Obsessive-Compulsive Disorder — MCQs
Drug most useful in the treatment of obsessive compulsive disorder is
Drug of choice for obsessive-compulsive disorder
In psychoanalytic terms, obsessive-compulsive disorder is fixed at -
Body dysmorphic disorder can be associated with all except
A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He reports that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work. He also has intrusive thoughts about stabbing his coworkers. He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters?
A woman comes to psychiatrist with history of spending a lot of time in washing her hands. She is distressed about it but says that she is not able to stop washing. This has started to affect her social life as well. What is the best mode of treatment for her?
Which disorder is characterized by fear of contamination, counting behaviors, and having to check and recheck?
Which of the following is not classified as OCD as per ICD 11?
A 15-year-old boy feels that dirt has clung to him whenever he passes through a dirty street. This repetitive thought causes much distress and anxiety. He knows that there is actually no such thing after he has cleaned once, but he is not satisfied and feels compelled to clean repeatedly. This has led to social withdrawal. He spends much of his time thinking about the dirt and contamination and performing cleaning rituals. This has also affected his studies. The most likely diagnosis is:
A person going to temple experiences recurrent, intrusive thoughts of abusing God that he finds distressing and cannot control. The most likely diagnosis is:
Obsessive-Compulsive Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Drug most useful in the treatment of obsessive compulsive disorder is
- A. Doxepin
- B. Fluoxetine (Correct Answer)
- C. Dothiepin
- D. Amoxapine
Explanation: ***Fluoxetine*** - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)**, which are considered first-line treatments for **obsessive-compulsive disorder (OCD)**. - SSRIs, including fluoxetine, are effective in **reducing the severity of obsessions and compulsions** by increasing serotonin levels in the brain. *Doxepin* - **Doxepin** is a **tricyclic antidepressant (TCA)** that primarily blocks the reuptake of norepinephrine and serotonin but also has significant anticholinergic and antihistaminic properties. - TCAs are generally **less preferred for OCD** due to their side effect profile and **SSRIs** typically showing greater efficacy. *Dothiepin* - **Dothiepin** is also a **tricyclic antidepressant (TCA)** with similar mechanisms and side effects to doxepin. - Like other TCAs, dothiepin is **not a first-line treatment for OCD**; SSRIs are more commonly used due to better tolerability and efficacy. *Amoxapine* - **Amoxapine** is a **tetracyclic antidepressant** with properties similar to TCAs, also acting as a **norepinephrine and dopamine reuptake inhibitor**. - While it has antidepressant effects, amoxapine is **not typically used for OCD** and carries a risk of inducing extrapyramidal side effects.
Question 2: Drug of choice for obsessive-compulsive disorder
- A. Haloperidol
- B. Buspirone
- C. Olanzapine
- D. Fluoxetine (Correct Answer)
Explanation: ***Fluoxetine*** - **Selective serotonin reuptake inhibitors (SSRIs)** like fluoxetine are considered **first-line pharmacological treatment for Obsessive-Compulsive Disorder (OCD)** due to their effectiveness in modulating serotonin pathways implicated in the disorder. - Multiple SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline) and clomipramine are equally effective first-line agents, but **SSRIs are preferred initially** due to better tolerability and safety profile. - Among the given options, fluoxetine is the appropriate choice as an established first-line SSRI for reducing the frequency and intensity of obsessions and compulsions. - **OCD typically requires higher doses and longer duration** (8-12 weeks) compared to depression treatment. *Haloperidol* - **Haloperidol** is a **first-generation antipsychotic** primarily used to treat psychotic disorders (e.g., schizophrenia) and severe behavioral disturbances. - It works by blocking **dopamine D2 receptors** and is not a first-line treatment for OCD, though it might be used as an **augmentation strategy** in severe, treatment-refractory cases, particularly when tic disorders coexist. *Buspirone* - **Buspirone** is an **anxiolytic** primarily used for generalized anxiety disorder (GAD). It acts as a **serotonin 5-HT1A receptor partial agonist**. - While it helps with generalized anxiety, it is **generally ineffective** for the specific obsessions and compulsions characteristic of OCD and is not recommended as monotherapy. *Olanzapine* - **Olanzapine** is a **second-generation antipsychotic** primarily used for schizophrenia and bipolar disorder. It blocks dopamine and serotonin receptors. - It is not a first-line treatment for OCD but can be used as an **adjunct to SSRIs** in severe, treatment-resistant cases, particularly when there is partial response to adequate SSRI trials or comorbid psychotic symptoms.
