Introduction to Psychiatry — MCQs

Introduction to Psychiatry Indian Medical PG Practice Questions and MCQs

Question 31: A well-dressed man presents with a feeling of being a woman trapped within a male body. What condition is he likely suffering from?

A. Paraphilia
B. Toucherism
C. Gender identity disorder (Correct Answer)
D. Frotteurism

Explanation: **Explanation:** The correct answer is **Gender Identity Disorder (GID)**, now more commonly referred to in modern classifications (DSM-5) as **Gender Dysphoria**. **1. Why Gender Identity Disorder is correct:** Gender identity refers to an individual’s internal sense of being male, female, or another gender. In GID, there is a strong, persistent cross-gender identification and a sense of discomfort with one’s assigned biological sex. The classic clinical description is a person feeling like a **"soul of one sex trapped in the body of another."** These individuals often desire to live and be accepted as members of the opposite sex and may seek hormonal or surgical gender reassignment. **2. Why the other options are incorrect:** * **Paraphilia (A):** This is an umbrella term for recurrent, intense sexually arousing fantasies or behaviors involving non-human objects, suffering/humiliation, or non-consenting persons. It relates to sexual *arousal* patterns, not gender *identity*. * **Frotteurism (D):** A specific paraphilia where an individual achieves sexual excitement by rubbing their genitals against a non-consenting person, usually in crowded places. * **Toucherism (B):** Often considered a subtype or synonym of frotteurism, it involves the urge to touch a stranger (usually their breasts or buttocks) in a sexual manner without consent. **High-Yield Clinical Pearls for NEET-PG:** * **Transsexualism:** The most extreme form of GID where the individual seeks medical intervention (SRS - Sex Reassignment Surgery) to change their physical characteristics. * **Transvestic Disorder:** This is a paraphilia where a person (usually a heterosexual male) dresses in clothes of the opposite sex for **sexual arousal**, whereas in GID, cross-dressing is done to express their internal identity. * **Ego-syntonic vs. Ego-dystonic:** GID is typically ego-syntonic (the person accepts these feelings as part of themselves), though the resulting social conflict causes distress.

Question 32: Deriving sexual pleasure by seeing or touching inanimate objects of the opposite sex is termed as?

A. Fetichism (Correct Answer)
B. Voyeurism
C. Masochism
D. Tribadism

Explanation: **Explanation:** The correct answer is **Fetichism**. This is a type of paraphilic disorder where sexual arousal and gratification are derived from the use of non-living (inanimate) objects (e.g., shoes, undergarments) or a highly specific focus on non-genital body parts. For a clinical diagnosis under DSM-5/ICD-11, these urges must be present for at least 6 months and cause significant distress or functional impairment. **Analysis of Incorrect Options:** * **Voyeurism (B):** This involves deriving sexual pleasure from observing unsuspecting individuals who are naked, disrobing, or engaging in sexual activity ("Peeping Tom"). * **Masochism (C):** This refers to sexual arousal derived from being subjected to pain, humiliation, or bondage. * **Tribadism (D):** This is a sexual practice (not a paraphilia) involving genital rubbing between two females. **High-Yield Clinical Pearls for NEET-PG:** * **Paraphilias** are generally more common in males and typically onset during adolescence. * **Frotteurism:** Sexual pleasure derived from touching or rubbing against a non-consenting person in crowded places. * **Exhibitionism:** Arousal from exposing one's genitals to an unsuspecting stranger. * **Treatment:** The primary pharmacological treatment for paraphilic disorders involves **SSRIs** (to reduce impulsive behavior) or **Anti-androgens** (like Medroxyprogesterone acetate or Cyproterone acetate) to reduce libido in severe cases. Cognitive Behavioral Therapy (CBT) is the mainstay of psychological intervention.

Question 33: Who is referred to as the Father of Psychoanalysis?

