Obsessive-Compulsive and Related Disorders Practice Questions

Q: In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?

Hoarding. ***Hoarding*** - **Hoarding** in OCD is considered a **poor prognostic factor** for ERP therapy due to the severe avoidance of discarding items and the strong emotional attachment to possessions. - Individuals with hoarding symptoms often display **low insight** into the irrationality of their hoarding behavior, making it more challenging to engage in and benefit from ERP. *Magical thinking* - While magical thinking can be a feature of OCD, it is not consistently associated with a **worse prognosis** in ERP compared to other symptom dimensions, especially when compared to hoarding. - ERP can effectively target rituals and compulsions driven by magical thoughts by gradually exposing the individual to feared outcomes without enacting the ritual. *Contamination* - **Contamination fears**, though distressing, often respond well to ERP through exposure to feared contaminants and prevention of washing/cleaning rituals. - While challenging, it is generally considered to have a **better prognosis** with ERP than hoarding. *Pathological doubt* - **Pathological doubt**, a core feature of many OCD presentations, is addressed in ERP by exposing individuals to situations that trigger doubt and preventing excessive checking or seeking reassurance. - Like contamination, it typically has a **more favorable prognosis** with ERP compared to hoarding due to the direct ability to target and prevent the compulsive behaviors.

Q: Obsession is a disorder of:

Thinking. ***Thinking*** - An obsession is defined as a **recurrent and persistent thought, urge, or image** that is experienced as intrusive and unwanted, indicating a primary disturbance in the content of thought. - Individuals typically attempt to **ignore or suppress these thoughts** or to neutralize them with some other thought or action (a compulsion). *Perception* - Disorders of perception involve distortions in how sensory information is interpreted, such as **hallucinations** or **illusions**. - Obsessions are not sensory experiences but rather cognitive events that occur in the mind. *Judgment* - Judgment refers to the ability to make sound decisions and evaluate situations appropriately. - While obsessions can impair judgment by leading to compulsive behaviors, the obsession itself is not primarily a disorder of judgment but rather a disorder of thought content. *Memory* - Memory disorders involve difficulties in recalling or forming new memories, such as **amnesia** or **dementia**. - Obsessions do not represent a failure of memory retrieval or encoding; rather, they are intrusive thoughts regardless of memory function.

Q: Body dysmorphic disorder can be associated with all except

Mania. ***Mania*** - **Mania** is a state of elevated, expansive, or irritable mood that is distinct from the persistent preoccupation with perceived bodily defects seen in **body dysmorphic disorder (BDD)**. - While agitation can occur in BDD, the core symptom profile of **mania**, including decreased need for sleep, grandiosity, and racing thoughts, is not a typical associated feature. *Bulimia nervosa* - **Bulimia nervosa** can co-occur with BDD, particularly when the perceived defects relate to body weight, shape, or specific body parts. - Both disorders involve intense preoccupation with body image and often lead to harmful behaviors to attempt to "correct" perceived flaws. *OCD* - **Obsessive-compulsive disorder (OCD)** shares strong phenomenological similarities with BDD, including intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - BDD is often conceptualized as part of the **OCD spectrum**, with both disorders involving obsessive thoughts and repetitive behaviors related to specific concerns. *Anxiety* - **Anxiety disorders** are highly comorbid with BDD, as individuals often experience significant distress, fear of judgment, and social avoidance due to their perceived flaws. - The constant preoccupation and efforts to conceal or fix perceived defects can lead to chronic anxiety and panic attacks.

