Psychosomatic Disorders — MCQs
Systemic desensitization therapy is used for
What is considered the most effective treatment for Borderline Personality Disorder?
A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:
Which of the following symptoms is NOT included in the diagnostic criteria for DSM-IV-TR somatization disorder?
Astasia-abasia is associated with which of the following conditions?
A 35 year old man feels that he is about to die because he is suffering from gastric cancer. All his radiological investigations prove the contrary. Which is the most probable diagnosis?
Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
Loosening of association is an example of
Which of the following is NOT considered a formal thought disorder?
Which class of medications is known to worsen the symptoms of delirium in patients post-cardiac surgery?
Psychosomatic Disorders Indian Medical PG Practice Questions and MCQs
Question 1: Systemic desensitization therapy is used for
- A. Phobia (Correct Answer)
- B. Depression/Mania
- C. Organic brain syndrome
- D. Schizophrenia
Explanation: ***Phobia*** - **Systemic desensitization** is a highly effective behavioral therapy specifically designed to treat **phobias** and other **anxiety disorders**. - It involves gradually exposing the individual to the feared object or situation while teaching them **relaxation techniques** to replace the anxiety response. *Depression/Mania* - These conditions are primarily treated with a combination of **pharmacotherapy** (e.g., antidepressants, mood stabilizers) and other forms of psychotherapy like **cognitive behavioral therapy (CBT)** or **interpersonal therapy**. - Systemic desensitization is not a primary or effective treatment for the core symptoms of **mood disorders**. *Organic brain syndrome* - This is a broad term referring to mental impairment caused by a **physical disease or injury affecting the brain**, such as dementia or delirium. - Treatment focuses on addressing the **underlying medical cause** and managing cognitive or behavioral symptoms, not desensitization. *Schizophrenia* - Schizophrenia is a severe mental illness characterized by **psychosis**, **disorganized thinking**, and significant functional impairment. - Treatment primarily involves **antipsychotic medications** and psychosocial interventions, rather than exposure-based therapies like systemic desensitization.
Question 2: 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 3: A nondiabetic, nonhypertensive patient has occasional extra heartbeats. The doctor informed them it is benign, but the patient continues to seek investigations from doctor to doctor. This is a type of:
- A. Depression
- B. Conversion disorder
- C. Somatoform pain
- D. Illness Anxiety Disorder (Correct Answer)
Explanation: ***Illness Anxiety Disorder*** - This condition is characterized by **preoccupation with having or acquiring a serious illness**, despite minimal or no somatic symptoms, or an excessive preoccupation if symptoms are present. - The patient's repeated seeking of investigations despite medical assurance of a benign condition aligns with the diagnostic criteria of **illness anxiety disorder**, where reassurance has little effect. *Depression* - While **depressive symptoms** (e.g., low mood, anhedonia) can coexist with health anxieties, the primary driver here is the fear of serious illness rather than pervasive sadness or loss of interest. - Patients with depression typically report a **generalized dysphoria** or lack of energy, which is not the central issue described. *Conversion disorder* - Involves **neurological symptoms** (e.g., paralysis, blindness, seizures) that are incompatible with recognized neurological conditions and are not intentionally produced. - The patient's concern is about a benign cardiac finding, not the sudden onset of **functional neurological deficits**. *Somatoform pain* - This term is older and has largely been replaced by **Somatic Symptom Disorder with predominant pain**, where psychological factors play a significant role in the onset, severity, exacerbation, or maintenance of pain. - The patient's main concern is about the **implication of a benign symptom** rather than experiencing overwhelming pain itself.
Question 4: Which of the following symptoms is NOT included in the diagnostic criteria for DSM-IV-TR somatization disorder?
