COMPILATION OF PSYCHOTIC DISORDERS

COMPILATION OF PSYCHOTIC DISORDERS

Q. 1 A 27-year-old woman states that for approximately 6 months, Shah Rukh Khan is in love with her. She insists that he has professed his intentions to marry her through messages in his songs lyrics. She has written numerous letters to him and loitered around his home, resulting in several arrests. She is irritated because, although he won’t meet her in person, he often calls her name outside her window when no one else is around. For the past several weeks, she has slept approximately only 2 hours a night but still has enough energy to continuously redecorate her apartment in preparation for her wedding to SRK. She admits to feeling “on top of the world” because the celebrity has chosen her and that she “can’t stop talking about it.”

Assertion: The lady in this scenario could be suffereing from a Schizoaffective disorder.

Reason: There is a 6 month history of psychotic and manic symptoms which could back up the diagnosis.

 A Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Q. 1

A 27-year-old woman states that for approximately 6 months, Shah Rukh Khan is in love with her. She insists that he has professed his intentions to marry her through messages in his songs lyrics. She has written numerous letters to him and loitered around his home, resulting in several arrests. She is irritated because, although he won’t meet her in person, he often calls her name outside her window when no one else is around. For the past several weeks, she has slept approximately only 2 hours a night but still has enough energy to continuously redecorate her apartment in preparation for her wedding to SRK. She admits to feeling “on top of the world” because the celebrity has chosen her and that she “can’t stop talking about it.”

Assertion: The lady in this scenario could be suffereing from a Schizoaffective disorder.

Reason: There is a 6 month history of psychotic and manic symptoms which could back up the diagnosis.

 A

Both Assertion and Reason are true, and Reason is the correct explanation for Assertion

 B

Both Assertion and Reason are true, and Reason is not the correct explanation for Assertion

 C

Assertion is true, but Reason is false

 D

Assertion is false, but Reason is true

Ans. A

Explanation:

The most likely diagnosis in this woman is schizoaffective disorder.

She describes a 6-month history of ideas of reference, delusions, and auditory hallucinations.

In addition, she has had clear manic symptoms for the past month, including an elevated mood, a decreased need for sleep, increased energy, increased goal-directed activities, and talkativeness.

Although she has symptoms consistent with schizophrenia, she has had a significant episode of mood disorder during her psychotic illness. Her psychotic symptoms, which preceded and occurred in the absence of mood symptoms, make primary mood disorder (mania) with psychotic features less likely.

Ref: CURRENT Diagnosis & Treatment: Psychiatry, 2e chapter 17


Q. 2

A 30 year old unmarried woman of average socio-economic background believes that her boss is in secretly love with her. She rings him up at odd hours and writes love letter to him despite his serious warning not to do so. She holds this belief despite contradiction from family members & his denial. However she is able to manage her daily activities as before. She is most likely to be suffering from:

 A

Depression

 B

Shizophrenia

 C

Delusional disorder

 D

No psychatric ailment

Ans. C

Explanation:

Ans:C-Delusional disorder

The lady is suffering from Erotomanic delusional disorder in which the content of delusion is that another person usually of higher status, is in love with the individual. Apart from delusional area, the personality, behaviour & functioning is not markedly impaired (almost normal) – characteristic of delusional disorder.


Q. 3

A 20 year old boy c/o hearing of voices, aggressive behavior since 2 days. He has fever since 2 days. When asked to his family, they say that he has been muttering to self and gesticulating. There is no of psychiatric illness. Likely diagnosis is:

 A Dementia

 B

Acute psychosis

 C

Delirium

 D

Delusional disorder

Ans. B

Explanation:

B i.e. Acute psychosis

–   Delusions or hallucinations (suchas hearing voices in this case) with grossly disorganized speech and behavior (such as muttering to self, gesticulation, aggressiveness in this case) of acute onset with normal cognition & consciousness indicate the diagnosis of acute psychosis (i.e. psychosis of acute onset). This acute psychosis may be d/t psychotic disorder d/t general medical condition (such as high fever as in this case) or d/t brief psychotic disorder (DSMIVTR), or d/t acute and transient psychotic disorder (ICD-10). So here the term acute psychosis is used to depict the clinical picture not the cause of that clinical picture.

Delirium can also present acute onset disorganized behavior (agitation) and speech (incoherent) with delusions or hallucinations but the delusions are poorly elaborated & transient, the course of disease is fluctuant (eg sun downing). And characteristically there is clouding of (disturbance in) consciousnesss (i.e. reduced clarity of awareness of the environment) and disorientation (change in cognition) in delirium. Just like psychosis clinical picture of delirium may also be d/t various reasons such as general medical condition / substance intoxication/ withdrawal.

– Dementia is a chronic slow/insiduous process presenting with decrement in intellectual abilities (such as short & long term memory, judgement, abstract thinking, impulse control, personal care and personality)Q.

–   Delusional disorder presents with nonbizarre delusions (involving situations that occur in real life) of at least 1 months durationQ. Apart from the impact of delusion (s) or its ramifications, functioning is not markedly impaired and behavior is not obviously odd or bizarre (i.e. criteria. A of schizophrenia has never been met). However, tactile or olfactory hallucinations may be present if they are related to delusional theme.


Q. 4 A patient came with complaints of having a deformed nose and also complained that nobody takes him seriously because of the deformity of his nose. He has visited several cosmetic surgeons but they have sent him back saying that there is nothing wrong with his nose. He is probably suffering from

 A Hypochondriasis

 B

Somatization

 C

Delusional Disorder

 D

OCD

Ans. C

Explanation:

C i.e. Delusional disorder 

In Delusional dysmorphophobia (delusional disorder) patient feels his body part or body ugly or mishappen.


