Schizophrenia and Other Psychotic Disorders MCQs

Psychiatry · 58 free questions with answers & explanations.

1. A 24-year-old man is brought by his family after six months of progressive social withdrawal, auditory hallucinations telling him he is a divine messenger, and the firm belief that neighbours are implanting thoughts into his mind. He maintains that these experiences are completely real. His affect is flat and he avoids eye contact. Which single criterion below is sufficient by itself to meet Criterion A for schizophrenia under DSM-5-TR?
2. A 30-year-old woman has been on haloperidol for six months. She now presents with involuntary, repetitive chewing movements and tongue protrusion that persist even when she is resting. She has no current psychotic symptoms. What is the most appropriate next step in management?
3. A 22-year-old university student presents with a sudden two-week episode of auditory hallucinations, grandiose delusions, and disorganised speech following a break-up. He had no prior psychiatric history. A full medical work-up is negative. All psychotic symptoms resolve completely after three weeks. What is the most accurate diagnosis?
4. Clozapine is being considered for a patient with treatment-resistant schizophrenia. Which of the following absolute contraindications must be excluded before initiating clozapine?
5. A 45-year-old woman presents with an unshakeable belief that her neighbour has been in love with her for two years, despite no evidence of any real relationship. She has no hallucinations, her speech is organised, and she functions normally at work. What is the most likely diagnosis?
6. A 28-year-old man with a 2-year history of schizophrenia on clozapine develops progressive cognitive slowing and seizures. His clozapine serum level is 1100 ng/mL (therapeutic: 350–600 ng/mL). Which metabolic pathway is primarily responsible for clozapine toxicity at high plasma levels?
7. Which criterion distinguishes Schizophreniform Disorder from Brief Psychotic Disorder in DSM-5?
8. A patient with treatment-resistant schizophrenia is started on clozapine. After 6 weeks, his ANC drops to 750 cells/µL. According to REMS guidelines, what is the appropriate management?
9. In ICD-11, which of the following correctly describes a major conceptual difference from ICD-10 in diagnosing schizophrenia?
10. A 32-year-old woman with schizophrenia develops severe hyperthermia (40.5°C), muscular rigidity, altered consciousness, and autonomic instability 4 days after starting haloperidol. Her CK is 4500 U/L and WBC is 15,000/µL. What is the most appropriate immediate pharmacological treatment?
11. A 28-year-old man with schizophrenia has been on clozapine 400 mg/day for 6 months. His absolute neutrophil count (ANC) drops to 900/mm³. According to current REMS monitoring guidelines, the most appropriate next step is:
12. In DSM-5, the diagnosis of Brief Psychotic Disorder requires that the psychotic episode lasts:
13. A patient with treatment-resistant schizophrenia develops a serum glucose of 310 mg/dL with polydipsia and polyuria after 8 months on clozapine. The mechanism most responsible for this metabolic complication is:
14. According to ICD-11, the distinction between schizophrenia and schizoaffective disorder is BEST described as:
15. A patient on long-term haloperidol develops rhythmic, involuntary tongue movements and lip-smacking that persist even after the drug is stopped. The pathophysiology of this movement disorder involves:
16. A 28-year-old man has been experiencing auditory hallucinations, persecutory delusions, and disorganized speech for the past 7 months. He had a 2-week prodromal period of social withdrawal before the active psychotic symptoms began. His symptoms have been continuously present. According to DSM-5, which specifier BEST applies to his current illness course?
17. A 35-year-old patient with schizophrenia is started on clozapine after failing two adequate trials of antipsychotics. Which of the following is the MOST life-threatening absolute contraindication to continuing clozapine therapy?
18. A 25-year-old woman presents with a 3-week episode of prominent auditory hallucinations and grandiose delusions. She has no prior psychiatric history. Physical examination and labs are normal. Her symptoms resolve completely within 4 weeks of onset. According to DSM-5, what is the MOST appropriate diagnosis?
19. A 32-year-old man with schizophrenia develops rigidity, hyperthermia (40.2°C), diaphoresis, and altered consciousness 2 days after his antipsychotic was switched to haloperidol at higher doses. Creatine kinase is markedly elevated. What is the FIRST-line pharmacological treatment?
20. Regarding the dopamine hypothesis of schizophrenia, which mesolimbic and mesocortical pathway imbalance BEST explains the co-existence of positive and negative symptoms?
