Psychiatric Assessment and Diagnosis Practice Questions

Q: Déjà vu is most commonly associated with which condition?

Temporal lobe epilepsy. **Explanation:** **Déjà vu** (French for "already seen") is a disturbance of memory where a person has the subjective feeling that a current novel experience has been lived through before. **1. Why Temporal Lobe Epilepsy (TLE) is the correct answer:** While déjà vu can occur in healthy people, it is most clinically significant as a **pathognomonic aura** of Temporal Lobe Epilepsy. It occurs due to abnormal electrical discharges in the medial temporal lobe, specifically the **hippocampus and amygdala**, which are responsible for memory processing and emotional coloring. In TLE, it is often accompanied by other "dreamy states," such as *déjà entendu* (already heard) or *jamais vu* (familiarity felt as strange). **2. Analysis of Incorrect Options:** * **A. Normal individuals:** Although approximately 60-70% of the healthy population experiences occasional déjà vu (often triggered by stress or fatigue), it is not considered a "condition" or a diagnostic hallmark in this context. In exams, when asked for an associated *medical condition*, TLE is the primary choice. * **C. Psychosis:** While patients with schizophrenia may experience distortions of reality, déjà vu is not a core feature of psychosis. Psychotic symptoms are more typically characterized by delusions and hallucinations rather than paroxysmal memory disturbances. **3. NEET-PG High-Yield Pearls:** * **Jamais vu:** The false feeling of unfamiliarity with a very well-known situation (the opposite of déjà vu). * **Aura of TLE:** Includes déjà vu, epigastric rising sensations (most common), olfactory hallucinations (uncinate fits), and intense fear. * **Localization:** Déjà vu is specifically linked to the **non-dominant** temporal lobe. * **Paramnesia:** Déjà vu is classified as a "phenomenon of recognition" or a type of paramnesia (distortion of memory).

Q: A brief 30-point questionnaire test is done for which psychiatric assessment?

Mini-mental state examination. The **Mini-Mental State Examination (MMSE)**, also known as the Folstein test, is a widely used 30-point questionnaire designed to screen for **cognitive impairment** and monitor the progression of dementia. It assesses five functional domains: Orientation (10 points), Registration (3 points), Attention and Calculation (5 points), Recall (3 points), and Language/Visuospatial skills (9 points). A score of <24 is typically suggestive of cognitive impairment. ### Why the other options are incorrect: * **Peabody Individual Achievement Test (PIAT):** This is a standardized, norm-referenced assessment used to measure **academic achievement** in subjects like reading, mathematics, and spelling. It is not a 30-point psychiatric screening tool. * **Stanford-Binet Test:** This is a classic **Intelligence Quotient (IQ) test** used to measure cognitive abilities and intelligence across five factors (fluid reasoning, knowledge, quantitative reasoning, visual-spatial processing, and working memory). * **Wide-Range Achievement Test (WRAT):** Similar to the PIAT, this focuses on **academic skills** (reading, sentence comprehension, spelling, and arithmetic) rather than general psychiatric or cognitive screening. ### High-Yield Clinical Pearls for NEET-PG: * **MMSE Scoring:** 24–30 (Normal), 18–23 (Mild impairment), 0–17 (Severe impairment). * **Limitation:** The MMSE is heavily influenced by the patient’s **educational level** and age; it may yield false positives in those with low education. * **Alternative:** The **Montreal Cognitive Assessment (MoCA)** is often preferred for detecting "Mild Cognitive Impairment" (MCI) as it is more sensitive than the MMSE. * **Key Domain:** The "Serial 7s" or spelling "WORLD" backwards specifically tests **Attention and Concentration**.

