Psychiatry
10 questionsIndications for ECT are all except?
In which condition is psychosurgery considered as a last resort treatment?
Flooding is a psychological treatment modality used in which of the following?
Child wakes up at night sweating and terrified, does not remember the episode - diagnosis?
Pyromania is characterized by an irresistible urge to engage in which of the following behaviors?
An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?
What is considered the most effective treatment for Borderline Personality Disorder?
Which personality disorder is commonly associated with bipolar disorder?
Which of the following is a characteristic of borderline personality disorder?
Which personality disorder is characterized by suspiciousness?
NEET-PG 2013 - Psychiatry NEET-PG Practice Questions and MCQs
Question 1181: Indications for ECT are all except?
- A. Severe psychosis
- B. Catatonic schizophrenia
- C. Severe manic attack (Correct Answer)
- D. Severe depression with suicidal risk
Explanation: ***Severe manic attack*** - While **severe mania IS a recognized indication for ECT**, it is generally considered **less commonly used as first-line therapy** compared to the other options listed. - In clinical practice, **acute severe mania** is typically managed initially with **antipsychotics and mood stabilizers** (lithium, valproate), with ECT reserved for **treatment-resistant cases** or when rapid response is critical. - ECT is highly effective for severe mania, particularly with **psychotic features** or **medication intolerance**, but is not the **most typical first-choice indication** compared to severe depression or catatonia. - This question reflects the **relative clinical priority** of ECT indications rather than absolute contraindication. *Severe depression with suicidal risk* - This is the **most common and well-established indication for ECT**. - ECT provides **rapid antidepressant effect** (often within 1-2 weeks) and is particularly indicated when there is **imminent suicide risk**, **psychotic depression**, or **treatment-resistant depression**. - Response rates exceed 70-90% in severe depression, making it a primary indication. *Catatonic schizophrenia* - **Catatonia is one of the strongest indications for ECT**, regardless of underlying etiology (schizophrenia, mood disorders, or medical conditions). - ECT rapidly resolves **catatonic symptoms** including mutism, stupor, posturing, and waxy flexibility. - Often considered **first-line treatment** for severe or malignant catatonia due to life-threatening complications. *Severe psychosis* - ECT is indicated for **severe psychotic disorders** that are **treatment-resistant** or when patients cannot tolerate antipsychotic medications. - Particularly effective in **acute psychotic agitation**, **treatment-refractory schizophrenia**, and psychosis with high risk of harm. - Provides rapid symptom control when pharmacotherapy has failed or is contraindicated.
Question 1182: In which condition is psychosurgery considered as a last resort treatment?
- A. Severe Generalized Anxiety Disorder
- B. Severe Obsessive-Compulsive Disorder (Correct Answer)
- C. Severe Depression
- D. Severe Phobia
Explanation: ***Severe Obsessive-Compulsive Disorder*** - Psychosurgery (e.g., **anterior cingulotomy**, **capsulotomy**) is considered for individuals with **severe, refractory OCD** who have not responded to conventional treatments. - This intervention aims to disrupt specific neural circuits implicated in OCD, such as the **corticostriatothalamocortical (CSTC) loop**. *Severe Generalized Anxiety Disorder* - While GAD can be debilitating, standard treatments like **psychotherapy (CBT)** and **pharmacotherapy (SSRIs, SNRIs)** are generally effective. - Psychosurgery is not typically considered for GAD, as less invasive and established treatments carry significantly lower risks. *Severe Depression* - For severe, treatment-resistant depression, **electroconvulsive therapy (ECT)** and **transcranial magnetic stimulation (TMS)** are more common and established interventions. - Psychosurgery is rarely, if ever, used for severe depression due to ethical concerns and the availability of less invasive options. *Severe Phobia* - Severe phobias primarily respond to **exposure therapy** and **cognitive behavioral therapy (CBT)**. - These therapies directly target the learned fear response and are highly effective without the need for invasive procedures.
