Psychotic Disorders Practice Questions

Q: Fregoli's Syndrome is characterized by which of the following delusions?

Delusion of doubles. **Explanation:** **Fregoli’s Syndrome** is a rare neuropsychiatric condition classified as a **Delusional Misidentification Syndrome (DMS)**. In this syndrome, the patient holds a delusional belief that different people are actually a single person (usually a perceived persecutor) who is changing their appearance or wearing a disguise to follow them. It is termed a **"delusion of doubles"** because the patient identifies a familiar person in the bodies of various strangers. * **Option A (Correct):** It is a delusion of doubles where the patient over-identifies strangers as familiar people. This is the opposite of **Capgras Syndrome**, where a patient believes a familiar person has been replaced by an identical-looking impostor. * **Option B (Incorrect):** While Fregoli’s often has a paranoid flavor, "Delusion of persecution" is a broad category seen in Schizophrenia and is not the specific definition of this syndrome. * **Option C (Incorrect):** "Delusion of twins" is not a standard psychiatric term, though it is sometimes confused with the "Subjective Double" (the belief that a doppelgänger of oneself exists). * **Option D (Incorrect):** Delusion of parasites (Ekbom Syndrome) is the false belief that one is infested with small organisms. **Clinical Pearls for NEET-PG:** * **Capgras Syndrome:** Most common DMS; "Hypo-identification" (Familiar person = Stranger/Impostor). * **Fregoli Syndrome:** "Hyper-identification" (Stranger = Familiar person). * **Intermetamorphosis:** Belief that people swap identities with each other both physically and psychologically. * **Anatomical Association:** Often associated with lesions in the **right hemisphere** or bifrontal lobes, leading to a disconnection between visual recognition and emotional significance.

Q: Auditory hallucination is common in which of the following conditions?

Schizophrenia. **Explanation:** **Schizophrenia** is the correct answer because **auditory hallucinations** (specifically third-person voices commenting or arguing) are a hallmark "First Rank Symptom" of the disorder. In psychiatry and neuroanatomy, schizophrenia is primarily associated with functional disturbances in the **superior temporal gyrus** (Heschl’s gyrus) and the dopaminergic pathways. While hallucinations can occur in various conditions, they are most consistently and characteristically auditory in schizophrenia. **Analysis of Incorrect Options:** * **Delirium Tremens:** This is a severe form of alcohol withdrawal characterized primarily by **visual hallucinations** (e.g., seeing animals or insects), autonomic hyperactivity, and clouded consciousness. * **Cocaine Bugs (Formication):** This is a specific type of **tactile hallucination** where the patient feels as if insects are crawling under their skin. It is a classic sign of stimulant withdrawal or toxicity. * **Temporal Lobe Epilepsy (TLE):** While TLE can cause sensory disturbances, it is more frequently associated with **olfactory hallucinations** (uncinate fits, often smelling burnt rubber) or complex partial seizures involving "déjà vu." **NEET-PG High-Yield Pearls:** * **Visual Hallucinations:** Most common in organic brain syndromes (Delirium, Head injury) and substance withdrawal. * **Gustatory/Olfactory Hallucinations:** Highly suggestive of organic pathology (e.g., Temporal lobe tumors or Epilepsy). * **Hypnagogic/Hypnopompic Hallucinations:** Occur while falling asleep or waking up; classically seen in **Narcolepsy**. * **Lilliputian Hallucinations:** Seeing people/objects as small; common in Alcohol Withdrawal.

Q: Generalized paresis of the insane is seen in which stage of syphilis?

Tertiary stage. **Explanation:** **Generalized Paresis of the Insane (GPI)**, also known as paretic neurosyphilis or dementia paralytica, is a chronic meningoencephalitis caused by the invasion of the brain parenchyma by *Treponema pallidum*. **Why Tertiary Stage is Correct:** Neurosyphilis is a manifestation of **Tertiary Syphilis**, occurring typically 10 to 25 years after the initial infection. GPI represents the "parenchymatous" form of neurosyphilis, characterized by a progressive decline in cognitive function, personality changes (classically megalomania/grandiosity), and neurological deficits. **Analysis of Incorrect Options:** * **Primary Stage:** Characterized by the appearance of a painless chancre at the site of inoculation. It is a localized infection. * **Secondary Stage:** Represents hematogenous dissemination, presenting with generalized lymphadenopathy, maculopapular rashes (palms and soles), and condyloma lata. While "asymptomatic" meningitis can occur here, GPI is not seen. * **Congenital Syphilis:** While neurosyphilis can occur in congenital cases (juvenile paresis), the classic description of "Generalized Paresis of the Insane" refers to the late-stage manifestation of acquired syphilis in adults. **High-Yield Clinical Pearls for NEET-PG:** * **Psychiatric Symptoms:** Memory loss, irritability, and **grandiose delusions** are hallmark features. * **Physical Sign:** **Argyll Robertson Pupil** (Accommodation reflex present, Light reflex absent) is frequently associated. * **The "Paressis" Mnemonic:** **P**ersonality, **A**ffect, **R**eflexes (hyperreflexia), **E**ye (Argyll Robertson), **S**ensorium (illusions/hallucinations), **I**ntellect (dementia), **S**peech (slurred). * **Diagnosis:** CSF-VDRL is highly specific for neurosyphilis.