21. A 28-year-old man is brought by his family after 7 months of gradual social withdrawal, deteriorating hygiene, and speaking to himself. He now has fixed beliefs that his thoughts are being broadcast on television. He has no mood episodes. DSM-5 requires the diagnosis of schizophrenia to fulfil a minimum duration criterion of active symptoms. Which minimum duration satisfies the Phase A (active phase) criterion alone?
22. A 32-year-old woman is hospitalised with persecutory delusions and command auditory hallucinations for 6 weeks. She simultaneously develops a 2-week episode of elevated mood, grandiosity, and decreased sleep. Both psychotic and mood symptoms resolve fully with treatment. What is the DSM-5 diagnosis?
23. In clozapine-treated patients, which receptor-binding profile is most responsible for its superior efficacy against treatment-resistant negative symptoms and low extrapyramidal side effect burden compared with haloperidol?
24. A 45-year-old man with a 15-year history of schizophrenia on haloperidol 10 mg/day develops repetitive, involuntary chewing movements and tongue protrusions that persist for 6 months. He scores 4 on the AIMS. Which mechanism best explains this adverse effect?
25. According to ICD-11, which feature most clearly distinguishes 'schizotypal disorder' (ICD-11 6A22) from schizophrenia and from personality disorder?
26. A 26-year-old man has experienced auditory hallucinations, disorganised speech, and flat affect for 8 months. Two months before the psychotic break, he had a period of marked social withdrawal and declining academic performance. According to DSM-5, which prodromal phase duration criterion does this presentation satisfy for a schizophrenia diagnosis?
27. A patient with schizophrenia develops markedly elevated serum prolactin, galactorrhea, and amenorrhea after starting an antipsychotic. The treating physician wishes to switch to an agent with the least prolactin-elevating effect while maintaining D2 receptor blockade. Which antipsychotic is most appropriate?
28. In Brief Psychotic Disorder as per DSM-5, which feature most reliably distinguishes it from Schizophreniform Disorder?
29. A 30-year-old woman believes her neighbour is in love with her based on his glances and nodding. No actual communication confirming this has occurred. She has no hallucinations, behaviour is otherwise normal, and the belief has persisted for 3 months. The most accurate DSM-5 diagnosis is:
30. Clozapine's superior efficacy in treatment-resistant schizophrenia is most closely attributed to which pharmacological property compared to other second-generation antipsychotics?
31. Tardive dyskinesia (TD) resulting from long-term antipsychotic use is best treated with which agent that has FDA approval specifically for TD?
32. According to ICD-11 (2022), which major structural change was made to the Schizophrenia spectrum classification compared to ICD-10?
33. A 28-year-old schizophrenic patient on olanzapine 20 mg/day develops polyuria, polydipsia, weight gain of 18 kg over 6 months, and a fasting blood glucose of 240 mg/dL. The antipsychotic most appropriate to switch to, offering minimal metabolic risk while maintaining antipsychotic efficacy, is:
34. A patient with schizophrenia on clozapine develops absolute neutrophil count (ANC) of 480/mm³ on routine blood monitoring. According to current REMS protocols, the immediate action is:
35. In the dopamine hypothesis of schizophrenia, the mesolimbic and mesocortical pathways are differentially affected. Which pairing of pathway-abnormality-symptom is CORRECT?
36. A 26-year-old man with treatment-resistant schizophrenia fails two adequate trials of antipsychotics. He is started on clozapine. After 6 weeks, his absolute neutrophil count drops to 900/mm³. The CORRECT management is:
37. In the dopamine hypothesis of schizophrenia, which pathway's HYPERACTIVITY is specifically responsible for the positive symptoms?
38. A 30-year-old man believes he is receiving special messages through the TV meant only for him, but his functioning is preserved, he has no formal thought disorder or hallucinations, and the delusion has been present for 4 months. The MOST likely diagnosis is:
39. Which of the following best describes the 'deficit syndrome' in schizophrenia and its significance?
40. A patient with schizophrenia is stabilized on clozapine 450 mg/day. His absolute neutrophil count (ANC) drops to 900 cells/mm³ on routine monitoring. According to REMS protocol, the next step is:
41. Schneiderian first-rank symptoms of schizophrenia are pathognomonic according to Kurt Schneider. Which of the following is NOT a first-rank symptom?