Question 3: In psychoanalytic terms, obsessive-compulsive disorder is fixed at -
- A. Oral stage
- B. Genital stage
- C. Anal stage (Correct Answer)
- D. Oedipal stage
Explanation: ***Anal stage*** - In psychoanalytic theory, **obsessive-compulsive disorder (OCD)** is often conceptualized as a fixation at the **anal stage** of psychosexual development. - The anal stage (ages 1-3) is associated with issues of **control, orderliness, cleanliness, and defiance**, which parallel many symptoms seen in OCD, such as excessive neatness, rigid routines, and fear of contamination. *Oral stage* - The oral stage (birth to 1 year) is associated with behaviors like **smoking, overeating, nail-biting, and dependency**, stemming from unmet oral needs. - Fixation at this stage typically leads to issues related to **dependency** and **trust**, not the control and orderliness seen in OCD. *Genital stage* - The genital stage (puberty onwards) represents mature sexual interests and healthy psychological functioning, where conflicts from earlier stages are hopefully resolved. - Fixation at this stage is not typically associated with specific neurotic disorders like OCD but rather with overall difficulty in forming mature relationships. *Oedipal stage* - The Oedipal stage refers to the **phallic stage** (ages 3-6), characterized by the **Oedipus complex** (or Electra complex for girls), where children develop sexual desires for the opposite-sex parent and rivalry with the same-sex parent. - Fixation at this stage is linked to issues of **gender identity, authority problems**, and **sexual inhibition**, not the specific symptoms of OCD.
Question 4: Body dysmorphic disorder can be associated with all except
- A. Bulimia nervosa
- B. OCD
- C. Anxiety
- D. Mania (Correct Answer)
Explanation: ***Mania*** - **Mania** is a state of elevated, expansive, or irritable mood that is distinct from the persistent preoccupation with perceived bodily defects seen in **body dysmorphic disorder (BDD)**. - While agitation can occur in BDD, the core symptom profile of **mania**, including decreased need for sleep, grandiosity, and racing thoughts, is not a typical associated feature. *Bulimia nervosa* - **Bulimia nervosa** can co-occur with BDD, particularly when the perceived defects relate to body weight, shape, or specific body parts. - Both disorders involve intense preoccupation with body image and often lead to harmful behaviors to attempt to "correct" perceived flaws. *OCD* - **Obsessive-compulsive disorder (OCD)** shares strong phenomenological similarities with BDD, including intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - BDD is often conceptualized as part of the **OCD spectrum**, with both disorders involving obsessive thoughts and repetitive behaviors related to specific concerns. *Anxiety* - **Anxiety disorders** are highly comorbid with BDD, as individuals often experience significant distress, fear of judgment, and social avoidance due to their perceived flaws. - The constant preoccupation and efforts to conceal or fix perceived defects can lead to chronic anxiety and panic attacks.
Question 5: A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He reports that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work. He also has intrusive thoughts about stabbing his coworkers. He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters?
