Introduction to Psychiatry — MCQs

Introduction to Psychiatry Indian Medical PG Practice Questions and MCQs

Question 51: According to Sigmund Freud, in which year was 'The Interpretation of Dreams' published?

A. 1990
B. 1900 (Correct Answer)
C. 1956
D. 1919

Explanation: **Explanation:** The correct answer is **1900**. Sigmund Freud, the father of Psychoanalysis, published his seminal work, *Die Traumdeutung* (*The Interpretation of Dreams*), in November 1899. However, the publisher post-dated the title page to **1900** to mark the beginning of the new century, symbolizing a new era in psychological understanding. In this book, Freud introduced the **Topographical Model of the Mind** (Conscious, Preconscious, and Unconscious) and proposed that dreams are the "royal road to the unconscious," representing the disguised fulfillment of repressed wishes. **Analysis of Incorrect Options:** * **A. 1990:** This is chronologically impossible as Freud passed away in 1939. * **C. 1956:** This year marks the centenary of Freud’s birth (1856), not the publication of his major work. * **D. 1919:** While Freud was active during this period, this year is more closely associated with his later developments in the "Death Instinct" (*Thanatos*) and the transition toward the Structural Model (Id, Ego, Superego) published in 1923. **High-Yield Clinical Pearls for NEET-PG:** * **Dream Work:** The process by which the **Latent content** (hidden, unconscious meaning) is transformed into **Manifest content** (the dream as remembered). * **Primary Process Thinking:** The type of thinking found in dreams and the unconscious, characterized by illogicality and lack of time sense. * **Key Techniques:** Freud utilized **Free Association** and **Dream Analysis** as primary tools in psychoanalytic therapy.

Question 52: Who proposed the concepts of id, ego, and superego?

A. Shatij Kapur
B. Freud (Correct Answer)
C. Buddha
D. Bleuler

Explanation: **Explanation:** The correct answer is **Freud (Option B)**. Sigmund Freud, the father of psychoanalysis, proposed the **Structural Model of Personality**, which divides the human psyche into three components: 1. **Id:** Operates on the **Pleasure Principle**. It is entirely unconscious and consists of instinctual drives (Libido). 2. **Ego:** Operates on the **Reality Principle**. It acts as a mediator between the unrealistic id and the external world, using **defense mechanisms** to manage anxiety. 3. **Superego:** Operates on the **Moral Principle**. It represents internalized societal values and conscience, aiming for perfection rather than pleasure. **Analysis of Incorrect Options:** * **Shatij Kapur (Option A):** A contemporary psychiatrist known for the **"Salience Hypothesis"** of schizophrenia, linking dopamine overactivity to the misattribution of importance to irrelevant stimuli. * **Buddha (Option C):** While Buddhist philosophy explores the nature of the mind and suffering, it is not the source of these specific psychoanalytic constructs. * **Bleuler (Option D):** Eugen Bleuler coined the term **"Schizophrenia"** and described the **"4 As"** (Association, Affect, Ambivalence, and Autism). **NEET-PG Clinical Pearls:** * **Topographical Model:** Freud also proposed the levels of consciousness: Conscious, Preconscious, and Unconscious. * **Defense Mechanisms:** These are functions of the **Ego** (e.g., Projection, Reaction Formation). * **Psychosexual Stages:** Freud’s stages of development include Oral, Anal, Phallic, Latency, and Genital. * **High-Yield Fact:** The **Id** is present at birth, the **Ego** develops in infancy, and the **Superego** develops around age 5-6 during the resolution of the Oedipus complex.

Question 53: Which of the following is NOT an ego defense mechanism?

