Obsessive-Compulsive and Related Disorders Practice Questions

Q: Which of the following conditions is associated with obsessive-compulsive disorder?

Depression. **Explanation:** **1. Why Depression is the Correct Answer:** Obsessive-Compulsive Disorder (OCD) and Major Depressive Disorder (MDD) share a high degree of comorbidity. Approximately **60-80%** of patients with OCD will experience a major depressive episode at some point in their lifetime, and about one-third are depressed at the time of initial presentation. This association is linked to shared neurobiological pathways, particularly involving **serotonergic dysregulation**. In many cases, the chronic distress and functional impairment caused by obsessions and compulsions lead to "secondary depression." **2. Analysis of Incorrect Options:** * **A. Mania:** While OCD can coexist with Bipolar Disorder, it is not the most characteristic association. In fact, SSRIs used to treat OCD can sometimes trigger a manic switch in predisposed individuals. * **C. Delusion:** By definition, OCD involves **obsessions**, which are recognized by the patient as their own thoughts (ego-dystonic) and are resisted. Delusions are fixed, false beliefs held with absolute certainty (ego-syntonic). If an obsession becomes a fixed belief, it is termed "OCD with poor/absent insight," but it remains distinct from primary delusional disorders. * **D. Schizophrenia:** Although "Schizo-obsessive" presentations exist, the prevalence is significantly lower than the association with depression. **3. Clinical Pearls for NEET-PG:** * **First-line Treatment:** SSRIs (at higher doses than used for depression) and CBT (Exposure and Response Prevention - ERP). * **Gold Standard Drug:** Clomipramine (a TCA with potent serotonin reuptake inhibition). * **Neuroanatomy:** OCD is associated with structural/functional abnormalities in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical or CSTC circuit). * **PANDAS:** Consider this diagnosis in children with sudden-onset OCD following a Group A Streptococcal infection.

Q: What is the primary defence mechanism observed in Obsessive-Compulsive Disorder (OCD)?

Reaction formation. **Explanation:** In Obsessive-Compulsive Disorder (OCD), the primary defense mechanisms are employed to manage the anxiety arising from aggressive or unacceptable id impulses. According to psychoanalytic theory, OCD is characterized by a regression from the oedipal phase to the **anal-sadistic phase**. **1. Why Reaction Formation is Correct:** Reaction formation is a key defense mechanism in OCD where an individual adopts behaviors and attitudes that are the exact opposite of their unconscious, unacceptable impulses. For example, a person with unconscious urges toward dirtiness or chaos becomes excessively meticulous, neat, and preoccupied with cleanliness. **2. Analysis of Incorrect Options:** * **Progression (A):** This is not a recognized defense mechanism in psychiatric literature. * **Regression (B):** While regression to the anal-sadistic phase occurs in OCD, it is the *process* leading to the symptoms rather than the primary defense mechanism used to handle the resulting anxiety. * **Magical Thinking (C):** This is a *symptom* or a cognitive distortion common in OCD (the belief that one’s thoughts can influence external events), not a defense mechanism. **High-Yield Clinical Pearls for NEET-PG:** * **The "Triad" of Defense Mechanisms in OCD:** Undoing, Isolation of Affect, and Reaction Formation. * **Undoing:** Performing a secondary act to "nullify" a previous unacceptable thought or action (e.g., compulsive handwashing to "wash away" a sinful thought). * **Isolation of Affect:** Stripping an idea of its emotional significance; the patient remembers the event but feels no emotion toward it. * **Gold Standard Treatment:** Exposure and Response Prevention (ERP) therapy + SSRIs (often at higher doses than used for depression). Clomipramine is the most effective TCA.

Q: A 30-year-old lady is diagnosed with Obsessive-Compulsive Disorder (OCD). Which of the following statements is not true about her condition?