A. Benjamin Rush
B. Emil Kraepelin
C. Sigmund Freud (Correct Answer)
D. Eugen Bleuler

Explanation: **Explanation:** **Correct Answer: C. Sigmund Freud** Sigmund Freud is universally recognized as the **Father of Psychoanalysis**. He developed this therapeutic technique and theoretical framework based on the exploration of the unconscious mind, the role of childhood experiences in shaping adult personality, and the dynamics of the Id, Ego, and Superego. His work on dream interpretation, defense mechanisms, and free association laid the foundation for modern psychotherapy. **Analysis of Incorrect Options:** * **A. Benjamin Rush:** Known as the **Father of American Psychiatry**. He was a signer of the Declaration of Independence and advocated that mental illness was a disease of the brain, not a result of demonic possession. * **B. Emil Kraepelin:** Often called the **Father of Modern Scientific Psychiatry**. He is credited with the "Kraepelinian Dichotomy," which distinguished between Dementia Praecox (now Schizophrenia) and Manic-Depressive Psychosis (now Bipolar Disorder). * **C. Eugen Bleuler:** A Swiss psychiatrist who **coined the term "Schizophrenia"** (replacing Kraepelin’s Dementia Praecox) and described the "4 As" of Schizophrenia (Ambivalence, Autism, Affective blunting, and Association looseness). **High-Yield Clinical Pearls for NEET-PG:** * **Father of Indian Psychiatry:** Dr. Girindra Sekhar Bose (who was also the first person outside Europe to be a member of the International Psychoanalytical Association). * **First Psychiatric Hospital in India:** Established in Bombay (1745). * **The term "Psychiatry"** was coined by Johann Christian Reil (1808). * **The term "Schizophrenia"** was coined by Eugen Bleuler (1911).

Question 34: What are the psychological features of AIDS?

A. Mania
B. Depression (Correct Answer)
C. Suicidal Tendency
D. Violence

Explanation: **Explanation:** The psychological impact of HIV/AIDS is multifaceted, involving both the biological effects of the virus on the CNS and the psychosocial stress of a chronic, stigmatized illness. **Why Depression is the Correct Answer:** **Depression** is the most common psychiatric complication in patients with HIV/AIDS. It occurs in approximately 20–30% of patients, a rate significantly higher than in the general population. It often manifests as a reaction to the diagnosis (Adjustment Disorder), a side effect of medications (e.g., Efavirenz), or as a direct result of HIV-associated neurocognitive changes. Identifying depression is crucial because it directly correlates with poor medication adherence and faster disease progression. **Analysis of Incorrect Options:** * **A. Mania:** While "Secondary Mania" can occur in late-stage AIDS (often due to opportunistic infections like Toxoplasmosis or CMV), it is much less frequent than depression. * **C. Suicidal Tendency:** Although the risk of suicide is elevated in HIV patients compared to the general public, it is usually a consequence of an underlying Major Depressive Disorder rather than a standalone feature. * **D. Violence:** Violence is not a characteristic feature of AIDS. Agitation or aggression may only be seen in the context of advanced HIV-associated dementia or delirium. **NEET-PG High-Yield Pearls:** * **Most common psychiatric disorder in HIV:** Depression. * **Drug-induced Depression:** **Efavirenz** (an NNRTI) is notorious for causing neuropsychiatric side effects, including vivid dreams, insomnia, and depression. * **HIV-Associated Neurocognitive Disorder (HAND):** This spectrum ranges from mild impairment to **AIDS Dementia Complex (ADC)**, characterized by subcortical dementia features (psychomotor slowing, apathy). * **Psychosis in HIV:** Usually occurs in advanced stages with low CD4 counts (<200 cells/mm³).

Question 35: What was the lifespan of Sigmund Freud?

A. 1856-1939 and he passed most of his life in Austria (Correct Answer)
B. 1859-1936 and he passed most of his life in Austria
C. 1859-1936 and he passed most of his life in Germany
D. 1859-1936 and he passed most of his life in France

Explanation: **Explanation:** Sigmund Freud, the founder of **Psychoanalysis**, was born on May 6, **1856**, in Freiberg (then part of the Austrian Empire) and died on September 23, **1939**, in London. Although he spent the final year of his life in the UK to escape Nazi persecution, he lived and practiced in **Vienna, Austria**, for nearly 80 years. His work laid the foundation for modern dynamic psychiatry, introducing concepts such as the unconscious mind, the id/ego/superego, and defense mechanisms. **Analysis of Options:** * **Option A (Correct):** Accurately reflects his lifespan (1856–1939) and his primary residence (Austria). * **Options B, C, and D (Incorrect):** These options provide incorrect dates (1859–1936). Furthermore, while Freud studied briefly in France under Jean-Martin Charcot (learning about hypnosis and hysteria), he was never a permanent resident of France or Germany. **High-Yield Clinical Pearls for NEET-PG:** * **Father of Psychoanalysis:** Freud transitioned from neurology to psychiatry, focusing on the "talking cure." * **Structural Model of Personality:** Id (pleasure principle), Ego (reality principle), and Superego (moral conscience). * **Topographical Model:** Conscious, Preconscious, and Unconscious. * **Psychosexual Stages:** Oral, Anal, Phallic, Latency, and Genital. * **Defense Mechanisms:** While Freud introduced them, his daughter **Anna Freud** significantly expanded the classification of ego defense mechanisms. * **Dream Analysis:** Freud famously called dreams the "Royal Road to the Unconscious."

