Obsessive-Compulsive and Related Disorders Practice Questions

Q: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?

Systematic desensitisation. ***Systematic desensitisation*** - This therapy is primarily used to treat **phobias** and other **anxiety disorders** where avoidance is a key feature and a clear, single trigger can be identified. - While it involves exposure, the gradual hierarchy and relaxation training are less effective for the complex, intrusive thoughts and compulsive rituals characteristic of **OCD**. *Cognitive behavioral therapy* - **CBT, particularly Exposure and Response Prevention (ERP)**, is considered the gold standard psychotherapy for OCD. - It directly addresses the **obsessions** by exposing the individual to feared thoughts or situations and then preventing the ritualistic responses. *SSRIs* - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. - They work by increasing the availability of **serotonin** in the brain. *Clomipramine* - **Clomipramine** is a tricyclic antidepressant (TCA) with potent **serotonergic effects**, making it highly effective in treating OCD, often when SSRIs are partially effective or not tolerated. - It is specifically approved for OCD and is sometimes considered a second-line or augmentation strategy.

Q: All are recognised features of Tourette's syndrome, EXCEPT:

Ataxia. ***Ataxia*** - **Ataxia** refers to impaired coordination and balance due to neurological dysfunction, which is not a characteristic feature of **Tourette's syndrome**. - Tourette's syndrome is a **neurodevelopmental disorder** primarily characterized by tics, not motor incoordination. *Coprolalia* - **Coprolalia**, the involuntary utterance of obscene words or socially inappropriate phrases, is a classic though uncommon feature of Tourette's syndrome. - It is a specific type of **vocal tic** seen in a subset of individuals with the condition. *Motor Tics* - **Motor tics**, such as blinking, head jerking, shoulder shrugging, or more complex movements, are a core diagnostic criterion for Tourette's syndrome. - For diagnosis, both multiple motor tics and at least one vocal tic must be present at some point during the illness. *Predominantly affects males* - **Tourette's syndrome** is more prevalent in males than in females, with a male-to-female ratio typically ranging from 3:1 to 4:1. - This demographic pattern is a recognized epidemiological feature of the disorder.

Q: Tics, hair pulling, and nail biting behaviors are best treated with?

Behavior therapy. ***Behavior therapy*** - **Behavior therapy**, particularly **Habit Reversal Training (HRT)**, is the first-line and most effective treatment for tics, hair pulling (trichotillomania), and nail biting (onychophagia). - It involves teaching individuals to identify triggers and recognize urges, and then substituting the undesirable behavior with a competing response. *Psychodynamic therapy* - This therapy focuses on uncovering **unconscious conflicts** and past experiences that may contribute to symptoms. - While it can be helpful for some psychological issues, it is generally **less effective** for directly addressing specific behavioral symptoms like tics or body-focused repetitive behaviors. *ECT* - **Electroconvulsive therapy (ECT)** is a powerful somatic treatment primarily used for severe mental illnesses like **treatment-resistant depression** or catatonia. - It is **not indicated** for tics, hair pulling, or nail biting due to the high risks and lack of evidence for its efficacy in these conditions. *Medications* - While some medications (e.g., **antipsychotics** for severe tics, **SSRIs** for co-occurring anxiety/OCD) can be used as an adjunct, **behavioral therapy** is generally more effective and the first-line approach for these specific behaviors. - Medications alone rarely resolve these behaviors completely without behavioral intervention, and they often come with side effects.

Q: A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He reports that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work. He also has intrusive thoughts about stabbing his coworkers. He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters?

Serotonin. ***Serotonin*** - The described symptoms (obsessive thoughts about harming others, compulsive checking, and attempts to neutralize thoughts with prayer) are highly characteristic of **Obsessive-Compulsive Disorder (OCD)**. - **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line pharmacological treatment for OCD, and they work by increasing the availability of serotonin in the synaptic cleft. *Dopamine* - Dopamine dysregulation is primarily implicated in disorders such as **schizophrenia** and **Parkinson's disease**, and to some extent in ADHD and addiction. - While dopamine may play a role in some aspects of OCD, typical first-line treatments do not primarily target dopamine. *Norepinephrine* - Norepinephrine is largely involved in the **fight-or-flight response**, attention, and arousal, and is a target for treating depression and anxiety disorders with SNRIs. - While some antidepressants that affect norepinephrine may be used if SSRIs are ineffective, they are not considered the primary neurotransmitter target for first-line OCD treatment. *Acetylcholine* - Acetylcholine is crucial for **muscle contraction**, learning, and memory, and imbalances are associated with conditions like **Alzheimer's disease** and myasthenia gravis. - It is not a primary target for the pharmacological treatment of OCD.