Ego syntonic. **Explanation:** The core concept tested here is the distinction between **Ego-dystonic (Ego-alien)** and **Ego-syntonic** symptoms. **Why "Ego-syntonic" is the correct answer (The "Not True" statement):** Obsessive-Compulsive Disorder (OCD) is characterized by **Ego-dystonic** (or Ego-alien) thoughts. This means the obsessions are inconsistent with the individual’s self-perception, values, and desires. The patient views these thoughts as intrusive, irrational, and distressing. In contrast, **Ego-syntonic** means the symptoms are perceived as compatible with the self-concept (seen in Obsessive-Compulsive *Personality* Disorder or OCPD). Therefore, calling OCD "Ego-syntonic" is factually incorrect. **Analysis of Incorrect Options:** * **A. Ego alien:** This is a synonym for Ego-dystonic. The patient feels the thoughts are "foreign" to their nature. This is a hallmark of OCD. * **B. Insight is present:** Most OCD patients have good or fair insight; they recognize that their obsessions and compulsions are unreasonable or excessive. (Note: ICD-11 and DSM-5 now allow for a "with poor insight" specifier, but the classic description remains "insight present"). * **C. Failure to resist:** By definition, OCD involves an attempt to resist the obsessions or compulsions, which leads to rising anxiety. When the patient "fails to resist," they perform the compulsion to neutralize the distress. **High-Yield Clinical Pearls for NEET-PG:** * **OCD vs. OCPD:** OCD is Ego-dystonic (distressing symptoms); OCPD is Ego-syntonic (perfectionism is seen as a virtue). * **First-line Treatment:** SSRIs (at higher doses than for depression) and CBT (specifically Exposure and Response Prevention - ERP). * **Drug of Choice (TCA):** Clomipramine (most serotonin-selective TCA). * **Neurobiology:** Associated with overactivity in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical circuit).

Q: For severe intractable obsessional neurosis, which psychosurgery is the treatment of choice?

Cingulotomy. **Explanation:** **Bilateral Cingulotomy** is the most common and preferred psychosurgical procedure for severe, treatment-resistant **Obsessive-Compulsive Disorder (OCD)** and chronic refractory depression. The procedure involves creating a lesion in the anterior cingulate cortex, effectively interrupting the circuit between the limbic system and the frontal lobes (the "worry circuit"). It is reserved for patients who have failed multiple trials of high-dose SSRIs, Clomipramine, and intensive Cognitive Behavioral Therapy (CBT/ERP). **Analysis of Options:** * **Bifrontal Tractotomy:** This involves lesioning the white matter tracts (subcaudate tractotomy) beneath the head of the caudate nucleus. While used for OCD and depression, it is generally considered a second-line surgical option compared to cingulotomy. * **Amygdalotomy:** This procedure targets the amygdala and is primarily indicated for the management of **intractable aggression** or violent behavior, not typically for obsessional neurosis. * **Temporal Lobe Lesion:** Surgical interventions in the temporal lobe (like anterior temporal lobectomy) are standard treatments for **refractory temporal lobe epilepsy**, but they have no established role in treating OCD. **High-Yield Pearls for NEET-PG:** * **Target Site:** The "Cingulate Gyrus" is the primary target for OCD psychosurgery. * **Alternative Modern Approach:** **Deep Brain Stimulation (DBS)** is increasingly preferred over ablative surgery because it is reversible and adjustable. The most common DBS target for OCD is the **Internal Capsule (Ventral Capsule/Ventral Striatum)**. * **Legal Aspect:** Under the Mental Healthcare Act (2017), psychosurgery in India requires approval from a designated State Mental Health Authority.

Q: Which of the following tricyclic antidepressants is used in the management of OCD?

Clomipramine. **Explanation:** **Clomipramine** is the correct answer because it is the only Tricyclic Antidepressant (TCA) specifically indicated and FDA-approved for the treatment of Obsessive-Compulsive Disorder (OCD). **Why Clomipramine?** The pathophysiology of OCD is strongly linked to dysregulation in the serotonergic system. Unlike most other TCAs which primarily inhibit the reuptake of norepinephrine, Clomipramine is a **potent and selective inhibitor of serotonin reuptake (SRI)**. Its metabolite, desmethylclomipramine, affects norepinephrine, but its parent compound’s high affinity for serotonin transporters makes it uniquely effective for obsessive-compulsive symptoms. **Analysis of Incorrect Options:** * **A. Imipramine:** Primarily used for Enuresis in children and Panic Disorder; it lacks the potent serotonergic activity required to treat OCD. * **B. Amitriptyline:** Frequently used for neuropathic pain, migraine prophylaxis, and depression, but it has no proven efficacy in managing OCD. * **C. Amoxapine:** A tetracyclic antidepressant with dopamine-blocking properties (antipsychotic-like effects); it is not used for OCD. **High-Yield NEET-PG Pearls:** * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line pharmacological treatment for OCD due to a better side-effect profile. * **Clomipramine Status:** It is considered the "Gold Standard" in terms of efficacy but is usually reserved for treatment-resistant cases due to TCA-related side effects (anticholinergic, sedative, and cardiotoxic). * **Dosage:** OCD often requires higher doses of antidepressants and a longer duration (10–12 weeks) to show a clinical response compared to Depression. * **Combination:** The most effective management for OCD is a combination of Pharmacotherapy and **Exposure and Response Prevention (ERP)**, a form of Cognitive Behavioral Therapy.

