Classification Systems in Psychiatry — MCQs
Which of the following is a validated screening tool for alcohol use disorder?
Which of the following is NOT a core component of the WHO's global STI control strategy?
What is the code for mental disorders in the ICD-10 classification?
Which of the following describes the purpose of ICD-10 codes?
In which of the following conditions is behavior therapy considered most effective?
In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-
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?
Which of the following is considered a mature defense mechanism?
Who proposed the concept of 'la belle indifférence'?
Classification Systems in Psychiatry Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following is a validated screening tool for alcohol use disorder?
- A. AUDIT
- B. CAGE questionnaire
- C. SADQ
- D. All of the options (Correct Answer)
Explanation: ***CAGE questionnaire and AUDIT*** - Both **CAGE** and **AUDIT** are widely validated screening tools specifically designed for alcohol use disorder [1]. - **CAGE** is a brief 4-item tool focusing on **C**ut down, **A**nnoyed, **G**uilty, and **E**ye-opener - ideal for quick screening in clinical settings [1]. - **AUDIT** (Alcohol Use Disorders Identification Test) is a comprehensive 10-item tool assessing consumption patterns, drinking behaviors, and alcohol-related problems. - AUDIT is considered the **gold standard** for screening and can assess risk levels and severity. *Why not SADQ alone?* - **SADQ** (Severity of Alcohol Dependence Questionnaire) is primarily a **severity assessment tool**, not a screening tool. - It is a 20-item instrument used to measure the **degree of alcohol dependence** in individuals already identified with alcohol problems. - While valuable for treatment planning, SADQ is more detailed and designed for assessment rather than initial screening [1]. - However, all three tools are validated and used in alcohol use disorder evaluation - CAGE and AUDIT for screening, SADQ for severity assessment.
Question 2: Which of the following is NOT a core component of the WHO's global STI control strategy?
- A. Case management
- B. Universal mandatory screening (Correct Answer)
- C. Strategic information systems
- D. Prevention services
Explanation: ***Universal mandatory screening*** - While screening is part of STI control, **universal mandatory screening** for all STIs in the general population is not a core component of the WHO's strategy due to feasibility, cost, and ethical considerations. - The strategy emphasizes **targeted screening** for at-risk populations and opportunistic screening. *Case management* - **Case management**, including accurate diagnosis and effective treatment, is a critical component for managing current infections and preventing further transmission. - This involves syndromic or etiologic approaches to treatment and partner notification. *Strategic information systems* - **Strategic information systems** are essential for monitoring trends, evaluating interventions, and informing policy decisions related to STI control. - This includes surveillance data, program monitoring, and research. *Prevention services* - **Prevention services** are a cornerstone of the WHO's strategy, aiming to reduce the incidence of new infections. - These services encompass health education, condom promotion and distribution, vaccination, and pre-exposure prophylaxis (PrEP).
Question 3: What is the code for mental disorders in the ICD-10 classification?
- A. E
- B. F (Correct Answer)
- C. P
- D. G
Explanation: ***F*** - In the **ICD-10 classification**, the chapter for **Mental and behavioural disorders** is designated by the letter **'F'**. - This chapter covers a wide range of conditions, from mental retardation to mood disorders and substance-related disorders. *E* - The letter **'E'** in ICD-10 is used for **Endocrine, nutritional and metabolic diseases**. - This category includes conditions like diabetes mellitus and thyroid disorders. *P* - The letter **'P'** in ICD-10 denotes **Certain conditions originating in the perinatal period**. - These are conditions that arise during the period around childbirth. *G* - The letter **'G'** in ICD-10 refers to **Diseases of the nervous system**. - This chapter includes conditions like epilepsy, Parkinson's disease, and stroke.
Question 4: Which of the following describes the purpose of ICD-10 codes?
- A. Used for mortality and morbidity statistics (Correct Answer)
- B. Published by WHO
- C. Contains alphanumeric codes
- D. Consists of 21 chapters
Explanation: ***Used for morbidity statistics*** - ICD-10 codes primarily serve to classify diseases and health problems for **mortality and morbidity statistics**. - They provide a standardized system for tracking and reporting causes of illness and death, crucial for public health surveillance and research. *Published by WHO* - While it's true that the **ICD-10 (International Classification of Diseases, 10th Revision)** is developed and published by the **World Health Organization (WHO)**, this describes its origin, not its primary purpose. - The publication aspect is a characteristic, not the fundamental reason for its existence or use. *Contains alphanumeric codes* - ICD-10 codes are indeed **alphanumeric**, with the first character being a letter followed by numbers. - This describes the **structure** of the codes, not their purpose in a healthcare or statistical context. *Consists of 21 chapters* - The **ICD-10 classification** is organized into **21 chapters**, each covering a specific category of diseases or health conditions. - This detail describes the **organization** or **scope** of the classification system, rather than its overarching purpose.
