Obsessive-Compulsive and Related Disorders — MCQs

A 28-year-old taxi driver is chronically consumed by fears of having accidentally run over a pedestrian. He tries to convince himself that his worries are silly, but his anxiety continues to mount until he drives back to the scene of the "accident" to prove to himself that nobody is lying in the street. This behavior is an example of which of the following?

Q59Easy

Kleptomania means?

Q60Easy

Which of the following conditions is considered a first-line treatment for SSRI?

Obsessive-Compulsive and Related Disorders Indian Medical PG Practice Questions and MCQs

Question 51: Which neurotransmitters are primarily involved in Obsessive-Compulsive Disorder (OCD)?

A. GABA
B. Norepinephrine
C. Dopamine
D. Serotonin (Correct Answer)

Explanation: **Explanation:** **1. Why Serotonin is Correct:** The **Serotonin Hypothesis** is the most widely accepted neurochemical theory for OCD. It is based on the clinical observation that **Selective Serotonin Reuptake Inhibitors (SSRIs)** and Clomipramine (a serotonergic TCA) are highly effective in reducing obsessive-compulsive symptoms. Research indicates a dysregulation in the serotonergic system, particularly involving the 5-HT receptors, which modulates the **Cortico-Striato-Thalamo-Cortical (CSTC) circuit**—the primary neuroanatomical pathway implicated in OCD. **2. Why Other Options are Incorrect:** * **GABA:** This is the primary inhibitory neurotransmitter. While it plays a significant role in **Generalized Anxiety Disorder (GAD)** and panic disorders, it is not the primary driver of OCD pathology. * **Norepinephrine:** This neurotransmitter is central to the "fight or flight" response and is primarily involved in **Panic Disorder** and **Depression**. Drugs that purely increase norepinephrine (like Desipramine) are generally ineffective in treating OCD. * **Dopamine:** While dopamine dysregulation in the basal ganglia is linked to OCD (especially in patients with comorbid Tic disorders), it is considered a **secondary** modulator rather than the primary neurotransmitter. **3. NEET-PG High-Yield Clinical Pearls:** * **Drug of Choice (DOC):** SSRIs (e.g., Fluoxetine, Fluvoxamine, Sertraline). * **Most Potent Drug:** **Clomipramine** (though not first-line due to side effects). * **Treatment Note:** OCD requires **higher doses** of SSRIs and a **longer duration** (10–12 weeks) to show a response compared to depression. * **Neuroanatomy:** The **Orbitofrontal Cortex (OFC)** and the **Anterior Cingulate Cortex** are the specific areas of the CSTC circuit most associated with OCD symptoms.

Question 52: A 25-year-old gentleman has repeated thoughts that he has not locked his car door properly and frequently checks it while driving. He also repeatedly checks the locks in his house. What is the most likely diagnosis?

A. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
B. Obsessive-Compulsive Personality Disorder (OCPD)
C. Phobia
D. Personality disorder

Explanation: ### Explanation The patient presents with classic symptoms of **Obsessive-Compulsive Disorder (OCD)**. The diagnosis is based on the presence of **obsessions** (recurrent, intrusive thoughts that the car/house is not locked) and **compulsions** (repetitive behaviors like frequent checking performed to neutralize the anxiety caused by the obsession). #### Why the Correct Answer is Right: In OCD, the symptoms are **ego-dystonic** (the patient recognizes the thoughts as irrational and distressing). The "Checking" subtype is one of the most common clinical presentations. According to ICD-11 and DSM-5, these symptoms must be time-consuming (taking >1 hour/day) or cause significant functional impairment. #### Why Other Options are Incorrect: * **Obsessive-Compulsive Personality Disorder (OCPD):** Unlike OCD, OCPD is **ego-syntonic**. The individual perceives their preoccupation with orderliness, perfectionism, and control as correct and desirable. They do not typically have true obsessions or ritualistic compulsions. * **Phobia:** This involves an irrational fear of a specific object or situation leading to avoidance. While anxiety is present, it lacks the ritualistic "thought-action" cycle seen in this case. * **Personality Disorder:** This is a broad category. While OCPD is a personality disorder, the specific presence of repetitive checking rituals points directly to the clinical syndrome of OCD rather than a pervasive pattern of personality traits. #### NEET-PG High-Yield Pearls: * **Neurobiology:** Linked to dysfunction in the **Cortico-Striato-Thalamo-Cortical (CSTC) circuit**. * **Neurotransmitters:** Primarily involves **Serotonin** deficiency. * **Treatment of Choice:** * **Pharmacotherapy:** SSRIs (at higher doses than for depression). **Clomipramine** (TCA) is the most potent but often second-line due to side effects. * **Psychotherapy:** Exposure and Response Prevention (ERP). * **Commonest Obsession:** Contamination; **Commonest Compulsion:** Checking.

