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Psychiatry Question Bank – 49 Multiple Choice Questions on “Schizophrenia”

1. Bleuler’s criteria for schizophrenia include all the fol­lowing, except:

A. Loosening of association

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B. Automatism

C. Inappropriate affect

D. Ambivalence

Fundamental symptoms of schizophrenia were explained by Bleuler. They include (4 A’s)

1. Loosening of association

2. Ambivalence

3. Autism

4. Affective disturbances

2. A drug of therapeutic benefit in schizophrenia is:

A. Fluphenazine

B. Imipramine

C. Lithium

D. Doxepin

Others include

Penfluridol

Flupenthixol deconate

Haloperidol deconate

Adjuvant antiparkinsonian medications to prevent extrapyramidal symtoms include:

1. Trihexy phenydyl (pacitane)

2. Orphenadrin

3. Procyclidine

3. Schizophrenia is characterized by all the following ex­cept:

A. Delusion of control

B. Delusion of reference

C. Waxy flexibility

D. Altered sensorium

4. Which type of schizophrenia has a late onset and has good prognosis:

A. Simple schizophrenia

B. Hebephrenic schizophrenia

C. Catatonic schizophrenia

D. Paranoid schizophrenia

Onset of catatonic subtype is usually acute, in the late 2nd and early 3rd decade. The course is usually episodic and recovery is complete.

5. In schizophrenia, early onset with poor prognosis is seen in:

A. Simple

B. Hebephrenic

C. Catatonic

D. Paranoid

Onset usually in the early 2nd decade, recovery from the episode classically never occurs. Hebephrenic (or disorganized) schizophrenia has one of the worst prognoses among subtypes of schizophrenia.

6. All the following are first-order rank symptoms of schizo­phrenia except:

A. Depersonalization

B. Running commentary

C. Primary delusion

D. Somatic passivity

7. A person quarrels and hits his neighbor. The next day he starts feeling that he is being followed by the police who may arrest him. He also feels that his neighbors are controling him through radio waves. The diagnosis is:

A. Delusions of persecution

B. Passivity

C. Thought insertion

D. Schizophrenia

To see the criteria for paranoid schizophrenia.

8. A 45-year-old male presents with waxy flexibility, nega­tivism and decreased motor behaviour. The most prob­able diagnosis is:

A. Hebephrenic SZP

B. Catatonic SZP

C. Paranoid SZP

D. Simple SZP

Clinical features of catatonic schizophrenic are:

1. Mutism

2. Rigidity

3. Negativism

4. Posturing

5. Stupor

6. Echolalia, Echopraxia

7. Waxy flexibility

8. Ambitendency

9. Mannerisms, stereotypes, automatic, obedience, variegation, preservation, etc.

Clinical features of paranoid SZP:

1. Delusion of persecution, reference, grandeur, control, infidelity.

2. Hallucinations usually have a persecutory/grandiose content

3. Disturbance of affect, volition, speech and motor behavior.

Onset – insidious, occurs later in life, late 3rd and early 4th decade.

Clinical features of hebephrenic or disorganized SZP:

1. Marked thought disorder incoherence of hallucina­tions are fragmentary and changeable.

2. Emotional disturbances

Onset—insidious, usually in early 2nd decade. The recovery from the episode classically never occurs (This is one of the worst prognosis).

Clinical features of simple SZP:

1. Presence of characteristic negative symptoms of residual schizophrenia (like marked social with­drawal, shallow emotional response, loss of initiation and drive).

Delusions and hallucination are usually absent.

Prognosis is usually very poor. Clinical features of residual and latent SZP:

1. Prominent negative schizophrenic symptoms.

2. Evidence in the past of at least one clear cut psychotic episode.

3. A period of at least 1 yr during which the intensity and frequency of florid symptoms such as delusions and hallucination have been minimal or substantially reduced and the negative schizophrenic syndrome has been present.

4. Absence of dementia/other organic brain disease/ disorder and of chronic depression or institutionalism sufficient to explain the negative impair­ments.

