Psychotic Disorders Practice Questions

Q: All of the following are positive features of Schizophrenia except?

Anhedonia. **Explanation:** In Schizophrenia, symptoms are broadly categorized into **Positive symptoms** (excess or distortion of normal functions) and **Negative symptoms** (diminution or loss of normal functions). **Why Anhedonia is the correct answer:** **Anhedonia** is defined as the inability to experience pleasure from activities usually found enjoyable. It is a classic **Negative symptom** of Schizophrenia, often grouped under the "5 A's" of negative symptoms (Affective flattening, Alogia, Anhedonia, Asociality, and Avolition). These symptoms are typically more resistant to traditional antipsychotic treatment and are associated with a poorer long-term prognosis. **Analysis of Incorrect Options:** * **Thought Disorder (A):** Specifically formal thought disorder (e.g., loosening of associations), is a **Positive symptom** representing a disorganized distortion of thinking. * **Visual Hallucination (C):** Hallucinations are sensory perceptions in the absence of external stimuli. They are hallmark **Positive symptoms**. While auditory hallucinations are most common in schizophrenia, visual ones also fall into this category. * **Delusion of Persecution (D):** Delusions are fixed, false beliefs. Persecutory delusions are the most common type in Schizophrenia and are classic **Positive symptoms**. **NEET-PG Clinical Pearls:** * **Positive Symptoms:** Mediated by increased dopamine in the **mesolimbic pathway**. They respond well to typical antipsychotics (D2 blockers). * **Negative Symptoms:** Mediated by decreased dopamine in the **mesocortical pathway**. They respond better to atypical antipsychotics (SDA). * **Schneider’s First Rank Symptoms (FRS):** These are all **Positive symptoms** (e.g., thought insertion, broadcasting, third-person hallucinations) used for diagnosis. Negative symptoms are *not* part of Schneider’s FRS.

Q: Which of the following is NOT one of Eugene Bleuler's 4 A's of schizophrenia?

Anhedonia. **Explanation:** Eugene Bleuler, a Swiss psychiatrist, coined the term "Schizophrenia" and identified four primary (fundamental) symptoms that characterize the disorder. These are famously known as **Bleuler’s 4 A’s**. **Why Anhedonia is the correct answer:** Anhedonia (the inability to feel pleasure) is a common negative symptom of schizophrenia, but it is **not** one of Bleuler’s original 4 A’s. It was later emphasized in different diagnostic frameworks, such as Schneider’s First Rank Symptoms or the DSM criteria for negative symptoms. **Analysis of the 4 A’s (Incorrect Options):** * **A - Association (Loosening of Association):** Refers to fragmented thought processes where ideas are disconnected and lack logical continuity. * **A - Affect (Inappropriate/Flattened Affect):** Refers to emotional responses that are either blunted or incongruent with the situation (e.g., laughing at a funeral). * **A - Autism:** Refers to social withdrawal and a preference for a private, internal fantasy world over external reality. * **A - Ambivalence:** (Though not listed as an option here, it is the 4th 'A') Refers to the simultaneous existence of contradictory feelings or impulses toward the same object or situation. **High-Yield Clinical Pearls for NEET-PG:** * **Bleuler vs. Schneider:** Bleuler focused on **fundamental symptoms** (the 4 A’s), whereas Kurt Schneider focused on **First Rank Symptoms (FRS)** (e.g., hallucinations, delusions), which are more useful for cross-sectional diagnosis. * Bleuler believed the 4 A's were present in every case of schizophrenia, regardless of the subtype. * **Mnemonic:** Remember **"4 A's"** = **A**ffect, **A**ssociation, **A**mbivalence, **A**utism.

Q: Poor prognosis of schizophrenia is associated with which of the following factors?

Predominance of negative symptoms. **Explanation:** The prognosis of schizophrenia is determined by a combination of clinical, social, and demographic factors. **Why "Predominance of Negative Symptoms" is correct:** Negative symptoms (e.g., apathy, anhedonia, poverty of speech, and social withdrawal) are strongly associated with a **poor prognosis**. These symptoms are often linked to structural brain changes (like ventricular enlargement), poor response to typical antipsychotics, and significant cognitive impairment. Unlike positive symptoms (hallucinations/delusions), which are often episodic and treatable, negative symptoms tend to be chronic and lead to long-term functional decline. **Analysis of Incorrect Options:** * **Female Sex:** Generally associated with a **better prognosis**. Females typically have a later age of onset, better premorbid social functioning, and better response to treatment compared to males. * **Presence of Depression:** While it increases suicide risk, the presence of affective symptoms (mood symptoms) is actually a **good prognostic factor**. It suggests a "Schizoaffective" picture, which typically has a better outcome than pure schizophrenia. * **Acute Onset:** An abrupt onset (triggered by a stressor) is a **good prognostic factor**. In contrast, an insidious (gradual) onset over years is associated with a poor outcome. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognostic Factor:** Good premorbid adjustment and presence of a clear precipitating stressor. * **Worst Prognostic Factor:** Early/Young age of onset (especially in males) and insidious onset. * **Family History:** A family history of **Mood Disorders** predicts a better prognosis, while a family history of **Schizophrenia** predicts a poorer one. * **Type I vs. Type II Schizophrenia:** Crow’s classification links Type II (Negative symptoms) with structural brain changes and poor treatment response.

