Psychotic Disorders Practice Questions

Q: Which of the following is considered a negative symptom of schizophrenia?

Ambivalence. **Explanation:** In Schizophrenia, symptoms are broadly categorized into **Positive** (excess or distortion of normal function) and **Negative** (loss or deficit of normal function). **Why Ambivalence is the Correct Answer:** Ambivalence refers to the simultaneous existence of contradictory emotions, ideas, or desires toward the same object or situation, leading to an inability to make decisions (avolition). It is one of the classic **"4 As" of Bleuler**, which are the fundamental symptoms of schizophrenia. Negative symptoms represent a "diminution" of normal emotional and behavioral states. Ambivalence reflects a deficit in goal-directed behavior and emotional integration, placing it firmly in the negative/deficit category. **Analysis of Incorrect Options:** * **A. Hallucination:** These are sensory perceptions in the absence of external stimuli. They represent an "added" abnormal experience, making them a hallmark **Positive symptom**. * **B. Delusion:** These are fixed, false beliefs held despite evidence to the contrary. Like hallucinations, they represent a distortion of thought content and are **Positive symptoms**. * **C. Motor Hyperactivity:** This is a feature of psychomotor agitation or catatonic excitement. Since it involves an "excess" of motor activity, it is classified as a **Positive/Disorganized symptom**. **NEET-PG High-Yield Pearls:** * **Bleuler’s 4 As:** Remember the mnemonic **A**ffective flattening, **A**utism, **A**mbivalence, and **A**ssociational looseness. * **Schneider’s First Rank Symptoms (FRS):** These focus primarily on positive symptoms (e.g., thought insertion, audible thoughts) and are used for diagnosis, but their absence does not rule out schizophrenia. * **Prognosis:** Negative symptoms (like apathy, anhedonia, and alogia) are generally more resistant to typical antipsychotics and are associated with a **poorer long-term prognosis** compared to positive symptoms.

Q: According to ICD-10 criteria, for how long must symptoms persist for the diagnosis of schizophrenia?

1 month. **Explanation:** The diagnosis of Schizophrenia requires a specific duration of symptoms to differentiate it from transient psychotic states. According to the **ICD-10** (International Classification of Diseases, 10th Revision), the characteristic symptoms (such as delusions, hallucinations, or thought disorder) must be present for a minimum period of **one month**. * **Why Option B is Correct:** ICD-10 criteria stipulate that at least one "very clear" symptom (from groups like thought echo, delusions of control, or persistent hallucinations) or two symptoms from less specific groups (like negative symptoms or catatonic behavior) must be present for **most of the time during a period of at least one month**. * **Why Option C is Incorrect:** A **6-month** duration is the requirement for Schizophrenia according to the **DSM-5** (Diagnostic and Statistical Manual of Mental Disorders). This is a frequent point of confusion in exams. * **Why Option D is Incorrect:** Symptoms lasting less than one month but more than a few days are often classified under **Acute and Transient Psychotic Disorders** (F23) in ICD-10. * **Why Option A is Incorrect:** Two months is not a standard diagnostic cutoff for schizophrenia in either major classification system. **High-Yield Clinical Pearls for NEET-PG:** 1. **ICD-10 vs. DSM-5:** Remember the "1 vs. 6" rule. ICD-10 = 1 month; DSM-5 = 6 months (which must include at least 1 month of active-phase symptoms). 2. **Schneider’s First Rank Symptoms (FRS):** These are highly suggestive of schizophrenia and are heavily weighted in the ICD-10 criteria. 3. **Prognosis:** Good prognostic factors include late onset, female sex, presence of mood symptoms, and being married. Poor prognosis is associated with insidious onset, young age, and prominent negative symptoms.

Q: A 37-year-old man reports that after a sudden financial loss, he had a bout of illness in which he felt sad and nervous and fearful, could not sleep or eat properly. He also began to hear voices telling him that he was useless and should kill himself. His symptoms stopped after approximately one week. He has had no similar episodes. Medical history includes no psychiatric conditions. Physical examination shows no abnormalities, and results of laboratory studies are within normal limits. Which of the following is the most likely diagnosis?

