Psychotic Disorders Practice Questions

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

Hallucinations. **Explanation:** Eugen Bleuler, who coined the term "Schizophrenia" in 1911, categorized symptoms into **Fundamental (Primary)** and **Accessory (Secondary)** symptoms. The correct answer is **Hallucinations** because Bleuler classified them as accessory symptoms—features that are common in schizophrenia but not essential for the diagnosis. **Bleuler’s Four A’s (Fundamental Symptoms):** 1. **Loosening of Associations (Option A):** A thought disorder where ideas shift from one subject to another in a completely unrelated manner. 2. **Disturbances of Affect (Option B):** Characterized by inappropriate, blunted, or flattened emotional responses. 3. **Autism (Option C):** A detachment from reality where the patient retreats into a private inner world of fantasies and delusions. 4. **Ambivalence:** The simultaneous existence of contradictory feelings or impulses toward the same object or situation. **Why the other options are incorrect:** Options A, B, and C are the core components of the "Four A’s." Along with Ambivalence, these were considered by Bleuler to be the pathognomonic features present in every case of schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Accessory Symptoms:** Include Hallucinations and Delusions. While clinically striking, Bleuler believed they could occur in other organic brain syndromes. * **Schneider’s First Rank Symptoms (FRS):** Unlike Bleuler, Kurt Schneider emphasized hallucinations (e.g., third-person auditory) and delusions as primary diagnostic criteria. * **The 4 A's Mnemonic:** **A**ssociation, **A**ffect, **A**utism, **A**mbivalence. * **Evolution of Diagnosis:** Modern criteria (DSM-5/ICD-11) now prioritize the symptoms Bleuler called "accessory" (delusions/hallucinations) for diagnosis.

Q: Blunting of affect is seen in which of the following conditions?

Schizophrenia. **Explanation:** **1. Why Schizophrenia is Correct:** Blunting of affect (or affective flattening) refers to a significant reduction in the intensity of emotional expression. It is a hallmark **Negative Symptom** of Schizophrenia. In these patients, the face appears immobile, there is poor eye contact, and the voice lacks inflection (monotone). This occurs due to the underlying neurocognitive deficit and is often associated with a poorer prognosis compared to positive symptoms. **2. Why the Other Options are Incorrect:** * **Depression:** While patients with depression experience a "depressed mood," their affect is typically described as **constricted** (mild reduction in range) or **depressed**, rather than truly blunted. In severe cases, they may show "anhedonia," but blunting is classically associated with the schizophrenia spectrum. * **Mania:** In mania, the affect is **elated, expansive, or irritable**. It is the opposite of blunting; emotions are expressed with heightened intensity and volatility. * **Delirium:** Delirium is an acute organic brain syndrome characterized by a clouding of consciousness and fluctuating attention. While emotional lability (rapid shifts) can occur, blunting is not a diagnostic feature. **3. Clinical Pearls for NEET-PG:** * **The "4 As" of Bleuler:** Remember that **Affective Blunting** is one of Eugen Bleuler’s fundamental symptoms of schizophrenia (along with Autism, Ambivalence, and Loosening of Associations). * **Flat vs. Blunted:** "Flat" is the most severe form (no expression at all), while "Blunted" is a severe reduction. * **Differential:** If a patient on antipsychotics shows blunting, always rule out **Drug-Induced Parkinsonism** (masked facies), which can mimic affective flattening. * **Prognostic Value:** Negative symptoms like blunting are often resistant to first-generation antipsychotics and are better managed with atypical antipsychotics (e.g., Clozapine, Amisulpride).

Q: Which coding system in ICD-10 is used for "Schizophrenia, schizotypal and delusional disorders"?

F20-F29. ### Explanation The **ICD-10 (International Classification of Diseases, 10th Revision)**, published by the WHO, organizes mental and behavioral disorders under Chapter V (the "F" codes). **1. Why F20-F29 is Correct:** This block is specifically designated for **Schizophrenia, Schizotypal, and Delusional disorders**. These disorders are grouped together because they share common features of psychosis, such as hallucinations, delusions, and thought disturbances. * **F20:** Schizophrenia (the most significant member of this group). * **F21:** Schizotypal disorder. * **F22:** Persistent delusional disorders. * **F25:** Schizoaffective disorders. **2. Analysis of Incorrect Options:** * **F10-F19:** Refers to **Mental and behavioral disorders due to psychoactive substance use** (e.g., Alcohol, Opioids, Cannabinoids). * **F30-F39:** Refers to **Mood [affective] disorders**, including Mania (F30), Bipolar Affective Disorder (F31), and Depressive episodes (F32). * **F40-F48:** Refers to **Neurotic, stress-related, and somatoform disorders**, such as Phobic anxiety (F40), OCD (F42), and Reaction to severe stress (F43). **3. High-Yield NEET-PG Clinical Pearls:** * **Schizophrenia (F20):** Diagnosis requires symptoms to be present for at least **one month** according to ICD-10 (Note: DSM-5 requires 6 months of continuous disturbance). * **Schneider’s First Rank Symptoms (FRS):** These are highly characteristic of Schizophrenia and include audible thoughts, third-person hallucinations, and delusions of control. * **Most Common Type:** Paranoid Schizophrenia (F20.0) is the most common subtype worldwide. * **Simple Schizophrenia (F20.6):** Characterized by an insidious onset of negative symptoms (apathy, social withdrawal) *without* prominent hallucinations or delusions.