Question 36: The anal phase of psychosexual stages of development is observed during which age period?

A. 0-1.5 years
B. 1.5-3 years (Correct Answer)
C. 3-5 years
D. 5-12 years

Explanation: **Explanation:** Sigmund Freud’s **Theory of Psychosexual Development** proposes that personality develops through a series of stages where the pleasure-seeking energies of the *Id* focus on specific erogenous zones. **Correct Option (B): 1.5–3 years** The **Anal Phase** typically occurs between 18 months and 3 years of age. During this period, the primary focus of gratification is the anus, specifically through the control of bladder and bowel movements (toilet training). The major conflict is the child’s struggle between the internal urge for immediate evacuation and the external social pressure to delay it. Successful resolution leads to a sense of autonomy and competence. **Incorrect Options:** * **A (0–1.5 years):** This corresponds to the **Oral Phase**, where the mouth is the primary erogenous zone (sucking, biting). * **C (3–5 years):** This corresponds to the **Phallic Phase**, characterized by the Oedipus/Electra complex and the discovery of anatomical sex differences. * **D (5–12 years):** This corresponds to the **Latency Period**, where sexual impulses are repressed, and energy is channeled into social and intellectual pursuits. **NEET-PG High-Yield Pearls:** * **Anal Retentive Personality:** Resulting from harsh toilet training; characterized by being overly orderly, stingy, stubborn, and perfectionistic (Obsessive-Compulsive traits). * **Anal Expulsive Personality:** Resulting from over-indulgent training; characterized by messiness, cruelty, and emotional outbursts. * **Sequence Mnemonic:** **O**ld **A**ge **P**eople **L**ove **G**rapes (**O**ral, **A**nal, **P**hallic, **L**atency, **G**enital).

Question 37: What is the most common form of dissociative hysteria?

A. Fugue
B. Amnesia (Correct Answer)
C. Multiple personality
D. Somnambulism

Explanation: **Explanation:** Dissociative disorders (formerly categorized under "Dissociative Hysteria") involve a disruption in the usually integrated functions of consciousness, memory, identity, or perception. **Why Amnesia is the Correct Answer:** **Dissociative Amnesia** is statistically the **most common** dissociative disorder encountered in clinical practice. It is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature, which is too extensive to be explained by ordinary forgetfulness. It typically presents as localized or selective amnesia following a psychological stressor. **Analysis of Incorrect Options:** * **A. Fugue:** Dissociative Fugue involves sudden, unexpected travel away from home combined with amnesia for one's past and identity. While classic, it is much rarer than simple dissociative amnesia. (Note: In ICD-11/DSM-5, Fugue is now considered a specifier of Dissociative Amnesia). * **C. Multiple Personality:** Now termed **Dissociative Identity Disorder (DID)**, this is the most severe and chronic form of dissociation but is clinically rare compared to amnesia. * **D. Somnambulism:** Also known as sleepwalking, this is classified as a **Parasomnia** (Sleep Disorder) rather than a primary dissociative disorder, although it involves a state of altered consciousness. **NEET-PG High-Yield Pearls:** * **Most common dissociative symptom:** Amnesia. * **Dissociative Amnesia vs. Organic Amnesia:** In dissociative amnesia, memory for personal identity is lost, but the ability to learn new information remains intact (Anterograde memory is preserved). In organic amnesia (e.g., head injury), the reverse is often true. * **Ganser Syndrome:** Also known as "Approximate Answers," it is a rare dissociative disorder often seen in prisoners. * **Primary Gain:** The internal relief from anxiety produced by the symptom. * **Secondary Gain:** The external benefits (attention, avoiding work) derived from being ill.

Question 38: A component of conversion disorder is?

