Psychiatry
10 questionsWho is known as the father of modern psychiatry?
Pavlov's experiment is an example of which of the following learning theories?
ECT is contraindicated in -
What is a contraindication for ECT?
Indications 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?
NEET-PG 2013 - Psychiatry NEET-PG Practice Questions and MCQs
Question 1341: Who is known as the father of modern psychiatry?
- A. Bleuler
- B. Freud
- C. Kraepelin
- D. Philippe Pinel (Correct Answer)
Explanation: ***Philippe Pinel*** - **Philippe Pinel** is widely regarded as the **father of modern psychiatry** due to his revolutionary reforms in the treatment of the mentally ill in the late 18th and early 19th centuries - He advocated for a more humane approach, removing chains from patients and emphasizing **moral treatment**, which laid the foundation for modern psychiatric care - His work at Bicêtre Hospital (1793) and Salpêtrière Hospital marked a paradigm shift from custodial care to therapeutic intervention *Bleuler* - **Eugen Bleuler** is known for coining the term **"schizophrenia"** (1911) and describing its fundamental symptoms (the "four A's": associations, affect, ambivalence, autism) - While his contributions were significant in understanding and classifying mental illness, he built upon the foundations of humane psychiatric care already laid by Pinel *Freud* - **Sigmund Freud** is considered the **father of psychoanalysis**, a distinct therapeutic approach and theory of personality - His work focused on the unconscious mind, defense mechanisms, and psychosexual development, which are central to psychoanalytic theory but not the foundational shift in psychiatric care management that Pinel initiated *Kraepelin* - **Emil Kraepelin** is often referred to as the **father of modern psychiatric classification** due to his systematic approach to categorizing mental disorders based on their clinical course and outcome (dementia praecox vs manic-depressive illness) - His work profoundly influenced the development of diagnostic manuals like the DSM, but his focus was on nosology and classification rather than the initial humane treatment reform
Question 1342: Pavlov's experiment is an example of which of the following learning theories?
- A. Modeling
- B. Classical conditioning (Correct Answer)
- C. Operant conditioning
- D. Learned helplessness
Explanation: ***Classical conditioning*** - Pavlov's experiment with dogs, where he conditioned them to **salivate** at the sound of a bell, is the quintessential example of **classical conditioning**. - This learning theory involves forming an association between a **neutral stimulus** (the bell) and a **natural stimulus** (food) that produces an involuntary response (salivation). *Modeling* - **Modeling**, or observational learning, involves learning by **observing and imitating** others. - This theory is associated with **Albert Bandura** and his Bobo doll experiment, which is different from Pavlov's stimulus-response pairing. *Operant conditioning* - **Operant conditioning** involves learning through **rewards and punishments** for voluntary behaviors. - This theory is primarily associated with **B.F. Skinner**, where an organism learns to associate a behavior with its consequences. *Learned helplessness* - **Learned helplessness** occurs when an individual or animal learns that they have no control over negative situations, leading to a sense of powerlessness and **giving up**. - This concept was developed by **Martin Seligman** and is not related to Pavlov's experiments on associative learning.
Question 1343: ECT is contraindicated in -
- A. Very ill patients
- B. Raised ICT (Correct Answer)
- C. Heart disease
- D. Pregnancy
Explanation: ***Raised ICT (Correct Answer)*** - An increase in **intracranial pressure (ICP)** is the **only absolute contraindication** to ECT in modern practice. - ECT causes a **transient rise in ICP** during the seizure due to increased cerebral blood flow and cerebral metabolic rate. - In patients with pre-existing raised ICP (from brain tumors, subdural hematoma, or other space-occupying lesions), this additional increase can precipitate **brain herniation**, which is potentially fatal. - This makes raised ICP an **absolute contraindication** where the risks clearly outweigh any potential benefits. *Very ill patients* - ECT is **not contraindicated** in medically ill patients; in fact, it can be **life-saving** in severe psychiatric emergencies. - With careful medical evaluation, monitoring, and management, ECT can be safely administered to medically fragile individuals. - The rapid therapeutic response of ECT makes it particularly valuable when other treatments have failed or when quick intervention is critical. *Heart disease* - Cardiac conditions are **relative contraindications**, not absolute contraindications. - While conditions like recent MI, unstable angina, or severe arrhythmias require careful evaluation, ECT can be performed safely with appropriate cardiac optimization and monitoring. - Modern anesthetic techniques and cardiovascular management allow most patients with heart disease to receive ECT when clinically indicated. *Pregnancy* - **Pregnancy is NOT a contraindication** to ECT and is considered one of the safest treatment options for severe psychiatric illness during pregnancy. - ECT can be performed safely throughout all trimesters with appropriate obstetric consultation, fetal monitoring, and positioning adjustments. - It avoids the teratogenic risks associated with many psychotropic medications, making it a preferred option for severe depression or psychosis in pregnancy.
Question 1344: What is a contraindication for ECT?
- A. Epilepsy
- B. HIV
- C. Cerebral aneurysm (Correct Answer)
- D. Arrhythmia
Explanation: ***Cerebral aneurysm*** * A **cerebral aneurysm** is considered a **relative contraindication** for electroconvulsive therapy (ECT) due to the increased risk of rupture from the transient, but significant, rise in **blood pressure** and **intracranial pressure** during the procedure. * The cardiovascular stress induced by the seizure can worsen pre-existing vascular pathologies in the brain, making it a high-risk condition. *Arrhythmia* * While various cardiac conditions require careful monitoring during ECT, **arrhythmias** are generally not an absolute contraindication. * Patients can often undergo ECT with proper **cardiac monitoring** and **pharmacological management** to control the heart rhythm during the procedure. *Epilepsy* * **Epilepsy** is not a contraindication for ECT; in fact, ECT *artificially induces a seizure* to achieve therapeutic effects. * The presence of epilepsy primarily impacts the choice of **anticonvulsant medications** and the need for potentially higher seizure thresholds, but it does not preclude ECT. *HIV* * **HIV infection** itself is not a contraindication for ECT. * ECT can be safely administered to HIV-positive individuals, with consideration given to the patient's overall **physical health**, **medication interactions**, and any co-morbid opportunistic infections.
Question 1345: 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 1346: 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 1347: 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 1348: 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 1349: 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 1350: 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.