Obsessive-Compulsive and Related Disorders Practice Questions

Q: Which of the following best describes a repetitive irresistible thought?

Obsession. ### Explanation **Correct Answer: B. Obsession** **Why it is correct:** An **obsession** is defined as a recurrent, persistent, and intrusive **thought**, image, or urge that is experienced as ego-dystonic (inconsistent with one’s self-image). These thoughts are perceived as "irresistible" because the patient cannot easily ignore or suppress them, leading to significant distress or anxiety. Key characteristics include being internal (originating in the patient's mind) and repetitive. **Why the other options are incorrect:** * **A. Phobia:** This is an excessive, irrational **fear** of a specific object, situation, or activity. While it involves avoidance, it is not characterized by a repetitive intrusive thought itself, but rather a reaction to an external stimulus. * **C. Compulsion:** This is a repetitive **behavior** or mental act (like counting or praying) that an individual feels driven to perform in response to an obsession. While obsessions are "thoughts," compulsions are the "actions" taken to neutralize the anxiety caused by those thoughts. * **D. Anxiety:** This is a generalized state of apprehension, tension, or uneasiness. It is a symptom or a broad category of disorders, not the specific repetitive thought process described. **Clinical Pearls for NEET-PG:** * **Ego-dystonic vs. Ego-syntonic:** OCD is typically ego-dystonic (the patient recognizes the thoughts are irrational), whereas OCPD (Personality Disorder) is ego-syntonic (the patient believes their way is correct). * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the pharmacological mainstay; Cognitive Behavioral Therapy (CBT) with **Exposure and Response Prevention (ERP)** is the gold-standard psychological intervention. * **Neurobiology:** OCD is associated with structural/functional abnormalities in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical circuit).

Q: A college student is brought to the student health center by his roommate. He has been missing class because he needs to check the room lock many times before he can leave. Once he starts to ride his bicycle to class, he frequently returns several times to lock the door. He repeats this ritual every morning and often when he leaves the house. He misses his appointments and his academic performance suffers. His hands are chafed. Which of the following is the most likely diagnosis?

Obsessive compulsive disorder. **Explanation:** The clinical presentation is a classic case of **Obsessive-Compulsive Disorder (OCD)**. The patient experiences recurrent, intrusive thoughts (obsessions) regarding security/safety, which lead to repetitive behaviors (compulsions) like checking the lock. These rituals are time-consuming, cause significant functional impairment (missing classes/appointments), and are ego-dystonic. The mention of "chafed hands" is a high-yield clinical sign suggesting excessive hand-washing, another common compulsion. **Why other options are incorrect:** * **Generalized Anxiety Disorder (GAD):** Characterized by excessive, uncontrollable worry about various everyday issues (finances, health, work) for at least 6 months, rather than specific ritualistic behaviors or obsessions. * **Panic Disorder:** Involves recurrent, unexpected panic attacks (sudden surges of intense fear with physical symptoms like palpitations and dyspnea) and the fear of future attacks. * **Paranoid Personality Disorder:** A pervasive pattern of distrust and suspiciousness where others' motives are interpreted as malevolent. It does not involve ritualistic compulsions. **Clinical Pearls for NEET-PG:** * **Ego-dystonic:** In OCD, the patient recognizes that the symptoms are irrational and a product of their own mind (unlike OCPD, which is ego-syntonic). * **First-line Treatment:** Cognitive Behavioral Therapy (CBT) with **Exposure and Response Prevention (ERP)** and/or **SSRIs** (often requiring higher doses than in depression). * **Neurobiology:** Associated with structural/functional abnormalities in the **Orbitofrontal cortex, Anterior Cingulate Cortex, and Caudate nucleus** (Cortico-striato-thalamo-cortical circuit).

Q: What is the most common psychiatric disorder seen with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)?