Q: The DSM-IV classification of psychiatric disorders, as proposed by the American Psychiatric Association, diagnoses patients on multiple axes. Of these, Axis V represents the degree of:

Global assessment of function. **Explanation:** The DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) utilized a **multiaxial system** to provide a holistic assessment of a patient’s mental health. **Axis V** was specifically designated for the **Global Assessment of Functioning (GAF)**. This was a numerical scale (0 through 100) used by clinicians to subjectively rate the social, occupational, and psychological functioning of an individual. A higher score indicated better functioning, while a lower score indicated severe impairment or danger to self/others. **Analysis of Incorrect Options:** * **Option A (Present state of symptoms):** These are primarily recorded under **Axis I** (Clinical Disorders, such as Schizophrenia or Depression). * **Option B (Comorbid medical condition):** General medical conditions that are relevant to the understanding or management of the mental disorder are recorded under **Axis III**. * **Option D (Comorbid psychological problem):** Personality disorders and Intellectual Disability (Mental Retardation) are recorded under **Axis II**. **High-Yield Clinical Pearls for NEET-PG:** * **The 5 Axes of DSM-IV:** * **Axis I:** Clinical Disorders (e.g., Mood disorders, Anxiety, Psychosis). * **Axis II:** Personality Disorders and Mental Retardation. * **Axis III:** General Medical Conditions. * **Axis IV:** Psychosocial and Environmental Problems (e.g., unemployment, divorce). * **Axis V:** Global Assessment of Functioning (GAF). * **Evolution to DSM-5:** It is crucial to remember that the **DSM-5 (2013) has discarded the multiaxial system** and the GAF scale. It now uses a non-axial documentation system, combining Axes I, II, and III into a single diagnostic listing. * **WHO Alternative:** The DSM-5 replaced the GAF with the **WHODAS 2.0** (World Health Organization Disability Assessment Schedule) for measuring disability.

Question 1

What differentiates delirium from dementia?

Accepted Answer

Sudden change in mental status

Answer

Confusion

Answer

Difficulty in communicating

Answer

Hallucination

Question 2

Which of the following is the test for immediate recall?

Accepted Answer

Digit span forward up to 7 digits with 2 skips allowed

Answer

Serial subtraction test up to 5 steps

Answer

Digit span backwards up to 5 digits with 2 skips allowed

Answer

Serial subtraction test up to 5 steps

Question 3

Perceptual misinterpretation of a real stimulus or object is known as:

Accepted Answer

Illusion

Answer

Delusion

Answer

Hallucination

Answer

Schizophrenia

Question 4

A 16-year-old female presents with recurrent abdominal pain, but biochemical assays and ultrasound of the abdomen are normal. After waking up from sleep, she suddenly complains of loss of vision in both eyes. An ophthalmologist finds nothing on examination. This condition is most probably due to which of the following?

Accepted Answer

Malingering

Answer

Bilateral optic neuritis

Answer

Posterior cerebellar artery infarct

Answer

Occipital hemorrhage

Question 5

Déjà vu is most commonly associated with which condition?

Accepted Answer

Temporal lobe epilepsy

Answer

Normal individuals

Answer

Psychosis

Answer

All of the above

Question 6

Which of the following are considered cognitive disorders?

Accepted Answer

Delirium

Answer

Depersonalization

Answer

Dementia

Answer

Secondary gain

Question 7

A 45-year-old male presents with a 8-year history of continuous, dull, non-progressive headache. He is convinced he has a brain tumor despite normal investigations and multiple consultations with neurologists. Psychiatric evaluation reveals disease conviction. What is the most probable diagnosis?

Accepted Answer

Hypochondriasis

Answer

Conversion disorder

Answer

Somatization disorder

Answer

Somatoform pain disorder

Question 8

Which of the following statements differentiates an obsessional idea from a delusion?

Accepted Answer

The idea is regarded as senseless by the patient.

Answer

The idea is not a conventional belief.

Answer

The idea is held in spite of contrary evidence.

Answer

The idea is held on inadequate grounds.

Question 9

A brief 30-point questionnaire test is done for which psychiatric assessment?

Accepted Answer

Mini-mental state examination

Answer

Peabody Individual Achievement Test

Answer

Stanford-Binet Test

Answer

Wide-Range Achievement Test

Question 10

The DSM-IV classification of psychiatric disorders, as proposed by the American Psychiatric Association, diagnoses patients on multiple axes. Of these, Axis V represents the degree of:

Accepted Answer

Global assessment of function

Answer

Present state of symptoms

Answer

Comorbid medical condition

Answer

Comorbid psychological problem

Psychiatric Assessment and Diagnosis — MCQs

Psychiatric Assessment and Diagnosis — MCQs

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