Obsessive-Compulsive and Related Disorders Practice Questions

Q: What is the drug of choice for obsessive-compulsive neurosis?

Clomipramine. **Explanation:** **Obsessive-Compulsive Disorder (OCD)**, formerly termed obsessive-compulsive neurosis, is primarily linked to dysregulation in the serotonergic system. The cornerstone of pharmacological management involves enhancing serotonin levels in the synaptic cleft. **Why Clomipramine is the Correct Answer:** Clomipramine is a **Tricyclic Antidepressant (TCA)** that stands out because it is highly selective for the inhibition of serotonin reuptake (SUI). It was the first FDA-approved medication for OCD and remains the "gold standard" in terms of efficacy. While Selective Serotonin Reuptake Inhibitors (SSRIs) like Fluoxetine are now used as first-line treatments due to a better side-effect profile, Clomipramine remains the specific "drug of choice" in classical textbook questions and for treatment-resistant cases. **Analysis of Incorrect Options:** * **A. Imipramine:** A prototype TCA that primarily inhibits the reuptake of norepinephrine. It is effective for depression and enuresis but lacks the potent serotonergic activity required to treat OCD. * **B. Chlorpromazine:** A typical antipsychotic (low potency). It blocks dopamine (D2) receptors and is used for schizophrenia, not for the primary treatment of obsessions or compulsions. * **C. Carbamazepine:** An anticonvulsant and mood stabilizer. It is used in epilepsy and Bipolar Disorder but has no role in treating OCD. **NEET-PG High-Yield Pearls:** * **First-line treatment:** SSRIs (Fluoxetine, Fluvoxamine, Sertraline) are preferred clinically due to safety. * **Dosage:** OCD requires higher doses of SSRIs/TCAs than Major Depressive Disorder. * **Duration:** A trial of at least 10–12 weeks is necessary to assess response. * **Best Outcome:** Combination of pharmacotherapy and **Exposure and Response Prevention (ERP)**, a form of CBT.

Q: A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Behavior therapy. ***Behavior therapy*** - This patient presents with **body dysmorphic disorder (BDD)**, characterized by preoccupation with a perceived defect in appearance that is not observable to others, leading to significant distress and impairment. - **Cognitive behavioral therapy (CBT)**, specifically **CBT-BDD with exposure and response prevention (ERP)**, is the **first-line treatment** with the strongest evidence base for BDD. - CBT-BDD addresses the core cognitive distortions, reduces checking behaviors, and provides sustained long-term improvement without medication side effects. - **Most appropriate management** involves CBT as primary treatment, often combined with pharmacotherapy for optimal outcomes. *SSRI* - **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line **pharmacotherapy** for BDD, often requiring higher doses than those used for major depressive disorder. - SSRIs are highly effective and can be used as monotherapy or preferably in combination with CBT. - While SSRIs are appropriate, CBT has superior evidence as the primary intervention for BDD. *Atypical antipsychotics* - **Atypical antipsychotics** may be considered as an augmentation strategy for BDD in cases that do not respond to SSRI monotherapy, especially with significant delusional features or severe functional impairment. - They are not first-line pharmacological treatment. *Allow her to have surgery* - Allowing plastic surgery is **contraindicated** in patients with BDD because it rarely alleviates distress and often leads to dissatisfaction with surgical outcomes, potentially worsening symptoms or causing further unnecessary procedures. - The core problem is distorted perception of self, not an actual physical defect that can be remedied surgically.

Q: A 30-year-old male needs to be dressed in female lingerie and high heels to feel aroused and have intercourse with a female. He denies any attraction towards males. What is the most likely diagnosis?