Q. 5 Folie a deux is seen in :

 A

Hysteria

 B

Paranoid

 C

OCD

 D

Neurasthenia

Ans. B

Explanation:

B i.e. Paranoid 

Induced Delusional Disorder

  • Characterized by sharing of delusions between usually two (Folie a deux)Q or rarely more (Folie a trois, Folic a quatre, Folie a famille) persons who usually have closely Knit emotional bond.
  • Only one person has genuine delusions due to an underlying psychiatric disorder.
  • On separation, dependant individual may give up their delusions and patient with genuine delusions: should be’ treated according to underlying disease.

Q. 6

A 41 year old woman working as an Executive Director is convinced that the management has denied her promotion by preparing false reports about her competence and have forged her signature on sensitive documents so as to convict her. She files a complaint in the police station and requests for security. Despite all this she attends to her work and manages the household. She is suffering from :

 A Paranoid Schizophrenia

 B Late onset Psychosis

 C

Persistent Delusional Disorder

 D

Obsessive Compulsive Disorder

Ans. C

Explanation:

Ans:C-Persistent delusional disorder

Important difference b/w schizophrenia & delusional disorder is that:

  • Behaviour,perssonality & contact with reality is markedly disturbed in all areas incase of schizophrenia
  • Behaviour,personality & contact with reality is disturbed in delusional area otherwise person is normal in delusional disorder.

Q. 7

A 30 year old unmarried woman from a low socio­economic status family believes that a rich boy staying in her neighbourhood is in deep love with her. The boy clearly denies his love towards this lady. Still the lady insists that his denial is a secret affirmation of his love towards her. She makes desperate attempts to meet the boy despite resistance from her family. She also develops sadness at times when her effort to meet the boy does not materialize. She is able to maintain her daily routine. She however, remains preoccupied with the thoughts of this boy. She is likely to be suffering from :

 A Delusional disorder

 B Depression

 C

Mania

 D

Schizophrenia

Ans. A

Explanation:

A i.e. Delusional disorder

This lady is suffering from erotomanic delusional disorder in which the content of delusion is that another person usually of higher status, is in love with the individual.


Q. 8

Schneiderian First rank symptoms are found in :

 A

Schizophrenia

 B

Organic delusional disorder

 C

Schizoaffective disorder

 D

All

Ans. D

Explanation:

Ans:D-A >> B, C

  • The presence of one of these Schneider’s first rank symptoms (SFRS) in the absence of intoxication, brain injury or clear affective illness, was sometimes taken as sufficient for making diagnosis of schizophrenia (Kaplan).
  • SFRS are not specifc for schizophrenia and may be seen in other psychiatric disorders such as mood disorder and organic psychiatric disordersQ (Ahuja)/affective psychosis (New oxford)
  • Schneider first rank symptoms, which he believed were pathognomic of schizophrenia (& became the forerunner of notion of positive signs & symptoms ), are now known not to be specific for schizophrenia, for they may also occur in mania, drug induced states, other disorders (CDTP) Classification of schizophrenia like disorders include cases that resemble schizophrenia in some respects and yet do not meet the criteria for diagnosis. These include
  • ICD-10

    DSM – IV

    Schizoaffective disorder Schizo affective disorder
    Persistent delusional disorder Delusional disorder
    Induced delusional disorder Shared psychotic disorder
    Acute & transient psychotic disorder Brief psychotic disorders
    Acute schizophrenia like psychotic disorder Schizophreniform disorder
    Unspecified non organic psychosis Psychotic disorder not otherwise specified
    Schizotypal disorder, Other non organic psychotic disorders

     

Q. 9 Depressive delusions that the world and everything related to it cease to exist is called:

 A Persecutory delusion

 B

Delusion of infidelity

 C

Nihilistic delusion

 D

Delusion of reference

Ans. C

Explanation:

Ans.C- Nihilistic delusion

Nihilistic delusion (ND) is one of an assortment of narrowly defined monothematic delusions characterized by nihilistic beliefs about self’s existence or life itself.

It is estimated to occur in less than 1% of older adults, 3% of older adults with severe depression, and less than 1% of patients with psychotic disorders


Q. 10

Cotard’s syndrome has ‑

 A

Persecutory delusions

 B

Religious delusions

 C

Nihilistic delusions

 D

Hypochondriacal delusions

Ans. C

Explanation:

Ans:C-Nihilistic delusions

Nihilistic delusions:- False belief that oneself, others or the world is non-existent or about to end. There are pessimistic ideas that the patient’s career is finished, he is about to die, world is doomed. These occur in severe depression. If nihilistic delusions are accompanied by ideas concerning bodily function failure, e.g., putrefaction of intestines, etc., the syndrome is called COTARD’s SYNDROME.


Q. 11 Which of the following is not true regarding delusional disorder?

 A

Held with absolute conviction

 B

Usually false

 C

Not amenable to reasoning

 D

Occurs at an early age

Ans. D

Explanation:

Ans:D. Occurs at an early age.

The delusional disorder may account for 1–2% of admissions to inpatient psychiatric hospitals.
Age at onset ranges from 18–90 years, with a mean age of 40 years


Q. 12

A girl falls in love with a film star & believes that he also loves her. It is best exemplified by?

 A

Persecutory delusion

 B

Grandiose delusion

 C

Erotomania

 D

Nymphomania

Ans. C

Explanation:

Ans. is’c’i.e., Erotomania

  • Erotomania (Delusions of love): – False belief that another person is in love with one (commoner in woman).


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