Q: Erotomania means

delusion of love. **Explanation:** **Erotomania**, also known as **De Clérambault’s Syndrome**, is a type of delusional disorder where the patient holds a fixed, false belief that another person—usually of higher social, financial, or professional status (e.g., a celebrity or a boss)—is deeply in love with them. Despite a lack of evidence or even direct denial from the object of affection, the patient interprets neutral actions as secret signs of love. **Analysis of Options:** * **A. Delusion of love (Correct):** This is the defining feature of Erotomania. It is more common in females, though males with the condition are more likely to exhibit stalking behavior. * **B. Delusion of doubles:** This refers to **Capgras Syndrome**, a delusional misidentification syndrome where the patient believes a familiar person has been replaced by an identical-looking impostor. * **C. Delusion of persecution:** This is the most common type of delusion, where the individual believes they are being conspired against, cheated, or harassed. It is a hallmark of Paranoid Schizophrenia. * **D. Delusion of nihilism:** Also known as **Cotard’s Syndrome**, the patient believes they are dead, non-existent, or that their internal organs are rotting/missing. It is typically seen in severe depressive psychosis. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Erotomania:** Occurs suddenly without other psychiatric symptoms. * **Secondary Erotomania:** Occurs in the context of other disorders like Schizophrenia or Bipolar Disorder. * **Fregoli Syndrome:** The opposite of Capgras; the belief that different strangers are actually a single familiar person in disguise. * **Othello Syndrome:** Delusion of infidelity (pathological jealousy).

Q: Which of the following is FALSE regarding delusional disorder?

Hallucinations are typically present.. **Explanation:** **Delusional Disorder** is characterized by the presence of one or more non-bizarre delusions (beliefs about situations that could occur in real life) lasting for at least **one month**. **Why Option D is the Correct (False) Statement:** In Delusional Disorder, **hallucinations are typically absent**. If they do occur, they are not prominent and are usually related to the delusional theme (e.g., the sensation of being infested with insects in the somatic subtype). A key diagnostic criterion is that the patient’s functioning is not markedly impaired, and behavior is not obviously odd or bizarre, which distinguishes it from Schizophrenia where hallucinations and disorganized behavior are hallmark features. **Analysis of Other Options:** * **Option A:** Delusion is indeed a **disorder of thought content**. It is defined as a fixed, false belief that is out of keeping with the patient’s social and cultural background and is held with absolute conviction despite contrary evidence. * **Option B:** By definition, a delusion is a **false belief**. * **Option C:** **Persecutory type** is clinically recognized as the most common subtype of delusional disorder, where the individual believes they are being conspired against, cheated, or harassed. **NEET-PG High-Yield Pearls:** * **Subtypes:** Erotomanic (De Clerambault’s Syndrome), Grandiose, Jealous (Othello Syndrome), Persecutory, and Somatic (e.g., Ekbom’s Syndrome/Monosymptomatic Hypochondriacal Psychosis). * **Age of Onset:** Usually middle to late life (older than Schizophrenia). * **Treatment:** Difficult to treat; **Atypical antipsychotics** are the first-line pharmacological treatment, though SSRIs may help in somatic types. Therapeutic alliance is crucial.

Question 1

A patient complains that people living upstairs are always talking about him and conspire against him. His son complains about his weird behavior, such as keeping shoes in the fridge and wearing a vest over a shirt. What is the likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Depression

Answer

Delusional disorder

Answer

Dementia

Question 2

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

Accepted Answer

Hallucinations

Answer

Loosening of associations

Answer

Disturbances of affect

Answer

Autism

Question 3

Blunting of affect is seen in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Depression

Answer

Mania

Answer

Delirium

Question 4

Which coding system in ICD-10 is used for "Schizophrenia, schizotypal and delusional disorders"?

Accepted Answer

F20-F29

Answer

F10-F19

Answer

F30-F39

Answer

F40-F48

Question 5

Erotomania means

Accepted Answer

delusion of love

Answer

delusion of doubles

Answer

delusion of persecution

Answer

delusion of nihilism

Question 6

The content of thought in delusional disorder, somatic type, is characterized by:

Accepted Answer

Preoccupation with sensations related to bodily functions or odors.

Answer

Preoccupation with a delusion of being ill with physical disease.

Answer

Preoccupation with a delusion of a bodily defect or dysfunction.

Answer

Preoccupation with an imagined physical defect.

Question 7

Impaired insight is evident in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Psychosomatic disorder

Answer

Anxiety neurosis

Answer

Post Traumatic Stress Disorder

Question 8

The least likely good prognostic factor in a patient with Schizophrenia is?

Accepted Answer

Premorbid personality issues

Answer

Acute onset

Answer

Female gender

Answer

History of mood disorder in the family

Question 9

Which of the following is FALSE regarding delusional disorder?

Accepted Answer

Hallucinations are typically present.

Answer

Delusion is a disorder of thought content.

Answer

The patient holds a false belief.

Answer

Delusions of persecution are the most common subtype.

Question 10

What is a delusion?

Accepted Answer

None

Answer

Comprehensible

Answer

Reasonable

Answer

Both

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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