Transvestic Disorder. ***Transvestic Disorder*** - This condition involves **recurrent, intense sexual arousal from cross-dressing** in clothes typically associated with the opposite sex. The man experiences this specifically for sexual arousal and activity with a female partner, rather than for gender identity reasons. - The patient's denial of attraction to males and the context of heterosexual intercourse confirm that this is a paraphilic disorder related to specific sexual arousal patterns. - This diagnosis (formerly called "Transvestic fetishism" in DSM-IV) is the appropriate term in DSM-5-TR. *Gender dysphoria* - This involves a **marked incongruence between one's experienced/expressed gender and one's assigned gender**, often accompanied by distress or impairment. The patient's desire to dress in female clothing is for sexual arousal, not because he identifies as female. - Individuals with gender dysphoria typically experience a persistent and profound discomfort with their birth-assigned gender and a strong desire to be of the other gender, which is not described in this case. *Homosexuality* - This refers to **sexual attraction to individuals of the same sex**. The patient explicitly denies any attraction towards males, indicating that his sexual orientation is not homosexual. - His arousal is tied to a specific activity, cross-dressing, in the context of heterosexual intercourse, not the gender of his partner. *Testicular feminization* - This is an older term for **Androgen Insensitivity Syndrome (AIS)**, a genetic condition where an individual who is genetically male (XY) is resistant to male hormones (androgens). This results in female external sexual characteristics or ambiguous genitalia. - This is a biological developmental disorder, not a psychological or sexual preference, and is unrelated to the behavioral description of sexual arousal from cross-dressing.

Q: Match the following: 1. Kleptomania 2. Pyromania 3. Mutilomania 4. Dipsomania A. Intense desire to drink alcoholic drinks B. Intense desire to mutilate C. Intense desire to steal items of trivial value D. Intense desire to burn things

1-C, 2-D, 3-B, 4-A. **1-C, 2-D, 3-B, 4-A** - **Kleptomania** is characterized by an **irresistible urge to steal objects** that are often of little value and not needed for personal use or monetary gain. - **Pyromania** involves a **preoccupation with fire** and an overwhelming urge to set fires and witness their effects. - **Mutilomania** is a rare impulse control disorder that involves an **intense desire to self-mutilate**. - **Dipsomania** describes an **uncontrollable craving for alcohol**, leading to recurrent bouts of excessive drinking. *1-C, 2-B, 3-D, 4-A* - This option incorrectly matches Pyromania with an intense desire to mutilate and Mutilomania with an intense desire to burn things. - **Pyromania** is specifically about fire, and **Mutilomania** is about self-harm. *1-D, 2-B, 3-A, 4-C* - This option incorrectly matches Kleptomania with the desire to burn things, Pyromania with the desire to mutilate, and Dipsomania with the desire to steal. - The core definitions of these terms are not aligned in this pairing. *1-D, 2-C, 3-B, 4-A* - This option incorrectly matches Kleptomania with the desire to burn things and Pyromania with the desire to steal. - The defining characteristics of these impulse control disorders are mismatched here.

Q: Which of the following is not classified as OCD as per ICD 11?

PTSD. ***PTSD*** - **Post-traumatic stress disorder (PTSD)** is classified under **disorders specifically associated with stress** in ICD-11, not as an OCD-related disorder. - PTSD involves symptoms like re-experiencing the traumatic event, avoidance, and hyperarousal following exposure to a **traumatic event**. *Hypochondriac disorder* - In ICD-11, **hypochondriac disorder (illness anxiety disorder)** is reclassified under **obsessive-compulsive or related disorders**, focusing on preoccupation with having a serious illness. - This reflects the **compulsive checking** and **obsessive fears** associated with the condition. *Body dysmorphic disorder* - **Body dysmorphic disorder** is classified under **obsessive-compulsive or related disorders** in ICD-11. - It is characterized by **preoccupation with perceived flaws in physical appearance** and repetitive behaviors (e.g., mirror checking) in response to these concerns. *Trichotillomania* - **Trichotillomania (hair-pulling disorder)** is classified as an **obsessive-compulsive or related disorder** in ICD-11. - It involves **recurrent pulling out of one's hair** resulting in hair loss, despite repeated attempts to stop.

