Psychiatric Assessment and Diagnosis Practice Questions

Q: Suicidal tendencies are least common with whom?

Being married. **Explanation:** The correct answer is **D. Being married**. This question assesses knowledge of the sociodemographic risk factors for suicide, a high-yield topic in Psychiatry. **1. Why "Being Married" is correct:** Marriage is considered a significant **protective factor** against suicide. It provides social support, emotional stability, and a sense of responsibility toward family members (especially if there are children). According to Durkheim’s sociological theory, marriage increases "social integration," which inversely correlates with suicide rates. **2. Why the other options are incorrect:** * **Being alone (A):** Social isolation, being single, divorced, or widowed significantly increases suicide risk. Living alone lacks the "buffer" of social support. * **Depression (B):** Psychiatric disorders are the strongest predictors of suicide. Approximately 15% of patients with severe Depressive Disorder eventually die by suicide. It is a major risk factor, not a protective one. * **Being male (C):** While women make more suicide *attempts* (3:1 ratio), men are more likely to *complete* suicide (3:1 ratio) because they tend to use more lethal methods (e.g., firearms, hanging). **Clinical Pearls for NEET-PG:** * **The "Sad Persons" Scale:** A mnemonic used to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol, Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness). * **Highest Risk Group:** Elderly white males (especially those with chronic pain or terminal illness). * **Paradoxical Suicide:** Risk increases shortly after starting antidepressants or during early recovery from depression, as the patient gains the physical energy to carry out a plan before the suicidal ideation subsides. * **Protective Factors:** Marriage, pregnancy, having young children, and strong religious beliefs.

Q: Hysteria is characterised by

Indifference to suffering. **Explanation:** The correct answer is **Indifference to suffering (Option A)**. In the context of psychiatry, "Hysteria" (historically used to describe what are now classified as **Dissociative (Conversion) Disorders**), is classically associated with a phenomenon known as ***La belle indifférence***. 1. **Why Option A is correct:** *La belle indifférence* refers to a paradoxical lack of concern or anxiety regarding severe physical symptoms (e.g., sudden paralysis or blindness) that have no organic cause. The patient appears emotionally detached from their disability, which is a hallmark clinical feature used to differentiate conversion disorders from organic pathologies or malingering. 2. **Why other options are incorrect:** * **Flight of ideas (B) and Pressure of speech (C):** These are classic features of a **Manic Episode** (Bipolar Disorder). Flight of ideas involves a rapid shifting of ideas with fragmented connections, while pressure of speech is an increased rate and quantity of speech that is difficult to interrupt. * **Autistic thinking (D):** This is one of the "4 As" of **Schizophrenia** described by Eugen Bleuler. It refers to a private, internal world of fantasy and preoccupation with self, where the patient loses touch with external reality. **High-Yield Clinical Pearls for NEET-PG:** * **Primary Gain:** The internal relief from anxiety by keeping an unconscious conflict out of awareness (the core mechanism of Conversion Disorder). * **Secondary Gain:** The external benefits derived from being "sick," such as avoiding work or gaining sympathy. * **Ganser Syndrome:** Often called "hysterical pseudodementia," characterized by "approximate answers" (e.g., 2+2=5), typically seen in forensic/prison settings.

Q: EEG is used in the diagnosis of which of the following conditions, except?

