INI-CET 2024 — Psychiatry

Q: Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?

Impaired communication. ***Impaired communication*** - Deficits in **social communication and social interaction** are one of the two core diagnostic criteria for Autism Spectrum Disorder (ASD) in DSM-5. - This includes deficits in social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships. - Communication impairments are essential for diagnosis and must be present across multiple contexts. *Impaired imagination* - While restricted, repetitive patterns of behavior (which can include rigid thinking patterns) are the second core criterion, "impaired imagination" is not specifically listed as a core diagnostic criterion in DSM-5. - Imaginative play deficits may be present but fall under the broader category of restricted/repetitive behaviors, not as a standalone core criterion. *Language developmental delay* - Language delay is **not a core diagnostic criterion** in DSM-5 for ASD. - DSM-5 explicitly states that ASD can occur with or without accompanying language impairment. - When present, language delay is noted as a specifier, not a required criterion. *Vision problems* - Vision problems are not a characteristic feature of Autism Spectrum Disorder. - Any vision issues in individuals with ASD are co-occurring conditions unrelated to the core diagnostic features. [Practice more Psychiatry PYQs on OnCourse]

Q: Rapid cycling is characterized by all of the following except?

Occurs commonly in men. ***A. Occurs commonly in men*** - **Rapid cycling** is more common in **women** (approximately 70-90% of rapid cyclers are female) and is associated with comorbid conditions like **hypothyroidism**. - This is the **EXCEPT** answer because rapid cycling does NOT commonly occur in men—it predominantly affects women. *B. Commonly associated with concomitant hypothyroidism* - **Hypothyroidism** is a frequently noted comorbidity in individuals with **rapid-cycling bipolar disorder** (seen in 20-30% of cases). - Thyroid dysfunction can affect mood regulation and contribute to the instability characteristic of rapid cycling. - This IS a true characteristic of rapid cycling. *C. Antidepressants increase likelihood* - **Antidepressants** can sometimes **induce or worsen rapid cycling** in individuals with bipolar disorder, especially when used without a mood stabilizer. - This is why great care is taken when prescribing antidepressants in bipolar disorder to monitor for mood shifts. - This IS a true characteristic of rapid cycling. *D. At least 4 distinct episodes per year* - This is the **DSM-5 diagnostic criterion** for rapid cycling, meaning an individual experiences four or more mood episodes (depressive, manic, mixed, or hypomanic) within a 12-month period. - These episodes must be distinct and separated by either a full remission or a switch to an episode of opposite polarity. - This IS a true characteristic of rapid cycling. [Practice more Psychiatry PYQs on OnCourse]

Q: Which of the following is the core component of Beck's cognitive theory of depression?

C. Dysfunctional belief. ***Dysfunctional belief*** - **Dysfunctional beliefs**, or **core beliefs**, are the central component of Beck's cognitive theory, acting as underlying assumptions that shape an individual's interpretation of events. - These deep-seated beliefs are often rigid, extreme, and influence the development of maladaptive thoughts and behaviors in depression. *Cognitive distortions* - **Cognitive distortions** are systematic errors in thinking that arise from dysfunctional beliefs but are not the fundamental cause themselves. - They are the *patterned ways* in which individuals misconstrue reality, such as **catastrophizing** or **all-or-nothing thinking**. *Automated thoughts* - **Automatic thoughts** are spontaneous, fleeting thoughts that occur in response to specific situations. - While they are a key symptom and target of therapy in Beck's model, they stem from underlying dysfunctional beliefs and cognitive distortions, rather than being the core component. *Introjection* - **Introjection** is a psychoanalytic concept referring to the unconscious absorption of attitudes, ideas, and behaviors from external sources into one's own personality. - This concept is primarily associated with **psychodynamic theories** and is not part of Beck's cognitive model of depression. [Practice more Psychiatry PYQs on OnCourse]

Q: mhGAP program includes all of the following disorders except?