Q: Drug of choice for obsessive-compulsive disorder

Fluoxetine. ***Fluoxetine*** - **Selective serotonin reuptake inhibitors (SSRIs)** like fluoxetine are considered **first-line pharmacological treatment for Obsessive-Compulsive Disorder (OCD)** due to their effectiveness in modulating serotonin pathways implicated in the disorder. - Multiple SSRIs (fluoxetine, fluvoxamine, paroxetine, sertraline) and clomipramine are equally effective first-line agents, but **SSRIs are preferred initially** due to better tolerability and safety profile. - Among the given options, fluoxetine is the appropriate choice as an established first-line SSRI for reducing the frequency and intensity of obsessions and compulsions. - **OCD typically requires higher doses and longer duration** (8-12 weeks) compared to depression treatment. *Haloperidol* - **Haloperidol** is a **first-generation antipsychotic** primarily used to treat psychotic disorders (e.g., schizophrenia) and severe behavioral disturbances. - It works by blocking **dopamine D2 receptors** and is not a first-line treatment for OCD, though it might be used as an **augmentation strategy** in severe, treatment-refractory cases, particularly when tic disorders coexist. *Buspirone* - **Buspirone** is an **anxiolytic** primarily used for generalized anxiety disorder (GAD). It acts as a **serotonin 5-HT1A receptor partial agonist**. - While it helps with generalized anxiety, it is **generally ineffective** for the specific obsessions and compulsions characteristic of OCD and is not recommended as monotherapy. *Olanzapine* - **Olanzapine** is a **second-generation antipsychotic** primarily used for schizophrenia and bipolar disorder. It blocks dopamine and serotonin receptors. - It is not a first-line treatment for OCD but can be used as an **adjunct to SSRIs** in severe, treatment-resistant cases, particularly when there is partial response to adequate SSRI trials or comorbid psychotic symptoms.

Q: Most common symptom associated with adult OCD?

Pathological doubt. ***Pathological doubt*** - **Pathological doubt** is one of the most common symptom dimensions in adult OCD, affecting approximately 25-30% of patients. - This manifests as persistent, overwhelming uncertainty that drives **checking compulsions** (e.g., repeatedly checking locks, appliances, switches). - Patients experience intense anxiety about potential mistakes or harm, leading to time-consuming verification rituals. - Often coexists with responsibility obsessions and is a core feature underlying many OCD presentations. *Need for symmetry* - While **symmetry and ordering obsessions** are characteristic of OCD, they affect a smaller proportion of patients (approximately 10-15%). - These manifest as urges to arrange objects symmetrically or perform actions in a balanced, "just right" manner. - Less common than contamination fears and pathological doubt in epidemiological studies. *Sexual* - **Sexual obsessions** involve intrusive, unwanted thoughts or images of a sexual nature that are ego-dystonic. - These occur in approximately 10-15% of OCD patients and are highly distressing but not the most prevalent symptom type. *Aggressive* - **Aggressive obsessions** involve intrusive thoughts of harming oneself or others, occurring in roughly 10-15% of cases. - Patients fear they might act on violent impulses, though they never do, as these thoughts are ego-dystonic. - Less common than contamination and doubt-related symptoms in adult OCD populations.

Q: Which of the following types of OCD has the poorest response to Exposure and Response Prevention therapy?

Hoarding. ***Hoarding*** - While previously classified as a subtype of OCD, **hoarding disorder** is now recognized as a distinct disorder in the **DSM-5**. - Its unique phenomenology and underlying neurobiology often lead to a **poorer response to traditional ERP therapy** compared to other OCD presentations. *Magical thinking* - This type of OCD involves beliefs that one's thoughts or actions can influence unrelated external events, which is typically well-addressed by **ERP targeting the specific rituals** and avoidance behaviors. - Patients can be exposed to situations that trigger the magical thoughts while preventing the associated compulsions. *Contamination* - **Contamination fears and washing compulsions** are among the most common and treatable forms of OCD with ERP therapy. - Patients are systematically exposed to feared contaminants and prevented from engaging in washing rituals. *Pathological doubt* - This type involves persistent and intrusive doubts (e.g., whether a door is locked, an appliance is off), leading to repetitive checking behaviors. - ERP for pathological doubt focuses on **reducing checking rituals** and increasing tolerance for uncertainty.

