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: All of the following are true about Obsessive compulsive disorder EXCEPT?

Insight is absent. In Obsessive-Compulsive Disorder (OCD), the defining characteristic is that the patient recognizes their obsessions and compulsions as **ego-dystonic** (irrational and originating from their own mind). **Explanation of Options:** * **Insight is absent (Correct Answer):** In OCD, insight is typically **preserved**. Patients are aware that their thoughts are excessive or unreasonable. While the DSM-5 allows for a specifier of "with absent insight/delusional beliefs," this is the exception rather than the rule. In contrast, absent insight is a hallmark of psychotic disorders (like Schizophrenia). * **Washers & Checkers:** These are the two most common clinical subtypes of OCD. **Washers** (Contamination obsessions) are the most frequent, followed by **Checkers** (Pathological doubt). * **Thought insertion causes distress:** In OCD, thoughts are perceived as internal but intrusive. If a patient experiences "thought insertion" (a Schneiderian First Rank Symptom), they feel the thought is alien. However, in the context of OCD-like presentations, the intrusive nature of these thoughts causes significant anxiety and distress, which the patient tries to neutralize. **High-Yield Clinical Pearls for NEET-PG:** * **Ego-dystonic vs. Ego-systonic:** OCD is ego-dystonic (distressing/unwanted), whereas Obsessive-Compulsive Personality Disorder (OCPD) is ego-syntonic (perceived as correct/ideal). * **First-line Treatment:** SSRIs (at higher doses than for depression) and Cognitive Behavioral Therapy (CBT) using **Exposure and Response Prevention (ERP)**. * **Drug of Choice (TCA):** Clomipramine (most potent serotonin reuptake inhibitor). * **Neurobiology:** Associated with hyperactivity in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical circuit).

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: A 25-year-old female presents with a 2-year history of repetitive, irresistible thoughts of contamination, associated with repetitive hand washing. She recognizes these thoughts to be her own and distressing, but is unable to overcome them despite medication. She is most likely to benefit from which of the following therapies?

Exposure and response prevention. **Explanation:** The clinical presentation describes a classic case of **Obsessive-Compulsive Disorder (OCD)**. The patient exhibits **obsessions** (repetitive, intrusive thoughts of contamination) and **compulsions** (repetitive hand washing) which she recognizes as her own (ego-dystonic). **Why Option D is Correct:** **Exposure and Response Prevention (ERP)** is the "Gold Standard" behavioral therapy for OCD. * **Exposure:** The patient is deliberately exposed to the stimulus that triggers anxiety (e.g., touching a "contaminated" surface). * **Response Prevention:** The patient is then prevented from performing the ritualistic behavior (e.g., washing hands). Over time, this leads to **habituation**, where the brain learns that the anxiety dissipates naturally without the need for compulsions. **Why Other Options are Incorrect:** * **A. Sensate Focusing:** A technique used in sex therapy to treat sexual dysfunctions (like premature ejaculation or erectile dysfunction) by focusing on non-genital physical sensations. * **B. Assertiveness Training:** A form of behavior therapy used to help individuals with social anxiety or avoidant traits express their feelings and rights without being aggressive. * **C. Systematic Desensitization:** Primarily used for **Phobias**. It involves reciprocal inhibition (pairing relaxation with a hierarchy of feared stimuli). While similar to ERP, it is less effective for the ritualistic nature of OCD. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Pharmacotherapy:** SSRIs (e.g., Fluoxetine, Fluvoxamine, Sertraline) are the drugs of choice. * **Best TCA for OCD:** Clomipramine (most serotonin-specific). * **Best overall treatment:** Combination of SSRIs + ERP. * **Ego-dystonic vs. Ego-syntonic:** OCD is ego-dystonic (patient hates the thoughts); OCPD (Personality Disorder) is ego-syntonic (patient thinks their way is right).

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).

Q: A 26-year-old woman presents with extreme distress, stating her life is significantly affected by intrusive thoughts she recognizes as senseless. She experiences repetitive checking behaviors, such as frequently checking the classroom lock and food, and checking envelopes before mailing. She follows strict routines for most activities. Which of the following is NOT a good long-term treatment option for this patient?

Diazepam. **Explanation:** The clinical presentation describes a classic case of **Obsessive-Compulsive Disorder (OCD)**, characterized by intrusive, ego-dystonic thoughts (obsessions) and repetitive behaviors (compulsions) like checking and rigid routines. **Why Diazepam is NOT a good long-term treatment:** Diazepam is a **Benzodiazepine**. While it may provide short-term relief for the acute anxiety associated with OCD, it has **no anti-obsessional properties**. Long-term use is contraindicated due to the high risk of tolerance, physical dependence, and potential for abuse. Furthermore, benzodiazepines can interfere with the efficacy of behavioral therapies like ERP by preventing the patient from experiencing and habituating to the anxiety. **Analysis of other options:** * **Exposure and Response Prevention (ERP):** This is the **gold-standard psychotherapy** for OCD. It involves exposing the patient to the anxiety-provoking stimulus (e.g., an unlocked door) and preventing the ritualistic response (checking). * **Fluoxetine:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the **first-line pharmacological treatment** for OCD. Note that OCD typically requires higher doses of SSRIs than Depression. * **Clomipramine:** A Tricyclic Antidepressant (TCA) that is highly effective for OCD due to its potent serotonergic activity. It is often considered the most effective drug but is usually second-line due to its side-effect profile (anticholinergic effects, cardiotoxicity). **High-Yield Clinical Pearls for NEET-PG:** * **First-line treatment:** SSRIs + ERP (Combination therapy is superior to either alone). * **Drug of choice (Pharmacological):** SSRIs (e.g., Fluoxetine, Fluvoxamine, Sertraline). * **Most effective drug:** Clomipramine (often used if SSRIs fail). * **Treatment Duration:** OCD requires long-term treatment (at least 1–2 years) as relapse rates are high upon discontinuation.

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

All of the following are true about Obsessive compulsive disorder EXCEPT?

Accepted Answer

Insight is absent

Answer

Washers

Answer

Checkers

Answer

Thought insertion causes distress

Question 4

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 5

A 25-year-old female presents with a 2-year history of repetitive, irresistible thoughts of contamination, associated with repetitive hand washing. She recognizes these thoughts to be her own and distressing, but is unable to overcome them despite medication. She is most likely to benefit from which of the following therapies?

Accepted Answer

Exposure and response prevention

Answer

Sensate focusing

Answer

Assertiveness training

Answer

Systematic desensitization

Question 6

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 7

Which of the following is NOT a characteristic of obsession?

Accepted Answer

Abstract thinking

Answer

Repetitive behavior

Answer

Ego-dystonic

Answer

Compulsion

Question 8

Which of the following describes repetitive, ritualistic actions performed to reduce anxiety or prevent a feared event?

Accepted Answer

Compulsion

Answer

Obsession

Answer

Anxiety

Answer

None of the above

Question 9

A 26-year-old woman presents with extreme distress, stating her life is significantly affected by intrusive thoughts she recognizes as senseless. She experiences repetitive checking behaviors, such as frequently checking the classroom lock and food, and checking envelopes before mailing. She follows strict routines for most activities. Which of the following is NOT a good long-term treatment option for this patient?

Accepted Answer

Diazepam

Answer

Exposure and Response Prevention

Answer

Clomipramine

Answer

Fluoxetine

Question 10

Which of the following is a recognized treatment for obsessive-compulsive disorder?

Accepted Answer

All of the above

Answer

Exposure and response prevention

Answer

Flooding

Answer

Psychoanalytic therapy

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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