Brief psychotic disorder. ### Explanation The correct diagnosis is **Brief Psychotic Disorder**. **1. Why Brief Psychotic Disorder is correct:** According to DSM-5/ICD criteria, Brief Psychotic Disorder is characterized by the sudden onset of at least one positive psychotic symptom (delusions, hallucinations, or disorganized speech/behavior). Crucially, the duration of the episode is **more than 1 day but less than 1 month**, with an eventual full return to the premorbid level of functioning. This patient’s symptoms (auditory hallucinations) lasted for **one week** and were preceded by a clear psychosocial stressor (financial loss), which is a common trigger. **2. Why the other options are incorrect:** * **Schizophreniform Disorder:** Requires the duration of symptoms to be **between 1 month and 6 months**. This patient’s symptoms lasted only one week. * **Schizophrenia:** Requires a continuous period of illness for **at least 6 months**, including at least one month of active-phase symptoms and significant functional decline. * **Schizo-affective Disorder:** Requires a period of illness where there is a major mood episode (manic or depressive) concurrent with symptoms of schizophrenia, preceded or followed by at least **2 weeks of delusions or hallucinations** in the absence of a major mood episode. **3. High-Yield Clinical Pearls for NEET-PG:** * **Duration-based differentiation is key:** * 6 months: Schizophrenia. * **Prognosis:** Brief Psychotic Disorder generally has a good prognosis, especially when triggered by a marked stressor (formerly called "Brief Reactive Psychosis"). * **Specifiers:** Always look for "with marked stressors" or "postpartum onset" in the history. * **Suicide Risk:** Even though the duration is short, the risk of suicide is high due to the sudden onset and nature of command hallucinations (as seen in this case).

Q: Which of the following is NOT considered a first-rank symptom of schizophrenia?

Ambivalence. To answer this question correctly, it is essential to distinguish between **Kurt Schneider’s First-Rank Symptoms (FRS)** and **Eugen Bleuler’s "4 As"** of schizophrenia. ### **Why Ambivalence is the Correct Answer** **Ambivalence** is one of the "4 As" described by Eugen Bleuler as a fundamental (primary) symptom of schizophrenia. It refers to the coexistence of contradictory emotions or desires toward the same object or situation. While characteristic of the disorder, it is **not** part of Schneider’s First-Rank Symptoms, which focus more on specific types of hallucinations and delusions. ### **Explanation of Incorrect Options (First-Rank Symptoms)** Schneider’s FRS are highly suggestive of schizophrenia in the absence of organic brain disease. The incorrect options are all classic examples: * **Running Commentary:** A specific auditory hallucination where a voice describes the patient’s actions as they happen. * **Primary Delusion:** Also known as delusional perception, where a normal perception is suddenly given a private, idiosyncratic, and delusional meaning. * **Somatic Passivity:** The delusional belief that one’s body is being influenced or acted upon by an external force (a "made" sensation). ### **Clinical Pearls for NEET-PG** * **Bleuler’s 4 As:** **A**ffective flattening, **A**utism, **A**mbivalence, and **A**ssociative looseness. * **Schneider’s FRS Categories:** 1. **Auditory Hallucinations:** Thought echo (Gedankenlautwerden), third-person voices, and running commentary. 2. **Thought Interference:** Thought withdrawal, insertion, and broadcasting. 3. **Passivity Phenomena:** "Made" feelings, "made" impulses, and "made" acts. 4. **Delusional Perception.** * **High-Yield Note:** FRS are no longer required for a diagnosis in the **DSM-5**, as they were found to be less specific than previously thought, but they remain a favorite topic in NEET-PG exams.

Q: A psychotic disorder most commonly pertains to which of the following symptoms?