A. Rationalization
B. Repression
C. Identification
D. Obsession (Correct Answer)

Explanation: ### Explanation The correct answer is **D. Obsession**. **Why Obsession is the correct answer:** In psychodynamic theory, **ego defense mechanisms** are unconscious psychological strategies used by the ego to protect the individual from anxiety arising from unacceptable thoughts or feelings. **Obsession**, however, is a **symptom**, not a defense mechanism. It is defined as a persistent, intrusive, and distressing thought, image, or urge that an individual cannot suppress. While obsessions are a core feature of Obsessive-Compulsive Disorder (OCD), they represent the "ego-dystonic" intrusion itself rather than the mechanism used to defend against it. **Analysis of Incorrect Options:** * **A. Rationalization:** A mature-leaning (Level III) defense mechanism where an individual justifies controversial behaviors or feelings in a seemingly logical way to avoid the true underlying reason. * **B. Repression:** A primary defense mechanism (Level II) involving the unconscious "forgetting" or pushing down of painful impulses or memories into the unconscious mind. (Note: *Suppression* is the conscious version). * **C. Identification:** A mechanism where an individual patterns their own behavior after another person to increase their sense of self-worth or to cope with the loss of a person. **Clinical Pearls for NEET-PG:** * **Hierarchy of Defenses (Vaillant’s Classification):** * **Narcissistic/Psychotic:** Projection, Denial, Distortion. * **Immature:** Acting out, Passive-aggression, Regression, Schizoid fantasy. * **Neurotic:** Rationalization, Repression, Displacement, Reaction Formation. * **Mature (High-Yield):** **S**ublimation, **A**ltruism, **S**uppression, **H**umor (**SASH**). * **Reaction Formation:** Transforming an unacceptable impulse into its opposite (e.g., being overly kind to someone you hate). This is frequently tested in the context of OCD.

Question 54: What is the most common cause of dementia in adults?

A. Alzheimer's disease (Correct Answer)
B. Multi-infarct dementia
C. Pick's disease
D. Metabolic causes

Explanation: **Explanation:** **Alzheimer’s Disease (AD)** is the most common cause of dementia worldwide, accounting for approximately **60–80% of all cases** in the elderly population. It is a neurodegenerative disorder characterized by the extracellular deposition of amyloid-beta plaques and intracellular neurofibrillary tangles (tau protein). Clinically, it presents with progressive memory loss (starting with episodic memory) and cognitive decline. **Analysis of Incorrect Options:** * **B. Multi-infarct dementia (Vascular Dementia):** This is the **second most common** cause of dementia. It results from multiple strokes or chronic cerebral ischemia. It is typically distinguished from AD by its "step-wise" decline and the presence of focal neurological deficits or cardiovascular risk factors. * **C. Pick’s Disease (Frontotemporal Dementia):** This is a rarer cause of dementia that typically occurs at an earlier age (40–60 years). It is characterized by early changes in personality, social behavior, and language, rather than initial memory loss. * **D. Metabolic causes:** While conditions like Vitamin B12 deficiency, hypothyroidism, and hepatic encephalopathy can cause cognitive impairment, these are categorized as **reversible causes** of dementia and are significantly less common than AD. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** The strongest risk factor for AD is increasing age. The **ApoE-ε4 allele** is the most significant genetic risk factor for late-onset AD, while mutations in **APP, PSEN1, and PSEN2** are linked to early-onset familial AD. * **Neurobiology:** AD shows a significant deficiency in **Acetylcholine** (due to atrophy of the Nucleus Basalis of Meynert). * **Imaging:** MRI typically shows **hippocampal atrophy** and compensatory ventricular enlargement (hydrocephalus ex-vacuo). * **Histopathology:** Silver stains reveal Senile (Amyloid) plaques and Neurofibrillary tangles.

Question 55: What is meant by 'run-amok'?

A. Running away from a stressful situation
B. Killing people randomly (Correct Answer)
C. Feeling of insects running under the skin
D. Ingesting corrosive substances in a rage

Explanation: **Explanation:** **Amok** (or 'running amok') is a classic **culture-bound syndrome** traditionally described in South Asian and Southeast Asian cultures (e.g., Malaysia, Indonesia). It is characterized by a sudden, unprovoked episode of indiscriminate homicidal behavior. 1. **Why Option B is Correct:** The condition typically follows a period of brooding or social withdrawal. The individual suddenly erupts into a state of violent frenzy, armed with a weapon, and attempts to **kill or severely injure people and animals randomly** until they are restrained, commit suicide, or are killed. This is followed by exhaustion and total amnesia regarding the event. 2. **Why Other Options are Incorrect:** * **Option A:** Running away from stress describes a **Dissociative Fugue**, where an individual wanders away from home and assumes a new identity due to psychological trauma. * **Option C:** The sensation of insects crawling under the skin is known as **Formication** (a type of tactile hallucination), often seen in cocaine intoxication (Cocaine bugs) or alcohol withdrawal. * **Option D:** Ingesting corrosives is a method of self-harm or suicide, but it is not a defining feature of any specific psychiatric syndrome like Amok. **High-Yield Clinical Pearls for NEET-PG:** * **Culture-bound syndromes** are often tested. Other important ones include: * **Koro:** Fear that the penis/nipples are retracting into the abdomen (South Asia). * **Latah:** Hypersensitivity to sudden fright, often with echolalia or echopraxia (Southeast Asia). * **Dhat Syndrome:** Severe anxiety regarding the loss of semen (Indian subcontinent). * Amok is often associated with a "dissociative state" triggered by a perceived insult or loss of honor.