Q: An irresistible urge to perform repetitive behaviors is characteristic of

Obsessive - compulsive disorder. ***Obsessive - compulsive disorder*** - This disorder is characterized by the presence of **obsessions** (recurrent and persistent thoughts, urges, or images) and/or **compulsions** (repetitive behaviors or mental acts that an individual feels driven to perform). - The "irresistible urge to do a thing repeatedly" perfectly describes a **compulsion**, which is aimed at reducing anxiety or preventing a dreaded event. *Schizophrenia* - This is a chronic mental disorder characterized by disturbances in thought processes, perception, emotion, and behavior, leading to **psychosis**. - Symptoms include **hallucinations**, **delusions**, disorganization of speech and behavior, and negative symptoms, which are distinct from repetitive urges. *Depression* - Depression is a mood disorder characterized by persistent sadness, loss of interest or pleasure, and a range of other emotional, cognitive, and physical symptoms. - While it can involve repetitive negative thoughts (**rumination**), it does not typically manifest as an "irresistible urge" to perform specific repetitive behaviors. *Schizoaffective disorder* - This disorder involves a combination of symptoms of **schizophrenia** (such as hallucinations or delusions) and **mood disorder** symptoms (either depression or bipolar disorder). - While it has psychotic features, it does not primarily involve irresistible repetitive urges as a core diagnostic criterion.

Q: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?

Carbamazepine. ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder. - It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**. *Fluoxetine* - **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD. - SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**. *Cognitive Behaviour Therapy* - **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD. - It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**. - It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.

Q: In OCD, if the patient tries to resist obsession, then patient develops?

Anxiety. ***Anxiety*** - In **Obsessive-Compulsive Disorder (OCD)**, attempts to resist obsessions or compulsions typically lead to a significant increase in **anxiety** and distress. - This heightened anxiety is a primary driver for individuals to engage in ritualistic compulsions, as these acts provide a temporary reduction in the uncomfortable feeling. *Delusion* - A **delusion** is a fixed, false belief that is impervious to reason or evidence, which is characteristic of psychotic disorders, not typically seen as a direct consequence of resisting obsessions in OCD. - While OCD can sometimes have poor insight, the core issue is intrusive thoughts and behaviors, not a break from reality. *Depression* - **Depression** is a mood disorder characterized by persistent sadness and loss of interest, and while it often co-occurs with OCD due to the chronic stress and impairment, it's not the immediate, direct consequence of resisting an obsession. - The immediate response to resistance is anxiety, which can contribute to depression over time. *Mania* - **Mania** is a state of abnormally elevated arousal, affect, and energy level often associated with bipolar disorder. - It is not a symptom or a direct outcome of attempting to resist obsessions in OCD.

Q: All of the following are OCD related disorders except:

Temper tantrums. ***Temper tantrums*** - **Temper tantrums** are outbursts of anger and frustration, common in young children, and are not classified as an **OCD-related disorder**. - They are typically associated with developmental stages or underlying emotional regulation difficulties, rather than **obsessive thoughts** or **compulsive behaviors**. *Hoarding disorder* - **Hoarding disorder** is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, due to a perceived need to save them. - It is classified under the **Obsessive-Compulsive and Related Disorders** category in the DSM-5 due to the compulsive nature of acquiring and retaining items. *Hair pulling disorder* - Also known as **trichotillomania**, this disorder involves repetitive, irresistible urges to pull out one's hair, resulting in noticeable hair loss. - It is an impulse control disorder categorized within the **Obsessive-Compulsive and Related Disorders** spectrum because of its repetitive, body-focused compulsive behavior. *Skin picking* - Also known as **excoriation disorder**, skin picking involves repetitive and compulsive picking of one's own skin, often leading to skin lesions. - This disorder is recognized as a **body-focused repetitive behavior** and is included in the **Obsessive-Compulsive and Related Disorders** category.

Q: Areas of brain involved in OCD include:

Basal ganglia. ***Basal ganglia*** - The **basal ganglia**, particularly the **caudate nucleus**, are a core component of the **cortico-striato-thalamo-cortical (CSTC) circuit**, which is the primary neurobiological model for OCD. - The CSTC circuit involves: **Orbitofrontal cortex → Caudate nucleus → Thalamus → back to cortex**. - Hyperactivity in the **caudate nucleus** is consistently found in OCD patients and correlates with symptom severity. - The basal ganglia's role in **habit formation, motor planning, and behavioral inhibition** directly relates to the compulsive behaviors and ritualistic patterns in OCD. - **Functional neuroimaging** (PET, fMRI) consistently shows increased metabolic activity in the caudate nucleus in OCD patients, which normalizes with successful treatment. *Temporal lobe* - The temporal lobe is **not a primary region** in the classical neurobiology of OCD. - While some studies show volumetric changes, it is not part of the core CSTC circuit. - The primary cortical areas in OCD are the **orbitofrontal cortex and anterior cingulate cortex**, not the temporal lobe. *Cerebellum* - The cerebellum has emerging evidence for involvement in cognitive and affective processing. - However, it is **not a core component** of the established CSTC circuit model for OCD. - Its role appears to be supplementary rather than primary in OCD pathophysiology. *All of the options* - This is incorrect because **temporal lobe is not a primary area** involved in OCD. - The core circuit is the **CSTC loop** involving orbitofrontal cortex, anterior cingulate cortex, basal ganglia (caudate), and thalamus.