Question 1183: Flooding is a psychological treatment modality used in which of the following?
- A. Phobia (Correct Answer)
- B. Depression
- C. Mania
- D. Schizophrenia
Explanation: ***Phobia*** - **Flooding** is a specific type of **exposure therapy** that involves immediate and intense exposure to the feared object or situation for a prolonged period, without the possibility of escape. - This technique is primarily used to overcome **phobias** and other **anxiety disorders** by breaking the association between the feared stimulus and the anxiety response. *Depression* - Treatment for **depression** typically involves a combination of **pharmacotherapy** (antidepressants) and **psychotherapy**, such as cognitive-behavioral therapy (CBT) or interpersonal therapy. - While exposure techniques exist for some aspects of depression (e.g., social anxiety in depressive contexts), **flooding** is not a primary or standalone treatment modality for core depressive symptoms. *Mania* - **Mania**, a characteristic feature of **bipolar disorder**, is primarily treated with **mood stabilizers** (e.g., lithium, valproate) and sometimes antipsychotics. - Psychological interventions focus on **psychoeducation**, symptom monitoring, and adherence to medication, rather than exposure-based therapies like flooding. *Schizophrenia* - The primary treatment for **schizophrenia** involves **antipsychotic medications** to manage psychotic symptoms like hallucinations and delusions. - Psychological therapies, such as **cognitive-behavioral therapy for psychosis (CBTp)** and **family therapy**, aim to improve coping skills, reduce distress, and enhance social functioning, but **flooding** is not an appropriate or effective treatment.
Question 1184: Child wakes up at night sweating and terrified, does not remember the episode - diagnosis?
- A. Narcolepsy
- B. Nightmares
- C. Night terrors (Correct Answer)
- D. Somnambulism
Explanation: ***Night terrors*** - **Night terrors** are characterized by partial arousals from **deep non-REM sleep** (typically N3 stage), often accompanied by loud screams, thrashing, and autonomic symptoms like sweating and tachycardia. - The child is very difficult to awaken or comfort during an episode and, crucially, has **no memory of the event** upon waking, which differentiates it from nightmares. *Narcolepsy* - **Narcolepsy** is a chronic neurological condition characterized by overwhelming daytime **sleepiness** and sudden attacks of sleep. - It often involves **cataplexy** (sudden loss of muscle tone triggered by strong emotions) and **hypnagogic/hypnopompic hallucinations**, which are not described. *Nightmares* - **Nightmares** are vivid, frightening dreams that occur during **REM sleep** and typically result in full awakening and the ability to **recall the dream content**. - While they cause fear and distress, episodes do not usually involve the terrified unresponsiveness or lack of recall seen in night terrors. *Somnambulism* - **Somnambulism** (sleepwalking) occurs during **deep non-REM sleep**, and affected individuals may perform complex actions while partially aroused. - While there is amnesia for the event, prominent features like **sweating and intense terror** are not typical components of sleepwalking.
Question 1185: Pyromania is characterized by an irresistible urge to engage in which of the following behaviors?
- A. Set objects on fire (Correct Answer)
- B. Overeat
- C. Excessive sleeping
- D. Steal items
Explanation: ***Set objects on fire*** - Pyromania is a **mental disorder** characterized by a powerful, **irresistible urge to start fires**. - The individual experiences **tension or arousal** before the act, followed by **pleasure, gratification, or relief** after setting a fire or witnessing its effects. - This is classified as an **impulse control disorder** in psychiatric nosology. *Overeat* - This behavior is characteristic of **eating disorders** such as **binge eating disorder** or **bulimia nervosa**, not pyromania. - While impulses are involved, the specific urge and gratification are linked to food consumption, not fire-setting. *Excessive sleeping* - **Hypersomnia** or **excessive daytime sleepiness** is a symptom of various sleep disorders or medical conditions, not an impulse control disorder. - There is no direct association between the urge to sleep excessively and the diagnostic criteria for pyromania. *Steal items* - This behavior is characteristic of **kleptomania**, another impulse control disorder. - While both pyromania and kleptomania involve irresistible urges, kleptomania specifically involves stealing objects not needed for personal use or monetary value.