Q: A 28-year-old female presents with complaints of reduced sleep and disorganized behavior for 9 months. She believes a camera is fixed behind her head that constantly follows her. Which of the following is the most likely diagnosis?

Paranoid schizophrenia. **Explanation:** The patient presents with **disorganized behavior** and a **delusion of being followed** (persecutory/bizarre delusion) persisting for **9 months**. According to ICD-11 and DSM-5 criteria, a diagnosis of Schizophrenia requires symptoms (such as delusions, hallucinations, or disorganized speech/behavior) to persist for at least 1 month (ICD) or 6 months (DSM), with significant social or occupational dysfunction. **Why Paranoid Schizophrenia is correct:** The presence of a complex delusion (camera fixed behind the head) combined with disorganized behavior and a chronic course (9 months) fits the classic profile of Schizophrenia. The "Paranoid" subtype is characterized by prominent delusions and/or auditory hallucinations without significant negative symptoms or catatonia at the forefront. **Why other options are incorrect:** * **Psychotic Depression:** Requires a primary mood disturbance (pervasive sadness, anhedonia) with mood-congruent delusions. There is no mention of depressed mood here. * **Delusional Disorder:** Characterized by non-bizarre delusions lasting ≥1 month. However, disorganized behavior and the "bizarre" nature of the camera delusion (physically impossible) point strongly toward Schizophrenia rather than Delusional Disorder. * **Insomnia:** This is merely a symptom (reduced sleep) and does not account for the psychotic features or behavioral changes. **NEET-PG High-Yield Pearls:** * **Duration Criteria:** Schizophreniform disorder ( 6 months). * **Schneider’s First Rank Symptoms (FRS):** Though no longer mandatory for diagnosis, delusions of being controlled or "passivity phenomena" are classic indicators of Schizophrenia. * **Prognosis:** Paranoid schizophrenia generally has a **better prognosis** and later age of onset compared to the Hebephrenic (disorganized) subtype.

Q: Which statement is true regarding the age and sex distribution of Schizophrenia?

Male sex is a poor prognostic factor.. **Explanation:** The epidemiology and prognosis of Schizophrenia are high-yield topics for NEET-PG. While the **incidence and prevalence** of Schizophrenia are roughly equal between genders, the clinical course and onset differ significantly. **1. Why Option C is Correct:** Male sex is considered a **poor prognostic factor**. On average, males have an earlier age of onset (15–25 years) compared to females (25–35 years). Males typically present with more **negative symptoms** (apathy, withdrawal), poorer premorbid adjustment, more structural brain abnormalities, and a less favorable response to neuroleptics. In contrast, females often have a better prognosis due to later onset and the protective effect of estrogen. **2. Why Other Options are Incorrect:** * **Option A:** The peak age of onset is **15–25 years for males** and **25–35 years for females**. Onset after age 45 is classified as Late-onset Schizophrenia and is relatively rare. * **Option B:** **Early onset is a poor prognostic factor.** The earlier the disease starts, the more it interferes with social/occupational development and the more likely it is to be associated with structural brain changes. * **Option D:** The **lifetime prevalence is equal** in both males and females (approximately 1%). Males are not "more prone" to the disease; they simply tend to develop it earlier and more severely. **High-Yield Clinical Pearls for NEET-PG:** * **Good Prognostic Factors:** Late onset, female sex, presence of mood symptoms (especially depression), positive symptoms (hallucinations/delusions), married status, and clear precipitating stressors. * **Poor Prognostic Factors:** Early onset, male sex, negative symptoms, family history of schizophrenia, and insidious onset. * **Bimodal Onset in Females:** Females show a second peak of incidence after age 40–45 (post-menopausal).

Q: Schneider's first-rank symptoms include all of the following except?

Perplexity. **Explanation:** Kurt Schneider (1959) identified a group of symptoms known as **First-Rank Symptoms (FRS)** which, in the absence of organic brain disease, are highly suggestive of Schizophrenia. **Why Perplexity is the correct answer:** **Perplexity** is a state of cognitive uncertainty or confusion often seen in the early stages of psychosis (Trema phase) or in acute and transient psychotic disorders. While it is a common clinical feature, it is **not** part of Schneider’s original list of 11 First-Rank Symptoms. **Analysis of incorrect options (Included in FRS):** * **Delusional Perception (A):** A two-stage phenomenon where a normal perception is suddenly given a private, idiosyncratic, and delusional meaning (e.g., "The traffic light turned red, so I knew I was the King of England"). * **Thought Insertion (B):** A "thought alienation" symptom where the patient believes thoughts are being put into their mind by an external agency. * **Third-person Auditory Hallucinations (C):** Hearing voices talking about the patient in the third person or providing a running commentary on their actions. **High-Yield Clinical Pearls for NEET-PG:** * **The 11 FRS include:** 1. **Auditory Hallucinations:** Voices arguing, Voices commenting, Audible thoughts (Gedankenlautwerden). 2. **Thought Alienation:** Insertion, Withdrawal, Broadcasting. 3. **Made Phenomena (Passivity):** Made Volition (acts), Made Affect (feelings), Made Impulses. 4. **Delusional Perception.** 5. **Somatic Passivity** (bodily sensations imposed by external agency). * **Note:** FRS are no longer required for a diagnosis in DSM-5 or ICD-11, as they lack high specificity (they can occur in Bipolar Disorder). * **Mnemonic:** Remember the **"ABCD"** of FRS: **A**uditory hallucinations (3rd person), **B**roadcasting of thoughts, **C**ontrolled feelings/acts (Passivity), **D**elusional perception.