Question 53: Which of the following is most commonly associated with Obsessive-Compulsive Disorder (OCD)?

A. Decreased interest in sex (Correct Answer)
B. Normal interest in sex
C. Obesity
D. Increased interest in sex

Explanation: **Explanation:** **Obsessive-Compulsive Disorder (OCD)** is a chronic psychiatric condition characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). The correct answer is **Decreased interest in sex (Option A)**. **Why it is correct:** Sexual dysfunction is highly prevalent in patients with OCD, with studies suggesting up to 75% of patients experience some form of it. The underlying medical concepts include: 1. **Psychological Interference:** Intrusive, ego-dystonic thoughts (often involving contamination or religious/moral scrupulosity) can interrupt the arousal phase. 2. **Anxiety and Hyper-vigilance:** The high baseline anxiety associated with OCD is physiologically incompatible with the relaxed state required for sexual desire. 3. **Pharmacological Side Effects:** First-line treatments for OCD are **SSRIs** (Selective Serotonin Reuptake Inhibitors) at high doses, which are notorious for causing decreased libido and anorgasmia. **Why other options are incorrect:** * **Option B & D:** Normal or increased interest in sex is rare in OCD. Increased sexual drive (hypersexuality) is more characteristic of the manic phase of Bipolar Disorder or certain impulse control disorders, rather than the inhibitory nature of OCD. * **Option C:** While weight gain can be a side effect of certain psychotropic medications (like atypical antipsychotics used as adjuncts), obesity is not a primary clinical association or diagnostic feature of OCD itself. **High-Yield Clinical Pearls for NEET-PG:** * **Neurobiology:** OCD is associated with structural/functional abnormalities in the **Orbitofrontal Cortex (OFC)**, Anterior Cingulate Cortex, and **Caudate Nucleus** (part of the Cortico-Striato-Thalamo-Cortical circuit). * **Neurotransmitters:** Primarily involves **Serotonin** dysregulation. * **Treatment:** First-line is **CBT (Exposure and Response Prevention - ERP)** and high-dose **SSRIs**. **Clomipramine** (TCA) is the most effective drug but is second-line due to side effects. * **Comorbidity:** The most common comorbid condition in OCD is **Depressive Disorder**, followed by Anxiety Disorders and Tic Disorders.

Question 54: Cingulotomy is used to treat which of the following conditions?

A. Parkinsonism
B. Schizophrenia
C. Obsessive-Compulsive Disorder (OCD) (Correct Answer)
D. Autism

Explanation: **Explanation:** **Cingulotomy** is a neurosurgical procedure involving the bilateral destruction of the anterior cingulate gyrus. It is currently the most common functional neurosurgical procedure used for **refractory Obsessive-Compulsive Disorder (OCD)**—cases that have failed to respond to multiple trials of high-dose SSRIs and Cognitive Behavioral Therapy (CBT). **Why OCD is correct:** The pathophysiology of OCD involves hyperactivity in the **Cortico-Striato-Thalamo-Cortical (CSTC) circuit**. The anterior cingulate cortex is a key node in this loop. By performing a cingulotomy, the overactive circuit is interrupted, leading to a reduction in obsessive thoughts and compulsive urges. It is also occasionally used for chronic refractory pain and treatment-resistant depression. **Analysis of Incorrect Options:** * **Parkinsonism:** Treated surgically via Deep Brain Stimulation (DBS) of the subthalamic nucleus or globus pallidus internus, or via levodopa therapy. * **Schizophrenia:** While "Prefrontal Leucotomy" was historically used, psychosurgery is no longer a standard or recommended treatment for schizophrenia due to lack of efficacy and severe personality changes. * **Autism:** This is a neurodevelopmental disorder managed primarily through behavioral interventions and educational support; there is no surgical indication. **NEET-PG High-Yield Pearls:** * **Other surgeries for OCD:** Subcaudate tractotomy, Limbic leucotomy (combination of cingulotomy and tractotomy), and Capsulotomy. * **Deep Brain Stimulation (DBS):** An alternative to ablative surgery; the most common target for OCD is the **Internal Capsule (Ventral Striatum)**. * **Indication:** Psychosurgery is only considered after at least 5 years of illness and failure of all conventional treatments.

