Consultation-Liaison Psychiatry Practice Questions

Q: Maintaining the sick role by any means is a characteristic feature of which of the following disorders?

Factitious disorder. **Explanation:** **Factitious Disorder** is characterized by the intentional production or feigning of physical or psychological signs or symptoms. The primary motivation is to assume the **"sick role"** (primary gain) without any external incentives (like financial gain or avoiding work). Patients may go to extreme lengths, such as self-harm or contaminating lab samples, to maintain this role and receive medical attention. **Analysis of Options:** * **Hypochondriasis (Illness Anxiety Disorder):** The patient is not feigning symptoms; rather, they have a persistent, distressing preoccupation with the fear of having a serious undiagnosed medical condition despite negative evaluations. * **Somatization Disorder:** This involves multiple, recurrent physical complaints (pain, GI, sexual, neurological) that are **not** intentionally produced. The patient truly feels the symptoms, but no organic cause is found. * **Conversion Disorder (Functional Neurological Symptom Disorder):** Symptoms (like paralysis or blindness) are unintentional and usually triggered by psychological stress. The patient is not consciously seeking the sick role. * **Malingering (Differential):** Unlike Factitious Disorder, Malingering involves intentional faking for **secondary gain** (e.g., insurance money, avoiding jail, obtaining drugs). **Clinical Pearls for NEET-PG:** * **Munchausen Syndrome** is the most severe, chronic form of Factitious Disorder involving physical symptoms and "hospital hopping." * **Factitious Disorder Imposed on Another (Munchausen by Proxy):** A caregiver (usually a mother) feigns or induces illness in a dependent (child) to gain attention. * **Key Differentiator:** In Factitious Disorder, the motivation is **internal/psychological** (the sick role), whereas in Malingering, it is **external/tangible**.

Q: A patient has been seeking repeated admissions to various hospitals with a variety of symptoms, having undergone appendicectomy, cholecystectomy, and other exploratory laparotomies on previous admissions. What is the most likely diagnosis?

Munchausen syndrome. ### Explanation **Munchausen Syndrome** (now classified under **Factitious Disorder Imposed on Self**) is the correct diagnosis. It is characterized by the intentional production or feigning of physical or psychological symptoms. Unlike simple malingering, the primary motivation is not external gain (like money or avoiding work) but to assume the "sick role" and gain medical attention. The clinical hallmark described in the question—**"hospital hopping"** (peregrination) and a **"gridiron abdomen"** (multiple surgical scars from unnecessary procedures like appendicectomies and laparotomies)—is classic for Munchausen syndrome. These patients often provide dramatic but inconsistent medical histories. **Why other options are incorrect:** * **Conversion Disorder (Functional Neurological Symptom Disorder):** Symptoms (usually neurological, like paralysis or seizures) are **unintentional** and triggered by psychological conflict. There is no conscious feigning. * **Hypochondriasis (Illness Anxiety Disorder):** The patient has a genuine **fear** of having a serious disease based on misinterpretation of bodily sensations. They do not intentionally produce symptoms; they are truly anxious. * **Ganser’s Syndrome:** Known as "prison psychosis," it is characterized by **approximate answers** (paralogia), such as saying "2+2=5." It is a dissociative disorder most commonly seen in forensic settings. **High-Yield Clinical Pearls for NEET-PG:** * **Munchausen by Proxy:** Intentionally producing symptoms in another person (usually a child) to gain attention; it is a form of child abuse. * **Malingering:** Not a psychiatric disorder. Symptoms are faked for **secondary gain** (e.g., insurance money, avoiding jail, obtaining drugs). * **Key differentiator:** In Factitious Disorder, the goal is the **Internal Gain** (the sick role/attention).

Q: Chronic hepatitis C infection is associated with which psychological illness that may worsen with interferon treatment?