Q: A 60-year-old male suffering from auditory hallucinations states that people living upstairs are talking about him and conspiring against him. He filed a police complaint against them, but the allegations were proven to be false. What is the most likely diagnosis?

Schizophrenia. ### Explanation **Correct Answer: D. Schizophrenia** The patient presents with two core psychotic symptoms: **Auditory hallucinations** (hearing voices talking about him) and **Delusions of persecution** (conspiring against him). According to ICD-10 and DSM-5 criteria, the presence of persistent hallucinations accompanied by delusions is a hallmark of Schizophrenia. While the age of onset (60 years) is late, "Late-onset Schizophrenia" (onset after age 40) frequently presents with prominent persecutory delusions and sensory hallucinations, often directed at neighbors or people in the environment. **Why other options are incorrect:** * **A. Depression:** While psychotic depression exists, the primary feature must be a pervasive low mood, anhedonia, or suicidal ideation. There is no mention of mood symptoms here. * **B. Dementia:** Although delusions can occur in dementia, the primary deficit must be cognitive decline (memory loss, executive dysfunction). The vignette focuses purely on psychotic symptoms. * **C. Delusional Disorder:** This is the most common distractor. In Delusional Disorder, the patient has non-bizarre delusions, but **prominent auditory hallucinations are absent**. Since this patient has clear auditory hallucinations, it points toward Schizophrenia. **NEET-PG High-Yield Pearls:** * **Schneider’s First Rank Symptoms (FRS):** Includes audible thoughts (thought echo), voices arguing, and voices commenting. These are highly suggestive of Schizophrenia. * **Late-onset Schizophrenia:** More common in females and often characterized by paranoid themes and better preservation of affect compared to early-onset. * **Diagnostic Duration:** For a diagnosis of Schizophrenia, symptoms should generally be present for at least 1 month (ICD-10) or 6 months (DSM-5). * **Key Distinction:** Delusional Disorder = Delusions ONLY; Schizophrenia = Delusions + Hallucinations + Disorganized behavior/speech.

Q: Pathological jealousy is defined as?

A delusion of infidelity. **Explanation:** **Pathological jealousy**, also known as **Othello Syndrome** or Conjugal Paranoia, is a type of delusional disorder where an individual is firmly convinced, without adequate evidence, that their spouse or sexual partner is being unfaithful. 1. **Why Option A is Correct:** Pathological jealousy is characterized by a **delusion of infidelity**. The patient often collects "evidence" (e.g., checking phone logs, examining bedsheets, or following the partner) to prove the perceived betrayal. It is more common in males and is strongly associated with chronic alcoholism and personality disorders. 2. **Why Other Options are Incorrect:** * **Option B (Delusion of Love):** Known as **Erotomania** or **de Clerambault’s Syndrome**, where the patient believes a person of higher status (e.g., a celebrity) is in love with them. * **Option C (Delusion of Doubles):** Known as **Capgras Syndrome**, where the patient believes a familiar person has been replaced by an identical-looking impostor. * **Option D (Delusion of Grandeur):** Common in Mania, where the patient has an exaggerated sense of their own importance, power, or identity. **High-Yield Clinical Pearls for NEET-PG:** * **Othello Syndrome** is frequently associated with **Alcohol Dependence Syndrome**. * It carries a high risk of **violence and homicide** toward the partner. * **Treatment:** Antipsychotics (e.g., Risperidone) and treating the underlying substance abuse. * **Fregoli Syndrome:** The opposite of Capgras; the belief that different people are actually a single person in disguise.

