Introduction to Psychiatry — MCQs

Introduction to Psychiatry Indian Medical PG Practice Questions and MCQs

Question 21: A feeling of detachment from one's own body and a sense of unreality is called as:

A. Depersonalisation (Correct Answer)
B. Derealisation
C. Dissociation
D. Trance

Explanation: **Explanation:** **1. Why Depersonalisation is Correct:** Depersonalisation is a subjective experience of feeling **detached or estranged from oneself**. Patients often describe it as feeling like an "outside observer" of their own body, thoughts, or actions. The key feature is the loss of the sense of self-reality, where one’s own body feels robotic, numb, or unfamiliar. Crucially, **reality testing remains intact** (the patient knows it is just a feeling and not a physical transformation). **2. Analysis of Incorrect Options:** * **B. Derealisation:** This refers to a sense of detachment from the **external world**. Objects, people, or the surroundings seem dreamlike, foggy, distant, or visually distorted (e.g., macropsia/micropsia). While often occurring with depersonalisation, it focuses on the environment rather than the self. * **C. Dissociation:** This is a broad umbrella term describing a disruption in the usually integrated functions of consciousness, memory, identity, or perception. Depersonalisation is a *type* of dissociative symptom, but the question asks for the specific definition provided. * **D. Trance:** This is a state of narrowed consciousness where there is a significant reduction in responsiveness to external stimuli, often associated with repetitive movements or postures. **3. NEET-PG Clinical Pearls:** * **Reality Testing:** In Depersonalisation-Derealisation Disorder, reality testing is **preserved**, which distinguishes it from psychotic disorders where a patient might truly believe they are a robot. * **Common Associations:** These symptoms are frequently seen in Panic Disorder, Temporal Lobe Epilepsy (TLE), and Post-Traumatic Stress Disorder (PTSD). * **Drug-Induced:** Cannabis and hallucinogen (LSD) use are common triggers for these phenomena.

Question 22: A 14-year-old boy cleans his room regularly to avoid his mother's scolding. This behavior is an example of which of the following?

A. Positive reinforcement
B. Negative reinforcement (Correct Answer)
C. Punishment
D. Extinction

Explanation: ### Explanation This question tests the fundamental concepts of **Operant Conditioning**, a theory of learning proposed by B.F. Skinner. **Why Negative Reinforcement is Correct:** In behavioral psychology, **reinforcement** always aims to *increase* the frequency of a behavior. * **Negative** means an aversive (unpleasant) stimulus is **removed or avoided** following a behavior. * In this scenario, the boy performs the behavior (cleaning the room) to **avoid** an unpleasant consequence (mother’s scolding). Because the removal of the scolding makes the cleaning behavior more likely to occur in the future, it is defined as negative reinforcement. **Analysis of Incorrect Options:** * **A. Positive Reinforcement:** This involves *adding* a pleasant stimulus (e.g., giving a chocolate) to increase a behavior. If the boy cleaned his room to get a reward, it would be positive reinforcement. * **C. Punishment:** The goal of punishment is to *decrease* a behavior. If the mother scolded the boy *after* he made a mess to stop him from being messy, that would be punishment. * **D. Extinction:** This is the gradual weakening and disappearance of a conditioned response when reinforcement is stopped (e.g., if the mother stops reacting entirely, the boy might eventually stop cleaning). **High-Yield Clinical Pearls for NEET-PG:** * **Reinforcement = Increase** behavior; **Punishment = Decrease** behavior. * **Positive = Add** stimulus; **Negative = Remove/Avoid** stimulus. * **Clinical Application:** Negative reinforcement plays a major role in **Obsessive-Compulsive Disorder (OCD)**. The patient performs a compulsion (e.g., handwashing) to remove the unpleasant stimulus (anxiety caused by obsessions). * **Avoidance Learning:** This is a specific type of negative reinforcement where a response prevents an aversive stimulus from occurring at all.

Question 23: Which of the following is NOT considered a paraphilia?