Q: Which of the following represents the behavioral component that distinguishes OCD from pure anxiety disorders?

compulsive behaviors. ***Compulsive behaviors*** - **Compulsive behaviors** (or mental acts) are the defining **behavioral component** of OCD that distinguish it from other anxiety disorders - These are repetitive behaviors (e.g., hand washing, checking) or mental acts (e.g., counting, praying) performed in response to obsessions - According to **DSM-5**, compulsions are aimed at reducing distress or preventing a dreaded event, though they are either excessive or not realistically connected to the feared outcome - The presence of these **time-consuming ritualistic behaviors** is what clinically distinguishes OCD from generalized anxiety disorder or other anxiety conditions *Intrusive thoughts* - Intrusive thoughts (obsessions) are indeed the cognitive component of OCD - However, intrusive thoughts alone can occur in many anxiety disorders, depression, and even normal populations - What makes OCD distinctive is the **behavioral response** (compulsions) to these thoughts, not just the thoughts themselves *Anxiety* - Anxiety is present in OCD and motivates the compulsive behaviors - However, anxiety is a feature of **all anxiety disorders** and many other psychiatric conditions - It is not the distinguishing feature that separates OCD from other anxiety-related disorders *Depression* - Depression is a **common comorbidity** with OCD (occurring in 25-50% of OCD patients) - It is a separate condition that frequently co-occurs but is **not a defining feature** of OCD - Depression does not distinguish OCD from other psychiatric disorders

Q: The psychiatric disorder that has been found to be associated with PANDAS is :

OCD. ***OCD*** - **PANDAS** (**Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections**) is a condition where **streptococcal infections** trigger or worsen neuropsychiatric symptoms, most notably **Obsessive-Compulsive Disorder (OCD)** and **tic disorders** [1]. - The sudden onset or exacerbation of **OCD symptoms** in children following a strep infection is a hallmark of PANDAS [1]. *ADHD* - While children with PANDAS may exhibit symptoms like hyperactivity or inattention, these are generally secondary to the primary **OCD** or tic symptoms, not the core presentation of **ADHD** itself [1]. - **ADHD** is often a chronic condition with an earlier onset and a different underlying neurobiological basis compared to the infection-triggered acute onset of PANDAS [1]. *Schizophrenia* - **Schizophrenia** is a severe psychiatric disorder characterized by psychosis, delusions, and hallucinations, which are not typical features of **PANDAS**. - Its etiology involves a complex interplay of genetic and environmental factors, distinct from the autoimmune response seen in PANDAS. *Depression* - While children with **OCD** or chronic illness may experience **depressive symptoms** due to distress or functional impairment, **major depressive disorder** is not the primary or defining psychiatric disorder directly associated with the onset of **PANDAS** [1]. - The acute, dramatic onset of mood changes following a strep infection is more likely to be part of the broader neuropsychiatric presentation, rather than isolated clinical **depression** [1].

Q: Irresistible desire to pull out hair

Trichotilomania. **Trichotilomania** - This term precisely describes the **irresistible urge to pull out one's own hair**, often leading to noticeable hair loss. - It is classified as an **obsessive-compulsive and related disorder** in the DSM-5. *Dipsomania* - This refers to an **uncontrollable craving for alcoholic drinks**, characterized by periodic bouts of excessive drinking. - It is related to **alcohol use disorder** but specifically highlights intermittent, intense cravings. *Satyriasis* - This term denotes **excessive or uncontrollable sexual desire in a man**. - It is the male counterpart to nymphomania. *Nymphomania* - This term describes **excessive or uncontrollable sexual desire in a woman**. - It specifically refers to hypersexuality in females.

Q: The most common major symptom of obsessive-compulsive disorder is:

Compulsive checking. ***Compulsive checking*** - **Compulsive checking** is the most common major symptom in OCD, affecting 50-60% of patients with the disorder. - This typically involves **repeatedly checking locks, appliances, switches**, or other safety-related concerns driven by obsessions about harm or danger. - The repetitive nature significantly impairs daily functioning and causes marked distress, fulfilling the core criteria for OCD compulsions. *Compulsive washing of hands* - **Contamination obsessions with washing compulsions** are very common in OCD (affecting 20-40% of patients) but are less prevalent than checking behaviors. - This compulsion can lead to dermatological issues due to excessive washing and significant functional impairment. - While highly visible and well-recognized, it is not the single most common major symptom. *Obsessive precision* - This refers to **symmetry, ordering, and arranging compulsions**, which represent another common OCD subtype. - While significant, these behaviors are less prevalent than checking compulsions as the primary presenting symptom. - Often co-occurs with other OCD symptoms rather than being the predominant feature. *Compulsive thinking about the same thing* - This describes **obsessions** (intrusive, unwanted thoughts), which are the cognitive component of OCD rather than the behavioral compulsion. - While obsessions are core to OCD diagnosis, the question specifically asks about the most common major *symptom*, which in clinical practice refers to the observable compulsive behaviors. - Checking compulsions remain the most prevalent behavioral manifestation.