Question 1186: An 18-year-old girl presents with a circumscribed bald patch. There is no evidence of organic disease. What is the most likely diagnosis?
- A. Depression
- B. OCD
- C. Phobia
- D. Trichotillomania (Hair-Pulling Disorder) (Correct Answer)
Explanation: ***Trichotillomania (Hair-Pulling Disorder)*** - This condition is characterized by the **recurrent pulling out of one's hair**, resulting in noticeable hair loss or **bald patches**. - The description of a **circumscribed bald patch** without evidence of organic disease in an 18-year-old girl is highly suggestive of trichotillomania, especially given that organic causes of hair loss have been ruled out. *Depression* - While depression can be a **comorbid condition** with trichotillomania, it does not directly cause a circumscribed bald patch. - Depression is a **mood disorder** primarily characterized by persistent sadness, loss of interest, and other emotional and physical symptoms. *OCD* - **Obsessive-compulsive disorder** (OCD) involves intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - Although trichotillomania can share some characteristics with OCD (e.g., repetitive behavior), it is classified as a distinct **body-focused repetitive behavior disorder** in the DSM-5, not OCD itself. *Phobia* - A phobia is an **anxiety disorder** defined by an intense and irrational fear of a specific object or situation. - Phobias do not directly cause **physical symptoms** like bald patches; their primary manifestation is avoidance and panic in the presence of the feared stimulus.
Question 1187: What is considered the most effective treatment for Borderline Personality Disorder?
- A. Combination of DBT and pharmacotherapy
- B. Cognitive Behavioural Therapy (CBT)
- C. Pharmacotherapy alone
- D. Dialectical Behaviour Therapy (DBT) (Correct Answer)
Explanation: ***Dialectical Behaviour Therapy (DBT)*** - **DBT** is the **gold standard** and most evidence-based psychotherapy specifically developed for Borderline Personality Disorder - Developed by **Marsha Linehan** specifically to target the core symptoms of BPD including emotional dysregulation, impulsivity, and interpersonal difficulties - Combines **cognitive-behavioral techniques** with mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills - Has the **strongest research evidence** for reducing suicidal behavior, self-harm, and improving overall functioning in BPD patients - Multiple RCTs demonstrate DBT's superiority in treating BPD compared to standard care *Cognitive Behavioural Therapy (CBT)* - While **CBT** is effective for many mental health conditions and can help with certain BPD symptoms, it was not specifically designed for BPD - DBT is actually a specialized adaptation of CBT tailored for BPD, making it more targeted and effective for this specific condition - Generic CBT may help with co-occurring conditions like depression or anxiety but lacks the comprehensive approach needed for core BPD features *Combination of DBT and pharmacotherapy* - This combination is clinically useful, especially when treating **co-morbid conditions** like depression, anxiety, or severe mood instability - However, psychotherapy (particularly DBT) remains the **cornerstone** of BPD treatment, with medications serving an adjunctive role - The question asks for the single most effective treatment, which is DBT alone *Pharmacotherapy alone* - **No medication** is FDA-approved specifically for BPD - Pharmacotherapy may help manage specific symptoms (mood swings, impulsivity, brief psychotic episodes) but does not address the core **personality pathology** - Generally not recommended as monotherapy for BPD; should always be combined with psychotherapy
Question 1188: Which personality disorder is commonly associated with bipolar disorder?
