Psychiatric Assessment and Diagnosis Practice Questions

Q: What is fetishism?

Sexual perversion. **Explanation:** **Fetishism** is a type of **Paraphilic Disorder** (historically and broadly referred to as **Sexual Perversion**). It involves the use of non-living objects (e.g., shoes, undergarments, leather) or a highly specific focus on a non-genital body part (e.g., feet) as the primary or exclusive source of sexual arousal and gratification. In psychiatric classification (DSM-5/ICD-11), it is considered a disorder when it causes significant distress or functional impairment. **Analysis of Options:** * **Option D (Correct):** Fetishism falls under the umbrella of sexual perversions (paraphilias), which are characterized by abnormal sexual desires or behaviors directed toward unconventional objects, situations, or individuals. * **Option A:** **Transvestism** (Transvestic Disorder) involves sexual arousal from cross-dressing. While it is also a paraphilia, it is a distinct entity from fetishism, though "fetishistic transvestism" is a specific subtype. * **Option B:** **Bestiality** (Zoophilia) involves sexual attraction to or acts with animals. It is a separate category of paraphilia. * **Option C:** **Buccal coitus** refers to oral sex. This is considered a variation of normal sexual behavior and is not classified as a psychiatric perversion or paraphilia. **High-Yield Clinical Pearls for NEET-PG:** * **Gender Prevalence:** Fetishism is diagnosed almost exclusively in **males**. * **Common Fetishes:** Inanimate objects (clothing, footwear) or specific body parts (podophilia/foot fetish). * **Diagnosis:** Symptoms must be present for at least **6 months** for a formal diagnosis of Fetishistic Disorder. * **Treatment:** Behavioral therapy (Aversion therapy, Covert sensitization) and SSRIs or anti-androgens to reduce compulsive sexual drive are the mainstays of management.

Q: What is the term for a persistent belief in something that is not a fact?

Delusion. **Explanation:** The correct answer is **Delusion**. In psychiatry, a delusion is defined as a **fixed, false belief** that is firmly held despite incontrovertible evidence to the contrary and is not consistent with the patient’s educational, cultural, or social background. It is a disorder of the **content of thought**. **Analysis of Options:** * **Delusion (Correct):** It is a subjective belief. Key characteristics include being unshakable, false, and out of keeping with the individual's socio-cultural context. * **Illusion:** This is a disorder of perception involving the **misinterpretation of a real external stimulus** (e.g., mistaking a rope for a snake in the dark). * **Hallucination:** This is a **perception in the absence of an external stimulus**. The person sees, hears, or feels something that is not there, but the experience has the vividness and impact of a real perception. * **Delirium:** This is an acute, transient, and reversible state of **confusion** characterized by clouded consciousness, disorientation, and fluctuating levels of attention. It is an organic mental disorder, not a specific term for a belief. **High-Yield Clinical Pearls for NEET-PG:** * **Overvalued Idea:** A solitary, abnormal belief that is neither delusional nor obsessive but is preoccupied with by the patient (e.g., hypochondriasis). Unlike a delusion, it is not necessarily "fixed" or "false." * **Bizarre vs. Non-Bizarre:** Delusions are "bizarre" if they are physically impossible (e.g., aliens replacing organs without scars) and "non-bizarre" if they are plausible but untrue (e.g., being followed by the police). * **Primary Delusion (Autochthonous):** Arises suddenly "out of the blue" without a preceding mental event; highly characteristic of Schizophrenia.

Q: Stereotypic movements are

Repetitive, spontaneous, nonfunctional movements. **Explanation:** **Stereotypic movements** (Stereotypies) are defined as repetitive, rhythmic, fixed, and nonfunctional motor behaviors. These movements are typically spontaneous and often occur in a predictable pattern (e.g., hand waving, body rocking, or head banging). They are commonly associated with Autism Spectrum Disorder (ASD), Intellectual Disability, and certain sensory deprivation states. Unlike tics, they are more rhythmic and can often be stopped by distraction. **Analysis of Incorrect Options:** * **A. Sustained posture against gravity:** This describes **Catalepsy**. It is a state of muscular rigidity where a patient maintains a fixed posture for a long duration, often seen in catatonic schizophrenia. * **B. Passive inducible movements:** This refers to **Mannerisms**. While often confused with stereotypies, mannerisms are goal-directed or functional movements (like a salute or a specific way of waving) that are performed in an odd, exaggerated, or stilted manner. * **C. Resistance to passive movements:** This describes **Gegenhalten** (paratonia) or **Negativism**. In catatonia, if the resistance is equal to the force applied, it is termed "rigid resistance"; if the patient resists all instructions or attempts to be moved, it is "negativism." **High-Yield Clinical Pearls for NEET-PG:** * **Stereotypy vs. Tic:** Stereotypies have an earlier age of onset (usually <3 years), are rhythmic, and lack the premonitory urge associated with tics. * **Waxy Flexibility (Cerea Flexibilitas):** A specific type of catatonic behavior where the patient offers initial resistance to moving a joint, but then allows the limb to be placed in a new position, which is then maintained (like bending a wax candle). * **Echopraxia:** The involuntary imitation of another person's movements, another key feature of catatonia.