Q: An irresistible desire to set fire is called

Pyromania. ***Pyromania*** - **Pyromania** is an impulse control disorder characterized by an **irresistible urge to set fires**. - Individuals with pyromania often experience tension or arousal before setting a fire and feel pleasure, gratification, or relief afterward. *Mutilomania* - **Mutilomania** is a term used to describe a compulsive desire to **mutilate oneself** or others. - This is a distinct impulse control issue that does not involve fire-setting. *Nymphomania* - **Nymphomania** refers to an excessive or uncontrollable sexual desire in women. - This disorder primarily involves an overwhelming sexual drive, which is unrelated to fire-setting. *Dipsomania* - **Dipsomania** is a historical term used to describe an **irresistible craving for alcohol**. - It is a form of alcohol use disorder, distinct from the impulse to set fires.

Question 1

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

Accepted Answer

Clomipramine

Answer

Imipramine

Answer

Chlorpromazine

Answer

Carbamazepine

Question 2

A 40-year-old female has visited multiple plastic surgeons requesting correction of a perceived facial deformity. She was referred to a psychiatrist because she repeatedly checks her face, insists that it is deformed and needs surgery despite no evidence on examination. She persists with her demand despite reassurances by family members and doctors. What is the most appropriate management?

Accepted Answer

Behavior therapy

Answer

SSRI

Answer

Atypical antipsychotics

Answer

Allow her to have surgery

Question 3

A 30-year-old male needs to be dressed in female lingerie and high heels to feel aroused and have intercourse with a female. He denies any attraction towards males. What is the most likely diagnosis?

Accepted Answer

Transvestic Disorder

Answer

Gender dysphoria

Answer

Homosexuality

Answer

Testicular feminization

Question 4

Match the following:

1. Kleptomania
2. Pyromania
3. Mutilomania
4. Dipsomania

A. Intense desire to drink alcoholic drinks
B. Intense desire to mutilate
C. Intense desire to steal items of trivial value
D. Intense desire to burn things

Accepted Answer

1-C, 2-D, 3-B, 4-A

Answer

1-C, 2-B, 3-D, 4-A

Answer

1-D, 2-B, 3-A, 4-C

Answer

1-D, 2-C, 3-B, 4-A

Question 5

Which of the following is not classified as OCD as per ICD 11?

Accepted Answer

PTSD

Answer

Hypochondriac disorder

Answer

Body dysmorphic disorder

Answer

Trichotillomania

Question 6

A person often feels that his hands are contaminated and is forced to wash his hands. Recently, he feels this repetitive, distressing thought of repetitive hand washing has begun affecting his performance. Which of the following is the best treatment option for this patient?

Accepted Answer

Exposure and response prevention

Answer

Systematic desensitization

Answer

Dialectical Behavior Therapy (DBT)

Answer

SSRI medication

Question 7

Drug of choice for obsessive-compulsive disorder

Accepted Answer

Fluoxetine

Answer

Haloperidol

Answer

Buspirone

Answer

Olanzapine

Question 8

Most common symptom associated with adult OCD?

Accepted Answer

Pathological doubt

Answer

Sexual

Answer

Aggressive

Answer

Need for symmetry

Question 9

Which of the following types of OCD has the poorest response to Exposure and Response Prevention therapy?

Accepted Answer

Hoarding

Answer

Magical thinking

Answer

Contamination

Answer

Pathological doubt

Question 10

An irresistible desire to set fire is called

Accepted Answer

Pyromania

Answer

Mutilomania

Answer

Nymphomania

Answer

Dipsomania

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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