Psychotic disorders: engaging a patient with delusional disorder: 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: engaging a patient with delusional disorder

Sample item

A 45-year-old businessman is firmly convinced that his neighbours are conspiring to harm him. He is otherwise well-organised, has no hallucinations, and refuses medicines saying he is not ill. What is the best initial approach?

AExpress agreement with his belief to gain his trustBPresent logical evidence to disprove the beliefCPlan compulsory ECT to remove the belief quicklyDBuild rapport, accept his distress, neither agree nor argue

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

The answer and the reasoning

D. Build rapport, accept his distress, neither agree nor argue

Delusions in delusional disorder are fixed and cannot be removed by argument, and collusion would reinforce them. Treatment begins with a therapeutic alliance in which the clinician empathises with the distress and the effect on his life without endorsing or confronting the belief; antipsychotics may then be negotiated.

Option by option

A. Express agreement with his belief to gain his trust
Agreeing with the belief amounts to collusion and strengthens the delusion.
B. Present logical evidence to disprove the belief
Arguing with evidence usually hardens the belief and damages rapport.
C. Plan compulsory ECT to remove the belief quickly
ECT has no role in treating delusional disorder and forced treatment is not an initial step.
D. Build rapport, accept his distress, neither agree nor argue (correct)
Correct. Alliance with empathy for the distress, without confronting or colluding, is the accepted first step.

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.

Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is D, Build rapport, accept his distress, neither agree nor argue. Delusions in delusional disorder are fixed and cannot be removed by argument, and collusion would reinforce them.

Why is "Express agreement with his belief to gain his trust" not the answer?

Agreeing with the belief amounts to collusion and strengthens the delusion.

Why is "Present logical evidence to disprove the belief" not the answer?

Arguing with evidence usually hardens the belief and damages rapport.

Why is "Plan compulsory ECT to remove the belief quickly" not the answer?

ECT has no role in treating delusional disorder and forced treatment is not an initial step.

What concept does this question test?

It tests Psychotic disorders: engaging a patient with delusional disorder in Psychiatry. Treatment begins with a therapeutic alliance in which the clinician empathises with the distress and the effect on his life without endorsing or confronting the belief; antipsychotics may then be negotiated.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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: engaging a patient with delusional disorder?

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.