9. A16-year-old boy does not attend school because of the fear of being harmed by school mats. He thinks that his class mates laugh at and take about him. He is even scared of going out to the market. He is most likely suf­fering from:

A. Anxiety neurosis

B. Manic-depressive psychosis

C. Adjustment Reaction

D. Schizophrenia

This person has:

Delusion of persecution

Delusion of reference

Poor socio occupational functioning.

10. The most frequent period for onset of schizophrenia:

A. Childhood

B. Adolescence

C. Middle adulthood

D. Old age

11. The major neurotransmitter hypothesis states that there is a hyperactivity of dopaminergic systems in:

A. Hysteria

B. Anxiety enuresis

C. Schizophrenia

D. Obsession

There is final increase of dopamine at the postsynaptic receptors in schizophrenia.

12. Auditory (third person) hallucinations, features of affect, disturbance, delusional perception, perplexity are seen in:

A. Anxiety neurosis

B. Hysteria

C. Depression

D. Schizophrenia

Schizophrenia was earlier known as dementia praecox. This term was coined by Eugen Bleuler. Schizophrenia means mental splitting. He described the characteristic symptoms known as the funda­mental symptoms of schizophrenia which is called as the 4A’s of Bleuler. 1. Ambivalence 2. Autism 3. Affect disturbances 4. Loosening of Association. He also described the active symptoms which included symptoms like delusions, hallucinations and negativism. Kurt Schneider described certain symptoms which are popularly called as Schneider’s first rank symptoms. They are as follows:

Hallucinations:

A. Audible thoughts

B. Voice heard arguing

C. Voice commenting on one’s action

Thought alienation phenomena:

A. Thought withdrawal

B. Thought insertion

C. Thought diffusion or broad coasting

Passivity phenomena:

A. Made feelings or affect

B. Made impulses

C. Made coalition or acts

D. Somatic passivity

Delusional perception – normal perception has a private and illogical meaning:

He also described second rank symptoms like other form of hallucinations, perplexity and affect distur­bances. Incidence is 1/1000.

13. Schneider’s diagnostic criteria for schizophrenia include the following first rank symptom:

A. Autism

B. Echolalia

C. Though insertion

D. Suicidal tendency

14. Incidence is schizophrennia in India is:

A. 1-5 per 1000

B. 0.015-0.5 per 1000

C. 5-10 per 1000

D. 10-15 per 1000

15. The prognosis of schizophrenia is unproved by:

A. Atypical symptoms

B. Emotional flattening

C. Strong family history of schizophrenia

D. None of these

Also remember Type I and Type II schizophrenia – coined by T J crow.

16. All of the following are Schneider’s first rank symptoms except:

A. Auditory hallucination

B. Delusional percept

C. Passivity phenomenon

D. Delusions of self-reference

Also remember-FRS is not specific to schizophrenia Total FRS – 11

An easy method to remember:

I. Three types of Hallucinations 1. Audible thoughts, 2. Voice discussing, 3. Voice commenting

II. Three types of though distufbance 1. though withdrawal, 2. though inertia, 3. though broadcast

III. Three types of made phenomena 1. Made affect, 2. Made impulse, 3. Made volition

Other-2: Somatic passivity and delusional percept.

17. Simple schizophrenia is best characterized by the fol­lowing feature:

A. Social withdrawal

B. Persistent hallucination

C. Persistent delusions

D. Formal thought

Simple schizophrenia – Has an early onset, insidious and progressive course. There is preponderance of negative symptoms. Delusions and hallucinations and ill systematized. Prognosis is poor.

18. Paranoid schizophrenia present with:

A. Abnormal behaviors

B. Persecutory or grandiose delusions

C. Psychomotor disturbance

D. Incoherence and incongruous affect

Paranoid subtype of schizophrenia is characterized by delusions of persecution/reference/grandeur/ infidelity and hallucinations. Personality deterioration is much less.

19. The following one is a first rank symptom in schizophre­nia:

A. Hallucination

B. Thought insertion

C. Delusions

D. Negativism

Schneider introduced concept of first rank symptom First rank symptoms are not specific to schizophrenia.

