Obsessive-Compulsive and Related Disorders Practice Questions

Q: All of the following are signs of poor prognosis in obsessive-compulsive disorder (OCD) except?

Good social adjustment. In Psychiatry, understanding the prognostic factors of Obsessive-Compulsive Disorder (OCD) is high-yield for competitive exams like NEET-PG. ### **Explanation** **OCD** is generally a chronic, waxing-and-waning condition. Prognosis is determined by the severity of symptoms, age of onset, and comorbid conditions. 1. **Why Option A is Correct:** **Good social adjustment** (and good premorbid personality) is a **favorable prognostic factor**. Patients who maintain strong social ties and functional capacity generally respond better to treatment and have higher rates of remission. 2. **Why Other Options are Incorrect (Signs of Poor Prognosis):** * **B. Coexisting Major Depression:** Comorbidity, especially with depression or personality disorders, complicates treatment and increases the risk of chronicity. * **C. Childhood Onset:** Early onset (pediatric OCD) is often associated with a more severe clinical course, higher genetic loading, and a higher likelihood of tic disorders. * **D. Bizarre Compulsions:** The presence of unusual or "bizarre" compulsions often indicates poor insight or a shift toward the psychotic spectrum, making the disorder more resistant to standard SSRI/CBT therapy. ### **High-Yield Clinical Pearls for NEET-PG** * **Good Prognosis Factors:** Late onset, short duration of symptoms, presence of a precipitating event, and episodic nature of symptoms. * **Poor Prognosis Factors:** Yielding to compulsions (not resisting), symmetry obsessions, presence of tics, and delusional intensity of beliefs (poor insight). * **Treatment of Choice:** Cognitive Behavioral Therapy (specifically **Exposure and Response Prevention - ERP**) + **SSRIs** (e.g., Fluoxetine, Fluvoxamine). * **Drug of Choice (TCA):** Clomipramine (most potent but second-line due to side effects).

Q: All of the following statements regarding obsessions are true EXCEPT:

Obsessions are a disorder of thought content.. ### Explanation **1. Why Option C is the correct answer (The "EXCEPT" statement):** In psychopathology, obsessions are classified as a **disorder of the possession of thought**, not thought content. The defining feature of an obsession is that the patient recognizes the thought as their own (internal origin) but feels it is being forced upon them. Disorders of thought content include delusions, phobias, and preoccupations. **2. Analysis of Incorrect Options:** * **Option A (Persist despite resistance):** This is a hallmark of OCD. Patients typically recognize the thoughts as irrational or excessive and make active attempts to ignore, suppress, or neutralize them with some other thought or action (compulsions). * **Option B (Ego-dystonic):** Obsessions are ego-dystonic, meaning they are inconsistent with the individual's self-image, beliefs, and values. This causes significant distress, unlike ego-syntonic conditions (e.g., OCPD or Delusions) where the patient views the thoughts as appropriate. * **Option D (Seen in schizophrenia):** While primarily associated with OCD, "obsessive-compulsive symptoms" (OCS) can occur in up to 25% of patients with schizophrenia. When both criteria are fully met, it is sometimes referred to as Schizo-obsessive disorder. **3. NEET-PG High-Yield Pearls:** * **Obsessions:** Disorder of **Possession** (Sense of Agency). * **Delusions:** Disorder of **Content**. * **Thought Insertion:** Disorder of **Possession** (Patient believes thoughts are alienated/external). * **OCD vs. OCPD:** OCD is ego-dystonic (distressing); OCPD (Personality Disorder) is ego-syntonic (perceived as correct/ideal). * **First-line Treatment:** SSRIs (at higher doses than for depression) and CBT (Exposure and Response Prevention - ERP).

Q: Which drug is most useful in the treatment of obsessive-compulsive disorder?