Q: False perception without any external stimulus is:

Hallucination. ### Explanation **Correct Answer: B. Hallucination** **Why it is correct:** A **hallucination** is defined as a sensory perception in the absence of an external stimulus. It is a "perception without an object." Hallucinations occur in the external space (unlike imagery) and possess the same vividness and quality as a real perception. They can occur in any sensory modality (auditory, visual, olfactory, gustatory, or tactile). **Why the other options are incorrect:** * **A. Illusion:** This is a **misinterpretation** of a real external stimulus (e.g., mistaking a rope for a snake in the dark). Unlike hallucinations, an external object is present. * **C. Delirium:** This is an acute, reversible state of confusion characterized by a clouding of consciousness, disorientation, and fluctuating attention. While hallucinations (especially visual) can occur *during* delirium, the term itself refers to the global cognitive syndrome, not the specific perceptual error. * **D. Delusion:** This is a disorder of **thought content**, not perception. It is defined as a fixed, false belief that is out of keeping with the patient’s social, cultural, and educational background and is held with absolute conviction despite logical evidence to the contrary. **High-Yield Clinical Pearls for NEET-PG:** * **Most common hallucination in Schizophrenia:** Auditory (specifically third-person "running commentary"). * **Most common hallucination in Organic Brain Syndromes (e.g., Delirium):** Visual. * **Hypnagogic vs. Hypnopompic:** Hallucinations occurring while falling asleep (Hypna**g**ogic = **G**oing to sleep) vs. waking up (Hypno**p**ompic = **P**op out of bed). * **Formication:** A tactile hallucination feeling like insects crawling under the skin, commonly seen in cocaine withdrawal ("Cocaine bugs") or alcohol withdrawal.

Q: Delusions are seen in all of the following conditions, except?

Conversion disorder. **Explanation:** The core of this question lies in distinguishing between **Psychotic Disorders** (characterized by a loss of reality testing) and **Somatoform/Dissociative Disorders**. **Why Conversion Disorder is the correct answer:** Conversion Disorder (Functional Neurological Symptom Disorder) is a condition where patients present with neurological symptoms (like paralysis, blindness, or seizures) that cannot be explained by a neurological disease. These symptoms are usually triggered by psychological stress. Crucially, Conversion Disorder involves **physical symptoms**, not disturbances in thought content. **Delusions**, which are fixed, false beliefs resistant to reasoning, are a hallmark of psychosis and are not a feature of Conversion Disorder. **Analysis of Incorrect Options:** * **Schizophrenia:** Delusions are a primary diagnostic criterion (Schneiderian First Rank Symptoms). Patients often exhibit persecutory, referential, or bizarre delusions. * **Depression:** In "Psychotic Depression," patients may experience delusions that are typically **mood-congruent**, such as delusions of guilt, poverty, or nihilism (Cotard’s syndrome). * **Dementia:** Psychotic symptoms are common in the behavioral and psychological symptoms of dementia (BPSD). For example, patients with Alzheimer’s often develop delusions of theft or infidelity. **Clinical Pearls for NEET-PG:** * **La Belle Indifference:** A classic (though not pathognomonic) sign in Conversion Disorder where the patient shows a surprising lack of concern regarding their severe physical disability. * **Secondary Gain:** Conversion symptoms often provide an unconscious "gain" (e.g., avoiding a stressful situation). * **Delusion Definition:** Always remember the "3 Fs"—**F**ixed, **F**alse belief, held despite contrary evidence, and not in keeping with the patient's social/cultural **F**ramework.

Q: Term partialism refers to fetishes involving which of the following?

Nonsexual body part. **Explanation:** **Partialism** is a specific form of paraphilic disorder where sexual interest and arousal are focused exclusively on a **nonsexual body part** (e.g., feet, hands, hair, or navel) rather than the genitals. While the DSM-5 classifies partialism under the umbrella of **Fetishistic Disorder**, it is distinguished by the fact that the fetish object is a part of the human body rather than an inanimate object. **Analysis of Options:** * **Option A (Correct):** Partialism specifically refers to the sexualization of body parts that are not traditionally considered erogenous or primary/secondary sexual organs. * **Option B (Incorrect):** Interest in specific clothing (e.g., shoes, stockings, or leather) is defined as **Fetishism** involving inanimate objects. If the clothing belongs to the opposite sex and is worn for arousal, it is termed **Transvestic Disorder**. * **Option C (Incorrect):** Sexual arousal involving food is known as **Sitiaurism** or "food play" and is not classified as partialism. * **Option D (Incorrect):** Focus on nonsexual behaviors or specific scenarios (e.g., watching others, inflicting pain) falls under other paraphilias like **Voyeurism** or **Sexual Sadism**, rather than partialism. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnosis:** According to DSM-5, Fetishistic Disorder is diagnosed only if the behavior causes clinically significant distress or impairment for at least **6 months**. * **Commonest Site:** The **foot** (podophilia) is the most common body part involved in partialism. * **Gender Distribution:** These disorders are diagnosed almost exclusively in **males**. * **Treatment:** Cognitive Behavioral Therapy (CBT) and SSRIs are first-line; Anti-androgens (e.g., Medroxyprogesterone) are used in severe cases to reduce libido.