Question 56: According to psychosexual development theory, who proposed the oral stage of development?

A. Sigmund Freud (Correct Answer)
B. Erik Erikson
C. Konrad Lorenz
D. Eugen Bleuler

Explanation: **Explanation:** **Sigmund Freud (Option A)** is the correct answer. Freud proposed the **Theory of Psychosexual Development**, which posits that personality develops through a series of childhood stages where the pleasure-seeking energies of the *Id* become focused on specific erogenous zones. The **Oral Stage** (0–1 year) is the first stage, where the infant’s primary source of interaction and pleasure occurs through the mouth (rooting, sucking, and feeding). **Analysis of Incorrect Options:** * **Erik Erikson (Option B):** Proposed the **Theory of Psychosocial Development**. While Freud focused on psychosexual stages, Erikson focused on social crises across the entire lifespan (e.g., *Trust vs. Mistrust* corresponds to Freud’s oral stage). * **Konrad Lorenz (Option C):** An ethologist known for his work on **Imprinting** and animal behavior, particularly with greylag geese. He is not associated with human psychosexual stages. * **Eugen Bleuler (Option D):** A Swiss psychiatrist who coined the term **"Schizophrenia"** and described the "4 As" (Affect, Association, Ambivalence, and Autism). **High-Yield Clinical Pearls for NEET-PG:** * **Freud’s Stages in Order:** Oral (0-1y) → Anal (1-3y) → Phallic (3-6y) → Latency (6-12y) → Genital (Puberty+). * **Fixation:** Freud believed that unresolved conflicts at any stage lead to "fixation." For example, oral fixation may manifest as smoking, overeating, or sarcasm in adulthood. * **Oedipus Complex:** Occurs during the **Phallic stage**, characterized by a child's unconscious desire for the opposite-sex parent. * **Structural Model:** Freud also proposed the tripartite structure of the mind: **Id** (pleasure principle), **Ego** (reality principle), and **Superego** (moral conscience).

Question 57: What is the new terminology for mental retardation according to DSM-5?

A. Mental handicap
B. Intellectual disability (Correct Answer)
C. Subnormal intelligence
D. Lunatic person

Explanation: **Explanation:** The **DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)** replaced the term "Mental Retardation" with **Intellectual Disability (Intellectual Developmental Disorder)**. This change reflects a shift toward a less stigmatizing clinical language and aligns with the International Classification of Diseases (ICD-11). **Why Option B is correct:** Under DSM-5, Intellectual Disability is defined by deficits in both **intellectual functioning** (reasoning, problem-solving) and **adaptive functioning** (independence, social responsibility). Crucially, the DSM-5 moved away from relying solely on IQ scores (e.g., <70) to determine severity, focusing instead on the level of adaptive impairment in conceptual, social, and practical domains. **Why other options are incorrect:** * **Option A & C:** "Mental handicap" and "Subnormal intelligence" are outdated, non-clinical terms that were used historically but lack the specific diagnostic criteria required by modern psychiatric frameworks. * **Option D:** "Lunatic" is an archaic, derogatory legal term used in the 19th century (e.g., the Indian Lunacy Act of 1912) and has no place in modern medical diagnosis. **High-Yield Clinical Pearls for NEET-PG:** * **Age of Onset:** Deficits must manifest during the **developmental period** (typically before age 18). * **Severity Levels:** Classified as Mild, Moderate, Severe, and Profound based on **adaptive functioning**, not just IQ. * **Most Common Cause:** Genetic factors (Down Syndrome is the most common chromosomal cause; Fragile X is the most common inherited cause). * **ICD-11 Update:** Uses the term **"Disorders of Intellectual Development."**

Question 58: Which component of the psyche is responsible for tolerating frustration?