Intermittent explosive disorder. **Explanation:** In psychiatric practice, the Electroencephalogram (EEG) is primarily used to rule out organic brain disorders (like epilepsy or tumors) that mimic psychiatric symptoms. **Why Intermittent Explosive Disorder (IED) is the correct answer:** IED is characterized by repeated, sudden episodes of impulsive, aggressive, or violent behavior. There is a strong clinical association between temporal lobe abnormalities and impulse control. Research indicates that a significant percentage of patients with IED (up to 20%–50%) show **non-specific EEG abnormalities**, such as slowing or paroxysmal discharges. Therefore, an EEG is a standard part of the diagnostic workup for IED to rule out **Temporal Lobe Epilepsy (TLE)**, which can present with similar "episodic dyscontrol." **Why the other options are incorrect:** * **Panic Disorder, Anxiety Disorder, and Bipolar Disorder:** These are considered "functional" psychiatric disorders. While research may show subtle changes in brain wave patterns in these conditions, EEG is **not** a diagnostic tool for them in clinical practice. Diagnosis for these conditions is based strictly on clinical criteria (DSM-5/ICD-11). Using an EEG for these would not provide diagnostic clarity or change the management plan. **High-Yield Clinical Pearls for NEET-PG:** * **EEG in Psychiatry:** Most useful in diagnosing Delirium (generalized slowing), Dementia (to rule out CJD), and differentiating Pseudo-seizures from Epilepsy. * **Delirium vs. Psychosis:** EEG is the gold standard to differentiate; Delirium shows generalized theta/delta slowing (except in Alcohol Withdrawal/DTs, where it shows low-voltage fast activity), while functional psychosis shows a normal EEG. * **Drug Effects:** Clozapine and Lithium are notorious for lowering the seizure threshold and causing EEG changes (spikes and sharp waves).

Q: Derealization and depersonalization are characteristic symptoms of which type of disorder?

Dissociative disorder. **Explanation:** **1. Why Dissociative Disorder is Correct:** Depersonalization and derealization are core symptoms of **Dissociative Disorders** (specifically Depersonalization-Derealization Disorder). * **Depersonalization:** A subjective experience of unreality or detachment from one’s own self (e.g., feeling like an outside observer of one’s body or mental processes). * **Derealization:** A sense of unreality or detachment from the surroundings (e.g., individuals or objects are experienced as dreamlike, foggy, or visually distorted). In these disorders, reality testing remains intact, but the individual experiences a profound disruption in the usually integrated functions of consciousness and perception. **2. Why Other Options are Incorrect:** * **Personality Disorders:** These are enduring, pervasive patterns of inner experience and behavior (e.g., Borderline, Schizoid). While transient dissociation can occur under extreme stress in Borderline Personality Disorder, it is not the defining characteristic of the category. * **Mania:** This is a mood state characterized by elation, pressured speech, and grandiosity. While a manic patient may experience psychosis (delusions/hallucinations), depersonalization is not a diagnostic hallmark of bipolar affective disorder. **3. Clinical Pearls for NEET-PG:** * **Reality Testing:** Unlike psychosis, in Depersonalization-Derealization disorder, the patient **knows** the feeling is not real (intact reality testing). * **ICD-10/11 & DSM-5:** Depersonalization-derealization syndrome is classified under Dissociative disorders. * **Common Trigger:** Severe anxiety or traumatic stress often precedes dissociative episodes. * **Differential:** Always rule out temporal lobe epilepsy or substance use (e.g., ketamine, marijuana) which can mimic these symptoms.

Q: A mentally ill person smells an unpleasant odor when none is present. This is an example of:

Hallucination. ### Explanation **Correct Answer: D. Hallucination** **Why it is correct:** A **hallucination** is defined as a false sensory perception in the absence of an external stimulus. In this scenario, the patient perceives an unpleasant odor (olfactory sensation) despite no physical source being present. Hallucinations can occur in any sensory modality (visual, auditory, olfactory, gustatory, or tactile). Olfactory hallucinations (phantosmia) are often associated with temporal lobe epilepsy (uncinate fits) or organic brain lesions, though they can also occur in schizophrenia and severe depression. **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). In the question, no stimulus is present at all. * **B. Delusion:** This is a disorder of **thought content**, defined as a fixed, false belief that is out of keeping with the patient’s social and cultural background and cannot be corrected by logic. It is not a sensory perception. * **C. Obsession:** This is a disorder of **thought form/process**, characterized by repetitive, intrusive, and distressing thoughts, impulses, or images that the patient recognizes as their own but finds difficult to resist. **NEET-PG High-Yield Pearls:** * **Hypnagogic vs. Hypnopompic:** Hallucinations occurring while falling asleep (Hypna**go**gic = **Go**ing to sleep) vs. waking up (Hypno**pom**pic = **Po**pping out of bed). * **Most common type:** Auditory hallucinations are the most common in Schizophrenia; Visual hallucinations are more common in organic brain syndromes (delirium/dementia). * **Formication:** A specific tactile hallucination (feeling of insects crawling under the skin) common in cocaine withdrawal and delirium tremens. * **Reflex Hallucination:** A stimulus in one sensory modality triggers a hallucination in another (e.g., hearing a sound triggers a visual hallucination).

