Psychotic Disorders Practice Questions

Q: In stupor catatonia, all are seen except -

Agitation. ***Agitation*** - **Stuporous catatonia** is characterized by a significant reduction or absence of motor activity and responsiveness, making **agitation**—increased motor activity—an unlikely feature. - In such a state, the patient is typically rigid, immobile, and unresponsive to external stimuli, which is the antithesis of agitation. *Catalepsy* - **Catalepsy** refers to a trance-like state with a loss of voluntary motion and active posturing, where the limbs maintain any position in which they are placed (waxy flexibility). - This is a hallmark feature of **catatonic stupor**, indicating a profound disturbance in motor control. *Mutism* - **Mutism** is the absence or profound reduction of speech, which is a common and defining feature of **catatonic stupor**. - Patients in a stuporous state typically do not speak or respond verbally to questions or commands. *Akinesia* - **Akinesia** is the absence of movement, or pronounced difficulty in initiating voluntary movements, which is a key component of **catatonic stupor**. - Patients exhibit severe motor retardation, often appearing frozen or rigid.

Q: Which of the following is considered a poor prognostic factor for schizophrenia?

Early onset. ***Early onset*** - An **earlier age of onset** (e.g., childhood or early adolescence) for schizophrenia is consistently associated with a **worse long-term prognosis**, including more severe symptoms, greater functional impairment, and a lower likelihood of full recovery. - This is thought to be due to the greater developmental disruption caused by the illness when it begins at a younger age. *Presence of depression* - While depression is common in schizophrenia, it is generally considered to be a **treatable co-occurring condition** rather than a primary poor prognostic factor for the core psychotic disorder itself. - Effective treatment for depression can actually **improve overall quality of life** and adherence to antipsychotic medication. *Presence of stressor* - The presence of a significant psychosocial stressor at the onset of schizophrenia is often associated with a **better prognosis**, as it suggests a more reactive and potentially remitting course. - This indicates that the illness might be more environmentally triggered and less intrinsically severe. *Female sex* - **Female sex** is typically associated with a **somewhat better prognosis** in schizophrenia, with a later age of onset and potentially less severe symptoms compared to males. - This may be influenced by hormonal factors and differences in social support networks.

Q: Which of the following is considered a poor prognostic factor for schizophrenia?

Poor premorbid adjustment. **Poor premorbid adjustment** - **Poor premorbid adjustment**, indicated by difficulties in social, academic, or occupational functioning before the onset of psychosis, is a consistent predictor of a worse outcome in schizophrenia. - This suggests a more pervasive and entrenched neurodevelopmental vulnerability impacting the individual's ability to cope and integrate socially. *Blunted affect (negative symptom)* - While **blunted affect** is a negative symptom often associated with poorer outcomes than positive symptoms, it is typically considered a *symptom* of the illness rather than a primary prognostic *factor* like premorbid adjustment. - Its presence contributes to disability, but it is not as strong an independent prognostic indicator as the life trajectory prior to illness onset. *Male sex (generally poorer prognosis)* - **Male sex** is generally associated with an **earlier age of onset** and often a **more severe course** of schizophrenia. - However, compared to significant functional impairment before disease onset, it is not as strong an individual predictor of overall long-term prognosis. *Presence of depression (often associated with better outcomes)* - The **presence of depressive symptoms** in schizophrenia is often associated with a **better prognosis**. - This is because depressive features can sometimes indicate a more preserved capacity for emotional experience and insight, which can align with higher functioning.

Q: Which of the following is the most common type of delusional misidentification syndrome?

Capgras. **Capgras** - **Capgras delusion** is a misidentification syndrome where an individual believes that a familiar person (e.g., a spouse, child, or parent) has been replaced by an identical imposter. - This delusion is often seen in psychiatric disorders like **schizophrenia** and neurological conditions such as **dementia**. *Fregoli* - **Fregoli delusion** involves the belief that different people are in fact a single person in disguise, who changes their appearance. - Unlike Capgras, where a familiar person is replaced, Fregoli focuses on the idea of a single persecutor or familiar individual appearing in various forms. *Cotard* - **Cotard delusion** is a rare mental illness in which the affected person holds the delusional belief that they are dead, do not exist, are rotting, or have lost their internal organs. - It does not involve the misidentification of other people but rather a nihilistic belief about one's own existence or body. *Subjective double* - The term "subjective double" is not a recognized classic delusion of misidentification in psychiatric diagnostic systems. - While concepts of "doubles" exist in various delusional states, this specific phrasing does not refer to a distinct, widely defined misidentification syndrome in the same way as Capgras or Fregoli.