Q: Waxy flexibility is characteristic of which condition?

Stuporous catatonia. **Explanation:** **Waxy flexibility (Cerea Flexibilitas)** is a classic psychomotor symptom where a patient offers initial resistance to being moved, but then allows their limbs to be placed in a position which they then maintain for a prolonged period (like a lead pipe or warm wax). 1. **Why Stuporous Catatonia is correct:** Catatonia is a neuropsychiatric syndrome characterized by motor abnormalities. It is broadly divided into two types: **Stuporous (Retarded)** and **Excited**. Waxy flexibility is a hallmark of the stuporous subtype, along with mutism, posturing, and negativism. In this state, the patient is conscious but unresponsive to external stimuli, maintaining fixed, often uncomfortable positions. 2. **Why other options are incorrect:** * **Excitatory Catatonia:** This is characterized by purposeless, excessive motor activity, agitation, shouting, and impulsivity. While it is a form of catatonia, waxy flexibility is specifically a feature of the inhibited/stuporous state. * **Obsessive-Compulsive Disorder (OCD):** OCD involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions). It does not involve the gross psychomotor disturbances or muscular rigidity seen in catatonia. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** Benzodiazepines (specifically **Lorazepam**) are the first-line treatment for catatonia (the "Lorazepam Challenge Test" is used for diagnosis). * **Definitive Treatment:** If BZDs fail or if the condition is life-threatening (Malignant Catatonia), **Electroconvulsive Therapy (ECT)** is the treatment of choice. * **Gegenhalten (Paratonia):** Often confused with waxy flexibility; it is a form of resistance where the patient resists passive movement with a force proportional to the stimulus. * **Mitmachen:** The patient moves their body in the direction of a slight push, despite being told to resist.

Question 1

All of the following are positive features of Schizophrenia except?

Accepted Answer

Anhedonia

Answer

Thought disorder

Answer

Visual hallucination

Answer

Delusion of persecution

Question 2

Which of the following is NOT one of Eugene Bleuler's 4 A's of schizophrenia?

Accepted Answer

Anhedonia

Answer

Autism

Answer

Affect

Answer

Association

Question 3

Which of the following are true about schizophrenia?

Accepted Answer

Makes violence

Answer

Thought broadcasting

Answer

Third person hallucination

Answer

Elated mood

Question 4

Poor prognosis of schizophrenia is associated with which of the following factors?

Accepted Answer

Predominance of negative symptoms

Answer

Female sex

Answer

Presence of depression

Answer

Acute onset

Question 5

A 28-year-old female presents with complaints of reduced sleep and disorganized behavior for 9 months. She believes a camera is fixed behind her head that constantly follows her. Which of the following is the most likely diagnosis?

Accepted Answer

Paranoid schizophrenia

Answer

Psychotic depression

Answer

Delusional disorder

Answer

Insomnia

Question 6

A man reports a history of a fight with his neighbour. The next day, he began to feel that the police are following him and that his brain is being controlled by radio waves emanating from his neighbour. The history is suggestive of which psychiatric sign/symptom?

Accepted Answer

Passivity

Answer

Thought insertion

Answer

Delusion of persecution

Answer

Obsession

Question 7

Which statement is true regarding the age and sex distribution of Schizophrenia?

Accepted Answer

Male sex is a poor prognostic factor.

Answer

The most common age of onset is greater than 50 years.

Answer

Early onset is a good prognostic factor.

Answer

Males are more prone to develop the disease.

Question 8

A 35-year-old woman who needs help with dressing and showering often giggles and laughs for no apparent reason. She spends most of her day rocking, muttering softly to herself, or looking at her reflection in a small mirror. What is the most likely diagnosis?

Accepted Answer

Schizophrenia, disorganized type

Answer

Schizophreniform disorder

Answer

Catatonia

Answer

Shared psychotic disorder

Question 9

Schneider's first-rank symptoms include all of the following except?

Accepted Answer

Perplexity

Answer

Delusional perception

Answer

Thought insertion

Answer

Third-person auditory hallucinations

Question 10

Waxy flexibility is characteristic of which condition?

Accepted Answer

Stuporous catatonia

Answer

Excitatory catatonia

Answer

Obsessive-Compulsive Disorder

Answer

All of the above

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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