Obsessive-Compulsive and Related Disorders — MCQs
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A 22-year-old woman presents with complaints of an intense urge to shower, spending hours in the shower and finding it difficult to exit. She follows a rigid sequence of actions while bathing, scrubbing each body part three times in the same order. Although aware that this behavior is abnormal, she becomes anxious if she attempts to deviate from this pattern. Her work as a receptionist is frequently disrupted due to her tardiness, yet she gets along well with her coworkers. What is the most appropriate first-line pharmacological treatment for her condition?
Which of the following statements about obsessive-compulsive disorder (OCD) is correct?
Kleptomania is classified as a/an?
Which of the following statements about kleptomania is true?
What neurotransmitter is mainly involved in obsessive-compulsive disorder (OCD)?
Which of the following represents a form of sexual behavior that is considered pathological and legally prohibited due to harm and exploitation?
Obsessive-Compulsive and Related Disorders Indian Medical PG Practice Questions and MCQs
Question 131: A 22-year-old woman presents with complaints of an intense urge to shower, spending hours in the shower and finding it difficult to exit. She follows a rigid sequence of actions while bathing, scrubbing each body part three times in the same order. Although aware that this behavior is abnormal, she becomes anxious if she attempts to deviate from this pattern. Her work as a receptionist is frequently disrupted due to her tardiness, yet she gets along well with her coworkers. What is the most appropriate first-line pharmacological treatment for her condition?
- A. Fluvoxamine (Correct Answer)
- B. Haloperidol
- C. Quetiapine
- D. Buspirone
Explanation: ***Fluvoxamine*** - The patient's symptoms of intense urges, compulsive showering rituals, and significant anxiety upon deviation are characteristic of **Obsessive-Compulsive Disorder (OCD)**. - **SSRIs** (Selective Serotonin Reuptake Inhibitors), such as fluvoxamine, are considered the first-line pharmacologic treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. *Buspirone* - Buspirone is an **anxiolytic** primarily used for generalized anxiety disorder, but it has limited efficacy in treating the core symptoms of OCD. - It works as a **serotonin 5-HT1A receptor partial agonist** and does not target the specific neurochemical imbalances associated with OCD. *Haloperidol* - Haloperidol is a **first-generation antipsychotic** used to treat psychotic disorders (e.g., schizophrenia) and severe behavioral disturbances. - It is not indicated for OCD as a primary treatment and its side effects, including **extrapyramidal symptoms**, make it unsuitable for this condition unless there are comorbid psychotic features. *Quetiapine* - Quetiapine is a **second-generation antipsychotic** used for conditions like schizophrenia, bipolar disorder, and as an adjunct for major depressive disorder. - While sometimes used **off-label as an augmentation strategy** in refractory OCD, it is not considered a first-line treatment and carries a risk of metabolic side effects.
Question 132: Which of the following statements about obsessive-compulsive disorder (OCD) is correct?
- A. The most common obsession is contamination.
- B. The most common compulsion is checking.
- C. All the above are true
- D. Obsessions are intrusive thoughts that cause significant anxiety. (Correct Answer)
Explanation: ***Obsessions are intrusive thoughts that cause significant anxiety.*** - **Obsessions** are defined as recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, causing marked anxiety or distress. - Individuals with OCD attempt to ignore, suppress, or neutralize these thoughts with another thought or action (i.e., a **compulsion**). *The most common obsession is contamination.* - While **contamination** is a very common obsession, studies suggest that fears of **harming others/accidental harm** or **perfectionism/symmetry** are equally or even more prevalent in some cohorts. - The prevalence of specific obsessions can vary, but contamination is definitely among the top recognized themes. *The most common compulsion is checking.* - **Checking** is indeed a very common compulsion in OCD; however, **washing/cleaning** rituals are also extremely frequent, especially in individuals with contamination obsessions. - Other common compulsions include **counting**, **ordering/arranging**, and **repeating actions**. *All the above are true* - This statement is incorrect because the previous two options (regarding the most common obsession and compulsion) are not definitively true across all populations and classifications.
Question 133: Kleptomania is classified as a/an?
- A. None of the options (Correct Answer)
- B. Impulse control disorder
- C. Anxiety disorder
- D. Mood disorder
Explanation: ***None of the options*** - **Kleptomania** is classified as an **Obsessive-Compulsive and Related Disorder** in the **DSM-5**, not as an impulse control disorder (which was its DSM-IV classification). - The condition is characterized by recurrent failure to resist urges to steal objects not needed for personal use or monetary value, with increasing tension before the act and relief or gratification afterward. - The reclassification reflects the **compulsive nature** of the behavior and phenomenological similarities with OCD, including repetitive behaviors and difficulty resisting urges. *Impulse control disorder* - This was the **DSM-IV classification** but is now **outdated**. - In DSM-5, kleptomania was moved to the Obsessive-Compulsive and Related Disorders category to better reflect its clinical phenomenology. *Anxiety disorder* - **Anxiety disorders** are primarily characterized by excessive fear, worry, or apprehension, which is not the core feature of kleptomania. - While anxiety may precede or follow an episode of stealing, it is not the primary driving pathology. *Mood disorder* - **Mood disorders** involve significant disturbances in emotional state, such as persistent sadness in depression or elevated mood in bipolar disorder. - The defining feature of kleptomania is the irresistible urge to steal, not a primary mood disturbance.