- A. Sexual symptom
- B. Pain symptom
- C. GI symptom
- D. Visual symptoms (Correct Answer)
Explanation: ***Visual symptoms*** - **Visual symptoms** is NOT a separate diagnostic category in DSM-IV-TR somatization disorder criteria. - While visual symptoms (such as **double vision** or **blindness**) ARE part of the diagnostic criteria, they fall under the **pseudoneurological symptom** category, not as a distinct standalone category. - The DSM-IV-TR required **one pseudoneurological symptom** (which could include visual, motor, sensory symptoms, or seizures), but did not list "visual symptoms" as one of the four main symptom categories. *Sexual symptom* - The DSM-IV-TR diagnostic criteria for somatization disorder explicitly included **sexual symptoms** as one of the four main categories. - At least **one sexual symptom** was required (such as sexual indifference, erectile dysfunction, irregular menses, or painful intercourse). *Pain symptom* - The DSM-IV-TR criteria included **pain symptoms** as one of the four main categories. - The criteria required **four pain symptoms** occurring in at least four different sites or functions (e.g., head, abdomen, back, joints, chest). *GI symptom* - The DSM-IV-TR criteria included **gastrointestinal symptoms** as one of the four main categories. - At least **two gastrointestinal symptoms** were required (such as nausea, bloating, vomiting other than during pregnancy, or diarrhea). **Key Point:** The four DSM-IV-TR symptom categories for somatization disorder were: (1) Pain, (2) Gastrointestinal, (3) Sexual, and (4) Pseudoneurological—NOT "visual symptoms" as a separate category.
Question 5: Astasia-abasia is associated with which of the following conditions?
- A. Post-Traumatic Stress Disorder
- B. Depressive Disorder
- C. Bipolar Mood Disorder
- D. Functional Neurological Symptom Disorder (Correct Answer)
Explanation: ***Functional Neurological Symptom Disorder*** - **Astasia-abasia**, which refers to an inability to stand (astasia) and walk (abasia) despite normal motor function when examined in bed, is a classical presentation of **Functional Neurological Symptom Disorder** (formerly conversion disorder). - This disorder involves neurological symptoms that are incompatible with recognized medical conditions and often linked to **psychological stressors**. - The gait disturbance is bizarre and inconsistent with any known neurological pattern. *Post-Traumatic Stress Disorder* - Characterized by re-experiencing a **traumatic event**, avoidance behaviors, negative alterations in cognitions and mood, and hyperarousal. - While it can manifest with physical symptoms, **astasia-abasia** is not a primary or characteristic feature. *Depressive Disorder* - Primarily involves persistent **sadness**, loss of interest or pleasure, changes in appetite or sleep, and feelings of worthlessness or guilt. - Although physical symptoms like fatigue and psychomotor retardation can occur, **astasia-abasia** is not a typical presentation. *Bipolar Mood Disorder* - Distinguished by episodes of both **mania** (or hypomania) and **depression**. - Symptoms are predominantly mood-related, including extreme shifts in energy, activity levels, and concentration, not specific neurological deficits like astasia-abasia.
Question 6: A 35 year old man feels that he is about to die because he is suffering from gastric cancer. All his radiological investigations prove the contrary. Which is the most probable diagnosis?
