Obsessive-Compulsive and Related Disorders — MCQs
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Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
All are recognised features of Tourette's syndrome, EXCEPT:
Tics, hair pulling, and nail biting behaviors are best treated with?
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?
Which of the following represents the behavioral component that distinguishes OCD from pure anxiety disorders?
The psychiatric disorder that has been found to be associated with PANDAS is :
Irresistible desire to pull out hair
The most common major symptom of obsessive-compulsive disorder is:
In obsessive-compulsive disorder, which medication is NOT used for treatment?
Oniomania is a disorder of compulsive:
Obsessive-Compulsive and Related Disorders Indian Medical PG Practice Questions and MCQs
Question 71: Which of the following will be LEAST useful in treating Obsessive Compulsive Disorder?
- A. Cognitive behavioral therapy
- B. SSRIs
- C. Clomipramine
- D. Systematic desensitisation (Correct Answer)
Explanation: ***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.
Question 72: All are recognised features of Tourette's syndrome, EXCEPT:
- A. Coprolalia
- B. Motor Tics
- C. Ataxia (Correct Answer)
- D. Predominantly affects males
Explanation: ***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.
Question 73: Tics, hair pulling, and nail biting behaviors are best treated with?
- A. Behavior therapy (Correct Answer)
- B. Psychodynamic therapy
- C. ECT
- D. Medications
Explanation: ***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.
Question 74: 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?
- A. Dopamine
- B. Serotonin (Correct Answer)
- C. Norepinephrine
- D. Acetylcholine
Explanation: ***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.
Question 75: Which of the following represents the behavioral component that distinguishes OCD from pure anxiety disorders?
- A. anxiety
- B. depression
- C. intrusive thoughts
- D. compulsive behaviors (Correct Answer)
Explanation: ***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
Question 76: The psychiatric disorder that has been found to be associated with PANDAS is :
- A. ADHD
- B. Schizophrenia
- C. OCD (Correct Answer)
- D. Depression
Explanation: ***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].
Question 77: Irresistible desire to pull out hair
- A. Dipsomania
- B. Trichotilomania (Correct Answer)
- C. Satyriasis
- D. Nymphomania
Explanation: **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.
Question 78: The most common major symptom of obsessive-compulsive disorder is:
- A. Obsessive precision
- B. Compulsive checking (Correct Answer)
- C. Compulsive thinking about the same thing
- D. Compulsive washing of hands
Explanation: ***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.
Question 79: In obsessive-compulsive disorder, which medication is NOT used for treatment?
- A. Sertraline
- B. Clomipramine
- C. Carbamazepine (Correct Answer)
- D. Haloperidol
Explanation: ***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.
Question 80: Oniomania is a disorder of compulsive:
- A. Gambling
- B. Buying (Correct Answer)
- C. Stealing
- D. Hair pulling
Explanation: ***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.
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
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