OCD in Children and Adolescents — MCQs
Drug most useful in the treatment of obsessive compulsive disorder is
The drug of choice for obsessive-compulsive disorder:
Double depression is seen in:
A 40-year-old teacher reports excessive handwashing, counting rituals, and difficulty in completing daily tasks. She believes these actions prevent harm to her students. What is the diagnosis?
Which of the following is NOT true about Obsessive-Compulsive Disorder (OCD)?
Which of the following conditions does not typically involve delusions?
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
Defence mechanism in OCD?
In treatment-resistant OCD, which augmentation has strongest evidence?
A person often feels that his hands are contaminated and is forced to wash his hands. Recently, he feels this repetitive, distressing thought of repetitive hand washing has begun affecting his performance. Which of the following is the best treatment option for this patient?
OCD in Children and Adolescents 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: The drug of choice for obsessive-compulsive disorder:
- A. Imipramine
- B. Fluoxetine (Correct Answer)
- C. Chlorpromazine
- D. Benzodiazepine
Explanation: ***Fluoxetine*** - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** and is considered a first-line treatment for **obsessive-compulsive disorder (OCD)** due to its efficacy in reducing obsessive thoughts and compulsive behaviors. - SSRIs, including fluoxetine, help increase serotonin levels in the brain, which is thought to be dysregulated in OCD. *Imipramine* - **Imipramine** is a **tricyclic antidepressant (TCA)** primarily used for depression and sometimes panic disorder. - While TCAs can have some serotonergic effects, they are generally less effective and have more side effects than SSRIs for treating OCD. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** mainly used to treat psychosis, such as in schizophrenia, and severe agitation. - It works primarily by blocking dopamine receptors and is not indicated as a primary treatment for OCD, though it might be used as an adjunct in severe, treatment-refractory cases. *Benzodiazepine* - **Benzodiazepines** are anxiolytics used for short-term relief of anxiety and panic attacks. - They provide symptomatic relief from anxiety associated with OCD but do not address the core obsessive-compulsive symptoms and are not considered a primary treatment due to potential for dependency and lack of effect on underlying mechanisms.
Question 3: Double depression is seen in:
- A. Depression with dysthymia (Correct Answer)
- B. Depression with anxiety attack
- C. Major depression with OCD
- D. Major depressive disorder from 2 years
Explanation: ***Depression with dysthymia*** - **Double depression** is a specific mood disorder characterized by the co-occurrence of a **major depressive episode** on top of a pre-existing **dysthymic disorder** (persistent depressive disorder). - This means an individual experiences the chronic, milder symptoms of dysthymia, which are then worsened by the more severe symptoms of a major depressive episode. *Depression with anxiety attack* - While depression and anxiety attacks can co-occur, this specific combination is not referred to as **double depression**. - **Anxiety attacks** are acute episodes of intense fear and discomfort, often associated with panic disorder, and are distinct from chronic low-grade depressive symptoms. *Major depression with OCD* - **Obsessive-compulsive disorder (OCD)** is a distinct anxiety disorder characterized by obsessions and compulsions, which can co-occur with major depression. - However, the term **double depression** specifically refers to the combination of major depression and dysthymia, not other psychiatric comorbidities. *Major depressive disorder from 2 years* - Experiencing **major depressive disorder for 2 years** implies a chronic course of major depression. - If the symptoms meet the criteria for major depressive disorder continuously for at least two years, it might be termed **chronic major depressive disorder**, but not double depression, unless there was an underlying dysthymia.
Question 4: A 40-year-old teacher reports excessive handwashing, counting rituals, and difficulty in completing daily tasks. She believes these actions prevent harm to her students. What is the diagnosis?
- A. Generalized anxiety disorder
- B. Obsessive-compulsive disorder (Correct Answer)
- C. Paranoid schizophrenia
- D. Phobic disorder
Explanation: ***Obsessive-compulsive disorder*** - The patient's presentation of **recurrent, intrusive thoughts** (worries about students' harm) and **repetitive behaviors** (excessive handwashing, counting rituals) performed to reduce anxiety or prevent a dreaded event is characteristic of OCD. - The individual recognizes that these obsessions or compulsions are **excessive or unreasonable**, causing significant distress and impairment in daily functioning. *Generalized anxiety disorder* - This disorder is characterized by **persistent and excessive worry** about various aspects of life, not typically focused on specific, intrusive obsessions leading to compulsive rituals. - While anxiety is present, it does not manifest as specific **compulsive behaviors** performed in response to obsessions. *Paranoid schizophrenia* - Schizophrenia involves **psychotic symptoms** such as delusions (fixed false beliefs, often persecutory), hallucinations, disorganized speech, and negative symptoms. - The patient's symptoms are not indicative of a thought disorder, delusions, or hallucinations but rather anxiety-driven, repetitive behaviors. *Phobic disorder* - **Phobic disorders** involve intense, irrational fear of specific objects or situations (e.g., social phobia, specific phobia). - The patient's symptoms are not primarily triggered by a specific phobic stimulus but rather by intrusive thoughts leading to ritualistic behaviors.