- A. Somatic symptom disorder
- B. Conversion disorder
- C. Delusional disorder
- D. Illness anxiety disorder (Correct Answer)
Explanation: ***Illness anxiety disorder*** - This patient exhibits a **preoccupation with having a serious illness** (gastric cancer) despite evidence to the contrary (negative radiological investigations). - The fear of illness is **persistent** and **causes significant distress**, leading to the belief that he is "about to die." - In illness anxiety disorder, patients may have **intense health anxiety** but typically retain some capacity for at least temporary reassurance with negative test results, even if the anxiety returns. - The presentation focuses on **fear and preoccupation** rather than an absolutely fixed, unshakeable delusional belief. *Somatic symptom disorder* - Characterized by **one or more significant physical symptoms** that cause significant distress or functional impairment, along with excessive thoughts, feelings, or behaviors related to these symptoms. - In this case, the primary concern is the *fear* of having a serious illness, rather than significant physical symptoms themselves. - The emphasis is on the **belief about having cancer** rather than distressing somatic symptoms. *Conversion disorder* - Involves **neurological symptoms** (e.g., altered motor or sensory function, weakness, paralysis, seizures) that are incompatible with recognized neurological or medical conditions. - The patient's presentation does not involve neurological deficits, and the primary concern is fear of a specific disease (gastric cancer) rather than unexplained neurological symptoms. *Delusional disorder* - Characterized by one or more **fixed, unshakeable, nonbizarre delusions** that persist for at least one month. - In **delusional disorder, somatic type**, the patient would have an absolutely fixed belief about having a disease with **no insight** and **no response to reassurance** despite clear contrary evidence. - While this patient has a strong belief about having cancer, the clinical presentation described (preoccupation with health concerns in the context of negative investigations) aligns more specifically with **illness anxiety disorder**, which is the more common diagnosis in this scenario per standard medical teaching.
Question 7: Which of the following disorders is classified under somatic symptom and related disorders in the DSM-5?
- A. Post-Traumatic Stress Disorder (PTSD)
- B. Phobic disorders (e.g., social anxiety disorder)
- C. Conversion disorder (functional neurological symptom disorder) (Correct Answer)
- D. Obsessive-Compulsive Disorder (OCD)
Explanation: ***Conversion disorder (functional neurological symptom disorder)*** - **Conversion disorder** is characterized by neurological symptoms (e.g., paralysis, blindness) that are **incompatible with recognized neurological or medical conditions**, yet are not intentionally produced. - It falls under **somatic symptom and related disorders** because the primary features are physical symptoms causing distress or functional impairment, rather than being malingered or feigned. *Phobic disorders (e.g., social anxiety disorder)* - **Phobic disorders** are classified under **anxiety disorders** in the DSM-5, not somatic symptom and related disorders. - They are primarily characterized by **intense, irrational fears** of specific objects or situations, leading to avoidance rather than prominent physical symptoms without a medical cause. *Post-Traumatic Stress Disorder (PTSD)* - **PTSD** is classified under **trauma- and stressor-related disorders** in the DSM-5, distinguished by symptoms developing after exposure to a traumatic event. - Its core features include **intrusive memories, avoidance, negative alterations in cognition and mood, and alterations in arousal and reactivity**, rather than unexplained physical symptoms. *Obsessive-Compulsive Disorder (OCD)* - **OCD** is classified under **obsessive-compulsive and related disorders** in the DSM-5. - It is primarily characterized by the presence of **obsessions (recurrent, intrusive thoughts)** and/or **compulsions (repetitive behaviors or mental acts)**, which are distinct from somatic symptoms.
Question 8: Loosening of association is an example of
- A. Concrete thinking
- B. Formal thought disorder (Correct Answer)
- C. Schneider's first symptoms
- D. Perseveration
Explanation: ***Formal thought disorder*** - **Loosening of association** is a classic symptom of **formal thought disorder**, where thoughts become disconnected, fragmented, or illogical. - It reflects a disturbance in the **structure and flow of thought**, leading to disorganized speech. *Schneider's first symptoms* - **Schneider's first-rank symptoms** are specific psychotic experiences (e.g., thought insertion, auditory hallucinations commenting on actions) that are highly suggestive of schizophrenia but do not include loosening of association as a primary symptom. - While sometimes seen in schizophrenia, loosening of association is a broader concept of thought disorganization rather than a first-rank symptom itself. *Perseveration* - **Perseveration** involves the **inappropriate repetition of words, phrases, or ideas**, even when the topic has changed. - While a form of thought disorder, it is distinct from the general disconnectedness seen in loosening of association. *Concrete thinking* - **Concrete thinking** is the **inability to comprehend abstract concepts or metaphors**, interpreting them literally. - This is a disorder of **thought content or style**, but not directly related to the disorganized flow of thought characterized by loosening of association.