A. Id
B. Ego (Correct Answer)
C. Super ego
D. Unconscious mind

Explanation: **Explanation:** The correct answer is **Ego (Option B)**. This question is based on Sigmund Freud’s **Structural Model of Personality**, which divides the psyche into three parts: the Id, Ego, and Superego. 1. **Why Ego is Correct:** The Ego operates on the **Reality Principle**. It acts as the mediator between the impulsive demands of the Id and the moral constraints of the Superego. A key function of the Ego is **frustration tolerance**—the ability to delay immediate gratification and endure tension until a socially acceptable outlet or realistic goal is found. It employs "Secondary Process Thinking," which is logical and rational. 2. **Why Incorrect Options are Wrong:** * **Id (Option A):** Operates on the **Pleasure Principle**. It seeks immediate gratification of instinctual drives (libido/aggression) and has zero tolerance for frustration. It uses "Primary Process Thinking" (illogical/wish-fulfillment). * **Super ego (Option B):** Operates on the **Morality Principle**. It represents the internalized conscience and societal values. It focuses on what is "right" or "wrong" rather than managing the practical tension of frustration. * **Unconscious mind (Option D):** This is a topographical layer of the mind containing repressed memories and urges. While the Id is entirely unconscious, the "Unconscious" itself is a location, not the functional component responsible for executive control or frustration management. **Clinical Pearls for NEET-PG:** * **Defense Mechanisms:** These are unconscious functions of the **Ego** used to reduce anxiety. * **Narcissistic/Borderline Personality Disorders:** Often characterized by "Low Frustration Tolerance" due to weak Ego strength. * **Reality Testing:** This is the most important function of the Ego; its loss is the hallmark of **Psychosis**.

Question 59: Of the following defense mechanisms, which is considered the most mature?

A. Denial
B. Sublimation (Correct Answer)
C. Dissociation
D. Regression

Explanation: **Explanation:** Defense mechanisms are unconscious psychological strategies used to protect the ego from anxiety. In psychiatry, these are classified by George Vaillant into four levels based on maturity. **Why Sublimation is Correct:** **Sublimation** is a **Level IV (Mature)** defense mechanism. It involves transforming socially unacceptable impulses or idealizations into socially productive and acceptable actions. For example, a person with aggressive urges becomes a professional boxer or surgeon. Because it integrates the impulse rather than just repressing it, it is considered a healthy, adaptive response. **Analysis of Incorrect Options:** * **A. Denial (Level I - Pathological):** This involves refusing to accept external reality because it is too threatening. It is a primitive defense common in children or acute psychosis. * **C. Dissociation (Level III - Neurotic):** This involves a temporary, drastic modification of one’s personal identity or character to avoid emotional distress (e.g., "spacing out" during trauma). While common, it is less adaptive than mature defenses. * **D. Regression (Level II - Immature):** This is a retreat to an earlier stage of development (e.g., a toilet-trained child wetting the bed when a new sibling is born) to avoid current frustrations. **NEET-PG High-Yield Pearls:** * **Mature Defenses (Mnemonic: SASH):** **S**ublimation, **A**ltruism, **S**uppression, **H**umor. * **Suppression vs. Repression:** Suppression is the **only conscious** defense mechanism (intentionally putting a thought aside). Repression is unconscious. * **Reaction Formation:** Transforming an unacceptable impulse into its opposite (e.g., being excessively kind to someone you hate). * **Projection:** Attributing one’s own unacknowledged feelings to others (e.g., "I don't hate him, he hates me").

Question 60: Who proposed the concept of the super-ego?

A. Eric Fromm
B. Sigmund Freud (Correct Answer)
C. Eric Erikson
D. Carl Jung

Explanation: **Explanation:** The correct answer is **Sigmund Freud**. He introduced the **Structural Theory of the Mind** in 1923, which divides the human psyche into three distinct components: the Id, the Ego, and the Super-ego. * **The Super-ego:** This represents the internalized moral standards, values, and ideals of society and parents. It acts as the "moral conscience," striving for perfection and inducing feelings of guilt when its standards are not met. * **The Id:** Operates on the "pleasure principle" (instinctual drives). * **The Ego:** Operates on the "reality principle," mediating between the unrealistic demands of the Id and the moral constraints of the Super-ego. **Analysis of Incorrect Options:** * **Eric Fromm (A):** A neo-Freudian known for his work on social psychology and the concept of "freedom" and "humanistic psychoanalysis." * **Eric Erikson (C):** Famous for the **8 Stages of Psychosocial Development** (e.g., Trust vs. Mistrust) and the concept of the "Identity Crisis." * **Carl Jung (D):** Founded **Analytical Psychology**. He is best known for concepts like the Collective Unconscious, Archetypes, and Introversion/Extroversion. **High-Yield Clinical Pearls for NEET-PG:** * **Topographical Model:** Freud’s earlier model (Conscious, Preconscious, Unconscious). * **Defense Mechanisms:** These are functions of the **Ego** used to manage anxiety arising from the conflict between the Id and Super-ego. * **Father of Psychoanalysis:** Sigmund Freud. * **Primary Process Thinking:** Associated with the Id (illogical, wish-fulfillment). * **Secondary Process Thinking:** Associated with the Ego (logical, rational).

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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