Obsessive-Compulsive and Related Disorders Practice Questions

Q: Psychosurgery is used in which of the following conditions?

Obsessive-Compulsive Disorder (OCD). **Explanation:** Psychosurgery, also known as functional neurosurgery for psychiatric disorders, is reserved for patients with severe, chronic, and treatment-resistant conditions who have failed to respond to multiple trials of pharmacotherapy (including high-dose SSRIs and augmentation) and intensive Cognitive Behavioral Therapy (CBT/ERP). **1. Why OCD is the Correct Answer:** OCD is the most common and well-established indication for psychosurgery today. The underlying pathophysiology involves hyperactivity in the **Cortico-Striato-Thalamo-Cortical (CSTC) circuit**. Surgical interventions aim to interrupt this circuit. Common procedures include: * **Subcaudate Tractotomy** * **Anterior Capsulotomy** (most common for OCD) * **Anterior Cingulotomy** * **Limbic Leukotomy** (combination of cingulotomy and tractotomy) **2. Why Other Options are Incorrect:** * **Phobia and GAD (Options A & B):** These anxiety disorders are primarily managed with psychotherapy (CBT) and pharmacotherapy (SSRIs/Benzodiazepines). There is no established surgical target or clinical evidence justifying psychosurgery for these conditions. * **Depression (Option D):** While "Treatment-Resistant Depression" (TRD) is a secondary indication for psychosurgery (specifically Cingulotomy), it is not the primary or most classic indication compared to OCD in the context of standard medical examinations. **High-Yield Clinical Pearls for NEET-PG:** * **Deep Brain Stimulation (DBS):** A modern, reversible alternative to ablative psychosurgery, often targeting the **Internal Capsule** or **Subthalamic Nucleus** for refractory OCD. * **Legal Aspect:** Under the **Mental Healthcare Act (MHCA) 2017** in India, psychosurgery can only be performed with the informed consent of the patient and prior approval from the State Mental Health Authority. * **Criteria:** Symptoms must be present for at least 5 years and be significantly disabling.

Q: An elderly male presents with a history of excessive hand washing and repetitive daily routines. Which of the following is NOT characteristic of obsessions?

Intrusive and unwanted mental events. ### Explanation The core of this question lies in distinguishing between **Obsessions** (mental events) and **Compulsions** (physical or mental acts). **Why Option D is the Correct Answer:** **Repetitive behaviors** are characteristic of **Compulsions**, not obsessions. According to DSM-5 criteria, compulsions are repetitive physical behaviors (e.g., hand washing, checking) or mental acts (e.g., praying, counting) that an individual feels driven to perform in response to an obsession or according to rigid rules. Obsessions, conversely, are strictly internal mental phenomena. **Analysis of Incorrect Options:** * **A. Repetitive thoughts or urges:** This is a hallmark of obsessions. They are persistent, recurrent ideas or impulses that dominate the patient's mind. * **B. Intrusive and unwanted mental events:** By definition, obsessions are intrusive (they enter the mind involuntarily) and cause marked anxiety or distress. *(Note: If the provided key marks this as correct, it is likely a technical error in the question source, as "Intrusive/Unwanted" is a defining feature of obsessions).* * **C. Ego-dystonic nature:** This is a high-yield term for NEET-PG. Ego-dystonic means the thoughts are inconsistent with the patient's self-concept and are viewed as irrational or "alien." This distinguishes OCD from OCPD (Obsessive-Compulsive Personality Disorder), where traits are **ego-syntonic** (perceived as appropriate). **NEET-PG Clinical Pearls:** * **Most common obsession:** Contamination (followed by pathological doubt). * **Most common compulsion:** Checking (followed by washing). * **Treatment of Choice:** SSRIs (at higher doses than for depression) and Cognitive Behavioral Therapy (specifically **Exposure and Response Prevention - ERP**). * **Neurobiology:** Associated with hyperactivity in the **Orbitofrontal Cortex, Anterior Cingulate Gyrus, and Caudate Nucleus** (Cortico-striato-thalamo-cortical circuit).

Q: Which of the following is NOT a characteristic of obsession?

Abstract thinking. **Explanation:** In Psychiatry, **Obsessions** are defined as recurrent, persistent, and intrusive thoughts, urges, or images that are experienced as unwanted and cause significant anxiety or distress. **Why "Abstract Thinking" is the correct answer:** Abstract thinking is a cognitive process involving the ability to understand complex concepts and generalize ideas. It is a component of a normal mental status examination and is **not** a pathological feature of Obsessive-Compulsive Disorder (OCD). In contrast, obsessions are specific, intrusive mental intrusions, not a generalized style of thinking. **Analysis of Incorrect Options:** * **Repetitive behavior:** While obsessions are mental events, they are characteristically **repetitive** in nature. The patient cannot easily dismiss these thoughts, leading to a cycle of recurrence. * **Ego-dystonic:** This is a hallmark of OCD. The patient recognizes that the thoughts are irrational, excessive, and **alien to their self-concept** (ego-dystonic). This distinguishes OCD from OCPD (Obsessive-Compulsive Personality Disorder), where traits are ego-syntonic (perceived as appropriate). * **Compulsion:** Obsessions and compulsions are intrinsically linked. Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession to neutralize anxiety. **High-Yield Clinical Pearls for NEET-PG:** * **Insight:** In OCD, insight is usually preserved (the patient knows the thoughts are their own and are irrational), which differentiates it from delusions in psychosis. * **Most common obsession:** Contamination. * **Most common compulsion:** Checking. * **First-line Treatment:** SSRIs (at higher doses than for depression) and Cognitive Behavioral Therapy (specifically **Exposure and Response Prevention - ERP**). * **Drug of Choice (TCA):** Clomipramine (most potent serotonin reuptake inhibitor).

Question 1

Psychosurgery is used in which of the following conditions?

Accepted Answer

Obsessive-Compulsive Disorder (OCD)

Answer

Phobia

Answer

Generalized anxiety disorder

Answer

Depression

Question 2

All are true about obsession, except:

Accepted Answer

Associated with dim light

Answer

Recurrent foolish thoughts

Answer

Attempts to resist intrusive ideas

Answer

Associated depression

Question 3

An elderly male presents with a history of excessive hand washing and repetitive daily routines. Which of the following is NOT characteristic of obsessions?

Accepted Answer

Intrusive and unwanted mental events

Answer

Repetitive thoughts or urges

Answer

Ego-dystonic nature

Answer

Repetitive behaviors

Question 4

Fixation at the anal stage of psychosexual development can lead to which of the following conditions?

Accepted Answer

Obsessive compulsive disorder

Answer

Anxiety disorders

Answer

Depression

Answer

Schizophrenia

Question 5

Which of the following is NOT a characteristic of obsession?

Accepted Answer

Abstract thinking

Answer

Repetitive behavior

Answer

Ego-dystonic

Answer

Compulsion

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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