the experience of **being controlled or influenced by an external agency**, which is a **First Rank Symptom** of schizophrenia according to Kurt Schneider. - The key feature is the belief in **external control over one's will or actions**, not merely attaching meaning to a perception. *Delusional perception* - This requires a **two-step process**: (1) a normal perception occurs, then (2) this perception is suddenly given **delusional significance** (e.g., "I saw the traffic light turn red and instantly knew I was the Messiah"). - The scenario described does **not** show the birds triggering a new delusional belief; rather, the patient already has an **established delusion of receiving divine commands**. - The birds are the **medium** through which control is exerted, not a perception given new meaning. *Visual hallucination* - A **hallucination** is a perception occurring in the **absence of an external stimulus**. - Since the white birds are actually present and the patient is seeing real birds, this is **not** a hallucination. - The pathology lies in the **delusional belief about being commanded**, not in perceiving something that isn't there. *Thought insertion* - This is a First Rank Symptom where the patient believes **thoughts are being inserted into their mind** by an external force. - The current scenario involves **receiving orders to perform actions** (passivity of volition), not the experience of alien thoughts being placed in one's mind. - While both involve external agency, thought insertion specifically concerns **thoughts**, whereas this case concerns **volitional control**.

Q: The following are manifestations of psychosis except:

Psychoneurosis. ***Psychoneurosis*** - **Psychoneurosis** is an older term referring to **neurotic disorders**, which involve distress but do not typically feature classic psychotic symptoms like **hallucinations**, **delusions**, or **disorganized thought**. - Individuals with neurotic disorders usually retain a grasp of reality and insight into their condition, distinguishing them from psychosis. *Manic depressive psychosis* - This is an archaic term for **bipolar disorder**, which can indeed involve psychotic features during severe manic or depressive episodes. - During these episodes, individuals may experience **hallucinations** or **delusions** consistent with their mood state. *Schizophrenia* - **Schizophrenia** is a chronic and severe mental disorder characterized by profound disruptions in thinking, perception, emotion, and behavior. - Its hallmark features include **delusions**, **hallucinations**, disorganized speech, and grossly disorganized or catatonic behavior, all of which are classic manifestations of psychosis. *Paranoia* - **Paranoia** involves intense anxious or fearful thoughts and beliefs, often centering on persecution, conspiracy, or threat. - Severe paranoia can develop into **paranoid delusions**, which are fixed false beliefs that are characteristic of psychotic disorders, such as **paranoid schizophrenia** or delusional disorder.

Q: A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?

Delusional disorder. ***Delusional disorder*** - This diagnosis fits the scenario as the patient holds a **false, fixed belief** (daughter wanting to kill him) that is not amenable to change in light of conflicting evidence. - The delusion is **non-bizarre** and relates to situations that can occur in real life, consistent with delusional disorder, and there are no other significant psychotic symptoms or impairment in functioning. *Cotard syndrome* - This is a rare syndrome characterized by **nihilistic delusions** (e.g., belief that one is dead, does not exist, or that organs have putrefied). - The patient's delusion in the question is persecutory, not nihilistic. *Illusions* - **Illusions** are misinterpretations of real external stimuli (e.g., seeing a coat in the dark and believing it's a person). - The patient's belief is a **false belief** without an external stimulus being misinterpreted. *Hallucinations* - **Hallucinations** are sensory experiences that occur in the absence of an external stimulus (e.g., hearing voices when no one is speaking). - The patient's presentation is characterized by a **fixed false belief**, not primarily by sensory perceptions without external stimuli.