Obsessive-Compulsive Disorder (OCD). **Explanation:** **PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)** is a clinical diagnosis characterized by the sudden, "overnight" onset of neuropsychiatric symptoms following a Group A Beta-hemolytic Streptococcal (GABHS) infection. **Why Obsessive-Compulsive Disorder (OCD) is correct:** The hallmark of PANDAS is the abrupt onset of **Obsessive-Compulsive Disorder (OCD)** or **Tic disorders**. The underlying pathophysiology involves **molecular mimicry**, where antibodies produced against streptococcal bacteria cross-react with the **basal ganglia** (specifically the caudate nucleus). Since the basal ganglia are integral to the cortico-striato-thalamo-cortical (CSTC) circuits that regulate behavior and motor control, their dysfunction manifests primarily as acute OCD. **Why other options are incorrect:** * **Anxiety Disorder:** While separation anxiety is a common *co-occurring* symptom in PANDAS, it is not the defining or most common primary diagnosis compared to OCD. * **Depression:** Mood lability and irritability are frequently seen, but clinical depression is not the primary diagnostic feature of the syndrome. * **Delusional Disorder:** Psychotic symptoms are rare in PANDAS; the presentation is typically neurodevelopmental and behavioral rather than psychotic. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria:** Sudden onset of OCD/Tics, prepubertal onset (usually ages 3–12), and temporal association with GABHS (confirmed by positive throat culture or elevated ASO/Anti-DNase B titers). * **Associated Symptoms:** "Sun-setting" of symptoms, urinary urgency, hyperactivity (ADHD-like), and deterioration in handwriting (dysgraphia). * **Treatment:** Standard OCD management (SSRIs, CBT) and, in severe cases, immunomodulatory therapies (IVIG or plasmapheresis). Antibiotics are used to treat the active infection.

Q: Which of the following therapies are used in the treatment of Obsessive-Compulsive Disorder (OCD)?

All of the above. **Explanation:** The treatment of Obsessive-Compulsive Disorder (OCD) involves a combination of pharmacotherapy (primarily SSRIs) and specialized behavioral therapies. The core principle of behavioral therapy in OCD is to break the cycle of anxiety and the subsequent ritualistic compulsion. **1. Exposure and Response Prevention (ERP):** This is the **gold standard** behavioral treatment for OCD. Patients are exposed to the anxiety-provoking stimulus (Exposure) and strictly prevented from performing the ritualistic compulsion (Response Prevention). This leads to **habituation**, where the patient learns that the anxiety decreases naturally without the need for a compulsion. **2. Flooding:** This is a form of intense exposure therapy where the patient is immediately exposed to their most feared stimulus for a prolonged period. Unlike ERP, which can be graded, flooding is "all-at-once." While effective, it is often less tolerated by patients due to the high initial distress. **3. Systematic Desensitization:** Developed by Joseph Wolpe, this involves creating a hierarchy of fears and pairing exposure with relaxation techniques (reciprocal inhibition). While more commonly used for phobias, it is a valid behavioral approach for OCD patients who cannot tolerate the intensity of ERP. **Clinical Pearls for NEET-PG:** * **First-line Drug:** SSRIs (e.g., Fluoxetine, Fluvoxamine, Sertraline) are the drugs of choice. Note that OCD requires **higher doses** and a **longer duration** (10-12 weeks) for a response compared to depression. * **Most Effective TCA:** Clomipramine (a serotonin-specific TCA) is highly effective but often second-line due to its side-effect profile. * **Neurosurgery for Refractory OCD:** Cingulotomy or Gamma knife capsulotomy are considered in severe, treatment-resistant cases. * **Deep Brain Stimulation (DBS):** Targets the ventral striatum or internal capsule.

Q: Which of the following selective serotonin reuptake inhibitors (SSRIs) is primarily used in the management of Obsessive-Compulsive Disorder (OCD)?

fluvoxamine. **Explanation:** **Correct Answer: D. Fluvoxamine** Fluvoxamine is a Selective Serotonin Reuptake Inhibitor (SSRI) that holds the distinction of being the first SSRI specifically FDA-approved for the treatment of **Obsessive-Compulsive Disorder (OCD)**. While most SSRIs are effective for OCD, Fluvoxamine is frequently highlighted in exams due to its historical significance and primary clinical association with OCD management rather than major depressive disorder. It works by increasing synaptic serotonin levels, which is the mainstay of pharmacological treatment for obsessive thoughts and compulsive behaviors. **Analysis of Incorrect Options:** * **A. Clomipramine:** While this is the "Gold Standard" drug for OCD and often more efficacious than SSRIs, it is a **Tricyclic Antidepressant (TCA)**, not an SSRI. The question specifically asks for an SSRI. * **B. Sertraline:** Although Sertraline is an SSRI used in OCD, Fluvoxamine is the more "classic" textbook answer when identifying an SSRI primarily associated with OCD in a multiple-choice format. * **C. Mirtazapine:** This is an **Atypical Antidepressant** (NaSSA – Noradrenergic and Specific Serotonergic Antidepressant). It is not a first-line treatment for OCD and is not an SSRI. **High-Yield Clinical Pearls for NEET-PG:** * **First-line treatment for OCD:** SSRIs (Fluoxetine, Fluvoxamine, Sertraline, Paroxetine). * **Dosage:** OCD requires **higher doses** of SSRIs compared to Depression (e.g., Fluvoxamine up to 300mg/day). * **Duration:** Treatment must be continued for at least **10–12 weeks** before assessing response. * **Most effective treatment:** Combination of Pharmacotherapy (SSRIs) and Behavioral Therapy (**Exposure and Response Prevention - ERP**).