Question 134: Which of the following statements about kleptomania is true?
- A. Men are more likely to present with kleptomania at a later age than women.
- B. Kleptomania typically does not develop from adolescent theft.
- C. Men are more likely to face legal consequences for kleptomania.
- D. Kleptomaniacs steal from various sources, not just stores. (Correct Answer)
Explanation: ***Kleptomaniacs steal from various sources, not just stores.*** - Individuals with kleptomania feel an urge to steal items regardless of their personal value or usefulness, and this can occur in various settings, including **homes, workplaces, and public places**, not exclusively retail stores. - The compulsion is driven by the **tension relief** associated with the act of stealing itself, rather than the acquisition of specific items from particular locations. - This is the most accurate statement as kleptomania is **not location-specific**. *Men are more likely to present with kleptomania at a later age than women.* - Kleptomania is reported to be **more prevalent in females** than males (approximately 3:1 ratio), with typical onset in **adolescence or early adulthood**. - There is **no consistent evidence** to suggest that men present at a significantly later age compared to women. *Kleptomania typically does not develop from adolescent theft.* - While this statement has some truth to it (most adolescent theft is **conduct disorder**, not kleptomania), the onset of true kleptomania **can occur in adolescence**. - However, kleptomania is diagnostically **distinct** from adolescent antisocial behavior or conduct disorder theft, which is driven by different motivations (peer pressure, need, rebellion). - The statement is considered false because kleptomania's **initial manifestation** can occur during adolescent years, even though it differs from typical adolescent theft behaviors. *Men are more likely to face legal consequences for kleptomania.* - There is **no strong evidence** that gender significantly determines legal consequences for kleptomania. - Legal outcomes depend more on **frequency of theft, value of items stolen, prior criminal record**, and local law enforcement practices rather than gender. - Both men and women with kleptomania face legal risks when caught stealing.
Question 135: What neurotransmitter is mainly involved in obsessive-compulsive disorder (OCD)?
- A. GABA
- B. NE
- C. Dopamine
- D. Serotonin (Correct Answer)
Explanation: ***Serotonin*** - The **serotonin system** is consistently implicated in the pathophysiology of OCD, and selective serotonin reuptake inhibitors (**SSRIs**) are the first-line pharmacotherapy. - Dysregulation in **serotonin levels** and receptor function is thought to contribute to the repetitive thoughts and compulsive behaviors characteristic of the disorder. *GABA* - **Gamma-aminobutyric acid (GABA)** is the primary inhibitory neurotransmitter in the brain and is mainly associated with anxiety disorders. - While anxiety is often comorbid with OCD, GABA dysregulation is not considered the primary neurochemical basis for the core symptoms of OCD. *NE* - **Norepinephrine (NE)** is a neurotransmitter involved in the 'fight or flight' response, attention, and mood. - While NE imbalances can contribute to anxiety and mood disorders, it is not considered the main neurotransmitter primarily implicated in the core pathology of OCD. *Dopamine* - **Dopamine** is mainly associated with reward, motivation, and motor control, and plays a role in conditions like schizophrenia and Parkinson's disease. - While dopamine has a **significant secondary role** in OCD (especially in the cortico-striato-thalamo-cortical circuits) and dopamine antagonists are used as augmentation therapy in treatment-resistant cases, **serotonin remains the primary neurotransmitter** implicated in OCD pathophysiology.
Question 136: Which of the following represents a form of sexual behavior that is considered pathological and legally prohibited due to harm and exploitation?
- A. Oral sex
- B. Same-sex relationships
- C. Sexual relations between close relatives (Correct Answer)
- D. Loss of control over bowel movements
Explanation: ***Sexual relations between close relatives (Incest)*** - **Incest** refers to sexual activity between close blood relatives and is universally prohibited due to **genetic risks, power imbalances, and psychological harm** - While not classified as a paraphilic disorder in DSM-5, incestuous behavior is considered pathological when it involves **exploitation, coercion, or abuse**, particularly with minors - It is **legally prohibited** in virtually all jurisdictions and violates fundamental ethical and social norms regarding consent and familial boundaries - Clinical significance arises from the **severe psychological trauma** to victims and the disruption of normal family dynamics *Oral sex* - Oral sex is a **normative sexual activity** between consenting adults and is part of typical human sexual behavior - It is not pathological, illegal, or considered atypical sexual behavior in modern psychiatric classification - Represents normal sexual variation and intimacy *Same-sex relationships* - Same-sex relationships represent **normal human sexual orientation diversity** and are not pathological - Homosexuality was removed from DSM in 1973 and is recognized as a natural variation of human sexuality - Same-sex relationships are legally recognized and protected in many countries *Loss of control over bowel movements* - **Fecal incontinence** is a **medical symptom** related to gastrointestinal or neurological dysfunction, not a sexual behavior - This is completely unrelated to sexual behavior classification and requires medical evaluation - Has no relevance to the assessment of sexual behavior patterns
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