Personality Disorders. ***Personality Disorders*** - The **mhGAP program** (Mental Health Gap Action Programme) focuses on scaling up services for common, severe mental, neurological, and substance use disorders in low- and middle-income countries. - **Personality disorders** are generally not included in the core conditions addressed by the mhGAP program due to their complex and chronic nature, requiring specialized and long-term management that may be beyond the scope of primary care settings targeted by mhGAP. *Schizophrenia* - **Schizophrenia** is one of the priority conditions addressed by the mhGAP program, recognizing its severity and significant impact on individuals and communities. - The program provides guidelines for the recognition, management, and long-term care of schizophrenia at the primary healthcare level. *Depression* - **Depression** is a core focus of the mhGAP program, given its high prevalence and treatability in primary care settings. - mhGAP provides clear guidelines for the identification, basic management, and follow-up of individuals with depression. *Childhood mental disorder* - **Childhood mental disorders**, such as conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and developmental disabilities, are also included as priority conditions within the mhGAP program. - The program aims to improve the detection and basic management of these conditions in children and adolescents, promoting early intervention. [Practice more Psychiatry PYQs on OnCourse]

Q: Which of the following is not associated with Korsakoff psychosis?

Ophthalmoplegia. ***Ophthalmoplegia*** - **Ophthalmoplegia** is a key feature of **Wernicke encephalopathy**, the acute phase preceding Korsakoff psychosis, but is not directly a symptom of Korsakoff psychosis itself. - While both conditions are linked to thiamine deficiency, **Korsakoff psychosis** primarily manifests as chronic memory deficits. *Amnesia* - **Anterograde amnesia** (inability to form new memories) and **retrograde amnesia** (loss of past memories) are defining characteristics of Korsakoff psychosis. - This severe memory impairment is a result of damage to areas like the **mammillary bodies** and **thalamus**. *Confabulation* - **Confabulation**, the fabrication of distorted or misinterpreted memories without an intention to deceive, is a common symptom in patients with Korsakoff psychosis. - This occurs as patients attempt to fill in gaps in their memory loss, often believing their own stories. *Polyneuropathy* - **Polyneuropathy**, nerve damage affecting multiple peripheral nerves, causing symptoms like pain, numbness, and muscle weakness, is associated with chronic **alcoholism** and **thiamine deficiency**. - While not a direct psychological symptom, it is frequently seen in the same patient population that develops Korsakoff psychosis due to shared etiology. [Practice more Psychiatry PYQs on OnCourse]

7 Previous Year Questions with Answers & Explanations

Questions

Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?

Rapid cycling is characterized by all of the following except?

Which of the following is the core component of Beck's cognitive theory of depression?

mhGAP program includes all of the following disorders except?

Which of the following is not associated with Korsakoff psychosis?

In which of the following patients would supportive therapy be most challenging to implement effectively?

Which of the following is not a paraphilia?

INI-CET 2024 - Psychiatry INI-CET Practice Questions and MCQs

Question 1: Which of the following is a CORE diagnostic criterion of autistic spectrum disorder according to DSM-5?

A. Impaired communication (Correct Answer)
B. Impaired imagination
C. Language developmental delay
D. Vision problems

Explanation: ***Impaired communication*** - Deficits in **social communication and social interaction** are one of the two core diagnostic criteria for Autism Spectrum Disorder (ASD) in DSM-5. - This includes deficits in social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships. - Communication impairments are essential for diagnosis and must be present across multiple contexts. *Impaired imagination* - While restricted, repetitive patterns of behavior (which can include rigid thinking patterns) are the second core criterion, "impaired imagination" is not specifically listed as a core diagnostic criterion in DSM-5. - Imaginative play deficits may be present but fall under the broader category of restricted/repetitive behaviors, not as a standalone core criterion. *Language developmental delay* - Language delay is **not a core diagnostic criterion** in DSM-5 for ASD. - DSM-5 explicitly states that ASD can occur with or without accompanying language impairment. - When present, language delay is noted as a specifier, not a required criterion. *Vision problems* - Vision problems are not a characteristic feature of Autism Spectrum Disorder. - Any vision issues in individuals with ASD are co-occurring conditions unrelated to the core diagnostic features.

Question 2: Rapid cycling is characterized by all of the following except?