Question 5: Which of the following is NOT true about Obsessive-Compulsive Disorder (OCD)?
- A. Insight is always present (Correct Answer)
- B. Ego-alien
- C. Patient tries to resist against
- D. Ego dystonic
Explanation: ***Insight is always present*** - While many individuals with OCD have good insight into the irrationality of their obsessions and compulsions, insight exists on a spectrum in OCD. - Some individuals may have **poor insight** or even **absent insight/delusional beliefs**, especially in severe cases, making this statement incorrect. *Ego-alien* - **Ego-alien** specifically refers to thoughts or impulses that are perceived as foreign, intrusive, and not originating from one's own self. - This term is often used interchangeably with **ego-dystonic**, describing the nature of obsessions in OCD. *Patient tries to resist against* - Individuals with OCD typically experience their obsessions and compulsions as distressing and make active efforts to **resist them** or neutralize them. - This resistance is a core feature, although it often fails, leading to the performance of compulsive acts. *Ego dystonic* - **Ego-dystonic** means that the thoughts, impulses, or behaviors are inconsistent with one's fundamental beliefs, values, and sense of self. - Obsessions in OCD are typically **ego-dystonic**, perceived as unpleasant, unwanted, and not in line with the person's character, which causes significant distress.
Question 6: Which of the following conditions does not typically involve delusions?
- A. Delirium
- B. Alcohol withdrawal
- C. OCD (Correct Answer)
- D. Schizophrenia
Explanation: ***OCD*** - **Obsessive-compulsive disorder** is characterized by recurrent, intrusive **thoughts (obsessions)** and repetitive **behaviors (compulsions)**, which the individual typically recognizes as irrational. - While patients with severe OCD may have **poor insight**, they generally do not experience **delusions**, which are fixed, false beliefs held despite evidence to the contrary. *Delirium* - **Delirium** is an acute, fluctuating disturbance of consciousness resulting from medical conditions or substance intoxication/withdrawal, often accompanied by **psychotic symptoms** including **delusions** and **hallucinations**. - The rapid onset and global cognitive impairment make **delusions** a common feature. *Schizophrenia* - **Schizophrenia** is a severe mental disorder characterized by **psychotic symptoms**, with **delusions** being one of the hallmark positive symptoms. - These **delusions** often include **persecutory**, **grandiose**, or **somatic themes**, among others. *Alcohol withdrawal* - Severe **alcohol withdrawal** can lead to **delirium tremens (DTs)**, which is associated with **psychotic symptoms** such as **delusions** and vivid **hallucinations** (often visual or tactile). - These **delusions** are often **persecutory** or referential in nature and contribute to the patient's fear and agitation.
Question 7: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. Obsessive-Compulsive Disorder (OCD)
- D. Adjustment disorder
Explanation: ***PTSD*** - The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**. - PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month. *Anxiety disorder* - While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident. - Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation. - The patient's distress stems from a past trauma, not from obsessions or compulsions. *Adjustment disorder* - An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD. - An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.
Question 8: Defence mechanism in OCD?
- A. Sublimation
- B. Regression
- C. Reaction formation (Correct Answer)
- D. Progression
Explanation: ***Reaction formation*** - In **Obsessive-Compulsive Disorder (OCD)**, individuals often use **reaction formation** by expressing the opposite of their true, unacceptable impulses or feelings. - This mechanism helps to keep unwanted **obsessive thoughts** or impulses out of conscious awareness by actively demonstrating behaviors or attitudes contrary to them. - **Note**: OCD also prominently involves other defense mechanisms like **undoing** (rituals to neutralize obsessions) and **isolation of affect** (separating emotion from thought). *Sublimation* - **Sublimation** involves channeling unacceptable impulses or emotions into socially acceptable or even productive behaviors. - While considered a mature defense mechanism, it is not the primary defense mechanism associated with the rigid and often ritualistic behaviors seen in OCD. *Regression* - **Regression** is a return to an earlier, more childlike, or less mature state of functioning in response to stress or anxiety. - While some individuals with OCD might show regressive behaviors, it is not the central or defining defense mechanism of the disorder. *Progression* - **Progression** is not a recognized psychological defense mechanism in psychodynamic theory. - It describes a movement forward or development, which is distinct from the unconscious strategies used to protect the ego from anxiety.