Q: Which of the following is characterized by repetitive, ritualistic behaviors or mental acts performed in response to obsessions?

Compulsion. **Explanation:** **1. Why Compulsion is Correct:** In Psychiatry, **Compulsions** are defined as repetitive physical behaviors (e.g., hand washing, checking, ordering) or mental acts (e.g., praying, counting, repeating words silently) that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly. The primary goal of these rituals is to **neutralize or reduce the distress and anxiety** caused by the obsession, or to prevent some dreaded event or situation. **2. Why Other Options are Incorrect:** * **A. Obsession:** These are the **preceding** components. They are recurrent and persistent thoughts, urges, or images that are experienced as intrusive and unwanted, causing marked anxiety or distress. Obsessions are the "thought," while compulsions are the "action." * **C. Anxiety:** This is the emotional state or "affect" that arises from the obsession. While anxiety drives the need for the compulsion, it is not the behavior itself. **3. NEET-PG High-Yield Clinical Pearls:** * **Ego-dystonic Nature:** In OCD, the patient typically recognizes that the obsessions/compulsions are irrational or excessive (preserved insight), making them "ego-dystonic." This distinguishes OCD from OCPD (Obsessive-Compulsive Personality Disorder), which is ego-syntonic. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (SSRIs) at higher doses than used for depression. * **Behavioral Therapy:** Exposure and Response Prevention (ERP) is the gold-standard psychotherapy. * **Neurobiology:** OCD is associated with structural/functional abnormalities in the **Cortico-Striato-Thalamo-Cortical (CSTC) circuit.**

Question 1

Which of the following conditions is associated with obsessive-compulsive disorder?

Accepted Answer

Depression

Answer

Mania

Answer

Delusion

Answer

Schizophrenia

Question 2

What is the primary defence mechanism observed in Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

Reaction formation

Answer

Progression

Answer

Regression

Answer

Magical thinking

Question 3

An anxiety reaction in which the mind is preoccupied with certain thoughts and ideas that cannot be driven away is known as what?

Accepted Answer

Obsession

Answer

Impulse

Answer

Phobia

Answer

Confabulation

Question 4

Which of the following is true regarding Trichotillomania?

Accepted Answer

It involves repetitive hair pulling driven by increasing tension.

Answer

It is not an impulse control disorder.

Answer

It involves repetitive hair pulling without preceding tension.

Answer

No hair loss is seen.

Question 5

A 30-year-old lady is diagnosed with Obsessive-Compulsive Disorder (OCD). Which of the following statements is not true about her condition?

Accepted Answer

Ego syntonic

Answer

Ego alien

Answer

Insight is present

Answer

Failure to resist

Question 6

For severe intractable obsessional neurosis, which psychosurgery is the treatment of choice?

Accepted Answer

Cingulotomy

Answer

Bifrontal tractotomy

Answer

Amygdalotomy

Answer

Temporal lobe lesion

Question 7

Which of the following tricyclic antidepressants is used in the management of OCD?

Accepted Answer

Clomipramine

Answer

Imipramine

Answer

Amitriptyline

Answer

Amoxapine

Question 8

Which of the following features is characteristic of Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

Egosyntonic

Answer

Irrational thought

Answer

Resisting the idea

Answer

Persistence of idea

Question 9

All of the following brain areas are involved with Obsessive compulsive disorder except?

Accepted Answer

Claustrum

Answer

Orbitofrontal cortex

Answer

Basal ganglia

Answer

Head of caudate nucleus

Question 10

Which of the following is characterized by repetitive, ritualistic behaviors or mental acts performed in response to obsessions?

Accepted Answer

Compulsion

Answer

Obsession

Answer

Anxiety

Answer

None of the above

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?