Psychiatric Assessment and Diagnosis — MCQs

Psychiatric Assessment and Diagnosis Indian Medical PG Practice Questions and MCQs

Question 111: Which of the following is characteristic of a dissociative disorder?

A. Amnesia (Correct Answer)
B. Depression
C. Phobia
D. Paranoia

Explanation: **Explanation:** **Dissociative disorders** are characterized by a disruption or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, and behavior. **Why Amnesia is Correct:** **Dissociative Amnesia** is the most common dissociative symptom. It involves an inability to recall important personal information, usually of a stressful or traumatic nature, which is too extensive to be explained by ordinary forgetfulness. Unlike organic amnesia, it is typically retrograde and selective. Other core dissociative phenomena include depersonalization, derealization, and identity confusion/alteration (as seen in Dissociative Identity Disorder). **Why Incorrect Options are Wrong:** * **B. Depression:** This is a **Mood (Affective) Disorder**. While patients with dissociation may have comorbid low mood, depression itself is characterized by anhedonia and persistent sadness, not a breakdown in consciousness or memory. * **C. Phobia:** This is an **Anxiety Disorder**. It involves an irrational, persistent fear of a specific object or situation, leading to avoidance behavior. * **D. Paranoia:** This is a symptom of **Psychotic Disorders** (like Schizophrenia) or **Personality Disorders** (Paranoid PD). It involves unfounded suspicion or mistrust of others. **NEET-PG High-Yield Pearls:** * **Ganser Syndrome:** Also known as "approximate answers," it is a rare dissociative disorder often seen in prison inmates. * **Dissociative Fugue:** A subtype of dissociative amnesia involving sudden, unexpected travel away from home combined with an inability to recall one's past. * **Primary Gain:** The internal relief from anxiety produced by the symptom itself (keeping the conflict out of conscious awareness). * **Secondary Gain:** The external benefits derived from being sick (e.g., attention, avoiding work).

Question 112: A male patient presents with symptoms suggestive of heart disease, but his ECG and chest X-ray are normal. What is the most likely diagnosis?

A. Angina pectoris
B. Panic attack (Correct Answer)
C. Autonomic nervous system instability
D. Vasovagal attack

Explanation: ### Explanation **Correct Answer: B. Panic Attack** **Why it is correct:** A panic attack is a discrete period of intense fear or discomfort that reaches a peak within minutes. It frequently presents with **somatic symptoms mimicking a myocardial infarction**, such as chest pain, palpitations, shortness of breath, and diaphoresis. The hallmark of a psychiatric cause in this scenario is the **discrepancy between the severity of physical symptoms and the normal objective findings** (normal ECG and Chest X-ray). In clinical practice, "cardiac neurosis" or "Da Costa’s syndrome" are historical terms for similar presentations where psychological distress manifests as physical cardiac symptoms. **Why the other options are incorrect:** * **A. Angina pectoris:** While it presents with chest pain, it is an organic condition caused by myocardial ischemia. It would typically show ST-segment changes on an ECG (especially during an attack) or be associated with risk factors and exertional triggers not mentioned here. * **C. Autonomic nervous system instability:** This is a vague, non-specific term. While panic attacks involve autonomic hyperactivity, "instability" is not a recognized clinical diagnosis for this specific presentation. * **D. Vasovagal attack:** This typically leads to **bradycardia and hypotension**, resulting in syncope (fainting). It is usually triggered by specific stimuli (e.g., sight of blood, prolonged standing) and does not typically present with the intense "impending doom" or chest pain characteristic of a panic attack. **NEET-PG High-Yield Pearls:** * **Diagnosis:** According to DSM-5, a panic attack requires at least 4 out of 13 symptoms (e.g., palpitations, sweating, trembling, fear of dying). * **Immediate Management:** Rule out organic causes first (ECG/Troponin). * **Treatment:** * **Acute attack:** Benzodiazepines (e.g., Alprazolam or Lorazepam). * **Long-term (Prophylaxis):** SSRIs (Drug of Choice) and Cognitive Behavioral Therapy (CBT). * **Differential:** Always consider **Pheochromocytoma** and **Hyperthyroidism** in patients with recurrent panic-like symptoms.