Delusions or hallucinations. **Explanation:** The hallmark of a **psychotic disorder** is the presence of **psychosis**, which is defined as a loss of contact with reality. In clinical psychiatry, the core features that define this state are **delusions** (fixed, false beliefs) and **hallucinations** (sensory perceptions in the absence of external stimuli). These symptoms represent a fundamental disturbance in the processing of reality and are the primary diagnostic criteria for disorders such as Schizophrenia, Delusional Disorder, and Brief Psychotic Disorder. **Analysis of Options:** * **A. Weeping or laughing:** These are disturbances of **affect or mood**. While they can occur in psychosis (e.g., inappropriate affect in schizophrenia), they are more characteristic of Mood Disorders (Depression/Bipolar) or Pseudobulbar affect. * **B. Agitation or retardation:** These are **psychomotor disturbances**. While common in severe psychosis, they are non-specific and are frequently seen in Major Depressive Disorder (Melancholic) or Catatonia. * **C. Obsessions or compulsions:** These are the defining features of **Obsessive-Compulsive Disorder (OCD)**. Unlike psychosis, patients with OCD usually maintain "insight"—they recognize their thoughts as irrational or products of their own mind. **NEET-PG High-Yield Pearls:** * **Schneider’s First Rank Symptoms (FRS):** A historical but high-yield list of symptoms (e.g., auditory hallucinations, thought withdrawal/insertion) used to diagnose Schizophrenia. * **Hallucination Type:** Auditory hallucinations (specifically third-person) are the most common in Schizophrenia, whereas visual hallucinations often suggest an organic/medical cause. * **Delusion Type:** Persecutory delusions are the most common type of delusion across psychotic disorders.

Q: Which of the following is not a Schneider's first-rank symptom of schizophrenia?

Delusion of self-reference. **Explanation:** Kurt Schneider identified a group of symptoms known as **First-Rank Symptoms (FRS)** which, in the absence of organic brain disease, were considered strongly suggestive of Schizophrenia. **Why "Delusion of self-reference" is the correct answer:** While delusions of reference (the belief that neutral events or coincidences have a special personal significance) are common in schizophrenia, they are **not** part of Schneider’s FRS. Schneider emphasized symptoms that involve a "blurring of boundaries" between the self and the environment. Delusions of reference are considered "Second-Rank Symptoms." **Analysis of Incorrect Options:** * **Passivity Phenomenon (Made Acts/Volition/Affect):** This is a core FRS where the patient feels their actions, feelings, or impulses are being controlled by an external force. * **Auditory Hallucinations:** Specifically, three types are FRS: **Third-person voices** (discussing the patient), **Running commentary** (narrating the patient's actions), and **Thought echo** (Gedankenlautwerden). * **Delusional Perception:** This is a two-stage process where a normal perception (e.g., seeing a red car) is suddenly given a private, idiosyncratic, and delusional meaning (e.g., "the red car means I am the chosen king"). This is a hallmark FRS. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for FRS (ABCD):** **A**uditory hallucinations (3 types), **B**roadcasting of thoughts, **C**ontrolled feelings/acts (Passivity), **D**elusional perception. * **Thought Alienation:** Includes Thought Insertion, Thought Withdrawal, and Thought Broadcasting. All are FRS. * **Current Status:** While historically significant, the DSM-5 has de-emphasized FRS because they lack diagnostic specificity (they can occur in bipolar disorder). * **Note:** Somatic passivity (feeling bodily sensations imposed by others) is also an FRS.

Q: In Schizophrenia, which subtype is associated with early onset and poor prognosis?

