Psychotic disorders: double orientation: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Psychotic disorders: double orientation

Sample item

A man with chronic schizophrenia firmly believes he is secretly the head of the intelligence service. Yet he arrives on time for his clerical job, does it competently, and never acts on the belief. Which concept, described by Bleuler, explains this?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Double bookkeeping

Double bookkeeping, or double orientation, is the coexistence of a delusional reality and the real world in the same patient, who keeps both sets of facts without trying to reconcile them. It explains why delusions need not impair all functioning in schizophrenia.

Option by option

  • A. Pseudologia fantastica

    Pseudologia fantastica is elaborate lying that the patient partly believes, and is not a fixed delusion.

  • B. Confabulation

    Confabulation is the filling of memory gaps with fabricated but sincere accounts.

  • C. Dissociative identity disorder

    Dissociative identity disorder involves distinct identity states and not a fixed delusion.

  • D. Double bookkeeping (correct)

    Correct. Delusional and real worlds are held in parallel, as in double orientation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, Double bookkeeping. Double bookkeeping, or double orientation, is the coexistence of a delusional reality and the real world in the same patient, who keeps both sets of facts without trying to reconcile them.

Why is "Pseudologia fantastica" not the answer?

Pseudologia fantastica is elaborate lying that the patient partly believes, and is not a fixed delusion.

Why is "Confabulation" not the answer?

Confabulation is the filling of memory gaps with fabricated but sincere accounts.

Why is "Dissociative identity disorder" not the answer?

Dissociative identity disorder involves distinct identity states and not a fixed delusion.

What concept does this question test?

It tests Psychotic disorders: double orientation in Psychiatry. It explains why delusions need not impair all functioning in schizophrenia.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Psychotic disorders: double orientation?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.