Hoarding Disorder — MCQs
Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?
Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
In which of the following conditions is behavior therapy considered most effective?
A person going to temple experiences unwanted, intrusive thoughts urging them to abuse God, which cause significant distress. The likely diagnosis is
Which disorder is characterized by fear of contamination, counting behaviors, and having to check and recheck?
Most common symptom associated with adult OCD?
Psychosurgery is used in which of the following conditions?
All are true about obsession, except:
All of the following are true about Obsessive compulsive disorder EXCEPT?
An elderly male presents with a history of excessive hand washing and repetitive daily routines. Which of the following is NOT characteristic of obsessions?
Hoarding Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Untreated ADHD persisting from childhood increases the risk of developing which of the following in adolescence?
- A. Selective mutism
- B. Conduct disorder (Correct Answer)
- C. Binge eating disorder
- D. Separation anxiety disorder
Explanation: ***Conduct disorder*** - **Untreated ADHD**, marked by impulsivity and difficulty with emotional regulation, significantly increases the risk of developing **conduct disorder** in adolescence. - Adolescents with untreated ADHD may struggle with following rules, exhibiting aggressive behaviors, and engaging in antisocial acts, which are hallmarks of conduct disorder. *Selective mutism* - This is an **anxiety disorder** characterized by a child's consistent failure to speak in specific social situations where there is an expectation for speaking despite speaking in other situations. - While it can co-occur with ADHD, it is not a direct consequence of untreated ADHD and involves distinct psychological mechanisms. *Binge eating disorder* - This disorder is characterized by recurrent episodes of **eating unusually large amounts of food** in a short period, often accompanied by a sense of loss of control. - While there is a higher prevalence of eating disorders in individuals with ADHD, it is not a primary or direct developmental risk from untreated ADHD in adolescence. *Separation anxiety disorder* - This disorder involves **excessive fear or anxiety** concerning separation from home or from attachment figures, beyond what is expected for the individual's developmental level. - While it can co-occur with ADHD, it is not a direct developmental risk that emerges from untreated ADHD in adolescence.
Question 2: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
- A. Cognitive behavioral therapy
- B. SSRIs
- C. Clomipramine
- D. Systematic desensitisation (Correct Answer)
Explanation: ***Systematic desensitisation*** - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where avoidance is a key feature and a clear, single trigger can be identified. - While it involves exposure, the gradual hierarchy and relaxation training are less effective for the complex, intrusive thoughts and compulsive rituals characteristic of **OCD**. *Cognitive behavioral therapy* - **CBT, particularly Exposure and Response Prevention (ERP)**, is considered the gold standard psychotherapy for OCD. - It directly addresses the **obsessions** by exposing the individual to feared thoughts or situations and then preventing the ritualistic responses. *SSRIs* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the availability of **serotonin** in the brain. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant (TCA) with potent **serotonergic effects**, making it highly effective in treating OCD, often when SSRIs are partially effective or not tolerated. - It is specifically approved for OCD and is sometimes considered a second-line or augmentation strategy.
Question 3: In which of the following conditions is behavior therapy considered most effective?
- A. Panic Attack
- B. Psychosis
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Generalized Anxiety Disorder
Explanation: ***Obsessive-Compulsive Disorder (OCD)*** - **Exposure and Response Prevention (ERP)**, a type of behavior therapy, is the gold standard and most effective treatment for OCD. - ERP directly targets the **obsessions** and **compulsions** by gradually exposing individuals to feared situations without allowing them to perform their rituals. - OCD shows the **highest response rates** to pure behavior therapy compared to other psychiatric conditions. *Psychosis* - While supportive therapy and cognitive behavioral therapy for psychosis (CBTp) can be helpful, **behavior therapy alone is not considered the primary or most effective treatment** for core psychotic symptoms. - Management of psychosis primarily relies on **antipsychotic medications** to address symptoms like hallucinations and delusions. *Panic Attack* - Behavior therapy and CBT are effective for **Panic Disorder**, but the effectiveness is somewhat lower than for OCD. - Treatment for panic disorder often requires a **combination of behavioral and cognitive techniques** rather than pure behavior therapy alone. - Management typically includes breathing exercises, exposure to physical sensations, and cognitive restructuring. *Generalized Anxiety Disorder* - **Cognitive Behavioral Therapy (CBT)**, which includes behavioral components, is highly effective for GAD, but the **cognitive elements are essential** for addressing worry and rumination. - Pure behavior therapy (e.g., systematic desensitization) is less effective for GAD compared to OCD, as GAD involves pervasive cognitive distortions that require cognitive restructuring.
Question 4: A person going to temple experiences unwanted, intrusive thoughts urging them to abuse God, which cause significant distress. The likely diagnosis is
- A. Mania
- B. Schizophrenia
- C. Delusion
- D. Obsessive-Compulsive Disorder (Correct Answer)
Explanation: ***Obsessive-Compulsive Disorder*** - The patient experiences **unwanted, intrusive thoughts** (obsessions) that cause significant anxiety and distress, such as the urge to abuse God. - The **irresistible urge** despite personal values suggests a compulsion to alleviate distress associated with the obsessive thought, even if the action is not performed. *Mania* - Characterized by an **elevated or irritable mood**, increased energy, and goal-directed activity, which does not fit the described symptom of internal, distressing urges. - Symptoms often include **racing thoughts**, grandiosity, and decreased need for sleep. *Schizophrenia* - Involves disruptions in thought processes, perceptions, emotional responsiveness, and social interactions, often including **hallucinations** or **delusions**. - The described symptom is an urge, not a break from reality or a hallucination. *Delusion* - A **fixed, false belief** that is not amenable to change in light of conflicting evidence. - The scenario describes an urge or an intrusive thought, which the person recognizes as distressing and unwanted, not a held belief.