Question 5: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Question 6: In both DSM-5 and proposed ICD-11, which of the following has been removed as core criterion of autism spectrum disorder-
- A. Disturbances of intellectual development
- B. Disturbance of social interaction
- C. Disturbances of communication (Correct Answer)
- D. Restricted, repetitive patterns of behaviour
Explanation: ***Disturbances of communication*** - In DSM-5 and proposed ICD-11, **communication deficits** are now subsumed under the broader category of **social communication deficits**. - This change reflects the understanding that communication difficulties in ASD are primarily related to their social function rather than being a separate, general communication disorder. *Disturbances of intellectual development* - While many individuals with ASD also have **intellectual disabilities**, this has never been a core diagnostic criterion for autism itself. - **Intellectual development** is considered a co-occurring condition rather than a defining feature of the spectrum. *Disturbance of social interaction* - **Deficits in social interaction** remain a core diagnostic criterion for autism spectrum disorder in both DSM-5 and ICD-11. - This domain emphasizes difficulties with **social-emotional reciprocity**, nonverbal communicative behaviors, and developing social relationships. *Restricted, repetitive patterns of behaviour* - **Restricted, repetitive patterns of behavior, interests, or activities** also remain a core diagnostic criterion in both diagnostic systems. - This includes a range of symptoms such as **stereotyped motor movements**, insistence on sameness, and highly restricted fixated interests.
Question 7: 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 8: 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 9: Which of the following is considered a mature defense mechanism?
- A. Sublimation (Correct Answer)
- B. Denial
- C. Projection
- D. Distortion
Explanation: **Explanation:** Defense mechanisms are unconscious psychological strategies used by the ego to manage anxiety arising from unacceptable impulses or external stressors. They are categorized based on their level of maturity (Vaillant’s classification). **Correct Answer: A. Sublimation** Sublimation is a **mature defense mechanism**. It involves transforming socially unacceptable impulses or urges into socially productive and acceptable behaviors. For example, a person with aggressive tendencies becomes a successful surgeon or a professional boxer. Other mature defenses include **Altruism, Humor, Suppression, and Anticipation.** **Analysis of Incorrect Options:** * **B. Denial:** This is a **narcissistic/immature defense**. It involves the refusal to accept external reality because it is too threatening (e.g., a patient with terminal cancer refusing to believe the diagnosis). * **C. Projection:** This is an **immature defense**. It involves attributing one’s own unacknowledged unacceptable feelings or thoughts to others (e.g., a person who is angry at their spouse accusing the spouse of being angry at them). * **D. Distortion:** This is a **narcissistic/psychotic defense**. It involves grossly reshaping external reality to suit inner needs, often seen in hallucinations or delusions. **NEET-PG High-Yield Pearls:** * **Mature Defenses (Mnemonic: SASH):** **S**ublimation, **A**ltruism, **S**uppression, **H**umor. * **Suppression vs. Repression:** Suppression is the **conscious** decision to delay paying attention to an emotion; Repression is **unconscious** forgetting (immature). * **Reaction Formation:** Transforming an unacceptable impulse into its opposite (e.g., being overly kind to someone you dislike). * **Identification with the Aggressor:** A person adopts the traits or behaviors of their victimizer (common in Stockholm Syndrome).
Question 10: Who proposed the concept of 'la belle indifférence'?
- A. Seligman
- B. Lorenz
- C. Freud (Correct Answer)
- D. Bleuler
Explanation: **Explanation:** The correct answer is **Freud**. The term **'la belle indifférence'** (the beautiful indifference) was popularized by **Sigmund Freud** to describe a specific clinical feature of **Conversion Disorder** (Functional Neurological Symptom Disorder). It refers to a paradoxical state where a patient shows a surprising lack of concern or anxiety regarding their severe physical symptoms (e.g., sudden paralysis or blindness), which have no organic cause and are rooted in psychological conflict. **Analysis of Options:** * **A. Seligman:** Martin Seligman is known for the theory of **'Learned Helplessness,'** which is a foundational model for understanding the etiology of Depression. * **B. Lorenz:** Konrad Lorenz was an ethologist famous for his work on **'Imprinting'** and attachment behaviors in animals. * **C. Freud (Correct):** As the father of psychoanalysis, Freud linked 'la belle indifférence' to the "primary gain" of conversion—where the physical symptom reduces the patient's internal anxiety. * **D. Bleuler:** Eugen Bleuler is renowned for naming **Schizophrenia** and defining its core symptoms, known as the **'4 As'** (Ambivalence, Autism, Affective flattening, and Association looseness). **NEET-PG High-Yield Pearls:** * **Conversion Disorder:** Now classified in DSM-5 as Functional Neurological Symptom Disorder. * **Primary Gain:** Internal relief from anxiety by converting psychological conflict into a physical symptom. * **Secondary Gain:** External benefits derived from being sick (e.g., attention, avoiding work). * **Clinical Note:** While classically associated with conversion disorder, 'la belle indifférence' is neither pathognomonic nor present in all cases; it can occasionally be seen in patients with organic brain lesions.
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