Hebephrenic Schizophrenia. **Explanation:** **Hebephrenic Schizophrenia** (also known as Disorganized Schizophrenia) is characterized by an **early onset** (typically between ages 15–25) and a **poor prognosis**. The clinical picture is dominated by disorganized speech, disorganized behavior, and flat or inappropriate affect (e.g., giggling without reason). The poor prognosis is attributed to the early onset, insidious progression, and the rapid development of "negative symptoms" and cognitive decline. **Analysis of Incorrect Options:** * **Simple Schizophrenia:** While it has an insidious onset and a very poor prognosis due to the absence of positive symptoms (hallucinations/delusions), it is characterized primarily by a slow decline in functioning and social withdrawal rather than the classic disorganized features of Hebephrenia. * **Catatonic Schizophrenia:** This subtype is characterized by psychomotor disturbances (stupor, waxy flexibility, or excitement). It generally has a **good prognosis** as it often responds rapidly to Benzodiazepines (Lorazepam) or Electroconvulsive Therapy (ECT). * **Paranoid Schizophrenia:** This is the most common subtype. It has a **late onset** (usually late 20s or 30s) and the **best prognosis** among all subtypes because the personality remains relatively preserved and patients respond well to antipsychotics. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognosis:** Paranoid Schizophrenia. * **Worst Prognosis:** Hebephrenic Schizophrenia. * **Most Common Subtype:** Paranoid Schizophrenia. * **Schneiderian First Rank Symptoms (SFRS):** These are diagnostic for schizophrenia but do not carry prognostic value. * **Prognostic Factors:** Acute onset, late age of onset, and presence of positive symptoms (hallucinations/delusions) indicate a **good prognosis**; insidious onset, early age, and negative symptoms indicate a **poor prognosis**.

Question 1

Anhedonia seen in schizophrenia is linked to which of the following neurotransmitter abnormalities?

Accepted Answer

Norepinephrine

Answer

Serotonin

Answer

Glutamate

Answer

GABA

Question 2

A 50-year-old male presents with a 5-year history of persistent doubt regarding his wife's fidelity, despite evidence to the contrary. All other aspects of his life are normal. What is the most probable diagnosis?

Accepted Answer

Delusional disorder

Answer

Panic disorder

Answer

Depressive disorder

Answer

Phobia

Question 3

Which of the following is considered a negative symptom of schizophrenia?

Accepted Answer

Ambivalence

Answer

Hallucination

Answer

Delusion

Answer

Motor hyperactivity

Question 4

According to ICD-10 criteria, for how long must symptoms persist for the diagnosis of schizophrenia?

Accepted Answer

1 month

Answer

2 months

Answer

6 months

Answer

2 weeks

Question 5

A 37-year-old man reports that after a sudden financial loss, he had a bout of illness in which he felt sad and nervous and fearful, could not sleep or eat properly. He also began to hear voices telling him that he was useless and should kill himself. His symptoms stopped after approximately one week. He has had no similar episodes. Medical history includes no psychiatric conditions. Physical examination shows no abnormalities, and results of laboratory studies are within normal limits. Which of the following is the most likely diagnosis?

Accepted Answer

Brief psychotic disorder

Answer

Schizophreniform disorder

Answer

Schizo-affective disorder

Answer

Schizophrenia

Question 6

A 16-year-old boy does not attend school due to the fear of being harmed by schoolmates. He believes his classmates laugh at and talk about him. He is also scared of going to the market. He is most likely suffering from which of the following disorders?

Accepted Answer

Schizophrenia

Answer

Anxiety neurosis

Answer

Adjustment reaction

Answer

Manic depressive psychosis

Question 7

Which of the following is NOT considered a first-rank symptom of schizophrenia?

Accepted Answer

Ambivalence

Answer

Running commentary

Answer

Primary delusion

Answer

Somatic passivity

Question 8

A psychotic disorder most commonly pertains to which of the following symptoms?

Accepted Answer

Delusions or hallucinations

Answer

Weeping or laughing

Answer

Agitation or retardation

Answer

Obsessions or compulsions

Question 9

Which of the following is not a Schneider's first-rank symptom of schizophrenia?

Accepted Answer

Delusion of self-reference

Answer

Passivity phenomenon

Answer

Auditory hallucinations

Answer

Delusional perception

Question 10

In Schizophrenia, which subtype is associated with early onset and poor prognosis?

Accepted Answer

Hebephrenic Schizophrenia

Answer

Simple Schizophrenia

Answer

Catatonic Schizophrenia

Answer

Paranoid Schizophrenia

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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