Question 9: Which of the following is NOT considered a formal thought disorder?
- A. Loosening of association
- B. Delusion
- C. Mania (Correct Answer)
- D. Schizophrenia
Explanation: ***Mania*** - While **mania** can involve disorganized thinking and speech, it is primarily classified as a **mood disorder**, characterized by elevated mood, increased energy, and decreased need for sleep. - The disorganized thought often present in mania is secondary to the rapid flow of ideas and flight of ideas, rather than a primary disruption in the logical connections between thoughts. - **Mania is NOT a formal thought disorder** - it is a mood state that may feature associated thought disturbances. *Delusion* - A **delusion** is a fixed, false belief that is not amenable to change in light of conflicting evidence. - **Important distinction:** Delusions are classified as **thought content disorders**, NOT formal thought disorders. - **Formal thought disorders** refer to disturbances in the *form/structure* of thinking (how thoughts connect), while **thought content disorders** refer to disturbances in the *content* of thinking (what is thought). - While delusions are thought disorders, they are specifically content-based, not formal/structural disorders. *Loosening of association* - **Loosening of association**, also known as **derailment**, refers to a disturbance in the logical progression of thought, where ideas shift from one subject to another without a clear connection. - This is a classic example of a **formal thought disorder**, as it reflects a disturbance in the *form* or structure of thought rather than its content. *Schizophrenia* - **Schizophrenia** is a diagnostic category for a severe mental disorder, not a formal thought disorder itself. - However, schizophrenia commonly features **formal thought disorders** as symptoms, including loosening of associations, tangentiality, and word salad. - The question asks about formal thought disorders as symptoms/phenomena, not diagnostic categories, making schizophrenia an inappropriate answer.
Question 10: Which class of medications is known to worsen the symptoms of delirium in patients post-cardiac surgery?
- A. Antipsychotics
- B. Anticholinergics (Correct Answer)
- C. Benzodiazepines (BZD)
- D. Antihistamines
Explanation: **Explanation:** **1. Why Anticholinergics are the Correct Answer:** Delirium is fundamentally characterized by a neurochemical imbalance, most notably a **cholinergic deficiency** and a dopaminergic excess. Medications with anticholinergic properties (e.g., atropine, scopolamine, or certain tricyclic antidepressants) block acetylcholine receptors in the brain, directly precipitating or severely worsening the symptoms of delirium (confusion, disorientation, and cognitive impairment). In post-cardiac surgery patients, the brain is already vulnerable due to systemic inflammation and micro-emboli; adding an anticholinergic agent further destabilizes the neurotransmitter balance. **2. Analysis of Incorrect Options:** * **A. Antipsychotics:** These are actually the **treatment of choice** for the agitation associated with delirium. Low-dose Haloperidol is frequently used because it antagonizes dopamine, helping to restore the neurochemical balance. * **C. Benzodiazepines (BZD):** While BZDs can worsen delirium in the elderly or cause "paradoxical agitation," they are not the primary pharmacological *cause* of the underlying cholinergic deficit. They are generally avoided in delirium **unless** the delirium is caused by Alcohol Withdrawal or BZD withdrawal. * **D. Antihistamines:** While first-generation antihistamines (like diphenhydramine) have anticholinergic side effects and can cause delirium, "Anticholinergics" as a class is the more specific and direct answer regarding the underlying pathophysiology. **3. High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice for Delirium:** Haloperidol (IV/IM/Oral). * **Delirium vs. Dementia:** Delirium is acute, reversible, and characterized by **fluctuating levels of consciousness** and impaired attention. * **The "BZD Exception":** Use Benzodiazepines for delirium *only* if the etiology is Alcohol or Sedative-Hypnotic withdrawal. * **Post-Op Risk:** Post-cardiac surgery delirium is common (up to 30-50%) and is associated with increased mortality and longer ICU stays.
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