Question 5: Which disorder is characterized by fear of contamination, counting behaviors, and having to check and recheck?
- A. Obsessive-compulsive disorder (Correct Answer)
- B. Panic disorder
- C. Agoraphobia (without panic attacks)
- D. Generalized anxiety disorder (GAD)
Explanation: ***Obsessive-compulsive disorder*** - This disorder is precisely characterized by repetitive, intrusive thoughts (obsessions) like **fear of contamination** and repetitive behaviors (compulsions) like **counting** and **checking** performed to reduce anxiety associated with these thoughts. - The individual feels compelled to perform these rituals to prevent a dreaded event or situation, even if they recognize the irrationality of their actions. *Panic disorder* - This disorder involves recurrent, unexpected **panic attacks** that cause intense fear and physical symptoms such as palpitations, shortness of breath, and dizziness. - It does not primarily involve obsessions about contamination or compulsive checking behaviors. *Agoraphobia (without panic attacks)* - This condition involves significant anxiety about being in places or situations from which escape might be difficult or embarrassing, or where help might not be available in case of incapacitating or embarrassing symptoms. - It is often associated with fear of public transportation, open spaces, enclosed places, standing in line, or being in a crowd, and does not typically involve contamination fears or repetitive checking. *Generalized anxiety disorder (GAD)* - GAD is characterized by persistent and excessive worry about a variety of daily life events or activities, such as work, finances, or health. - While it involves chronic anxiety, it does not typically manifest with specific obsessions like contamination or compulsive behaviors such as counting and checking.
Question 6: Most common symptom associated with adult OCD?
- A. Sexual
- B. Aggressive
- C. Need for symmetry
- D. Pathological doubt (Correct Answer)
Explanation: ***Pathological doubt*** - **Pathological doubt** is one of the most common symptom dimensions in adult OCD, affecting approximately 25-30% of patients. - This manifests as persistent, overwhelming uncertainty that drives **checking compulsions** (e.g., repeatedly checking locks, appliances, switches). - Patients experience intense anxiety about potential mistakes or harm, leading to time-consuming verification rituals. - Often coexists with responsibility obsessions and is a core feature underlying many OCD presentations. *Need for symmetry* - While **symmetry and ordering obsessions** are characteristic of OCD, they affect a smaller proportion of patients (approximately 10-15%). - These manifest as urges to arrange objects symmetrically or perform actions in a balanced, "just right" manner. - Less common than contamination fears and pathological doubt in epidemiological studies. *Sexual* - **Sexual obsessions** involve intrusive, unwanted thoughts or images of a sexual nature that are ego-dystonic. - These occur in approximately 10-15% of OCD patients and are highly distressing but not the most prevalent symptom type. *Aggressive* - **Aggressive obsessions** involve intrusive thoughts of harming oneself or others, occurring in roughly 10-15% of cases. - Patients fear they might act on violent impulses, though they never do, as these thoughts are ego-dystonic. - Less common than contamination and doubt-related symptoms in adult OCD populations.
Question 7: Psychosurgery is used in which of the following conditions?
- A. Phobia
- B. Generalized anxiety disorder
- C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- D. Depression
Explanation: **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.
Question 8: All are true about obsession, except:
- A. Recurrent foolish thoughts
- B. Associated with dim light (Correct Answer)
- C. Attempts to resist intrusive ideas
- D. Associated depression
Explanation: **Explanation:** Obsessive-Compulsive Disorder (OCD) is characterized by **obsessions** (intrusive, repetitive thoughts, urges, or images) and **compulsions** (repetitive behaviors or mental acts). **Why Option B is the correct answer (False statement):** There is no clinical or diagnostic association between obsessions and **dim light**. While some psychiatric conditions (like Seasonal Affective Disorder) are linked to light exposure, or certain phobias (like nyctophobia) involve darkness, light intensity is not a diagnostic feature or a known trigger for the phenomenology of obsessions. **Analysis of other options (True statements about obsession):** * **Option A (Recurrent foolish thoughts):** Obsessions are defined as recurrent and persistent thoughts that are often perceived by the patient as irrational, "foolish," or senseless (egodystonic). * **Option C (Attempts to resist):** A hallmark of obsession is that the individual recognizes the thoughts as a product of their own mind and typically makes active **attempts to ignore, suppress, or neutralize** them with some other thought or action (compulsion). * **Option D (Associated depression):** Comorbidity is extremely high in OCD. Approximately **60–80%** of patients with OCD will experience a Major Depressive Episode during their lifetime. **High-Yield Clinical Pearls for NEET-PG:** * **Egodystonic nature:** The patient recognizes the thoughts as irrational and contrary to their self-image (unlike delusions). * **Insight:** Usually preserved in OCD, though it can vary (good, fair, or poor insight). * **First-line Treatment:** Pharmacotherapy with **SSRIs** (often at higher doses than for depression) and psychotherapy, specifically **Exposure and Response Prevention (ERP)**. * **Neurobiology:** Associated with structural/functional abnormalities in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical circuit).
Question 9: All of the following are true about Obsessive compulsive disorder EXCEPT?
- A. Washers
- B. Checkers
- C. Thought insertion causes distress
- D. Insight is absent (Correct Answer)
Explanation: 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).
Question 10: An elderly male presents with a history of excessive hand washing and repetitive daily routines. Which of the following is NOT characteristic of obsessions?
- A. Repetitive thoughts or urges
- B. Intrusive and unwanted mental events (Correct Answer)
- C. Ego-dystonic nature
- D. Repetitive behaviors
Explanation: ### 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).
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