Question 113: Which of the following cognitive functions is typically unaffected in dementia?

A. Consciousness (Correct Answer)
B. Memory
C. Judgment
D. Intellect

Explanation: **Explanation:** The hallmark of **Dementia** (Major Neurocognitive Disorder) is a chronic, progressive decline in cognitive functions occurring in a **clear state of consciousness**. Unlike Delirium, which is characterized by a "clouding of consciousness" and fluctuating levels of awareness, patients with dementia remain alert and awake until the very late stages of the disease. **Analysis of Options:** * **Consciousness (Correct):** In the early and middle stages of dementia, the level of arousal and sensorium remains intact. If a patient presents with cognitive deficits and altered consciousness, the diagnosis shifts toward **Delirium**. * **Memory (Incorrect):** Memory impairment (especially short-term memory) is typically the earliest and most prominent symptom in most dementias, such as Alzheimer’s disease. * **Judgment (Incorrect):** Executive functions, including the ability to make sound decisions, solve problems, and understand consequences (judgment), are significantly impaired as the disease involves the frontal and temporal lobes. * **Intellect (Incorrect):** Dementia involves a global decline in intellectual capacity, including language (aphasia), motor activities (apraxia), and recognition (agnosia). **High-Yield Clinical Pearls for NEET-PG:** 1. **Dementia vs. Delirium:** The most important differentiating factor is **Consciousness** (Intact in Dementia; Impaired/Fluctuating in Delirium). 2. **Reversible Dementias:** Always rule out Vitamin B12 deficiency, Hypothyroidism, and Normal Pressure Hydrocephalus (NPH). 3. **Pseudodementia:** This refers to **Depression** in the elderly where cognitive deficits mimic dementia, but the patient often complains of memory loss ("I don't know") rather than trying to hide it. 4. **Mini-Mental State Examination (MMSE):** A score of **<24** is generally suggestive of cognitive impairment.

Question 114: A 45-year-old male is always preoccupied with the feeling of illness. What is the most likely diagnosis?

A. Somatoform disorder
B. Hypochondriasis (Correct Answer)
C. Munchausen syndrome
D. Dissociative disorder

Explanation: ### Explanation **Correct Option: B. Hypochondriasis** Hypochondriasis (now classified in DSM-5 as **Illness Anxiety Disorder**) is characterized by a persistent preoccupation with the fear or idea of having a serious medical illness. This belief is based on a misinterpretation of normal bodily sensations or minor symptoms. Key features include: * The preoccupation persists despite appropriate medical evaluation and reassurance. * The focus is on the **fear of having a disease** rather than the symptoms themselves. * It must last for at least 6 months for a formal diagnosis. **Why other options are incorrect:** * **A. Somatoform disorder:** This is an umbrella term. While hypochondriasis is a type of somatoform disorder, the question asks for the most specific diagnosis. In Somatization Disorder specifically, the focus is on multiple, distressing physical symptoms rather than the fear of a specific underlying disease. * **C. Munchausen syndrome (Factitious Disorder):** Here, the patient **intentionally** produces or feigns physical or psychological symptoms to assume the "sick role" without external incentives (like money or avoiding work). In hypochondriasis, the patient truly believes they are ill. * **D. Dissociative disorder:** These involve a breakdown of memory, identity, or perception (e.g., amnesia, fugue, or dissociative motor disorders). There is no primary preoccupation with physical illness. **High-Yield Pearls for NEET-PG:** * **Hypochondriasis vs. Somatization:** Hypochondriasis = Fear of *disease*; Somatization = Distress over *symptoms*. * **Malingering:** Unlike Munchausen, symptoms are faked for **secondary gain** (e.g., disability benefits, avoiding jail). * **Treatment of choice:** Cognitive Behavioral Therapy (CBT). SSRIs are useful if there is comorbid anxiety or depression. * **Doctor Shopping:** Patients with hypochondriasis frequently visit multiple doctors due to dissatisfaction with reassurances.