Q: Ego's defense mechanism "Undoing" is typically seen in which of the following conditions?

Obsessive compulsive neurosis. **Explanation:** The correct answer is **Obsessive compulsive neurosis (OCD)**. **1. Why "Undoing" is the correct mechanism:** In psychodynamic theory, **Undoing** is a primary defense mechanism where an individual performs a specific action or ritual to symbolically "cancel out" or "reverse" an unacceptable, anxiety-provoking thought or previous action. In OCD, the **compulsion** serves as the physical manifestation of undoing. For example, a patient who has a "sinful" thought (obsession) may wash their hands repeatedly (compulsion) to "undo" the perceived guilt or harm. **2. Analysis of Incorrect Options:** * **Depression:** Typically associated with defense mechanisms like **Introjection** (turning anger inward) and **Learned Helplessness**. * **Schizophrenia:** Characterized by primitive/narcissistic defenses such as **Projection**, **Denial**, and **Splitting**. * **Hysteria (Conversion Disorder):** Classically associated with **Repression** and **Identification**. The primary mechanism is the conversion of psychic anxiety into a physical symptom (somatization). **3. NEET-PG High-Yield Pearls:** * **OCD Defense Triad:** The three classic defense mechanisms seen in OCD are **Undoing**, **Isolation of Affect** (separating an idea from its emotional significance), and **Reaction Formation** (acting the opposite of one's impulses). * **Ego-Dystonic:** OCD symptoms are "ego-dystonic" (the patient recognizes the thoughts as irrational and unwanted), whereas OCPD (Personality Disorder) is "ego-syntonic." * **Neurobiology:** OCD is linked to the **Orbitofrontal-Striatal-Thalamic circuit** and serotonin dysregulation. * **Treatment:** First-line treatment includes **SSRIs** (at higher doses than depression) and **Exposure and Response Prevention (ERP)** therapy.

Question 1

Which of the following best describes a repetitive irresistible thought?

Accepted Answer

Obsession

Answer

Phobia

Answer

Compulsion

Answer

Anxiety

Question 2

A child with obsessive-compulsive disorder (OCD) undergoes imaging of the brain. Which of the following structures is likely to show atrophy?

Accepted Answer

Caudate nucleus

Answer

Putamen

Answer

Cerebellum

Answer

Globus pallidus

Question 3

A college student is brought to the student health center by his roommate. He has been missing class because he needs to check the room lock many times before he can leave. Once he starts to ride his bicycle to class, he frequently returns several times to lock the door. He repeats this ritual every morning and often when he leaves the house. He misses his appointments and his academic performance suffers. His hands are chafed. Which of the following is the most likely diagnosis?

Accepted Answer

Obsessive compulsive disorder

Answer

Generalized anxiety disorder

Answer

Panic disorder

Answer

Paranoid personality disorder

Question 4

What is the most common psychiatric disorder seen with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)?

Accepted Answer

Obsessive-Compulsive Disorder (OCD)

Answer

Depression

Answer

Anxiety disorder

Answer

Delusional disorder

Question 5

Which of the following therapies are used in the treatment of Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

All of the above

Answer

Exposure and response prevention

Answer

Flooding

Answer

Systemic desensitization

Question 6

Recurrent thoughts of doing something are known as?

Accepted Answer

Obsession

Answer

Compulsion

Answer

Preoccupation

Answer

Confabulations

Question 7

A person washes hands repeatedly due to a fear of contracting HIV. What condition is this person likely suffering from?

Accepted Answer

Obsessive-compulsive disorder

Answer

Phobic disorder

Answer

Dissociative and conversion disorder

Answer

Somatoform disorder

Question 8

Which of the following selective serotonin reuptake inhibitors (SSRIs) is primarily used in the management of Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

fluvoxamine

Answer

clomipramine

Answer

sertraline

Answer

mirtazapine

Question 9

Ego's defense mechanism "Undoing" is typically seen in which of the following conditions?

Accepted Answer

Obsessive compulsive neurosis

Answer

Depression

Answer

Schizophrenia

Answer

Hysteria

Question 10

All are treatment modalities of Obsessive-Compulsive Disorder except?

Accepted Answer

MAO inhibitors

Answer

Exposure and response prevention

Answer

Psychoanalytic psychotherapy

Answer

Clomipramine

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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