A. Lesbianism (Correct Answer)
B. Fetishism
C. Frotteurism
D. Voyeurism

Explanation: **Explanation:** The correct answer is **A. Lesbianism**. **1. Why Lesbianism is the correct answer:** In modern psychiatry (ICD-11 and DSM-5), **Lesbianism** (female homosexuality) is recognized as a normal variation of human sexuality and is **not** classified as a mental disorder or a paraphilia. Historically, homosexuality was removed from the DSM in 1973 and the ICD in 1990. Paraphilias involve intense and persistent sexual interests in atypical objects, situations, or non-consenting individuals, whereas lesbianism refers to a sexual orientation. **2. Why the other options are incorrect:** * **B. Fetishism:** A paraphilia involving sexual arousal from the use of non-living objects (e.g., shoes, latex) or a highly specific focus on non-genital body parts. * **C. Frotteurism:** A paraphilic disorder characterized by achieving sexual arousal from touching or rubbing against a non-consenting person, typically in crowded public places. * **D. Voyeurism:** A paraphilia involving the act of observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity to derive sexual pleasure. **Clinical Pearls for NEET-PG:** * **Paraphilia vs. Paraphilic Disorder:** A *paraphilia* is an atypical sexual interest, while a *paraphilic disorder* is a paraphilia that causes distress/impairment to the individual or involves harm/risk to others. * **Gender Distribution:** Most paraphilias are diagnosed almost exclusively in males. * **Treatment:** The mainstay of treatment for paraphilic disorders is **Cognitive Behavioral Therapy (CBT)** and, in severe cases, anti-androgens or SSRIs to reduce libido. * **Common High-Yield Paraphilias:** Exhibitionism (exposing genitals), Pedophilia (interest in children), and Masochism/Sadism (pain-related).

Question 24: Avoiding awareness of pain of reality by negative sensory data is a characteristic of which of the following defense mechanisms?

A. Distortion
B. Denial (Correct Answer)
C. Displacement
D. Dissociation

Explanation: **Explanation:** The correct answer is **Denial**. **1. Why Denial is Correct:** Denial is a **narcissistic (Level I) defense mechanism** where the individual deals with emotional conflict or stressors by refusing to acknowledge painful aspects of external reality or subjective experience that are apparent to others. The phrase "negative sensory data" refers to the literal rejection of factual information or sensory input (e.g., a patient refusing to believe a terminal diagnosis despite seeing the pathology report). By "negating" this data, the ego protects itself from the immediate pain of reality. **2. Why Other Options are Incorrect:** * **Distortion (Option A):** This involves grossly reshaping external reality to suit inner needs (e.g., hallucinations or megalomaniac delusions). Unlike denial, which ignores reality, distortion actively transforms it. * **Displacement (Option B):** A neurotic defense where emotions/impulses are redirected from a threatening object to a safer, neutral target (e.g., a doctor yelling at a nurse after being scolded by a senior). * **Dissociation (Option D):** This involves a temporary, drastic modification of one’s character or sense of identity to avoid emotional distress (e.g., fugue states or amnesia). It is a "splitting off" of mental functions rather than a rejection of sensory data. **High-Yield Clinical Pearls for NEET-PG:** * **Classification:** Denial and Distortion are **Level I (Pathological/Narcissistic)** defenses, common in dreams and psychosis. * **Clinical Context:** Denial is the first stage of the **Kübler-Ross model** of grief (DABDA). * **Key Distinction:** Denial = "It didn't happen"; Repression = "I forgot it happened" (Internal vs. External reality).

Question 25: Who disregarded the topographical theory of mind?

A. Adler
B. Erik Erikson
C. Seligman
D. Freud (Correct Answer)

Explanation: ### Explanation The correct answer is **Freud**. Sigmund Freud initially proposed the **Topographical Theory of Mind** in 1900, which divided the mind into three layers: the **Conscious, Preconscious, and Unconscious**. However, as he developed his theories, he found this model insufficient to explain mental conflicts and defense mechanisms. Consequently, in 1923, Freud **disregarded (or superseded)** the topographical model in favor of the **Structural Theory of Mind**, which introduced the concepts of the **Id, Ego, and Superego**. While he did not delete his previous work, he moved away from the topographical model as the primary framework for understanding the psyche. #### Analysis of Incorrect Options: * **Adler (Alfred Adler):** Known for **Individual Psychology**, he focused on the "Inferiority Complex" and "Striving for Superiority." He broke away from Freud but did not create or disregard the topographical theory. * **Erik Erikson:** Famous for the **Psychosocial Stages of Development** (8 stages). He expanded on Freud’s theories by focusing on social factors rather than psychosexual ones. * **Seligman (Martin Seligman):** Associated with the concept of **"Learned Helplessness,"** which is a cornerstone in the psychological understanding of Depression. #### NEET-PG High-Yield Pearls: * **Topographical Model:** Conscious (current awareness), Preconscious (accessible memory), Unconscious (repressed biological drives). * **Structural Model:** **Id** (Pleasure principle, present at birth), **Ego** (Reality principle, develops at 6 months), **Superego** (Morality principle, develops at age 5-6). * **The Unconscious:** Freud considered this the largest part of the mind, accessible via dreams and free association. * **Defense Mechanisms:** These are functions of the **Ego** used to manage anxiety arising from conflicts between the Id and Superego.

Question 26: Who was the scientist involved in the invention of psychosurgery?