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

Delusion of self-reference. **Explanation:** Kurt Schneider’s **First-Rank Symptoms (FRS)** are a group of specific psychotic symptoms that, in the absence of organic brain disease, are highly suggestive of Schizophrenia. While they are no longer mandatory for diagnosis in modern systems like DSM-5, they remain high-yield for exams. **Why "Delusion of Self-Reference" is the correct answer:** Delusion of reference (the belief that neutral events or coincidences have a special personal significance) is a common symptom of schizophrenia but is **not** classified as a Schneiderian First-Rank Symptom. It is considered a "second-rank" symptom because it lacks the specific diagnostic weight Schneider attributed to the FRS. **Analysis of Incorrect Options:** * **Passivity Phenomenon (A):** This is a core FRS where the patient feels their actions, impulses, or emotions are being controlled by an external force (e.g., "Made" acts, "Made" affect). * **Auditory Hallucinations (B):** Specifically, three types are FRS: **Third-person hallucinations** (voices arguing), **Running commentary** (voices describing the patient's actions), and **Thought Echo** (Gedankenlautwerden). * **Delusional Perception (D):** This is a two-stage process where a normal perception is suddenly given a delusional, highly significant meaning (e.g., seeing a red car and instantly "knowing" it means the secret police are coming). **Clinical Pearls for NEET-PG:** * **Mnemonic for FRS (ABCD):** **A**uditory Hallucinations (3 types), **B**roadcasting of thoughts, **C**ontrol (Passivity), **D**elusional Perception. * **Thought Alienation:** Includes Thought Insertion, Thought Withdrawal, and Thought Broadcasting (all are FRS). * **Exam Trap:** Somatic hallucinations are FRS, but simple visual or olfactory hallucinations are not. * **Current Status:** FRS are no longer required for a diagnosis of Schizophrenia in DSM-5, as they were found to be less specific than previously thought.

Question 1

Fregoli's Syndrome is characterized by which of the following delusions?

Accepted Answer

Delusion of doubles

Answer

Delusion of persecution

Answer

Delusion of twins

Answer

Delusion of parasites

Question 2

A 25-year-old housewife presented to the psychiatry outpatient department complaining that her nose was longer than usual. She felt that her husband did not like her because of this perceived deformity and had developed a relationship with the neighboring girl. Furthermore, she complained that people made fun of her. It was not possible to convince her that there was no deformity. What do her symptoms suggest?

Accepted Answer

Delusion

Answer

Depression

Answer

Hallucination

Answer

Depersonalization

Question 3

Auditory hallucination is common in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Delirium tremens

Answer

Cocaine bugs

Answer

Temporal lobe epilepsy

Question 4

Generalized paresis of the insane is seen in which stage of syphilis?

Accepted Answer

Tertiary stage

Answer

Primary stage

Answer

Secondary stage

Answer

Congenital syphilis

Question 5

Which of the following is NOT an environmental risk factor for schizophrenia?

Accepted Answer

Higher socioeconomic status

Answer

Cannabis use

Answer

Migration

Answer

Obstetric complications

Question 6

A 60-year-old male suffering from auditory hallucinations states that people living upstairs are talking about him and conspiring against him. He filed a police complaint against them, but the allegations were proven to be false. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Depression

Answer

Dementia

Answer

Delusional disorder

Question 7

A 23-year-old engineering student presents with a history of gradual onset of suspiciousness, muttering and smiling without clear reason, decreased socialization, violent outbursts, and lack of interest in studies for 8 months. Mental status examination reveals a blunt affect, thought broadcast, relatively preserved cognition, and impaired judgment and insight. What is the most likely diagnosis?

Accepted Answer

Schizophrenia

Answer

Delusional disorder

Answer

Depression

Answer

Anxiety disorder

Question 8

A 30-year-old man presents with a 2-month history of believing his wife is having an affair with his boss, and that his friend from abroad is involved and providing technical support. He also believes people speak ill of him. His friends have tried to convince him otherwise, but he remains unconvinced. He exhibits no thought disorder or other inappropriate behavior. What is the most likely diagnosis?

Accepted Answer

Persistent delusional disorder

Answer

Paranoid personality disorder

Answer

Schizophrenia

Answer

Acute and transient psychotic disorder

Question 9

Pathological jealousy is defined as?

Accepted Answer

A delusion of infidelity

Answer

A delusion of love

Answer

A delusion of doubles

Answer

A delusion of grandeur

Question 10

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

Accepted Answer

Delusion of self-reference

Answer

Passivity phenomenon

Answer

Auditory hallucinations

Answer

Delusional perception

Psychotic Disorders — MCQs

Psychotic Disorders — MCQs

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