Q: Drug of choice for obsessive-compulsive disorder is:

Fluoxetine. ***Fluoxetine*** - **Selective serotonin reuptake inhibitors (SSRIs)** are the first-line pharmacological treatment for **obsessive-compulsive disorder (OCD)**. - **Fluoxetine** was traditionally considered a primary choice for OCD treatment and is FDA-approved for this indication. - It works by selectively inhibiting serotonin reuptake, increasing serotonergic neurotransmission, which is crucial in OCD pathophysiology. - Higher doses are typically required for OCD compared to depression (40-80 mg/day). *Sertraline* - **Sertraline** is also an **SSRI** and equally effective as fluoxetine for OCD treatment. - It is FDA-approved for OCD and considered a first-line option. - In current clinical practice, **all SSRIs (fluoxetine, sertraline, fluvoxamine, paroxetine) are considered equally appropriate first-line choices** with no single "drug of choice." - Selection depends on individual patient factors, side effect profile, and drug interactions. - **Note:** Both fluoxetine and sertraline are correct answers in modern practice; this question reflects historical exam teaching. *Alprazolam* - **Alprazolam** is a **benzodiazepine** used for short-term relief of anxiety and panic attacks. - It does not address the core pathophysiology of OCD (obsessions and compulsions). - Not recommended as monotherapy for OCD; may be used adjunctively for severe anxiety symptoms. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** used primarily for schizophrenia and psychotic disorders. - Not indicated for OCD treatment as monotherapy. - Antipsychotics may be used as **augmentation** in treatment-resistant OCD but only as add-on to SSRIs.

Question 1

In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?

Accepted Answer

Hoarding

Answer

Magical thinking

Answer

Contamination

Answer

Pathological doubt

Question 2

Obsession is a disorder of:

Accepted Answer

Thinking

Answer

Perception

Answer

Judgment

Answer

Memory

Question 3

All of the following statements are true about obsession except:

Accepted Answer

Patient believes that the images or thoughts are imposed by others

Answer

It is a repetitive thought or image

Answer

Patient gets disturbed when unable to remove the thoughts or images

Answer

Content of obsession can be about sex or god

Question 4

Body dysmorphic disorder can be associated with all except

Accepted Answer

Mania

Answer

Bulimia nervosa

Answer

OCD

Answer

Anxiety

Question 5

An irresistible urge to perform repetitive behaviors is characteristic of

Accepted Answer

Obsessive - compulsive disorder

Answer

Schizophrenia

Answer

Depression

Answer

Schizoaffective disorder

Question 6

Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?

Accepted Answer

Carbamazepine

Answer

Fluoxetine

Answer

Cognitive Behaviour Therapy

Answer

Clomipramine

Question 7

In OCD, if the patient tries to resist obsession, then patient develops?

Accepted Answer

Anxiety

Answer

Delusion

Answer

Depression

Answer

Mania

Question 8

All of the following are OCD related disorders except:

Accepted Answer

Temper tantrums

Answer

Hoarding disorder

Answer

Hair pulling disorder

Answer

Skin picking

Question 9

Areas of brain involved in OCD include:

Accepted Answer

Basal ganglia

Answer

Temporal lobe

Answer

All of the options

Answer

Cerebellum

Question 10

Drug of choice for obsessive-compulsive disorder is:

Accepted Answer

Fluoxetine

Answer

Sertraline

Answer

Alprazolam

Answer

Chlorpromazine

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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