Q: Which of the following statements is NOT true about type 1 schizophrenia?

It has a poor prognosis.. ***It has a poor prognosis.*** - This statement is **NOT true** about type 1 schizophrenia, making it the correct answer to this question. - Type 1 schizophrenia is generally associated with a **better prognosis** and good response to antipsychotic medication. - It is characterized by the prominence of **positive symptoms**, which tend to be more responsive to treatment. *It is an acute illness.* - This statement is **TRUE** about type 1 schizophrenia, so it is not the answer. - Type 1 schizophrenia is often characterized by an **acute onset** of symptoms, particularly positive symptoms. - This acute presentation differentiates it from type 2, which typically has a more insidious onset. *Intellect is usually maintained.* - This statement is **TRUE** about type 1 schizophrenia, so it is not the answer. - In type 1 schizophrenia, **cognitive function**, including intellect, is usually better preserved compared to type 2 schizophrenia. - While some cognitive deficits may occur, they are generally less severe and less pervasive than in type 2. *It is characterized by negative symptoms.* - This statement is **FALSE** about type 1 schizophrenia, but it is not the best answer because the prognosis statement is more definitively incorrect. - Type 1 schizophrenia is primarily characterized by the predominance of **positive symptoms**, such as hallucinations, delusions, and disorganized thought. - **Negative symptoms** (e.g., apathy, anhedonia, alogia, blunted affect) are the hallmark of type 2 schizophrenia.

Q: Waxy flexibility is a feature of ?

Catatonia. ***Catatonia*** - **Waxy flexibility** (or catalepsy) is a classic symptom of **catatonia**, where an individual's limbs can be **placed in any position by the examiner and remain in that position for an extended period**, as if molded from wax. - It reflects a severe psychomotor disturbance, often seen in conditions like **schizophrenia** or **mood disorders** with catatonic features. *Echolalia* - **Echolalia** refers to the **involuntary repetition of another person's spoken words**, typically without understanding. - It is a symptom of thought disorder or communication difficulties, not a state of motor rigidity. *Stereotypy* - **Stereotypy** involves **repetitive, seemingly purposeless movements or utterances** (e.g., body rocking, hand flapping). - While repetitive, it does not involve maintaining a fixed posture imposed by another, as seen in waxy flexibility. *Mannerisms* - **Mannerisms** are **habitual, idiosyncratic gestures or behaviors** that may appear odd but are often voluntary and goal-directed (e.g., an exaggerated bow before speaking). - They are distinct from the involuntary, often rigid, posturing characteristic of waxy flexibility.

Q: In which socioeconomic strata is schizophrenia most commonly observed?

Low. ***Low*** - Epidemiological studies consistently show a **higher prevalence of schizophrenia** in individuals from **lower socioeconomic strata**. - This association is explained by the "**social drift**" hypothesis, where individuals with schizophrenia experience a decline in social class due to the chronic and disabling nature of the illness, or the "**social causation**" hypothesis, which posits that adverse social conditions contribute to the development of the disorder. *Middle* - While individuals from all socioeconomic backgrounds can develop schizophrenia, it is **less common** compared to the lowest strata. - The middle socioeconomic group generally experiences **better access to resources** and support systems, which may mitigate some risk factors. *Upper* - Schizophrenia is **least common** in the upper socioeconomic strata. - Individuals in this group typically have **greater financial stability**, better living conditions, and access to high-quality healthcare, which might protect against environmental stressors. *Upper middle* - Similar to the middle and upper strata, the upper-middle class experiences a **lower prevalence of schizophrenia** compared to the low socioeconomic group. - This group often benefits from **good educational opportunities** and stable employment, reducing some of the psychosocial stressors associated with the disorder.

Q: Which type of delusion is primarily associated with Cotard's syndrome?

Nihilistic delusions. ***Nihilistic delusions*** - **Cotard's syndrome** is characterized by beliefs of **non-existence**, such as the patient being dead, not existing, or having lost their organs, which are typical of **nihilistic delusions**. - These delusions can also extend to the belief that the world or parts of it no longer exist. *Persecutory delusions* - These involve the belief that one is being **harassed, tricked, spied upon, or conspired against**, which is not the primary feature of Cotard's syndrome. - While they can co-occur with other psychiatric conditions, **persecutory themes** are distinct from the non-existence themes of Cotard's. *Religious delusions* - These delusions focus on **religious or spiritual themes**, such as believing one is a prophet or has a special relationship with a deity. - They are not a core component of Cotard's syndrome, which centers on themes of **death and non-existence**. *Hypochondriacal delusions* - These involve a preoccupation with the belief that one has a **serious, undiagnosed medical condition**, despite medical reassurance. - While Cotard's syndrome can involve bodily concerns, the belief in **non-existence of organs** or death goes beyond typical hypochondriacal fears of illness.