A. Occurs commonly in men (Correct Answer)
B. Commonly associated with concomitant hypothyroidism
C. Antidepressants increase likelihood
D. At least 4 distinct episodes per year

Explanation: ***A. Occurs commonly in men*** - **Rapid cycling** is more common in **women** (approximately 70-90% of rapid cyclers are female) and is associated with comorbid conditions like **hypothyroidism**. - This is the **EXCEPT** answer because rapid cycling does NOT commonly occur in men—it predominantly affects women. *B. Commonly associated with concomitant hypothyroidism* - **Hypothyroidism** is a frequently noted comorbidity in individuals with **rapid-cycling bipolar disorder** (seen in 20-30% of cases). - Thyroid dysfunction can affect mood regulation and contribute to the instability characteristic of rapid cycling. - This IS a true characteristic of rapid cycling. *C. Antidepressants increase likelihood* - **Antidepressants** can sometimes **induce or worsen rapid cycling** in individuals with bipolar disorder, especially when used without a mood stabilizer. - This is why great care is taken when prescribing antidepressants in bipolar disorder to monitor for mood shifts. - This IS a true characteristic of rapid cycling. *D. At least 4 distinct episodes per year* - This is the **DSM-5 diagnostic criterion** for rapid cycling, meaning an individual experiences four or more mood episodes (depressive, manic, mixed, or hypomanic) within a 12-month period. - These episodes must be distinct and separated by either a full remission or a switch to an episode of opposite polarity. - This IS a true characteristic of rapid cycling.

Question 3: Which of the following is the core component of Beck's cognitive theory of depression?

A. A. Cognitive distortions
B. B. Automatic thoughts
C. C. Dysfunctional belief (Correct Answer)
D. D. Introjection

Explanation: ***Dysfunctional belief*** - **Dysfunctional beliefs**, or **core beliefs**, are the central component of Beck's cognitive theory, acting as underlying assumptions that shape an individual's interpretation of events. - These deep-seated beliefs are often rigid, extreme, and influence the development of maladaptive thoughts and behaviors in depression. *Cognitive distortions* - **Cognitive distortions** are systematic errors in thinking that arise from dysfunctional beliefs but are not the fundamental cause themselves. - They are the *patterned ways* in which individuals misconstrue reality, such as **catastrophizing** or **all-or-nothing thinking**. *Automated thoughts* - **Automatic thoughts** are spontaneous, fleeting thoughts that occur in response to specific situations. - While they are a key symptom and target of therapy in Beck's model, they stem from underlying dysfunctional beliefs and cognitive distortions, rather than being the core component. *Introjection* - **Introjection** is a psychoanalytic concept referring to the unconscious absorption of attitudes, ideas, and behaviors from external sources into one's own personality. - This concept is primarily associated with **psychodynamic theories** and is not part of Beck's cognitive model of depression.

Question 4: mhGAP program includes all of the following disorders except?

A. Schizophrenia
B. Depression
C. Childhood mental disorder
D. Personality Disorders (Correct Answer)

Explanation: ***Personality Disorders*** - The **mhGAP program** (Mental Health Gap Action Programme) focuses on scaling up services for common, severe mental, neurological, and substance use disorders in low- and middle-income countries. - **Personality disorders** are generally not included in the core conditions addressed by the mhGAP program due to their complex and chronic nature, requiring specialized and long-term management that may be beyond the scope of primary care settings targeted by mhGAP. *Schizophrenia* - **Schizophrenia** is one of the priority conditions addressed by the mhGAP program, recognizing its severity and significant impact on individuals and communities. - The program provides guidelines for the recognition, management, and long-term care of schizophrenia at the primary healthcare level. *Depression* - **Depression** is a core focus of the mhGAP program, given its high prevalence and treatability in primary care settings. - mhGAP provides clear guidelines for the identification, basic management, and follow-up of individuals with depression. *Childhood mental disorder* - **Childhood mental disorders**, such as conduct disorder, attention-deficit/hyperactivity disorder (ADHD), and developmental disabilities, are also included as priority conditions within the mhGAP program. - The program aims to improve the detection and basic management of these conditions in children and adolescents, promoting early intervention.

Question 5: Which of the following is not associated with Korsakoff psychosis?