Question 55: Domestic squalor is related to which of the following disorders?

A. Somatoform disorder
B. Body dysmorphic disorder
C. Hoarding disorder (Correct Answer)
D. Olfactory reference syndrome

Explanation: ### Explanation **Correct Option: C. Hoarding disorder** **Domestic squalor** refers to a state of extreme filth, clutter, and neglect in a person's living environment. It is a hallmark complication of **Hoarding Disorder**. In this condition, patients have persistent difficulty discarding or parting with possessions, regardless of their actual value. This leads to an accumulation of items that congest and clutter active living areas, compromising their intended use. When the accumulation includes organic waste or trash, it results in domestic squalor, which poses significant health and fire risks. **Why other options are incorrect:** * **A. Somatoform disorder:** These patients present with physical symptoms that suggest a medical condition but are not fully explained by one. It does not typically involve environmental neglect or clutter. * **B. Body dysmorphic disorder (BDD):** Characterized by a preoccupation with perceived defects in physical appearance. While related to OCD, its focus is on self-image, not the accumulation of objects. * **D. Olfactory reference syndrome:** A condition where an individual falsely believes they emit a foul or offensive body odor. This leads to excessive grooming or social withdrawal, not domestic squalor. **High-Yield Clinical Pearls for NEET-PG:** * **Diogenes Syndrome:** A specific geriatric syndrome characterized by extreme self-neglect, domestic squalor, social withdrawal, and hoarding. It is often associated with dementia or personality disorders. * **Treatment of Hoarding:** It is notoriously difficult to treat. **Cognitive Behavioral Therapy (CBT)** tailored for hoarding is the first-line psychological treatment, often combined with **SSRIs**. * **DSM-5 Classification:** Hoarding Disorder is now a distinct diagnosis under the "Obsessive-Compulsive and Related Disorders" category, rather than just a symptom of OCD.

Question 56: Compulsive hair pulling that produces bald spots is called:

A. Trichotillomania (Correct Answer)
B. Kleptomania
C. Pyromania
D. Diposomania

Explanation: **Explanation:** **Correct Answer: A. Trichotillomania** Trichotillomania is a psychiatric disorder characterized by the recurrent, irresistible urge to pull out one's own hair (scalp, eyebrows, or eyelashes), resulting in noticeable hair loss or bald spots. Under the DSM-5 and ICD-11, it is classified under **Obsessive-Compulsive and Related Disorders (OCRD)**. Patients often experience a sense of tension before pulling and a sense of relief or gratification afterward. **Analysis of Incorrect Options:** * **B. Kleptomania:** An impulse control disorder characterized by the recurrent failure to resist urges to steal objects that are not needed for personal use or monetary value. * **C. Pyromania:** An impulse control disorder involving deliberate and purposeful fire-setting on more than one occasion, driven by an internal tension or affective arousal. * **D. Dipsomania:** An older term used to describe an uncontrollable craving for alcohol, often occurring in periodic paroxysms (binge drinking). **High-Yield Clinical Pearls for NEET-PG:** 1. **Trichobezoar (Rapunzel Syndrome):** A classic surgical complication where patients with Trichotillomania also ingest the hair (Trichophagia), leading to a hairball in the stomach that can cause intestinal obstruction. 2. **Gender Ratio:** It is significantly more common in females (approx. 10:1 ratio). 3. **Treatment:** The behavioral therapy of choice is **Habit Reversal Training (HRT)**. Pharmacologically, **SSRIs** (like Fluoxetine) or **Clomipramine** are often used. 4. **Histopathology:** On scalp biopsy, "Trichomalacia" (distorted, fragmented hair shafts) and "pigment casts" are characteristic findings.

Question 57: Obsessive Compulsive Disorder is NOT associated with which of the following?