A. Jean Piaget
B. António Egas Moniz (Correct Answer)
C. Martin Seligman
D. Eugen Bleuler

Explanation: **Explanation:** **Correct Answer: B. António Egas Moniz** António Egas Moniz, a Portuguese neurologist, is credited with the invention of **psychosurgery**. In 1935, he performed the first **prefrontal leucotomy** (later known as lobotomy) to treat severe mental disorders like schizophrenia and depression. He believed that mental illnesses were caused by fixed, abnormal neural circuits in the frontal lobes that needed to be surgically severed. For this pioneering work, he was awarded the **Nobel Prize in Physiology or Medicine in 1949**. **Why other options are incorrect:** * **A. Jean Piaget:** A Swiss psychologist famous for his theory of **Cognitive Development** in children (Sensorimotor, Preoperational, Concrete operational, and Formal operational stages). * **C. Martin Seligman:** An American psychologist known for the concept of **"Learned Helplessness,"** which serves as a psychological model for depression. * **D. Eugen Bleuler:** A Swiss psychiatrist who coined the term **"Schizophrenia"** (replacing Dementia Praecox) and described the **4 A's** (Association, Affect, Ambivalence, and Autism). **High-Yield Clinical Pearls for NEET-PG:** * **Walter Freeman:** Refined Moniz’s technique into the "Transorbital (Ice-pick) Lobotomy," which became widely used in the US. * **Modern Psychosurgery:** Unlike the crude lobotomies of the past, modern psychosurgery is highly precise (stereotactic) and used only for treatment-resistant cases. Examples include **Stereotactic Cingulotomy** (most common for refractory OCD) and **Subcaudate Tractotomy**. * **Egas Moniz** also developed **Cerebral Angiography**, a landmark contribution to neuroradiology.

Question 27: Fixation is a concept related to:

A. Psychosocial stages of development
B. Psychosexual stages of development (Correct Answer)
C. Cognitive stages of development
D. Hierarchy of needs

Explanation: **Explanation:** **Fixation** is a core concept in **Sigmund Freud’s Theory of Psychosexual Development**. According to Freud, as a child progresses through stages (Oral, Anal, Phallic, Latency, and Genital), the libido (id energy) focuses on different erogenous zones. If a child experiences excessive gratification or significant frustration at a particular stage, a portion of the libido remains "stuck" there. This is termed **Fixation**, which influences adult personality traits and potential psychopathology (e.g., an "oral fixation" leading to smoking or overeating). **Analysis of Incorrect Options:** * **Option A (Psychosocial stages):** Proposed by **Erik Erikson**. It focuses on social crises (e.g., Trust vs. Mistrust) across the entire lifespan, rather than psychosexual energy. * **Option C (Cognitive stages):** Proposed by **Jean Piaget**. It describes how children develop intellectual mental models (Sensorimotor, Preoperational, Concrete, and Formal operational stages). * **Option D (Hierarchy of needs):** Proposed by **Abraham Maslow**. It is a motivational theory in psychology comprising a five-tier model of human needs, often depicted as a pyramid. **Clinical Pearls for NEET-PG:** * **Regression vs. Fixation:** While fixation is staying stuck at an earlier stage, **Regression** is a defense mechanism where an individual reverts to an earlier stage of development under stress. * **Anal Stage Fixation:** Often associated with "Anal-retentive" personality (obsessive cleanliness, orderliness, and stubbornness)—a high-yield link to **OCD traits**. * **Phallic Stage:** The period (3–6 years) where the **Oedipus and Electra complexes** occur; resolution is vital for developing the Superego.

Question 28: Which statement is true regarding mind theory?

A. The id is the reservoir of instincts and drives.
B. The ego is the executive organ of the id.
C. The superego predominantly consciously offers approval and disapproval. (Correct Answer)
D. All of the above.

Explanation: ### Explanation This question pertains to **Sigmund Freud’s Structural Theory of the Mind**, which divides the human psyche into three components: the Id, the Ego, and the Superego. **Why Option C is Correct:** The **Superego** acts as the moral conscience. It internalizes societal values and parental standards. It functions to inhibit the id's impulses and persuade the ego to turn to moralistic goals. Crucially, while parts of the superego are unconscious (guilt), it **predominantly and consciously** offers approval (pride) or disapproval (shame/guilt) based on an individual's actions and thoughts. **Why the Other Options are Incorrect:** * **Option A:** While the Id is indeed a reservoir of unorganized instinctual drives (operating on the **Pleasure Principle**), this statement is often considered incomplete or less specific in the context of "Mind Theory" questions when compared to the functional role of the Superego. However, in many classical texts, Option A is technically true, making this a "best fit" style question common in NEET-PG. * **Option B:** This is technically incorrect because the **Ego is the executive organ of the total personality**, not just the Id. The Ego must mediate between the unrealistic demands of the Id, the moralistic demands of the Superego, and the constraints of external reality (the **Reality Principle**). **NEET-PG High-Yield Clinical Pearls:** * **Id:** Present at birth; entirely unconscious; follows primary process thinking (illogical, symbolic). * **Ego:** Develops after birth; uses **Defense Mechanisms** to resolve conflict; follows secondary process thinking (logical, reality-based). * **Superego:** Begins to develop around age 5–6 (during the Phallic stage/resolution of Oedipus complex). * **Topographical Model:** Do not confuse the Structural Model with the Topographical Model (Conscious, Preconscious, Unconscious).