A. Hysteric fits (Correct Answer)
B. Derealisation
C. Depersonalisation
D. Amnesia

Explanation: **Explanation:** **Conversion Disorder (Functional Neurological Symptom Disorder)** is characterized by the presence of neurological symptoms (motor or sensory) that cannot be explained by a known neurological or medical condition. The core psychological mechanism involves the "conversion" of internal emotional distress into physical symptoms. **Why "Hysteric fits" is the correct answer:** Historically, Conversion Disorder was termed "Hysteria." **Hysteric fits** (also known as **Pseudo-seizures** or Psychogenic Non-Epileptic Seizures - PNES) are a classic motor manifestation of conversion disorder. These episodes mimic generalized tonic-clonic seizures but lack the characteristic EEG changes, post-ictal confusion, or tongue biting seen in true epilepsy. They are often triggered by psychological stressors and occur in the presence of an audience. **Analysis of Incorrect Options:** * **B & C (Derealization and Depersonalization):** These are components of **Dissociative Disorders** (specifically Depersonalization-Derealization Disorder). While conversion and dissociation often co-occur, these represent disturbances in the perception of self or the environment, rather than physical/neurological dysfunction. * **D (Amnesia):** This refers to **Dissociative Amnesia**, where a patient is unable to recall important personal information, usually of a stressful nature. It is a cognitive-memory deficit, not a motor or sensory conversion symptom. **High-Yield Clinical Pearls for NEET-PG:** * **La Belle Indifference:** A classic (though not pathognomonic) feature where the patient shows a surprising lack of concern regarding their severe physical disability. * **Primary Gain:** Internal relief from anxiety by keeping the conflict out of conscious awareness. * **Secondary Gain:** External benefits derived from being "sick" (e.g., attention, avoidance of work). * **Hoover’s Sign:** A clinical test used to differentiate conversion-related leg weakness from organic causes.

Question 39: Which of the following psychiatric disorders is characterized by "rationalization"?

A. Schizophrenia
B. Phobia
C. Obsessive compulsive disorder
D. Substance abuse disorder (Correct Answer)

Explanation: **Explanation:** **Rationalization** is a defense mechanism where an individual justifies logically inconsistent or unacceptable behaviors, motives, or feelings by providing seemingly logical reasons or "excuses." **Why Substance Abuse Disorder is the correct answer:** In Substance Abuse Disorders, rationalization is one of the most frequently employed defense mechanisms. Patients often justify their substance use by attributing it to external stressors (e.g., "I drink because my job is stressful" or "I only use drugs because of my difficult childhood"). This allows the individual to avoid the guilt and reality of their addiction, maintaining their self-esteem while continuing the maladaptive behavior. Along with **denial** and **projection**, rationalization forms the core psychological barrier to seeking treatment in addiction. **Analysis of Incorrect Options:** * **Schizophrenia:** The primary defense mechanism associated with schizophrenia is **projection** (attributing one's own unacceptable thoughts to others, common in paranoid delusions) and **splitting**. * **Phobia:** The hallmark defense mechanism here is **displacement**. The anxiety regarding an internal conflict is displaced onto a specific external object or situation. * **Obsessive-Compulsive Disorder (OCD):** The characteristic defense mechanisms are **undoing**, **isolation of affect**, and **reaction formation**. **NEET-PG Clinical Pearls:** * **Denial** is considered the most common defense mechanism in the *early* stages of substance abuse. * **Reaction Formation** is high-yield for OCD (e.g., a person with aggressive urges becomes excessively pacifist). * **Identification with the Aggressor** is often seen in "Stockholm Syndrome." * **Sublimation and Altruism** are classified as "Mature" defense mechanisms and are frequently tested as "healthy" coping strategies.

Question 40: All of the following are defence mechanisms of the ego except?

A. Projection
B. Conversion
C. Reaction formation
D. Transference (Correct Answer)

Explanation: **Explanation:** The correct answer is **Transference**. **1. Why Transference is the correct answer:** Defence mechanisms are unconscious psychological strategies used by the **ego** to protect the individual from anxiety arising from unacceptable thoughts or feelings. **Transference**, however, is not a defence mechanism; it is a **phenomenon** occurring during psychotherapy where a patient unconsciously redirects (transfers) feelings, desires, and expectations from significant figures in their past (e.g., parents) onto the therapist. While it involves unconscious processes, its purpose is not primarily ego-protection, but rather a repetition of relational patterns. **2. Why the other options are incorrect:** * **Projection (Immature Defence):** Attributing one’s own unacknowledged unacceptable/distressing feelings or thoughts to others (e.g., a person who is angry accusing others of being hostile). * **Conversion (Immature Defence):** The unconscious transformation of psychological conflict into physical symptoms (e.g., sudden blindness or paralysis after a traumatic event with no organic cause). * **Reaction Formation (Neurotic Defence):** Transforming an unacceptable impulse into its diametrical opposite (e.g., being excessively kind to someone you unconsciously dislike). **Clinical Pearls for NEET-PG:** * **Counter-transference:** When the therapist displaces their own unconscious feelings onto the patient (the reverse of transference). * **Classification:** Remember the Vaillant hierarchy: * *Narcissistic/Psychotic:* Denial, Distortion, Projection. * *Immature:* Acting out, Passive-aggression, Regression. * *Neurotic:* Displacement, Isolation, Rationalization. * *Mature (High-yield):* **S**ublimation, **A**ltruism, **S**uppression, **H**umor (**SASH**). * **Suppression** is the only **conscious** defence mechanism.

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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