- A. Dopamine
- B. Serotonin (Correct Answer)
- C. Norepinephrine
- D. Acetylcholine
Explanation: ***Serotonin*** - The described symptoms (obsessive thoughts about harming others, compulsive checking, and attempts to neutralize thoughts with prayer) are highly characteristic of **Obsessive-Compulsive Disorder (OCD)**. - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD, and they work by increasing the availability of serotonin in the synaptic cleft. *Dopamine* - Dopamine dysregulation is primarily implicated in disorders such as **schizophrenia** and **Parkinson's disease**, and to some extent in ADHD and addiction. - While dopamine may play a role in some aspects of OCD, typical first-line treatments do not primarily target dopamine. *Norepinephrine* - Norepinephrine is largely involved in the **fight-or-flight response**, attention, and arousal, and is a target for treating depression and anxiety disorders with SNRIs. - While some antidepressants that affect norepinephrine may be used if SSRIs are ineffective, they are not considered the primary neurotransmitter target for first-line OCD treatment. *Acetylcholine* - Acetylcholine is crucial for **muscle contraction**, learning, and memory, and imbalances are associated with conditions like **Alzheimer's disease** and myasthenia gravis. - It is not a primary target for the pharmacological treatment of OCD.
Question 6: A woman comes to psychiatrist with history of spending a lot of time in washing her hands. She is distressed about it but says that she is not able to stop washing. This has started to affect her social life as well. What is the best mode of treatment for her?
- A. Exposure and response prevention (Correct Answer)
- B. Systematic desensitization
- C. Cognitive behavioral therapy
- D. Pharmacological agents
Explanation: ***Exposure and response prevention*** - **Exposure and response prevention (ERP)** is the **most specific and evidence-based** psychotherapy for **obsessive-compulsive disorder (OCD)**. - It is a specialized form of **Cognitive Behavioral Therapy (CBT)** that directly targets OCD by gradually exposing the individual to situations or objects that trigger their obsessions (e.g., dirt) and then preventing them from performing their compulsive rituals (e.g., handwashing). - **ERP is considered the gold standard psychotherapy** for OCD with the strongest evidence base, making it the **best** (most specific) answer. *Systematic desensitization* - This technique is primarily used for **specific phobias** and involves pairing relaxation techniques with gradual exposure to feared stimuli. - While it involves exposure, it does **not address the response prevention component** critical for treating compulsive rituals in OCD. - Less effective than ERP for OCD specifically. *Cognitive behavioral therapy* - **CBT is also a correct treatment** for OCD, as ERP is delivered within a CBT framework. - However, when answering "best mode of treatment," **ERP is the more specific answer** as it identifies the particular CBT technique with the strongest evidence for OCD. - Standard CBT without the specific ERP component (focusing only on cognitive restructuring) would be less effective than ERP for compulsive behaviors. *Pharmacological agents* - **SSRIs** (particularly high-dose) are first-line pharmacological treatment for OCD and often used in combination with ERP. - However, **psychotherapy with ERP** is generally considered the first-line treatment and can achieve significant long-term remission even as monotherapy. - The question asks for "mode of treatment" in a clinical context where behavioral intervention is being considered, making ERP the best answer.
Question 7: 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 8: Which of the following is not classified as OCD as per ICD 11?
- A. Hypochondriac disorder
- B. Body dysmorphic disorder
- C. PTSD (Correct Answer)
- D. Trichotillomania
Explanation: ***PTSD*** - **Post-traumatic stress disorder (PTSD)** is classified under **disorders specifically associated with stress** in ICD-11, not as an OCD-related disorder. - PTSD involves symptoms like re-experiencing the traumatic event, avoidance, and hyperarousal following exposure to a **traumatic event**. *Hypochondriac disorder* - In ICD-11, **hypochondriac disorder (illness anxiety disorder)** is reclassified under **obsessive-compulsive or related disorders**, focusing on preoccupation with having a serious illness. - This reflects the **compulsive checking** and **obsessive fears** associated with the condition. *Body dysmorphic disorder* - **Body dysmorphic disorder** is classified under **obsessive-compulsive or related disorders** in ICD-11. - It is characterized by **preoccupation with perceived flaws in physical appearance** and repetitive behaviors (e.g., mirror checking) in response to these concerns. *Trichotillomania* - **Trichotillomania (hair-pulling disorder)** is classified as an **obsessive-compulsive or related disorder** in ICD-11. - It involves **recurrent pulling out of one's hair** resulting in hair loss, despite repeated attempts to stop.