A. Ophthalmoplegia (Correct Answer)
B. Amnesia
C. Confabulation
D. Polyneuropathy

Explanation: ***Ophthalmoplegia*** - **Ophthalmoplegia** is a key feature of **Wernicke encephalopathy**, the acute phase preceding Korsakoff psychosis, but is not directly a symptom of Korsakoff psychosis itself. - While both conditions are linked to thiamine deficiency, **Korsakoff psychosis** primarily manifests as chronic memory deficits. *Amnesia* - **Anterograde amnesia** (inability to form new memories) and **retrograde amnesia** (loss of past memories) are defining characteristics of Korsakoff psychosis. - This severe memory impairment is a result of damage to areas like the **mammillary bodies** and **thalamus**. *Confabulation* - **Confabulation**, the fabrication of distorted or misinterpreted memories without an intention to deceive, is a common symptom in patients with Korsakoff psychosis. - This occurs as patients attempt to fill in gaps in their memory loss, often believing their own stories. *Polyneuropathy* - **Polyneuropathy**, nerve damage affecting multiple peripheral nerves, causing symptoms like pain, numbness, and muscle weakness, is associated with chronic **alcoholism** and **thiamine deficiency**. - While not a direct psychological symptom, it is frequently seen in the same patient population that develops Korsakoff psychosis due to shared etiology.

Question 6: In which of the following patients would supportive therapy be most challenging to implement effectively?

A. Patient who is severely ill and has significant ego dysfunction
B. Person who is motivated and has good self-control
C. Person with good cognitive and functional abilities
D. Patient who is severely ill and uncooperative (Correct Answer)

Explanation: ***Patient who is severely ill and uncooperative*** - A **severely ill** patient who is **uncooperative** presents the most **immediate and direct barrier** to implementing supportive therapy effectively. Their **active resistance** to therapeutic interventions (refusing medication, declining to engage, missing appointments) makes it practically impossible to deliver care. - **Uncooperativeness** represents active opposition to treatment, requiring resolution before any therapeutic work can proceed. Without patient engagement, even the most basic supportive interventions cannot be implemented. - While other patients may have limitations, an uncooperative patient fundamentally blocks the therapeutic alliance necessary for any psychotherapy. *Patient who is severely ill and has significant ego dysfunction* - **Ego dysfunction** (impaired reality testing, poor impulse control, weak sense of self) is indeed challenging and represents a relative contraindication to insight-oriented therapies. - However, patients with ego dysfunction may still **passively participate** in supportive therapy, especially when the therapy is structured and focused on basic stabilization rather than insight. - The key difference: ego dysfunction is a **structural limitation** requiring adaptation of technique, whereas uncooperativeness is an **active barrier** preventing any intervention. A patient with ego dysfunction can still potentially benefit from modified supportive approaches, but an uncooperative patient cannot be engaged at all. *Person who is motivated and has good self-control* - This patient would be the **easiest to treat** with supportive therapy due to their intrinsic motivation and ability to manage their own behavior. - Their **motivation** and **self-control** would facilitate adherence to treatment plans and active participation in their care, making implementation straightforward. *Person with good cognitive and functional abilities* - This patient would be **highly amenable to supportive therapy** as their cognitive and functional capacities allow them to understand and participate in treatment. - Good cognitive and functional abilities enable them to comprehend instructions, manage their own care, and engage effectively with healthcare providers, presenting minimal implementation challenges.

Question 7: Which of the following is not a paraphilia?

A. Necrophilia
B. Adultery (Correct Answer)
C. Fetishism
D. Paedophilia

Explanation: ***Adultery*** - **Adultery** refers to consensual sexual activity between a married person and someone who is not their spouse. - While it may involve **moral** or **social transgression**, it does not inherently involve **unusual sexual fantasies** or **non-consenting partners** that define paraphilias. *Necrophilia* - **Necrophilia** is a paraphilia defined by sexual attraction to or sexual acts with **corpses**. - It involves a **deviation from typical sexual arousal** patterns towards a non-living object. *Fetishism* - **Fetishism** is a paraphilia characterized by recurrent, intense **sexual arousal from inanimate objects** (e.g., shoes, clothing) or specific non-genital body parts. - The object or body part is essential for **sexual gratification**. *Paedophilia* - **Paedophilia** is a paraphilia involving recurrent, intense sexual attraction to **prepubescent children**. - This paraphilia is characterized by the **sexual targeting of children**, which falls outside of typical sexual behaviors and is illegal.