Depression. **Explanation:** The correct answer is **Depression**. Chronic Hepatitis C (HCV) infection is frequently associated with neuropsychiatric complications, most notably **Major Depressive Disorder**. The pathophysiology involves systemic inflammation and the release of pro-inflammatory cytokines that cross the blood-brain barrier, altering neurotransmitter metabolism (specifically serotonin and dopamine). **Interferon-alpha (IFN-α)**, historically a mainstay of HCV treatment, is notorious for inducing or exacerbating depression. It increases the activity of the enzyme *indoleamine 2,3-dioxygenase (IDO)*, which shunts tryptophan away from serotonin synthesis toward the neurotoxic kynurenine pathway. This "Interferon-induced depression" can be severe, leading to suicidal ideation, and often requires pretreatment screening or prophylactic SSRIs. **Analysis of Incorrect Options:** * **A. OCD & B. PTSD:** While patients with chronic illness may experience anxiety, there is no specific pathophysiological link between HCV/Interferon and the development of OCD or PTSD. * **D. Schizophrenia:** While interferon can occasionally cause acute psychosis or delirium, it is not classically associated with the development of Schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Screening:** Always screen for depression using tools like the PHQ-9 before starting Interferon therapy. * **Management:** SSRIs (like Paroxetine or Sertraline) are the first-line treatment for Interferon-induced depression. * **Modern Context:** With the advent of Direct-Acting Antivirals (DAAs) like Sofosbuvir, the use of Interferon has significantly declined, reducing the incidence of treatment-induced depression. * **Other Side Effects:** Interferon is also associated with "flu-like symptoms," irritability, and cognitive "brain fog."

Q: What does Consultation-liaison (C-L) psychiatry involve?

Psychiatric illness in medically ill. ***Psychiatric illness in medically ill*** - Consultation-liaison (C-L) psychiatry focuses on the **diagnosis** and **management** of mental health conditions that arise in individuals with co-occurring medical illnesses. - It involves close collaboration between psychiatrists and other medical teams to address the psychological impact of physical disease and optimize overall patient care. - This is the **core definition** of C-L psychiatry—psychiatric complications in the context of primary medical illness. *Suicidal tendency in psychiatric patients* - While suicide risk assessment is a crucial part of general psychiatry, this option is too broad as it doesn't emphasize the unique context of C-L psychiatry. - C-L psychiatry specifically addresses psychiatric issues in the context of patients with existing **medical conditions**, not general psychiatric patients. *Suicidal tendency in medically ill* - This is a significant aspect of C-L psychiatry, as medically ill patients may experience **depression** and **distress** leading to suicidal ideation. - However, C-L psychiatry encompasses a **broader range** of psychiatric illnesses in medically ill patients, not just suicidal tendencies—this option is too narrow. *Medical illness of psychiatric patients* - This describes a situation where a patient with a primary psychiatric diagnosis develops a medical illness, which is the **reverse** of the typical C-L psychiatry focus. - While this bidirectional care is also relevant, the core concept of C-L psychiatry is addressing **psychiatric complications** that emerge in the context of a primary medical illness in medical/surgical settings.

Q: Which personality type is believed to be more prone to coronary heart disease?

Type A. ***Type A*** - Individuals with a **Type A personality** are characterized by traits such as **competitiveness**, **time urgency**, **hostility**, and **aggression**. - These traits are associated with increased physiological stress responses, including elevated **blood pressure** and **heart rate**, contributing to a higher risk of developing **coronary heart disease**. *Type B* - **Type B personalities** are generally described as being more **relaxed**, **patient**, and **less driven** by external pressures. - This personality type is considered to have a **lower risk** of stress-related conditions, including heart disease, compared to Type A. *All are equally prone* - This statement is incorrect as research, particularly studies on **Type A and B personalities**, has shown differential risks for certain health conditions. - Specific personality traits and behaviors have been linked to varying levels of susceptibility to diseases like **coronary heart disease**. *Type C* - **Type C personalities** are often characterized by being **detail-oriented**, **introverted**, and tending to **suppress emotions**, particularly anger. - While sometimes linked to conditions like cancer in early theories, Type C is **not primarily associated** with an increased risk of coronary heart disease in the way Type A is.

Q: Which of the following is an example of a functional somatic disorder?

A condition involving severe, unexplained fatigue.. ***A condition involving severe, unexplained fatigue.*** - Functional somatic disorders, such as **Chronic Fatigue Syndrome (CFS)**, are characterized by persistent, debilitating fatigue that is not explained by an underlying medical condition. - The fatigue significantly impacts daily functioning and is often accompanied by other symptoms like **muscle pain**, cognitive difficulties, and sleep disturbances, without clear organic pathology. *A disorder involving multiple physical complaints without a clear medical cause.* - This description aligns more with **somatic symptom disorder** (formerly somatization disorder), where individuals present with multiple, persistent physical symptoms that are distressing or result in significant disruption of daily life. - While it shares the characteristic of "no clear medical cause" with functional somatic disorders, the emphasis here is on the **multiplicity and breadth of physical complaints** across different body systems rather than a specific pattern. *A disorder involving preoccupation with perceived physical defects.* - This description refers to **body dysmorphic disorder**, a psychiatric condition where individuals are excessively preoccupied with a perceived flaw in their physical appearance that is often imagined or slight to others. - It is primarily a **mental health disorder** focused on self-image rather than a functional somatic disorder with physical symptoms. *A condition characterized by excessive worry about having a serious illness.* - This describes **illness anxiety disorder** (formerly hypochondriasis), where individuals are preoccupied with the idea of having or acquiring a serious illness despite minimal or no somatic symptoms. - The core feature is the **anxiety about illness** itself, not the direct experience of unexplained physical symptoms typical of functional somatic disorders.