20. Psychomotor features are seen in the following type of schizophrenia:

A. Paranoid

B. Residual

C. Catatonic

D. Hebephrenic

Catatonia can present as excitement and stupor.

21. Percentage of schizophrenia affected patients in a popu­lation is (life time risk of schizophrenia):

A. 1 percent

B. 2 percent

C. 0.5 percent

D. 5 percent

22. Percentage of monozygotic twins with schizophrenia:

A. 0.1 percent

B. 1 percent

C. 10 percent

D. Over 50 percent

Actual concordance rate for monozygotic twins 46 percent

23. Bad prognosis in schizophrenia is associated with the following factors:

A. Catatonia

B. Gradual onset

C. Presence of Depression

D. Absence of family history

24. Which of the following is not a feature of schizophrenia?

A. Literally means “Splitting of mind”

B. Peak incidence occurs is 15 to 30 years age group

C. People with low intelligence are more predisposed

D. Predominantly a disease of females

25. All are features of schizophrenia except:

A. Altered affect

B. Incongruity of emotion

C. Altered intellectual functions

D. Neologisms

26. Schizophrenia like picture is a side effect of:

A. Fortwin

B. Phenobarbitone

C. Morphine

D. Amphetamine

Acute amphetamine intoxication can present like schizophrenia (paranoid subtype).

27. Schizophrenia with worst prognosis:

A. Paranoid

B. Undifferentiated

C. Catatonia

D. Differentiated

Subjects of schizophrenia with poor prognosis are – disorganized, simple, undifferentiated.

28. The most common type of hallucinations seen in schizo­phrenia is:

A. Tactile

B. Auditory

C. Visual

D. Olfactory

Types are thought echo, elementary, third person, running commentary.

29. The good prognostic factor in schizophrenia is:

A. Affective disorder

B. Gradual onset

C. Family history

D. Hebephrenic type

30. Drug of choice for the treatment of negative symptoms of schizophrenia is:

A. Chlorpromazine

B. Haloperidol

C. Clozapine

D. Doxepine

Atypical ant psychotics (risperidone, clozapine, olanzapine, ziprasidone) are effective in the treatment of negative symptoms.

31. Negative symptoms of schizophrenia include all of the following, except:

A. Affective blunting and flattening

B. Hallucination

C. Anhedonia

D. Poverty of thought content

Negative symptoms – Apathy, a motivation, poverty of speech, affective blunting, a socializations.

32. One of these symptoms does not occur in schizophrenia:

A. Thought alienation

B. Paranoid delusion

C. Disorientation

D. Hallucination

33. Which type of schizophrenia has an early onset and bad Prognosis?

A. Hebephrenic

B. Catatonia

C. Schizo-affective

D. Simple schizophrenia.

34. Best prognosis is seen with which symptom of schizo­phrenia:

A. Apathy

B. Anhedonia

C. Auditory hallucination

D. Poverty of thought

Apathy, anhedonia, and poverty of thought are negative symptoms and indicate poor prognosis.

35. All of the following are characteristic features of cata­tonic schizophrenia, except:

A. Mannerism

B. Negativism

C. Echolalia

D. Flight of ideas

Features of catatonia mutism, rigidity, negativism, posturing, stupor, echolalia, echopraxia, waxy flexibility, ambitendency, mannerism, verbigeration.

36. The Primary defect in schizophrenia is:

A. Delusions

B. Hallucinations

C. Thought disorder

D. Confabulation

37. The commonest type of schizophrenia is:

A. Hebephrenic

B. Catatonic

C. Simple

D. Paranoid

38. A bad prognostic factors in schizophrenia is:

A. Late onset

B. Family history of schizophrenia

C. Affective symptoms

D. Presence of depression

39. Schizophrenia-like syndrome is seen in drug abuses of:

A. Amphetamine

B. Cocaine

C. Opium

D. Pentazocine

40. All the following are features of schizophrenia, except:

A. Hallucination

B. Elated mood

C. Autochthonous derision

D. Anhedonia

41. A 65-year-old man feels there are some people living upstairs who are going to take all his wealth and are always criticizing him, while his attendant states that there is no one living upstairs. The attendant also complains of the man’s weird behavior like keeping his shoes in the fridge, had wearing his vest over his shirt. The most likely diagnosis is:

A. Delusion

B. Schizophrenia

C. Depression

D. Hallucination

In this case pt has delusions of persecutions of reference and this is likely to b? a case of paranoid schizophrenia.