Q: In obsessive-compulsive disorder, which medication is NOT used for treatment?

Carbamazepine. ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for **epilepsy** and **bipolar disorder**. - It does not have a primary role in the treatment of **obsessive-compulsive disorder (OCD)**. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** approved for **OCD** treatment. - SSRIs are considered **first-line pharmacological agents** for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that is a potent **serotonin reuptake inhibitor**. - It is one of the **most effective medications for OCD** and has been historically used as a first-line treatment. *Haloperidol* - **Haloperidol**, an **antipsychotic**, can be used as an **augmentation strategy** for OCD that is **resistant to SSRI treatment**. - It may be particularly helpful in OCD presentations with **comorbid tic disorders** or significant behavioral disinhibition.

Q: Oniomania is a disorder of compulsive:

Buying. ***Buying*** - **Oniomania** is characterized by an uncontrollable urge to buy things, often leading to significant financial and social problems. - It is also known as **compulsive shopping** or **buying disorder**, fitting the description of a compulsive buying behavior. *Gambling* - The compulsion to gamble is known as **pathological gambling** or **gambling disorder**, not oniomania. - This disorder focuses specifically on recurrent problematic gambling behavior. *Stealing* - The compulsive urge to steal is a distinct impulse control disorder called **kleptomania**. - Kleptomania involves repeated stealing of items not needed for personal use or monetary value. *Hair pulling* - Compulsive hair pulling is known as **trichotillomania**, which is a body-focused repetitive behavior disorder. - It involves recurrent pulling out of one's hair, resulting in hair loss.

Question 1

Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?

Accepted Answer

Systematic desensitisation

Answer

Cognitive behavioral therapy

Answer

SSRIs

Answer

Clomipramine

Question 2

All are recognised features of Tourette's syndrome, EXCEPT:

Accepted Answer

Ataxia

Answer

Coprolalia

Answer

Motor Tics

Answer

Predominantly affects males

Question 3

Tics, hair pulling, and nail biting behaviors are best treated with?

Accepted Answer

Behavior therapy

Answer

Psychodynamic therapy

Answer

ECT

Answer

Medications

Question 4

A 19-year-old man working as a driver comes to Psychiatrist with excessive anxiety and fear. He reports that every time he drives over a bump in the road, he is convinced that he has accidentally run over a small child. He has to pull over and check underneath his car for blood and retrace his driving route to look for any injured children. As a result, he is always late for work. He also has intrusive thoughts about stabbing his coworkers. He prays to try to erase these thoughts from his mind, but this rarely helps. First-line pharmacological treatment of this patient's condition primarily affects which of the following neurotransmitters?

Accepted Answer

Serotonin

Answer

Dopamine

Answer

Norepinephrine

Answer

Acetylcholine

Question 5

Which of the following represents the behavioral component that distinguishes OCD from pure anxiety disorders?

Accepted Answer

compulsive behaviors

Answer

anxiety

Answer

depression

Answer

intrusive thoughts

Question 6

The psychiatric disorder that has been found to be associated with PANDAS is :

Accepted Answer

OCD

Answer

ADHD

Answer

Schizophrenia

Answer

Depression

Question 7

Irresistible desire to pull out hair

Accepted Answer

Trichotilomania

Answer

Dipsomania

Answer

Satyriasis

Answer

Nymphomania

Question 8

The most common major symptom of obsessive-compulsive disorder is:

Accepted Answer

Compulsive checking

Answer

Obsessive precision

Answer

Compulsive thinking about the same thing

Answer

Compulsive washing of hands

Question 9

In obsessive-compulsive disorder, which medication is NOT used for treatment?

Accepted Answer

Carbamazepine

Answer

Sertraline

Answer

Clomipramine

Answer

Haloperidol

Question 10

Oniomania is a disorder of compulsive:

Accepted Answer

Buying

Answer

Gambling

Answer

Stealing

Answer

Hair pulling

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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