Fluoxetine. **Explanation:** **Obsessive-Compulsive Disorder (OCD)** is primarily managed through a combination of Pharmacotherapy and Cognitive Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP). 1. **Why Fluoxetine is correct:** The first-line pharmacological treatment for OCD consists of **Selective Serotonin Reuptake Inhibitors (SSRIs)**. Fluoxetine is a potent SSRI that increases synaptic serotonin levels, which is crucial in modulating the orbitofrontal-striatal circuitry implicated in OCD. It is important to note that in OCD, SSRIs are typically used at **higher doses** than those required for depression (e.g., 40–80 mg of Fluoxetine). 2. **Why the other options are incorrect:** * **Flucytosine:** An antifungal medication used primarily in systemic candidiasis or cryptococcal meningitis. * **Fluorouracil (5-FU):** A cytotoxic chemotherapy agent (antimetabolite) used in treating various cancers (e.g., colorectal, breast). * **Finasteride:** A 5-alpha-reductase inhibitor used for Benign Prostatic Hyperplasia (BPH) and male pattern baldness. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC):** SSRIs (Fluoxetine, Fluvoxamine, Sertraline, Paroxetine) are the first-line agents. * **Most Effective Drug:** **Clomipramine** (a TCA) is often considered the most efficacious drug for OCD due to its potent serotonergic activity, but it is second-line due to its side-effect profile (anticholinergic effects, cardiotoxicity). * **Treatment Duration:** OCD requires a longer trial (8–12 weeks) to see a clinical response compared to depression (2–4 weeks). * **Refractory Cases:** Deep Brain Stimulation (DBS) targeting the **ventral striatum** or **internal capsule** may be considered.

Question 1

Which of the following Obsessive-Compulsive and Related Disorders carries the worst prognosis for treatment?

Accepted Answer

Hoarding disorder

Answer

Pathological doubt

Answer

Contamination

Answer

Obsessive thought disorder

Question 2

All of the following are signs of poor prognosis in obsessive-compulsive disorder (OCD) except?

Accepted Answer

Good social adjustment

Answer

Coexisting major depression

Answer

Childhood onset

Answer

Bizarre compulsions

Question 3

Which of the following characterizes Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

Onset typically occurs in late adulthood.

Answer

Obsessions of contamination are rare.

Answer

Buspirone is used to augment therapy.

Answer

The patient readily discusses the symptoms.

Question 4

What is the drug of choice for obsessive-compulsive disorder?

Accepted Answer

Sertraline

Answer

Amoxapine

Answer

Hydroxyzine

Answer

Alprazolam

Question 5

All of the following statements regarding obsessions are true EXCEPT:

Accepted Answer

Obsessions are a disorder of thought content.

Answer

Obsessions persist despite resistance by the patient.

Answer

Obsessions are ego-dystonic.

Answer

Obsessions can be seen in schizophrenia.

Question 6

Which drug is most useful in the treatment of obsessive-compulsive disorder?

Accepted Answer

Fluoxetine

Answer

Flucytosine

Answer

Fluorouracil

Answer

Finasteride

Question 7

A 12-year-old boy presents with unusual behaviors, including spending over two hours in the shower due to a preoccupation with 'germs' and a compulsive need to wash repeatedly, despite recognizing the irrationality of these actions. He also exhibits repetitive checking behavior, such as checking his bag for a pen every five minutes, which significantly impacts his ability to complete exams on time. What is the most likely diagnosis?

Accepted Answer

Obsessive Compulsive Disorder

Answer

Specific phobia for germs

Answer

Autism Spectrum Disorder

Answer

Cyclothymia

Question 8

A person has recurrent intrusive thoughts which he thinks are irrational and wants to stop is:

Accepted Answer

Obsession

Answer

Compulsion

Answer

Delusion

Answer

Hallucination

Question 9

In obsessive-compulsive disorder, which of the following is NOT a commonly used medication?

Accepted Answer

Haloperidol

Answer

Clomipramine

Answer

Sertraline

Answer

Carbamazepine

Question 10

A feeling of uncertainty and an excessive sense of responsibility is characteristic of which condition?

Accepted Answer

Obsessive-compulsive disorder

Answer

Generalized anxiety disorder

Answer

Phobia

Answer

Personality disorder

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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