Question 115: What is the code given to psychiatric diseases in ICD-10?

A. E
B. F (Correct Answer)
C. P
D. G

Explanation: ### Explanation **Correct Answer: B. F** The **ICD-10 (International Classification of Diseases, 10th Revision)**, published by the World Health Organization (WHO), uses an alphanumeric coding system where each chapter is assigned a specific letter. * **Chapter V (F00–F99)** is dedicated to **Mental and Behavioral Disorders**. * This chapter categorizes psychiatric conditions into blocks, such as F10–F19 for psychoactive substance use, F20–F29 for Schizophrenia and delusional disorders, and F30–F39 for Mood (affective) disorders. --- ### Analysis of Incorrect Options: * **Option A (E):** This chapter covers **Endocrine, nutritional, and metabolic diseases** (e.g., Diabetes Mellitus, Thyroid disorders). * **Option C (P):** This chapter covers **Certain conditions originating in the perinatal period** (neonatal conditions). * **Option D (G):** This chapter covers **Diseases of the Nervous System** (e.g., Epilepsy, Parkinson’s disease, Meningitis). While related to psychiatry, organic neurological pathologies are coded under G. --- ### High-Yield Clinical Pearls for NEET-PG: 1. **ICD vs. DSM:** While the ICD-10 is the global standard for general diagnostic purposes, the **DSM-5 (Diagnostic and Statistical Manual of Mental Disorders)**, published by the APA, is also frequently used in psychiatric research and clinical practice. 2. **ICD-11 Update:** The ICD-11 has been released and is being implemented. In ICD-11, Mental, behavioral, or neurodevelopmental disorders are now found in **Chapter 06**. 3. **Key ICD-10 Codes to Remember:** * **F20:** Schizophrenia * **F32:** Depressive Episode * **F41.1:** Generalized Anxiety Disorder * **F00:** Dementia in Alzheimer's disease

Question 116: What is the most common cause of dementia?

A. Fronto-temporal dementia
B. Senile dementia
C. Multi-infarct dementia
D. Alzheimer’s disease (Correct Answer)

Explanation: **Explanation:** **1. Why Alzheimer’s Disease is Correct:** Alzheimer’s disease (AD) is the most common cause of dementia worldwide, accounting for approximately **60–80% of all cases**. It is a neurodegenerative condition characterized by the accumulation of amyloid-beta plaques and tau neurofibrillary tangles. Clinically, it presents with progressive memory loss (especially episodic memory), disorientation, and cognitive decline. **2. Why the Other Options are Incorrect:** * **A. Fronto-temporal dementia (FTD):** While it is a significant cause of dementia in younger patients (under age 65), it is much rarer than AD. It typically presents with prominent personality changes or language deficits rather than early memory loss. * **B. Senile dementia:** This is an outdated, descriptive term rather than a specific pathological diagnosis. It simply refers to dementia occurring in old age. Most cases historically labeled as "senile dementia" are actually Alzheimer’s disease. * **C. Multi-infarct dementia:** Also known as Vascular Dementia, this is the **second most common** cause of dementia (approx. 10–20%). It is characterized by a "step-ladder" pattern of decline and is associated with cardiovascular risk factors and strokes. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common cause of dementia:** Alzheimer’s Disease. * **Second most common cause:** Vascular Dementia. * **Early sign of AD:** Loss of recent memory (Anterograde amnesia). * **Genetic markers:** APOE-ε4 (risk factor), Presenilin 1 & 2 (early-onset). * **Neurobiology:** Atrophy of the hippocampus and deficiency of Acetylcholine. * **Treatment of choice:** Cholinesterase inhibitors (Donepezil, Rivastigmine) and NMDA antagonists (Memantine).