A. Repetitive behavior
B. Thought insertion (Correct Answer)
C. Anxiety
D. Paranoid behavior

Explanation: **Explanation:** **Obsessive-Compulsive Disorder (OCD)** is characterized by recurrent, intrusive thoughts (obsessions) and repetitive mental or physical acts (compulsions) that the individual feels driven to perform. **Why "Thought Insertion" is the correct answer:** Thought insertion is a **First Rank Symptom (FRS)** of Schizophrenia, not OCD. In thought insertion, the patient believes that thoughts are being put into their mind by an external agency. Crucially, in OCD, the patient recognizes that the obsessions are **products of their own mind** (ego-dystonic but internal). If a patient believes thoughts are coming from an outside source, it indicates a loss of reality testing, pointing toward a psychotic disorder rather than an anxiety-related disorder like OCD. **Analysis of other options:** * **Repetitive behavior:** This is a hallmark of OCD (Compulsions). These are performed to reduce the distress caused by obsessions (e.g., hand washing, checking). * **Anxiety:** OCD was historically classified as an Anxiety Disorder. While now in its own category, intense anxiety or "psychic tension" is the primary driver that leads to compulsive rituals. * **Paranoid behavior:** While not a core diagnostic criterion, patients with OCD often exhibit avoidant or "paranoid-like" guardedness regarding their rituals or contamination fears. However, compared to the pathognomonic nature of thought insertion for psychosis, it is considered associated with the clinical spectrum of OCD. **Clinical Pearls for NEET-PG:** * **Ego-dystonic:** OCD symptoms are recognized by the patient as irrational and unwanted (Insight is usually preserved). * **Most common obsession:** Contamination. * **Most common compulsion:** Checking. * **Treatment of choice:** SSRIs (High dose) and Exposure and Response Prevention (ERP) therapy. * **Neurobiology:** Associated with hyperactivity in the **Orbitofrontal Cortex (OFC)** and Anterior Cingulate Cortex.

Question 58: A 28-year-old taxi driver is chronically consumed by fears of having accidentally run over a pedestrian. He tries to convince himself that his worries are silly, but his anxiety continues to mount until he drives back to the scene of the "accident" to prove to himself that nobody is lying in the street. This behavior is an example of which of the following?

A. A compulsion secondary to an obsession (Correct Answer)
B. An obsession triggered by a compulsion
C. A delusional ideation
D. A typical manifestation of obsessive-compulsive personality disorder

Explanation: ### Explanation **Correct Option: A. A compulsion secondary to an obsession** This clinical scenario describes the classic cycle of **Obsessive-Compulsive Disorder (OCD)**. 1. **The Obsession:** The patient experiences recurrent, intrusive, and distressing thoughts (fears of having run over a pedestrian). These are ego-dystonic, as he recognizes they are "silly" yet cannot dismiss them. 2. **The Compulsion:** To neutralize the mounting anxiety caused by the obsession, he performs a repetitive mental or physical act (driving back to the scene to check). In OCD, **compulsions are secondary to obsessions**; they are functional attempts to reduce the distress triggered by the obsessive thought. **Analysis of Incorrect Options:** * **B. An obsession triggered by a compulsion:** This reverses the clinical sequence. Compulsions are the *response* to the anxiety generated by obsessions, not the cause of them. * **C. A delusional ideation:** A delusion is a fixed, false belief held with absolute certainty. This patient has **preserved insight** (he tries to convince himself the worries are "silly"), which distinguishes an obsession from a delusion. * **D. Obsessive-compulsive personality disorder (OCPD):** OCPD is characterized by perfectionism, orderliness, and control (**ego-syntonic**). It does not typically involve the discrete, distressing obsession-compulsion cycles seen in OCD. **High-Yield Clinical Pearls for NEET-PG:** * **Ego-dystonic vs. Ego-syntonic:** OCD is ego-dystonic (the patient views symptoms as alien/irrational); OCPD is ego-syntonic (the patient views their behavior as correct/ideal). * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (SSRIs) at high doses and Cognitive Behavioral Therapy (CBT) using **Exposure and Response Prevention (ERP)**. * **Neurobiology:** Associated with hyperactivity in the **Orbitofrontal Cortex (OFC)**, Anterior Cingulate Cortex, and Caudate Nucleus (Cortico-striato-thalamo-cortical circuit).

Question 59: Kleptomania means?