Q: Which of the following is NOT considered one of Bleuler's fundamental symptoms of schizophrenia?

Delusions. ***Delusions*** - **Delusions** are considered a **first-rank symptom** of schizophrenia according to Schneider, but not one of Bleuler's fundamental "4 A's". - Bleuler classified delusions as **accessory symptoms**, which are variable and not always present, unlike fundamental symptoms. *Loosening of associations* - This is one of Bleuler's **"4 A's"**, representing a disturbance in the logical flow of thought, leading to incoherent speech and fractured thinking. - Bleuler saw this as a core cognitive dysfunction in schizophrenia. *Affect disturbances* - This refers to **inappropriate affect** (e.g., laughing at a funeral) or **blunted/flattened affect**, which is another of Bleuler's "4 A's." - It signifies a disruption in the normal experience and expression of emotions. *Autism* - Bleuler's term **"autism"** (or autismus) refers to a pathological self-preoccupation, withdrawal from social interaction, and an immersion in one's own internal world. - This is also one of Bleuler's **"4 A's"**, highlighting a foundational disturbance in social engagement.

Q: According to DSM-5 criteria, symptoms of brief psychotic disorder must resolve within what time period to differentiate it from longer-term psychotic conditions like schizophreniform disorder?

1 month. ***1 month*** - According to **DSM-5 criteria**, brief psychotic disorder is characterized by symptoms lasting more than **1 day** but less than **1 month**. - If psychotic symptoms persist for **1 month or longer**, it indicates a different diagnosis, such as schizophreniform disorder or schizophrenia, requiring further evaluation. *1 week* - While psychotic symptoms may be present for 1 week in brief psychotic disorder, this duration is within the disorder's diagnostic window but not its defining upper limit. - The key differentiator for brief psychotic disorder is that symptoms resolve within **1 month**. *2 weeks* - Similar to 1 week, 2 weeks is a duration that can occur within brief psychotic disorder, but it does not represent the minimum duration that distinguishes it from longer-term conditions. - The crucial threshold for duration in brief psychotic disorder is **less than 1 month**. *3 weeks* - Three weeks also falls within the diagnostic duration for brief psychotic disorder. - The essential criteria specify that psychotic symptoms must last **less than 1 month** to be classified as brief psychotic disorder.

Question 1

In stupor catatonia, all are seen except -

Accepted Answer

Agitation

Answer

Mutism

Answer

Akinesia

Answer

Catalepsy

Question 2

Which of the following is considered a poor prognostic factor for schizophrenia?

Accepted Answer

Early onset

Answer

Presence of depression

Answer

Presence of stressor

Answer

Female sex

Question 3

Which of the following is considered a poor prognostic factor for schizophrenia?

Accepted Answer

Poor premorbid adjustment

Answer

Male sex

Answer

Presence of depression

Answer

Blunted affect

Question 4

Which of the following is the most common type of delusional misidentification syndrome?

Accepted Answer

Capgras

Answer

Fregoli

Answer

Cotard

Answer

Subjective double

Question 5

Which of the following statements is NOT true about type 1 schizophrenia?

Accepted Answer

It has a poor prognosis.

Answer

Intellect is usually maintained.

Answer

It is an acute illness.

Answer

It is characterized by negative symptoms.

Question 6

Waxy flexibility is a feature of ?

Accepted Answer

Catatonia

Answer

Echolalia

Answer

Stereotypy

Answer

Mannerisms

Question 7

In which socioeconomic strata is schizophrenia most commonly observed?

Accepted Answer

Low

Answer

Middle

Answer

Upper

Answer

Upper middle

Question 8

Which type of delusion is primarily associated with Cotard's syndrome?

Accepted Answer

Nihilistic delusions

Answer

Persecutory delusions

Answer

Religious delusions

Answer

Hypochondriacal delusions

Question 9

Which of the following is NOT considered one of Bleuler's fundamental symptoms of schizophrenia?

Accepted Answer

Delusions

Answer

Loosening of associations

Answer

Affect disturbances

Answer

Autism

Question 10

According to DSM-5 criteria, symptoms of brief psychotic disorder must resolve within what time period to differentiate it from longer-term psychotic conditions like schizophreniform disorder?

Accepted Answer

1 month

Answer

1 week

Answer

3 weeks

Answer

2 weeks

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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