Question 117: Which of the following differentiates pseudohallucination from hallucination?

A. Disorder of perception
B. Absence of real stimulus
C. External objective space (Correct Answer)
D. Involuntary

Explanation: To differentiate between a **hallucination** and a **pseudohallucination**, one must look at the **location** of the perception and the **subjective conviction** of the patient. ### **Explanation of the Correct Answer** The defining difference lies in the **spatial location (External objective space)**. * **Hallucinations** are perceived as occurring in **outer objective space** (e.g., hearing a voice coming from the garden). They possess the same vividness and "concrete reality" as a true sense perception. * **Pseudohallucinations** are perceived as occurring in **inner subjective space** (e.g., hearing a voice "inside the head" or seeing an image in the "mind's eye"). ### **Analysis of Incorrect Options** * **A. Disorder of perception:** Both are considered disorders of perception (specifically sensory distortions/deceptions), so this does not differentiate them. * **B. Absence of real stimulus:** This is a **shared feature**. Both hallucinations and pseudohallucinations occur in the absence of an external stimulus (unlike illusions, which require a stimulus). * **C. Involuntary:** Both experiences are **involuntary** and cannot be conjured or dismissed at will by the patient. ### **NEET-PG High-Yield Pearls** * **Insight:** In pseudohallucinations, insight is often preserved (the patient realizes the perception is not "real"), whereas in true hallucinations, insight is typically absent. * **Jasper’s Criteria for Hallucination:** 1. As vivid as a real perception, 2. Occurs in external space, 3. Involuntary. * **Clinical Context:** Pseudohallucinations are frequently seen in **Dissociative disorders**, personality disorders, or during bereavement, whereas true hallucinations are hallmark features of **Schizophrenia** and **Psychotic Depression**. * **Hypnagogic/Hypnopompic** phenomena are technically "physiological hallucinations" but are often experienced as pseudohallucinations.

Question 118: Hallucination is a disorder of?

A. Thought
B. Perception (Correct Answer)
C. Memory
D. Intelligence

Explanation: **Explanation:** **1. Why Perception is Correct:** Perception is the process of interpreting sensory information. **Hallucination** is defined as a **"perception in the absence of an external stimulus."** Unlike illusions (which are misinterpretations of actual stimuli), hallucinations occur spontaneously in objective space and have the force and clarity of a real perception. Since it involves the sensory system (visual, auditory, olfactory, etc.) without a physical trigger, it is classified as a primary disorder of perception. **2. Why Other Options are Incorrect:** * **Thought:** Disorders of thought are divided into form (e.g., Loosening of association), content (e.g., **Delusions**), and stream (e.g., Flight of ideas). While hallucinations often coexist with delusions in psychosis, they are sensory, not ideational. * **Memory:** Disorders of memory include **Amnesia** (retrograde/anterograde) or Paramnesias (e.g., Confabulation, Déjà vu). * **Intelligence:** Disorders here involve deficits in cognitive functioning and IQ, such as **Intellectual Disability** or Dementia. **3. High-Yield Clinical Pearls for NEET-PG:** * **Hypnagogic Hallucinations:** Occur while falling asleep (Normal/Narcolepsy). * **Hypnopompic Hallucinations:** Occur while waking up (Normal/Narcolepsy). * **Auditory Hallucinations:** Most common type in **Schizophrenia** (specifically third-person "commenting" voices). * **Visual Hallucinations:** Highly suggestive of **Organic Brain Syndromes** (Delirium) or substance withdrawal (Delirium Tremens). * **Lilliputian Hallucinations:** Seeing objects/people as smaller than they are; common in Alcohol Withdrawal. * **Formication:** The sensation of insects crawling on the skin (Tactile hallucination); classic in **Cocaine** use (Cocaine bugs).

Question 119: A 40-year-old woman presents with a complaint of abnormal behavior. During the interview, she laughs and cries spontaneously over very short periods. Her affect is best described as?