Q: What is the IQ range for moderate mental retardation?

50-35. **Explanation:** Mental Retardation (now clinically referred to as **Intellectual Disability**) is categorized based on Intelligence Quotient (IQ) scores. According to the ICD-10 classification, **Moderate Mental Retardation** corresponds to an **IQ range of 35–49 (often rounded to 35–50)**. Individuals in this category are considered "trainable"; they can acquire communication skills and perform semi-skilled work under supervision but usually require support to live independently. **Analysis of Options:** * **Option A (90–70):** This range represents **Borderline Intelligence**. It is not classified as mental retardation, though individuals may face significant learning challenges. * **Option B (70–50):** This is **Mild Mental Retardation** (Educable). It is the most common type (85% of cases). These individuals can achieve academic skills up to the 6th-grade level. * **Option C (50–35):** **Correct.** This defines **Moderate Mental Retardation**. * **Option D (35–20):** This is **Severe Mental Retardation**. These individuals may learn to talk and can be trained in basic self-care (e.g., toileting) but require a highly structured environment. (IQ <20 is classified as Profound). **High-Yield Clinical Pearls for NEET-PG:** * **Most common cause:** Genetic (Down Syndrome is the most common chromosomal cause; Fragile X is the most common inherited cause). * **Assessment Tool:** In children, the **Binet-Kamat Test** or **VSMS** (Vineland Social Maturity Scale) are frequently used in India. * **The "Rule of 15":** A quick way to remember the ranges is to subtract 15 points for each level starting from 70 (70-55 Mild, 55-40 Moderate, 40-25 Severe), though the ICD-10 ranges (70-50-35-20) are the standard for exams.

Question 1

Suicidal tendencies are least common with whom?

Accepted Answer

Being married

Answer

Being alone

Answer

Depression

Answer

Being male

Question 2

Hysteria is characterised by

Accepted Answer

Indifference to suffering

Answer

Flight of ideas

Answer

Pressure of speech

Answer

Autistic thinking

Question 3

EEG is used in the diagnosis of which of the following conditions, except?

Accepted Answer

Intermittent explosive disorder

Answer

Panic disorder

Answer

Anxiety disorder

Answer

Bipolar disorder

Question 4

Derealization and depersonalization are characteristic symptoms of which type of disorder?

Accepted Answer

Dissociative disorder

Answer

Personality disorders

Answer

Mania

Answer

None of the above

Question 5

A mentally ill person smells an unpleasant odor when none is present. This is an example of:

Accepted Answer

Hallucination

Answer

Illusion

Answer

Delusion

Answer

Obsession

Question 6

A patient presents with a discrepancy between their reported history and examination findings. Which of the following conditions should you be aware of in this situation?

Accepted Answer

Malingering

Answer

Factitious disorder

Answer

Somatization syndrome

Answer

Dissociative fugue

Question 7

What is the IQ range for moderate mental retardation?

Accepted Answer

50-35

Answer

90-70

Answer

70-50

Answer

35-20

Question 8

Astasia-abasia is seen in patients with which of the following disorders?

Accepted Answer

Conversion disorder

Answer

Illness anxiety disorder

Answer

Somatic symptom disorder

Answer

Depression

Question 9

Which of the following is related to Ganser syndrome in a patient who is apparently healthy physically?

Accepted Answer

Approximate answers

Answer

Ataxia

Answer

Confusion

Answer

Repeated answers

Question 10

A patient presents with a history of continuous headache for the past 8 years. Repeated examinations have failed to reveal any lesion. The patient is convinced that he has a tumor in his brain. What is the most likely diagnosis?

Accepted Answer

Hypochondriasis

Answer

Somatization

Answer

Somatoform pain disorder

Answer

Obsessive Compulsive Disorder

Psychiatric Assessment and Diagnosis — MCQs

Psychiatric Assessment and Diagnosis — MCQs

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