Q: Which type of pain is primarily associated with psychological factors and lacks a clear physical cause?

Pain with no identifiable physical cause. ***Pain with no identifiable physical cause*** - This describes **psychogenic pain** (also termed **somatic symptom disorder** in modern classification), where psychological factors like stress, anxiety, or depression significantly contribute to the experience of pain without a clear **physical pathology**. - The pain is real to the individual, even if a physical origin cannot be found, highlighting the strong **mind-body connection**. - Common in **conversion disorder**, **somatization disorder**, and **persistent somatoform pain disorder** (ICD-10). *Pain caused by nerve damage* - This is **neuropathic pain**, a type of chronic pain resulting from damage to the **somatosensory nervous system**. - It has a clear physical cause, such as **diabetic neuropathy**, **post-herpetic neuralgia**, or a **herniated disc**. *Pain resulting from physical injury* - This is **nociceptive pain**, which arises from actual or threatened damage to **non-neural tissue** and is due to the activation of **nociceptors**. - Examples include sprains, fractures, burns, or post-surgical pain, all of which have a clear **physical etiology**. *Pain from internal organs* - This is **visceral pain**, which originates from internal organs and is often described as diffuse, deep, and poorly localized. - It has a clear anatomical source, such as **appendicitis**, **gallstones**, **myocardial infarction**, or **ureteral colic**.

Question 1

Maintaining the sick role by any means is a characteristic feature of which of the following disorders?

Accepted Answer

Factitious disorder

Answer

Hypochondriasis

Answer

Somatization disorder

Answer

Conversion disorder

Question 2

A patient has been seeking repeated admissions to various hospitals with a variety of symptoms, having undergone appendicectomy, cholecystectomy, and other exploratory laparotomies on previous admissions. What is the most likely diagnosis?

Accepted Answer

Munchausen syndrome

Answer

Conversion reaction

Answer

Hypochondriasis

Answer

Ganser's syndrome

Question 3

Chronic hepatitis C infection is associated with which psychological illness that may worsen with interferon treatment?

Accepted Answer

Depression

Answer

Obsessive-compulsive disorder (OCD)

Answer

Post-traumatic stress disorder (PTSD)

Answer

Schizophrenia

Question 4

All of the following are features of somatization disorder except?

Accepted Answer

Professional patients

Answer

Frequently changing pain sites

Answer

Sexual symptoms

Answer

Paresthesia

Question 5

Which of the following statements regarding myocardial infarction and depression is false?

Accepted Answer

Only cognitive behavioral therapy is used after myocardial infarction.

Answer

Depression is a risk factor for myocardial infarction.

Answer

Myocardial infarction is a risk factor for depression.

Answer

Selective serotonin reuptake inhibitors (SSRIs) can be used post-myocardial infarction for the treatment of depression.

Question 6

What does Consultation-liaison (C-L) psychiatry involve?

Accepted Answer

Psychiatric illness in medically ill

Answer

Suicidal tendency in psychiatric patients

Answer

Suicidal tendency in medically ill

Answer

Medical illness of psychiatric patients

Question 7

Which personality type is believed to be more prone to coronary heart disease?

Accepted Answer

Type A

Answer

Type B

Answer

All are equally prone

Answer

Type C

Question 8

Which of the following is an example of a functional somatic disorder?

Accepted Answer

A condition involving severe, unexplained fatigue.

Answer

A disorder involving multiple physical complaints without a clear medical cause.

Answer

A disorder involving preoccupation with perceived physical defects.

Answer

A condition characterized by excessive worry about having a serious illness.

Question 9

Which type of pain is primarily associated with psychological factors and lacks a clear physical cause?

Accepted Answer

Pain with no identifiable physical cause

Answer

Pain caused by nerve damage

Answer

Pain resulting from physical injury

Answer

Pain from internal organs

Consultation-Liaison Psychiatry — MCQs

Consultation-Liaison Psychiatry — MCQs

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