Question 9: A 15-year-old boy feels that dirt has clung to him whenever he passes through a dirty street. This repetitive thought causes much distress and anxiety. He knows that there is actually no such thing after he has cleaned once, but he is not satisfied and feels compelled to clean repeatedly. This has led to social withdrawal. He spends much of his time thinking about the dirt and contamination and performing cleaning rituals. This has also affected his studies. The most likely diagnosis is:
- A. Obsessive compulsive disorder (Correct Answer)
- B. Conduct disorder
- C. Agoraphobia
- D. Adjustment disorder
Explanation: ***Obsessive compulsive disorder*** - The presence of **recurrent, intrusive thoughts** (obsessions) about dirt and contamination, coupled with **repetitive cleaning rituals** (compulsions) performed to alleviate distress, is characteristic of **Obsessive-Compulsive Disorder (OCD)**. - The patient has **insight** (recognizes thoughts are irrational after cleaning once) but cannot resist the compulsion to continue cleaning. - The significant amount of time spent on these obsessions and compulsions, along with their impact on daily functioning (academic decline) and social withdrawal, confirms the diagnosis. - **DSM-5 criteria met:** obsessions causing anxiety, compulsions to reduce anxiety, time-consuming (>1 hour/day), and causing functional impairment. *Conduct disorder* - **Conduct disorder** is characterized by a persistent and repetitive pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. - It usually presents with **aggression to people and animals**, **destruction of property**, **deceitfulness or theft**, and **serious violations of rules** none of which are described in the clinical vignette. *Agoraphobia* - **Agoraphobia** is an anxiety disorder characterized by fear and avoidance of situations that might cause panic, helplessness, or embarrassment, especially in public spaces or situations where escape might be difficult. - The patient's symptoms are centered around contamination obsessions and cleaning compulsions, not fear of open spaces or situations where escape is difficult. *Adjustment disorder* - **Adjustment disorder** is an emotional or behavioral reaction to an identifiable stressor that develops within 3 months of the onset of the stressor, and resolves once the stressor is removed. - While the patient is experiencing distress, the symptoms are specific to obsessions and compulsions rather than a generalized reaction to a life stressor; the chronic nature and specific symptom pattern do not align with an adjustment disorder.
Question 10: A person going to temple experiences recurrent, intrusive thoughts of abusing God that he finds distressing and cannot control. The most likely diagnosis is:
- A. Schizophrenia
- B. Delusion
- C. Obsessive - Compulsive disorder (Correct Answer)
- D. Mania
Explanation: ***Obsessive-Compulsive disorder*** - This scenario describes **religious obsessions** (also called scrupulosity), a well-recognized subtype of OCD characterized by intrusive, blasphemous thoughts. - The key features include: **unwanted, intrusive thoughts** that are **ego-dystonic** (distressing to the patient), **recurrent**, and **difficult to control** - all hallmarks of obsessions in OCD. - The patient recognizes these thoughts as his own (intact reality testing) but finds them distressing and unwanted, which is pathognomonic for obsessions. - Religious obsessions are among the most common obsessive themes in OCD, particularly in cultures with strong religious values. *Schizophrenia* - Schizophrenia involves **psychotic symptoms** such as delusions, hallucinations, and disorganized thinking with **loss of reality contact**. - While religious themes can occur in schizophrenia, the patient would typically not recognize the thoughts as abnormal or distressing in the same way. - The **preserved insight** and **ego-dystonic nature** of the thoughts argue against a psychotic disorder. *Delusion* - A delusion is a **fixed, false belief** held with conviction despite evidence to the contrary and not in keeping with one's cultural background. - In this case, the patient experiences **intrusive thoughts** (not beliefs), recognizes them as problematic and unwanted, and likely does not believe in their validity. - The **ego-dystonic** quality and intact insight differentiate this from a delusional belief. *Mania* - Mania presents with **elevated or irritable mood**, increased energy, grandiosity, decreased need for sleep, and racing thoughts. - While mania may include racing thoughts, they are typically **ego-syntonic** (consistent with the person's inflated self-image) rather than distressing. - The core feature here is a **specific, intrusive, distressing thought**, not the pervasive mood elevation and associated symptoms of mania.
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