Obsessive-Compulsive and Related Disorders — MCQs

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

Question 81: In exposure and response prevention therapy which one of the following is a poor prognostic factor in OCD?

A. Magical thinking
B. Contamination
C. Hoarding (Correct Answer)
D. Pathological doubt

Explanation: ***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.

Question 82: Obsession is a disorder of:

A. Perception
B. Judgment
C. Thinking (Correct Answer)
D. Memory

Explanation: ***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.

Question 83: All of the following statements are true about obsession except:

A. It is a repetitive thought or image
B. Patient gets disturbed when unable to remove the thoughts or images
C. Content of obsession can be about sex or god
D. Patient believes that the images or thoughts are imposed by others (Correct Answer)

Explanation: ***Patient believes that the images or thoughts are imposed by others*** - This statement is **FALSE** about obsessions and is the **correct answer** to this EXCEPT question. - This describes **thought insertion**, a **first-rank psychotic symptom** where an individual believes external forces are putting thoughts into their mind. - In **true obsessions**, patients recognize the thoughts as their **own** (even if unwanted and ego-dystonic), not externally imposed. - This is a **key differentiating feature** between obsessions and psychotic thought disorders. *It is a repetitive thought or image* - This statement is TRUE. Obsessions are characterized by **recurrent and persistent thoughts, urges, or images** that are experienced as intrusive and unwanted (DSM-5 criteria). - These thoughts are **repetitive** and cause significant anxiety or distress. *Patient gets disturbed when unable to remove the thoughts or images* - This statement is TRUE. Individuals with obsessions actively attempt to **suppress or neutralize** these intrusive thoughts. - The **inability to control or eliminate** these thoughts is a core source of distress and functional impairment in OCD. - This distress often leads to **compulsive behaviors** as attempts to reduce anxiety. *Content of obsession can be about sex or god* - This statement is TRUE. Obsessions can involve diverse themes including **sexuality, religion (scrupulosity/blasphemous thoughts), contamination, aggression, symmetry, or harm**. - These themes are typically **ego-dystonic**, meaning they are inconsistent with the person's values and beliefs, which increases distress.

Question 84: Body dysmorphic disorder can be associated with all except

A. Bulimia nervosa
B. OCD
C. Anxiety
D. Mania (Correct Answer)

Explanation: ***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.

Question 85: An irresistible urge to perform repetitive behaviors is characteristic of

A. Obsessive - compulsive disorder (Correct Answer)
B. Schizophrenia
C. Depression
D. Schizoaffective disorder

Explanation: ***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.

Question 86: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?

A. Fluoxetine
B. Carbamazepine (Correct Answer)
C. Cognitive Behaviour Therapy
D. Clomipramine

Explanation: ***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.

Question 87: In OCD, if the patient tries to resist obsession, then patient develops?

A. Delusion
B. Depression
C. Mania
D. Anxiety (Correct Answer)

Explanation: ***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.

Question 88: All of the following are OCD related disorders except:

A. Temper tantrums (Correct Answer)
B. Hoarding disorder
C. Hair pulling disorder
D. Skin picking

Explanation: ***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.

Question 89: Areas of brain involved in OCD include:

A. Basal ganglia (Correct Answer)
B. Temporal lobe
C. All of the options
D. Cerebellum

Explanation: ***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.

Question 90: Drug of choice for obsessive-compulsive disorder is:

A. Sertraline
B. Fluoxetine (Correct Answer)
C. Alprazolam
D. Chlorpromazine

Explanation: ***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.

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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