Q: A 45-year-old male presents with a 7-day history of continuous, non-progressive headache. He believes he has a brain tumor and has consulted multiple neurologists, with all investigations being within normal limits. He requests further investigations to confirm the presence of a brain tumor. Psychiatric evaluation suggests the condition is present despite normal investigations. What is the most probable diagnosis?

Hypochondriasis. **Explanation:** The core feature of this case is the **preoccupation with the fear or idea of having a serious disease** (brain tumor) based on a misinterpretation of bodily symptoms (headache), which persists despite medical reassurance and normal investigations. **1. Why Hypochondriasis is correct:** In **Hypochondriasis** (now termed Illness Anxiety Disorder in DSM-5), the patient’s primary concern is the *meaning* of the symptom rather than the symptom itself. The patient is convinced they have a specific, serious underlying pathology. The duration (though typically 6 months for a formal diagnosis, the clinical presentation here is classic) and the "doctor-shopping" behavior are hallmark features. **2. Why other options are incorrect:** * **Somatization Disorder:** Characterized by multiple, recurrent, and frequently changing physical symptoms (involving gastrointestinal, sexual, and neurological systems) rather than a preoccupation with a single serious disease. * **Somatoform Pain Disorder:** The primary complaint is persistent, severe, and distressing pain that cannot be fully explained by a physiological process. The focus is on the *pain* itself, not a specific underlying diagnosis like a tumor. * **Conversion Disorder (Functional Neurological Symptom Disorder):** Involves a loss or change in motor or sensory function (e.g., paralysis, blindness, seizures) that suggests a neurological condition but is triggered by psychological conflict or stress. **Clinical Pearls for NEET-PG:** * **Hypochondriasis:** Focus is on the **Disease** (Fear of having a tumor). * **Somatization:** Focus is on the **Symptoms** (Multiple vague complaints). * **Conversion:** Focus is on **Function** (Loss of voluntary motor/sensory power). * **Factitious Disorder:** Symptoms are intentionally produced to assume the "sick role" (internal gain). * **Malingering:** Symptoms are faked for external gain (e.g., money, avoiding work).

Question 1

What is fetishism?

Accepted Answer

Sexual perversion

Answer

Transvestism

Answer

Bestiality

Answer

Buccal coitus

Question 2

A 25-year-old housewife presented to the psychiatry outpatient department complaining that her nose was longer than usual. She felt that her husband did not like her because of this perceived deformity and had developed a relationship with the neighboring girl. Furthermore, she complained that people made fun of her. It was not possible to convince her that there was no deformity. What do her symptoms suggest?

Accepted Answer

Delusion

Answer

Depression

Answer

Hallucination

Answer

Depersonalization

Question 3

What is the term for a persistent belief in something that is not a fact?

Accepted Answer

Delusion

Answer

Illusion

Answer

Hallucination

Answer

Delirium

Question 4

Stereotypic movements are

Accepted Answer

Repetitive, spontaneous, nonfunctional movements

Answer

Sustained posture against gravity

Answer

Passive inducible movements

Answer

Resistance to passive movements

Question 5

Which of the following is the odd one out?

Accepted Answer

Briquet syndrome

Answer

Dhat syndrome

Answer

Run amok

Answer

Koro

Question 6

Which of the following is NOT true about dementia?

Accepted Answer

Clouding of consciousness is common

Answer

Often irreversible

Answer

Hallucinations are not common

Answer

Nootropics have limited role

Question 7

False perception without any external stimulus is:

Accepted Answer

Hallucination

Answer

Illusion

Answer

Delirium

Answer

Delusion

Question 8

Delusions are seen in all of the following conditions, except?

Accepted Answer

Conversion disorder

Answer

Schizophrenia

Answer

Depression

Answer

Dementia

Question 9

Term partialism refers to fetishes involving which of the following?

Accepted Answer

Nonsexual body part

Answer

Specific clothing

Answer

Specific type of food

Answer

Nonsexual behavior

Question 10

A 45-year-old male presents with a 7-day history of continuous, non-progressive headache. He believes he has a brain tumor and has consulted multiple neurologists, with all investigations being within normal limits. He requests further investigations to confirm the presence of a brain tumor. Psychiatric evaluation suggests the condition is present despite normal investigations. What is the most probable diagnosis?

Accepted Answer

Hypochondriasis

Answer

Somatization disorder

Answer

Somatoform pain disorder

Answer

Conversion disorder

Psychiatric Assessment and Diagnosis — MCQs

Psychiatric Assessment and Diagnosis — MCQs

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