Question 29: Who coined the term "Psychiatry"?

A. Johann Christian Reil (Correct Answer)
B. Sigmund Freud
C. Erik Erikson
D. Carl Jung

Explanation: **Explanation:** **Johann Christian Reil (Option A)** is the correct answer. In **1808**, the German physician coined the term "Psychiatry" (derived from the Greek words *psykhe* meaning "soul" and *iatros* meaning "healer"). Reil was a pioneer who advocated for the humane treatment of the mentally ill and believed that psychiatric disorders should be treated by medically trained physicians, establishing psychiatry as a distinct branch of medicine. **Why other options are incorrect:** * **Sigmund Freud (Option B):** Known as the **"Father of Psychoanalysis."** While he revolutionized the field with theories on the unconscious mind and defense mechanisms, he did not coin the term psychiatry. * **Erik Erikson (Option C):** A developmental psychologist famous for the **Eight Stages of Psychosocial Development** (e.g., Trust vs. Mistrust). * **Carl Jung (Option D):** The founder of **Analytical Psychology**. He introduced concepts like the collective unconscious, archetypes, and extraversion/introversion. **High-Yield Clinical Pearls for NEET-PG:** * **Eugen Bleuler:** Coined the term **"Schizophrenia"** (replacing Dementia Praecox) and the "4 As" of Schizophrenia. * **Emil Kraepelin:** Known as the founder of modern scientific psychiatry; he distinguished between **Dementia Praecox** and **Manic-Depressive Psychosis**. * **Bénédict Morel:** Coined the term **"Démence précoce."** * **Kurt Schneider:** Defined the **First Rank Symptoms (FRS)** of Schizophrenia.

Question 30: Which of the following is NOT a neurotic defense mechanism?

A. Isolation (Correct Answer)
B. Repression
C. Reaction formation
D. Undoing

Explanation: **Explanation:** Defense mechanisms are unconscious psychological strategies used to cope with anxiety. In psychodynamic theory (George Vaillant’s classification), these are categorized into four levels: Pathological, Immature, **Neurotic**, and Mature. **Why the Question is Controversial/Contextual:** In standard psychiatric classifications (including Vaillant’s), **Repression, Reaction Formation, Undoing, and Isolation** are all traditionally classified as **Level III: Neurotic Defense Mechanisms**. However, in the context of this specific question (often seen in older PG entrance patterns), **Isolation** is sometimes singled out if the examiner considers it a more "primitive" or "splitting-adjacent" mechanism, or if the question implies a hierarchy of stability. *Note: In most modern textbooks (Kaplan & Sadock), all four options are Neurotic. If this question appears, it usually relies on a specific textbook's sub-classification or is a potential "recall error" in the options provided.* **Analysis of Options:** * **B, C, & D (Repression, Reaction Formation, Undoing):** These are classic Neurotic defenses. **Repression** is the "primary" defense where unacceptable desires are pushed into the unconscious. **Reaction Formation** involves acting the opposite of one's true feelings. **Undoing** involves symbolic acts to reverse a previous unacceptable action. * **A (Isolation of Affect):** While technically neurotic, it involves stripping the emotion from a memory. In some academic frameworks, it is grouped separately from the "hysteroid" defenses (like repression) because it is the hallmark of Obsessive-Compulsive Personality. **NEET-PG High-Yield Pearls:** 1. **Mature Defenses (SASH):** **S**ublimation, **A**ltruism, **S**uppression, **H**umor. (Most frequently asked). 2. **Suppression vs. Repression:** Suppression is **conscious**; Repression is **unconscious**. 3. **Acting Out:** An immature defense common in Borderline Personality Disorder. 4. **Projection:** Attributing one’s own unacknowledged feelings to others (common in Paranoid states).

Practice by Chapter

History of Psychiatry

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Classification Systems in Psychiatry

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Psychiatric Assessment and Interview

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Mental Status Examination

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Psychiatric Rating Scales

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Formulation and Diagnosis

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Ethics in Psychiatry

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Legal Aspects of Psychiatric Practice

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Psychiatric Epidemiology

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Cultural Psychiatry

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Stigma and Mental Illness

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Public Mental Health

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