Obsessive-Compulsive and Related Disorders — MCQs
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Which of the following best describes a repetitive irresistible thought?
A child with obsessive-compulsive disorder (OCD) undergoes imaging of the brain. Which of the following structures is likely to show atrophy?
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?
What is the most common psychiatric disorder seen with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)?
Which of the following therapies are used in the treatment of Obsessive-Compulsive Disorder (OCD)?
Recurrent thoughts of doing something are known as?
A person washes hands repeatedly due to a fear of contracting HIV. What condition is this person likely suffering from?
Which of the following selective serotonin reuptake inhibitors (SSRIs) is primarily used in the management of Obsessive-Compulsive Disorder (OCD)?
Ego's defense mechanism "Undoing" is typically seen in which of the following conditions?
All are treatment modalities of Obsessive-Compulsive Disorder except?
Obsessive-Compulsive and Related Disorders Indian Medical PG Practice Questions and MCQs
Question 41: Which of the following best describes a repetitive irresistible thought?
- A. Phobia
- B. Obsession (Correct Answer)
- C. Compulsion
- D. Anxiety
Explanation: ### 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).
Question 42: A child with obsessive-compulsive disorder (OCD) undergoes imaging of the brain. Which of the following structures is likely to show atrophy?
- A. Putamen
- B. Cerebellum
- C. Caudate nucleus (Correct Answer)
- D. Globus pallidus
Explanation: ### Explanation **Correct Option: C. Caudate nucleus** The pathophysiology of Obsessive-Compulsive Disorder (OCD) is primarily linked to the **Cortico-Striato-Thalamo-Cortical (CSTC) circuit**. In patients with OCD, there is a functional and structural abnormality within this loop. Specifically, neuroimaging studies (MRI and CT) have consistently demonstrated **bilateral reduction in the volume (atrophy)** of the **caudate nucleus**. The caudate nucleus acts as a "gatekeeper" that normally filters out repetitive, intrusive thoughts. When the caudate is atrophied or dysfunctional, it fails to inhibit these signals, leading to the persistent obsessions and compulsions characteristic of the disorder. PET scans often complement this finding by showing hypermetabolism in the orbitofrontal cortex and the anterior cingulate gyrus. **Analysis of Incorrect Options:** * **A. Putamen:** While the putamen is part of the striatum, it is more closely associated with motor regulation (e.g., Tourette’s syndrome). In OCD, the primary pathology lies in the caudate rather than the putamen. * **B. Cerebellum:** The cerebellum is primarily involved in motor coordination and balance. While some recent research explores its role in cognition, it is not a classic site of atrophy in OCD. * **D. Globus pallidus:** Although part of the basal ganglia and the CSTC circuit, it typically does not show primary atrophy in OCD. Its involvement is usually secondary to the dysfunction in the caudate and orbitofrontal cortex. **High-Yield Clinical Pearls for NEET-PG:** * **Neurobiology:** OCD is associated with **Serotonin** dysregulation (hence SSRIs are first-line). * **Imaging:** Look for **decreased caudate volume** and **increased activity** in the **Orbitofrontal Cortex (OFC)**. * **PANDAS:** Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections can cause sudden-onset OCD due to inflammation of the basal ganglia. * **Surgery:** In refractory OCD, **Cingulotomy** or **Gamma knife capsulotomy** are the surgical interventions of choice.
Question 43: 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?
- A. Generalized anxiety disorder
- B. Obsessive compulsive disorder (Correct Answer)
- C. Panic disorder
- D. Paranoid personality disorder
Explanation: **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).
Question 44: What is the most common psychiatric disorder seen with PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections)?
- A. Depression
- B. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
- C. Anxiety disorder
- D. Delusional disorder
Explanation: **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.
Question 45: Which of the following therapies are used in the treatment of Obsessive-Compulsive Disorder (OCD)?
- A. Exposure and response prevention
- B. Flooding
- C. Systemic desensitization
- D. All of the above (Correct Answer)
Explanation: **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.
Question 46: Recurrent thoughts of doing something are known as?
- A. Obsession (Correct Answer)
- B. Compulsion
- C. Preoccupation
- D. Confabulations
Explanation: **Explanation:** **Obsessions** are defined as recurrent, persistent, and intrusive thoughts, urges, or images that are experienced as ego-dystonic (inconsistent with one’s self-image). These thoughts are often distressing and cause significant anxiety. In the context of the question, the "recurrent thought of doing something" (e.g., the thought of stabbing someone or jumping from a height) is the hallmark of an obsession. **Analysis of Incorrect Options:** * **Compulsion:** These are repetitive **behaviors** (e.g., hand washing) or mental acts (e.g., counting) that an individual feels driven to perform in response to an obsession or according to rigid rules. While obsessions are thoughts, compulsions are the actions taken to neutralize the resulting anxiety. * **Preoccupation:** This refers to a state where a person’s mind is absorbed by a particular topic (e.g., preoccupation with perceived defects in Body Dysmorphic Disorder). Unlike obsessions, these are not necessarily intrusive or ego-dystonic. * **Confabulations:** This is a memory disturbance where a patient fills in memory gaps with fabricated or distorted information, typically seen in **Korsakoff’s Psychosis**. It is a disorder of memory, not thought content. **High-Yield Clinical Pearls for NEET-PG:** * **Ego-dystonic vs. Ego-syntonic:** OCD is typically ego-dystonic (the patient recognizes the thoughts are irrational), whereas OCPD (Obsessive-Compulsive Personality Disorder) is ego-syntonic. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the pharmacological treatment of choice, often requiring higher doses than in depression. * **Behavioral Therapy:** Exposure and Response Prevention (ERP) is the most effective psychological intervention. * **Neurobiology:** OCD is associated with structural and functional abnormalities in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical circuit).