A. Apathy
B. Blunted affect
C. Euthymic affect
D. Labile affect (Correct Answer)

Explanation: ### Explanation **Correct Option: D. Labile affect** The patient is demonstrating **affective lability**. In psychiatry, "affect" refers to the external, observable expression of an individual's internal emotional state. **Labile affect** is characterized by rapid, abrupt, and significant shifts in emotional expression (e.g., moving from laughter to tears within seconds or minutes) that are often disproportionate to external stimuli. This is commonly seen in conditions like Bipolar Disorder (manic episodes), Borderline Personality Disorder, Histrionic Personality Disorder, and organic brain syndromes (Pseudobulbar affect). **Analysis of Incorrect Options:** * **A. Apathy:** This refers to a lack of feeling, emotion, interest, or concern. It is a state of indifference rather than a shift in emotions. * **B. Blunted affect:** This is a significant reduction in the intensity of emotional expression. The patient’s face may remain relatively immobile and their voice monotonous. It is a "negative symptom" frequently seen in Schizophrenia. * **C. Euthymic affect:** This represents a "normal" or stable range of mood and affect, implying the absence of depressed or elevated states. **NEET-PG High-Yield Pearls:** * **Affect vs. Mood:** Mood is the pervasive, sustained internal emotional "climate" (subjective), while affect is the fluctuating emotional "weather" (objective/observed). * **Incongruent Affect:** When the emotional expression does not match the content of the patient's speech (e.g., laughing while describing a tragedy). * **Flat Affect:** The most severe form of blunting where there is virtually no expression of emotion; classic in chronic Schizophrenia. * **Pseudobulbar Affect (PBA):** Pathological laughing and crying due to neurological damage (e.g., Stroke, ALS, MS), often mistaken for a primary mood disorder.

Question 120: Jamais vu is:

A. The illusion that what one is hearing, one has heard previously
B. An unfamiliar thought regarded as a repetition of a previous thought
C. Unfamiliar situations or events feel strangely familiar
D. A feeling of strangeness in a familiar situation (Correct Answer)

Explanation: **Explanation:** **Jamais vu** (French for "never seen") is a phenomenon of **paramnesia** characterized by a false sense of unfamiliarity. It occurs when an individual encounters a situation, person, or place that is objectively familiar but feels completely strange or new. In psychiatric practice, it is often associated with temporal lobe epilepsy, migraines, or dissociative disorders. **Analysis of Options:** * **Option D (Correct):** This accurately describes Jamais vu—the subjective feeling that a well-known situation is being experienced for the first time. * **Option A (Incorrect):** This describes **Déjà entendu** ("already heard"), where a person feels they have heard a specific sound or conversation before, despite no prior evidence. * **Option B (Incorrect):** This refers to **Déjà pensé** ("already thought"), where a novel idea is mistakenly perceived as a past thought. * **Option C (Incorrect):** This describes **Déjà vu** ("already seen"), which is the opposite of Jamais vu. It is the illusion of familiarity in a completely new situation. **Clinical Pearls for NEET-PG:** * **Déjà vu and Jamais vu** are both "disturbances of memory" (specifically paramnesias) and are frequently seen as **auras in Temporal Lobe Epilepsy (TLE)**. * While occasional Déjà vu is common in healthy individuals (especially during stress or fatigue), frequent **Jamais vu** is more clinically significant and more strongly associated with neurological pathology. * **Confabulation** is another high-yield paramnesia, but unlike the "vu" phenomena, it involves filling memory gaps with fabricated stories, typically seen in Korsakoff’s psychosis.

Practice by Chapter

Clinical Interview Techniques

Practice Questions

Mental Status Examination

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Diagnostic Formulation

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Rating Scales and Questionnaires

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Psychological Testing

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Neuropsychological Assessment

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Risk Assessment

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Laboratory Investigations in Psychiatry

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Neuroimaging in Clinical Assessment

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Cultural Considerations in Assessment

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Developmental Assessment

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Diagnostic Classification Systems

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