42. Delusional disorder is characterized by which feature that DISTINGUISHES it from schizophrenia?
43. A patient with treatment-resistant schizophrenia (TRS) is started on clozapine. After 8 weeks at adequate plasma levels (>350 ng/mL), he continues to have significant positive symptoms. The evidence-based augmentation strategy with the strongest support is:
44. A 22-year-old man has his first psychotic episode with thought broadcasting and persecutory delusions. He is started on an antipsychotic. After 8 weeks he has no residual psychosis. What is the recommended minimum duration of continuation antipsychotic therapy after a first episode of schizophrenia, per current guidelines?
45. Clozapine is considered treatment-resistant schizophrenia's gold-standard drug. Which potentially fatal haematological adverse effect requires mandatory ANC (absolute neutrophil count) monitoring, and what ANC level necessitates immediate clozapine cessation?
46. A 30-year-old man has a 4-week episode of persecutory delusions and auditory hallucinations following the sudden death of his father. Between onset and recovery there is full return to premorbid functioning with no ongoing symptoms at 6 weeks. The MOST accurate DSM-5 diagnosis is:
47. A 22-year-old male engineering student is brought by his parents after a 7-month history of social withdrawal, declining academic performance, and increasingly odd beliefs. For the past 2 months he has reported hearing voices that comment on his actions, and he believes his classmates are transmitting thoughts into his head. He has never had a manic or depressive episode. Neurological examination and routine investigations are normal. What is the most likely diagnosis?
48. A 35-year-old woman with no prior psychiatric history presents believing that her neighbor, a famous celebrity, is secretly in love with her and sends her coded messages through television broadcasts. She has no hallucinations, her behavior is not disorganized, and her affect is appropriate. She holds a steady job and maintains social relationships. She has held this belief firmly for 5 months despite clear evidence to the contrary. What is the most likely diagnosis?
49. A 26-year-old woman with schizophrenia on haloperidol 10 mg/day for 4 months develops rhythmic, involuntary movements of her tongue and lips along with slow, writhing movements of her fingers. These movements persist even when she is instructed to stop them. She has no cogwheel rigidity or tremor. What is the most likely diagnosis and the appropriate next step?
50. A 30-year-old man with treatment-resistant schizophrenia (failed two adequate antipsychotic trials) is started on clozapine. After 3 weeks he presents with a fever of 39.5°C, sore throat, and malaise. His white cell count is 1,200/mm³ with an absolute neutrophil count of 400/mm³. What is the most appropriate immediate action?
51. A 19-year-old college student develops sudden onset of auditory hallucinations, persecutory delusions, and disorganized speech 1 day after a major academic examination. Her parents confirm she had no psychiatric symptoms prior to this event. After 8 days all symptoms resolve completely and she returns to baseline. A full medical and neurological workup is negative. What is the most accurate diagnosis?
52. A 48-year-old woman with a 12-year history of schizophrenia on risperidone presents with galactorrhea and amenorrhea for the past 6 months. Her pregnancy test is negative. Serum prolactin is 95 ng/mL (normal < 20 ng/mL). Brain MRI shows no pituitary adenoma. What is the mechanism behind this adverse effect?
53. A medical student who fails an exam becomes very angry at his roommate for minor reasons later that evening. According to Vaillant's hierarchy, which defence mechanism is he using, and which level does it belong to?
54. A 45-year-old physician who is privately terrified of dying from cancer goes out of his way to reassure patients with terminal cancer that 'everything will be fine' and minimizes their fears. He is never anxious when discussing cancer. Which defence mechanism is MOST likely operating?
55. A 30-year-old woman with borderline personality disorder, when angry with her therapist, describes him as 'the worst therapist in the world who has never helped anyone,' yet one week prior praised him as 'the only one who truly understands her.' This pattern BEST exemplifies which defence mechanism?
56. ICD-11 introduced a significant change to schizophrenia criteria compared to ICD-10. Which change is MOST notable?
57. A patient presents with features of both major depressive episodes and schizophrenia simultaneously. Psychotic symptoms have been present for a total of 8 months; mood episodes were present for 6 of those 8 months. According to DSM-5, what is the MOST appropriate diagnosis?
58. A 30-year-old man with no prior psychiatric history develops depressed mood, anhedonia, weight loss, and nihilistic delusions ('My organs are rotting away') for 6 weeks. MSE reveals mood-congruent psychotic features. He has no manic episodes. According to DSM-5, what is the MOST appropriate diagnosis?