Q: Neologism is seen in:

Schizophrenia. ***Schizophrenia*** - **Neologisms** are newly coined words that have meaning only to the person who invents them, and they are a characteristic **thought disorder** symptom often observed in schizophrenia. - This symptom reflects the **disorganized thinking** and **impaired communication** typical of the disorder. *Mania* - While individuals in a manic episode may exhibit **rapid speech**, **flight of ideas**, and **pressured speech**, they typically do not create entirely new words (neologisms). - Their speech is usually characterized by **excessive quantity** and quick topic changes, rather than word invention. *Depression* - Depression is associated with **poverty of speech**, **slowed thought processes**, and a focus on negative themes. - **Neologisms** are not a feature of depressive episodes. *Dysphasia* - **Dysphasia** (or aphasia) refers to an impairment in the production or comprehension of language due to brain injury, such as stroke. - While speech may be **disrupted** or **grammatically incorrect**, it primarily involves difficulty using existing words correctly rather than producing entirely new ones.

Q: Negative symptoms of schizophrenia are all except:-

Over activity. ***Over activity*** - **Overactivity** is a manifestation of disorganized or positive symptoms in schizophrenia, such as **agitation** or purposeless movements, rather than a deficiency. - While it can occur in schizophrenia, it represents an excess or distortion of normal function, distinguishing it from **negative symptoms** which reflect a reduction or absence of typical behaviors. *Apathy* - **Apathy**, or avolition, is a core negative symptom characterized by a **lack of motivation** and an inability to initiate or persist in goal-directed activities. - Patients with apathy often show diminished interest in daily activities and personal care. *Anhedonia* - **Anhedonia** is a negative symptom defined by the **inability to experience pleasure** from activities that are usually enjoyable. - This can include a loss of interest in social interactions, hobbies, and other rewarding experiences. *Alogia* - **Alogia**, or poverty of speech, is a negative symptom characterized by a **reduction in the quantity and fluency of speech**. - Individuals with alogia may provide brief, empty responses and exhibit long pauses during conversation.

Question 1

A person has a false belief that he owns a lot of property and that someone he knows is trying to take it away from him. Which of the following best describes the type of delusions he is experiencing?

Accepted Answer

Delusion of grandeur and persecution

Answer

Delusion of grandeur and nihilism

Answer

Delusion of grandeur and reference

Answer

Delusion of nihilism

Question 2

A patient shows flat affect. What does it indicate?

Accepted Answer

Negative symptom

Answer

Affect symptom

Answer

Cognitive symptom

Answer

Positive symptom

Question 3

You see a middle-aged man presenting to the psychiatry OPD who reports aliens have been speaking to him and telling him to kill his relatives over the past 7 months. What is the likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Delusional disorder

Answer

Brief psychotic disorder

Question 4

A 22-year-old male presents with a 6-month history of hearing voices commenting on his actions, social withdrawal, and belief that his thoughts are being broadcast to others. He has poor self-care and blunted affect. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Delusional disorder

Answer

Brief psychotic disorder

Answer

Schizoaffective disorder

Question 5

A patient with schizophrenia says, "Lord Hanuman was celibate, I am celibate too, so I am Lord Hanuman." Which thought abnormality is present in this patient?

Accepted Answer

Autistic thinking

Answer

Verbigeration

Answer

Neologism

Answer

Loosening of association

Question 6

A man reports that he is receiving orders from God to follow white birds in a specific direction. What is the most appropriate description of this symptom?

Accepted Answer

Passivity phenomenon

Answer

Delusional perception

Answer

Visual hallucination

Answer

Thought insertion

Question 7

The following are manifestations of psychosis except:

Accepted Answer

Psychoneurosis

Answer

Manic depressive psychosis

Answer

Schizophrenia

Answer

Paranoia

Question 8

A 43-year-old presents to the emergency department accompanied by police. He came to the police station accusing his daughter of wanting to kill him. The police, after investigating the family and the neighbors, understood that it was a false accusation. His physical examination is not remarkable. What is the most likely diagnosis here?

Accepted Answer

Delusional disorder

Answer

Cotard syndrome

Answer

Illusions

Answer

Hallucinations

Question 9

Neologism is seen in:

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Depression

Answer

Dysphasia

Question 10

Negative symptoms of schizophrenia are all except:-

Accepted Answer

Over activity

Answer

Apathy

Answer

Anhedonia

Answer

Alogia

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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