Question 9: In treatment-resistant OCD, which augmentation has strongest evidence?
- A. Aripiprazole (Correct Answer)
- B. Lamotrigine
- C. Risperidone
- D. Clomipramine
Explanation: ***Aripiprazole*** - **Aripiprazole**, an atypical antipsychotic, has the **strongest and most consistent evidence** for augmentation in **treatment-resistant OCD** based on recent meta-analyses and randomized controlled trials. - It works as a **partial dopamine agonist** and **serotonin modulator**, enhancing SSRI response when added to ongoing SSRI therapy. - **Better tolerability profile** compared to other antipsychotics, with lower risk of metabolic side effects and extrapyramidal symptoms. - Multiple RCTs (2010-2023) demonstrate significant symptom reduction when added to SSRIs in SSRI non-responders. *Risperidone* - **Risperidone** also has evidence for augmentation in treatment-resistant OCD and was historically used frequently. - However, recent meta-analyses suggest it may be **less effective and less well-tolerated** than aripiprazole. - Higher risk of metabolic side effects and extrapyramidal symptoms limits its use as a preferred augmentation agent. *Lamotrigine* - **Lamotrigine** is an anticonvulsant and mood stabilizer primarily used in **bipolar disorder** and epilepsy. - Evidence for augmentation in **treatment-resistant OCD is limited and inconsistent**, with only small case series and open-label trials. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant that is highly effective for OCD as **monotherapy** and is considered first-line treatment. - While it can be used when switching from SSRIs, the term "augmentation" typically refers to **adding** a medication to ongoing SSRI therapy, not replacing it. - Among serotonergic agents, it has the most potent serotonin reuptake inhibition but is not typically used as an add-on to SSRIs.
Question 10: A person often feels that his hands are contaminated and is forced to wash his hands. Recently, he feels this repetitive, distressing thought of repetitive hand washing has begun affecting his performance. Which of the following is the best treatment option for this patient?
- A. Exposure and response prevention (Correct Answer)
- B. Systematic desensitization
- C. Dialectical Behavior Therapy (DBT)
- D. SSRI medication
Explanation: ***Exposure and Response Prevention (ERP)*** - This is the **gold standard psychotherapy** for **Obsessive-Compulsive Disorder (OCD)**, which is clearly indicated by the repetitive distressing thoughts (obsessions about contamination) and compulsive handwashing (compulsion). - ERP involves gradually exposing the patient to the feared situation (contamination) while preventing the compulsive ritual (handwashing), allowing habituation to anxiety. - **CBT with ERP is considered first-line treatment** alongside SSRIs, with ERP often preferred as initial **monotherapy** due to **durable effects** and **no medication side effects**. *Systematic Desensitization* - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where a specific fear is present, rather than the obsession-compulsion cycle seen in OCD. - It involves gradual exposure with relaxation techniques, but **does not include response prevention**, which is crucial for breaking the compulsive cycle in OCD. *Dialectical Behavior Therapy (DBT)* - DBT is primarily developed for **Borderline Personality Disorder** and conditions with severe emotional dysregulation, self-harm, and interpersonal difficulties. - While it can help with emotional regulation, it **does not specifically target the obsession-compulsion cycle** that is the core pathology of OCD. *SSRI Medication* - **SSRIs are also first-line treatment for OCD** and are highly effective, particularly at higher doses than those used for depression. - However, when comparing initial treatment options, **ERP (psychotherapy) is often preferred** as monotherapy because it produces **sustained improvement** even after treatment ends, with lower relapse rates compared to medication discontinuation. - **Combination therapy (ERP + SSRI)** is typically reserved for moderate-to-severe OCD or when monotherapy is insufficient. - In this scenario asking for "best treatment option," ERP represents the most specific and effective **psychotherapeutic intervention** for OCD.
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