A. Irresistible desire to set fire
B. Irresistible desire to steal things (Correct Answer)
C. Compulsive hair pulling
D. Pathological gambling

Explanation: **Explanation:** **Kleptomania** is an impulse control disorder characterized by a recurrent failure to resist urges to steal objects. Unlike shoplifting, the theft is not motivated by monetary gain, personal use, or vengeance. Instead, the individual experiences a rising sense of tension before the act and a feeling of gratification, relief, or pleasure immediately after committing the theft. The stolen items are often discarded, given away, or hoarded. **Analysis of Options:** * **Option B (Correct):** Kleptomania specifically refers to the pathological and irresistible urge to steal items that are usually of little value. * **Option A (Incorrect):** This describes **Pyromania**, where an individual has a repetitive, deliberate pattern of starting fires to relieve internal tension. * **Option C (Incorrect):** This describes **Trichotillomania**, now classified under "Obsessive-Compulsive and Related Disorders" in DSM-5, involving the recurrent pulling out of one's own hair. * **Option D (Incorrect):** This describes **Ludomania** (Pathological Gambling), which is now classified as a "Non-Substance Related Addictive Disorder." **High-Yield Clinical Pearls for NEET-PG:** * **Gender Predominance:** Kleptomania is more common in females (3:1 ratio). * **Comorbidity:** It is frequently associated with mood disorders (Depression), anxiety disorders, and eating disorders (especially Bulimia Nervosa). * **Treatment:** The mainstay of pharmacological treatment includes **SSRIs** (e.g., Fluoxetine) and sometimes Opioid antagonists (e.g., **Naltrexone**) to reduce the "rush" associated with stealing. Cognitive Behavioral Therapy (CBT) is the preferred psychological intervention. * **Legal Note:** In forensic psychiatry, Kleptomania is a rare defense; the individual usually feels intense guilt or shame after the act, unlike a typical criminal.

Question 60: Which of the following conditions is considered a first-line treatment for SSRI?

A. Obsessive-compulsive disorder
B. Panic disorder
C. Social phobia (Correct Answer)
D. Post-traumatic stress disorder

Explanation: **Explanation:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the established **first-line pharmacological treatment** for a wide spectrum of anxiety and obsessive-compulsive disorders. However, in the context of this specific question, **Social Phobia (Social Anxiety Disorder)** is highlighted as a primary indication where SSRIs are the gold standard for long-term management. **Why Social Phobia is Correct:** SSRIs (such as Escitalopram, Sertraline, and Paroxetine) are the first-line agents because they effectively address both the cognitive symptoms (fear of scrutiny) and the functional impairment associated with the disorder. While Beta-blockers (Propranolol) are used for "performance anxiety," SSRIs are the treatment of choice for the generalized form of Social Phobia. **Analysis of Other Options:** * **Obsessive-Compulsive Disorder (OCD):** While SSRIs are first-line, they often require **higher doses** and a longer duration (10–12 weeks) to show a response compared to anxiety disorders. * **Panic Disorder:** SSRIs are first-line; however, treatment often starts at very low doses to avoid "jitteriness syndrome" (initial worsening of anxiety). * **Post-Traumatic Stress Disorder (PTSD):** SSRIs (Sertraline, Fluoxetine) are first-line, but the treatment approach often heavily emphasizes trauma-focused psychotherapy (CBT/EMDR) alongside medication. **NEET-PG High-Yield Pearls:** * **Drug of Choice (DOC):** SSRIs are the DOC for OCD, Panic Disorder, Social Phobia, PTSD, and GAD. * **OCD Specifics:** Fluoxetine is often preferred; Clomipramine (TCA) is the most effective but is second-line due to its side-effect profile. * **Side Effects:** Sexual dysfunction (most common long-term), GI upset, and Sleep disturbances. * **Black Box Warning:** Increased risk of suicidal ideation in children and young adults.

Practice by Chapter

Obsessive-Compulsive Disorder

Practice Questions

Body Dysmorphic Disorder

Practice Questions

Hoarding Disorder

Practice Questions

Trichotillomania

Practice Questions

Excoriation (Skin-Picking) Disorder

Practice Questions

Tic Disorders

Practice Questions

Tourette's Syndrome

Practice Questions

Pharmacotherapy for OCD and Related Disorders

Practice Questions

Cognitive-Behavioral Therapy for OCD

Practice Questions

Neurosurgical Approaches

Practice Questions

OCD in Children and Adolescents

Practice Questions

OCD Spectrum Disorders

Practice Questions

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free