42. A 22-year-old female hears voices asking her to do em­phasizing thing like sleep with the person sitting next to her and she does so. She is a schizophrenic on treat­ment with chlorpromazine for the past 10 years. The in­tensity of the voice decreases but persists. She is to be treated with:

A. Clozapine

B. Haloperidol

C. Tianeptine

D. Sulpiride

Clozapine is effective in management of treatment- resistant schizophrenia.

43. Kalloo, a 24-year-old occasional alcoholic shows a change in behaviors. He suspects that people are con­spiring in behaviors; he suspects that people are aspir­ing against him though his father states that there is no reason for his fears. He also gets hallucinations of voice commenting on his actions. What is the most probable diagnosis?

A. Delirium tremens

B. Alcohol-induced psychosis

C. Schizophrenia

D. Delusional disorder

In this case as patients have voices commenting on his actions, he is likely to have schizophrenia.

44. A schizophrenic patient is on antipsychotic, after a few days, he is not sleeping, not eating properly, not taking any interest in his surroundings. This indicates the possi­bility of all of the following except:

A. Emergence of negative symptoms

B. Major depression

C. Parkinsonian features

D. Reacting to demands of external environment

45. Lalloo, a 40-year-old, has recently started writing book. The matter in his book cannot be understood by anybody since it contains words which are not there in any dictionary and the theme is very disjointed, Nowadays he has become very shy and self-absorbed when he ad­dresses people he speaks about metaphysical ideas what is the weekly diagnosis:

A. Mania

B. Schizophrenia

C. A genius writer

D. Delusional disorder

In this case patient seems to have formal thought disorder which is suggestive of schizophrenia.

46. Kalloo, a 25 -year-old male living alone, starts suspecting that his neighbors are conspiring, against him. He lodges a complaint against them in the police station, which he is unable to prove. He also has auditory hallucinations. The symptoms have been present for the past 2 years. The diagnosis is:

A. Schizophrenia

B. Depression

C. Mania

D. Acute psychosis

In this case delusion of persecution and auditory hallucinations have been present for 2 years, the diagnosis is likely to be schizophrenia.

47. 76-year-old TM Naidu presents with persecutory delusions third person hallucinations and disorganized behaviour since one month. His tendon reflexes are brisk and pu­pils normal, while his mini mental score is 20/30 and his memory is impressed. The diagnosis is:

A. Dementia

B. Schizophrenia

C. Transient global amnesia

D. MDP

In view of to fulfilling 1 month criteria also presence of persecutory delusions disorganized behaviour and third person hallucinations the diagnosis is. schizophrenia.

48. The most accepted hypothesis explaining the biological basis for schizophrenia is:

A. The transmethylation hypothesis

B. The double bind hypothesis

C. The serologic hypothesis

D. The dopamine hypothesis

E. The endogenous opiate hypothesis

49. A person for the past 10 months has not been taking care of himself, laughs by himself, and talks about spiritualis­tic ideas alone in the room. The most likely diagnosis is:

A. Schizophrenia

B. Highly spiritualistic person

C. Mania

D. Psychosis

Answer

1.B 2.A 3.D 4.C 5.B 6.A 4.D .B 9.D 10.B 11.C 12.D 13.C 14.A 15.D 16.D 17.A 18.B 19.B 20.C 21.A 22.D 23.B 24.D 25.C 26.D 27.B 28.B 29.A 30.C 31.B 32.C 33.D 34.C 35.D 36.C 37.B 38.B 39.A 40.B 41.A 42.A 43.C 44.D 45.B 46.A 47.B 48.D 49.A

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