- A. Narcissistic Personality Disorder
- B. Borderline Personality Disorder (Correct Answer)
- C. Obsessive-Compulsive Personality Disorder
- D. Antisocial Personality Disorder
Explanation: ***Borderline Personality Disorder*** - **Borderline Personality Disorder (BPD)** and **bipolar disorder** share overlapping symptoms such as mood instability, impulsivity, and relational difficulties. - Due to these shared features, there is a high comorbidity rate, and distinguishing between the two can be challenging, often requiring careful assessment of symptom origins and patterns. *Obsessive-Compulsive Personality Disorder* - **Obsessive-Compulsive Personality Disorder (OCPD)** is characterized by a preoccupation with orderliness, perfectionism, and control. - While an individual can have both, OCPD does not typically share the prominent **mood instability** or **impulsivity** that are core to bipolar disorder. *Narcissistic Personality Disorder* - **Narcissistic Personality Disorder (NPD)** involves a pervasive pattern of grandiosity, a need for admiration, and a lack of empathy, often presenting with inflated self-esteem or sense of superiority. - While **grandiosity** can be seen in manic phases of bipolar disorder, the chronic and pervasive nature of NPD, particularly the lack of empathy, differs from the episodic mood extremes of bipolar disorder. *Antisocial Personality Disorder* - **Antisocial Personality Disorder (ASPD)** is characterized by a disregard for and violation of the rights of others, often involving deception, impulsivity, and criminal behavior. - While **impulsivity** and **reckless behavior** can occur during manic episodes in bipolar disorder, ASPD's core features are a pervasive pattern of deceitfulness and lack of remorse, which are not primary symptoms of bipolar disorder.
Question 1189: Which of the following is a characteristic of borderline personality disorder?
- A. Unstable interpersonal relationship (Correct Answer)
- B. Grandiosity
- C. Low self esteem
- D. Excessive need for admiration
Explanation: ***Unstable interpersonal relationship*** - A core feature of **borderline personality disorder (BPD)** is a pattern of intense and unstable relationships, often characterized by idealization and devaluation. - Individuals with BPD struggle with a **fear of abandonment**, leading to desperate efforts to avoid real or imagined separation. *Excessive need for admiration* - This is a hallmark feature of **narcissistic personality disorder**, where individuals consistently seek praise and attention. - In BPD, the need is more focused on affirmation and avoiding abandonment rather than pure admiration. *Grandiosity* - **Grandiosity** is a defining characteristic of **narcissistic personality disorder**, involving an exaggerated sense of self-importance and superiority. - While individuals with BPD may have an unstable sense of self-worth, grandiosity is not a primary or consistent feature. *Low self esteem* - While individuals with BPD often experience **low self-esteem** and feelings of worthlessness, this is a symptom present in many mental health conditions and is not specific enough to characterize BPD alone. - The more defining features relate to **identity disturbance**, **affective instability**, and **impulsivity**.
Question 1190: Which personality disorder is characterized by suspiciousness?
- A. Paranoid personality disorder (Correct Answer)
- B. Schizoid personality disorder
- C. Anankastic personality disorder
- D. Schizotypal personality disorder
Explanation: ***Paranoid personality disorder*** - This disorder is fundamentally characterized by a pervasive **distrust and suspiciousness** of others' motives, interpreting them as malevolent. - Individuals with this disorder often believe others are exploiting, harming, or deceiving them, even without sufficient evidence. *Schizoid personality disorder* - Characterized by a pervasive pattern of **detachment from social relationships** and a restricted range of emotional expression in interpersonal settings. - Individuals with schizoid personality disorder typically show no interest in social interactions and exhibit **emotional coldness**, not suspiciousness. *Anankastic personality disorder* - This is another name for **Obsessive-Compulsive Personality Disorder (OCPD)**, which is characterized by a preoccupation with orderliness, perfectionism, and mental and interpersonal control. - Individuals with OCPD are concerned with rules, details, and schedules, often at the expense of flexibility and efficiency, and do not typically exhibit suspiciousness. *Schizotypal personality disorder* - Characterized by a pattern of acute discomfort with, and reduced capacity for, close relationships, as well as **cognitive or perceptual distortions** and eccentricities of behavior. - While they may exhibit odd beliefs or magical thinking, their primary feature is not suspiciousness but rather unique patterns of thought, perception, and behavior.