Question 47: A person washes hands repeatedly due to a fear of contracting HIV. What condition is this person likely suffering from?
- A. Phobic disorder
- B. Obsessive-compulsive disorder (Correct Answer)
- C. Dissociative and conversion disorder
- D. Somatoform disorder
Explanation: **Explanation:** The correct answer is **Obsessive-compulsive disorder (OCD)**. **Why it is correct:** OCD is characterized by two key components: **Obsessions** (recurrent, intrusive thoughts, impulses, or images that cause anxiety) and **Compulsions** (repetitive behaviors or mental acts performed to neutralize that anxiety). In this scenario, the persistent fear of contracting HIV is the *obsession* (contamination theme), and the repeated handwashing is the *compulsion*. The behavior is ego-dystonic, meaning the patient often recognizes the irrationality of the act but feels driven to perform it to alleviate distress. **Why the other options are incorrect:** * **Phobic disorder:** While phobias involve fear of a specific stimulus (e.g., blood or needles), they are characterized by **avoidance** rather than the performance of ritualistic, repetitive motor acts like handwashing. * **Dissociative and conversion disorder:** These involve a loss of integration between memories, identity, or motor/sensory functions (e.g., sudden paralysis or amnesia) usually triggered by psychological stress, not repetitive ritualistic behaviors. * **Somatoform disorder:** These patients present with physical symptoms (like pain or fatigue) that suggest a medical condition but lack an organic cause. The focus is on the physical symptom itself, not a ritualistic cycle of thoughts and actions. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Treatment:** SSRIs (at higher doses than for depression) and Cognitive Behavioral Therapy (specifically **Exposure and Response Prevention - ERP**). * **Drug of Choice (TCA):** Clomipramine (most serotonin-selective TCA). * **Neurobiology:** Associated with hyperactivity in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical circuit). * **Epidemiology:** Equal prevalence in males and females; however, males often have an earlier age of onset.
Question 48: Which of the following selective serotonin reuptake inhibitors (SSRIs) is primarily used in the management of Obsessive-Compulsive Disorder (OCD)?
- A. clomipramine
- B. sertraline
- C. mirtazapine
- D. fluvoxamine (Correct Answer)
Explanation: **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**).
Question 49: Ego's defense mechanism "Undoing" is typically seen in which of the following conditions?
- A. Depression
- B. Schizophrenia
- C. Obsessive compulsive neurosis (Correct Answer)
- D. Hysteria
Explanation: **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 50: All are treatment modalities of Obsessive-Compulsive Disorder except?
- A. Exposure and response prevention
- B. Psychoanalytic psychotherapy
- C. Clomipramine
- D. MAO inhibitors (Correct Answer)
Explanation: **Explanation:** The management of Obsessive-Compulsive Disorder (OCD) primarily involves a combination of Pharmacotherapy and Cognitive Behavioral Therapy (CBT). **Why MAO Inhibitors are the correct answer:** Monoamine Oxidase Inhibitors (MAOIs) are **not** considered a standard or first-line treatment for OCD. While they are used in treatment-resistant depression or certain anxiety disorders, they lack robust clinical evidence for efficacy in OCD compared to drugs that specifically target the serotonergic system. **Analysis of other options:** * **Exposure and Response Prevention (ERP):** This is the **gold standard** behavioral therapy for OCD. It involves exposing the patient to the anxiety-provoking stimulus (Exposure) while preventing the ritualistic behavior (Response Prevention). * **Clomipramine:** A Tricyclic Antidepressant (TCA) that is highly serotonergic. It was the first FDA-approved drug for OCD and remains one of the most effective pharmacological agents, though often used as a second-line due to its side-effect profile compared to SSRIs. * **Psychoanalytic Psychotherapy:** While historically used, it is generally considered **ineffective** for the core symptoms of OCD. However, in the context of NEET-PG questions, MAOIs are a more definitive "except" because ERP and serotonergic drugs (SSRIs/Clomipramine) are the established evidence-based modalities. **High-Yield Clinical Pearls for NEET-PG:** 1. **First-line Pharmacotherapy:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line drugs (e.g., Fluoxetine, Fluvoxamine, Sertraline). 2. **Dosage:** OCD requires **higher doses** of SSRIs and a **longer duration** (10–12 weeks) to show a response compared to Depression. 3. **Surgery:** For severe, treatment-refractory OCD, surgical options include **Cingulotomy** (most common) or Gamma knife capsulotomy. 4. **Deep Brain Stimulation (DBS):** Targeted at the internal capsule or subthalamic nucleus is also an option for refractory cases.
Practice by Chapter
Obsessive-Compulsive Disorder
Practice Questions
Body Dysmorphic Disorder
Practice Questions
Hoarding Disorder
Practice Questions
Trichotillomania
Practice Questions
Excoriation (Skin-Picking) Disorder
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Tic Disorders
Practice Questions
Tourette's Syndrome
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Pharmacotherapy for OCD and Related Disorders
Practice Questions
Cognitive-Behavioral Therapy for OCD
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Neurosurgical Approaches
Practice Questions
OCD in Children and Adolescents
Practice Questions
OCD Spectrum Disorders
Practice Questions
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