Psychiatric Assessment and Diagnosis — MCQs

Psychiatric Assessment and Diagnosis Indian Medical PG Practice Questions and MCQs

Question 421: Taking off one's clothes and running in public is called:

A. Exhibitionism (Correct Answer)
B. Undinism
C. Mooning
D. Voyeurism

Explanation: ***Exhibitionism*** - **Exhibitionism** is characterized by recurrent, intense sexual urges, fantasies, or behaviors involving the exposure of one's genitals to an unsuspecting stranger. - The act of deliberately removing clothing and running naked in public is a paraphilic behavior consistent with exhibitionistic disorder, where the primary aim is to expose oneself to others for sexual gratification. - This is the psychiatric term used to describe such public exposure behaviors in the context of paraphilic disorders. *Undinism* - **Undinism** (urolagnia) is a paraphilic interest in urine, often involving sexual arousal from urination or being urinated upon. - This condition does not involve public nudity or exposure, differentiating it from the described scenario. *Mooning* - **Mooning** specifically involves the baring of one's buttocks as a form of insult, protest, or jest. - While it involves partial nudity in public, it is specifically limited to buttock exposure and does not involve complete disrobing or full-body nudity as described in the question. *Voyeurism* - **Voyeurism** is the act of obtaining sexual gratification from observing unsuspecting individuals who are naked, disrobing, or engaging in sexual activity. - In this scenario, the individual is the one exposing themselves, not observing others without consent, which is the opposite of voyeuristic behavior.

Question 422: Which of the following is a cognitive disorder?

A. Dementia (Correct Answer)
B. Intellectualization
C. Depersonalization
D. All of the options

Explanation: ***Dementia*** - **Dementia** is a syndrome characterized by a significant decline in **cognitive function**, specifically in areas like memory, language, problem-solving, and reasoning. - It impairs a person's ability to perform everyday activities and is caused by various diseases that damage brain cells, such as **Alzheimer's disease**. *Intellectualization* - **Intellectualization** is an **ego defense mechanism** where a person uses excessive abstract thinking and intellectual concepts to avoid confronting emotions or internal conflicts. - While it involves thought processes, it is a psychological coping mechanism, not a cognitive disorder characterized by neurological impairment. *Depersonalization* - **Depersonalization** is a dissociative symptom characterized by a feeling of detachment from one's own body, thoughts, feelings, or actions, as if observing oneself from outside. - It's a symptom of a **dissociative disorder** or other mental health conditions, not a disorder primarily defined by cognitive impairment in the way dementia is. *All of the options* - This option is incorrect because only dementia is classified as a primary **cognitive disorder**. - Intellectualization and depersonalization are psychological phenomena or symptoms of other mental health conditions, not standalone cognitive disorders.

Question 423: Subcortical dementia is seen in all except:

A. HIV related dementia
B. Parkinson's disease
C. Alzheimer's disease (Correct Answer)
D. Multiple sclerosis

Explanation: ***Alzheimer's disease*** - Alzheimer's disease is categorized as a **cortical dementia**, primarily affecting the cerebral cortex. - It is characterized by early impairment in **memory**, language, and executive functions due to cortical atrophy and **neurofibrillary tangles** and amyloid plaques primarily in cortical regions. *HIV related dementia* - HIV-associated neurocognitive disorders (HAND) often manifest as a **subcortical dementia**, affecting white matter and deep gray matter structures. - Patients typically present with prominent **psychomotor slowing**, executive dysfunction, and apathy, rather than profound memory deficits in early stages. *Parkinson's disease* - Parkinson's disease, particularly when dementia develops, is considered a **subcortical dementia**. - It involves pathology in the **basal ganglia** and other subcortical structures, leading to deficits in executive function, attention, and visuospatial skills. *Multiple sclerosis* - Cognitive impairments in multiple sclerosis often present as a **subcortical dementia**, particularly involving processing speed, attention, and executive functions. - This is due to **demyelination** and axonal damage primarily affecting white matter tracts and subcortical gray matter.

Question 424: Slow waves in EEG activity are seen in:

A. Delirium (Correct Answer)
B. Depression
C. Schizophrenia
D. Mania

Explanation: **Delirium** - **Generalized slowing** of EEG activity is characteristic of **delirium**, reflecting global brain dysfunction. - This finding is often associated with **encephalopathy**, metabolic disturbances, or drug intoxication. *Depression* - EEG changes in depression are typically **less pronounced** and may involve subtle alterations in alpha rhythm, not widespread slow waves. - Depression is primarily a **mood disorder**, and while it can affect cognitive function, it does not usually cause the global cerebral dysfunction seen in delirium. *Schizophrenia* - EEG findings in schizophrenia are often **non-specific** or involve subtle changes like increased theta activity, but not generalized slow waves. - Schizophrenia is a **psychotic disorder** characterized by thought disturbances, which are not reflected as global EEG slowing. *Mania* - Acute manic episodes are generally associated with **normal EEG activity**, or sometimes increased fast activity. - Mania is a **mood disorder** characterized by elevated energy and mood, distinct from the global cognitive impairment of delirium.

Question 425: Global cerebral dysfunction characterised by alteration in cognitive function and consciousness is known as

A. Delirium (Correct Answer)
B. Dementia
C. Depression
D. Acute anxiety

Explanation: ***Delirium*** - Delirium is characterized by an **acute onset** of global cerebral dysfunction, marked by fluctuations in **attention, consciousness, and cognition**. - It is a medical emergency that can be caused by various underlying medical conditions, medications, or substance withdrawal. *Dementia* - Dementia is a **chronic** and progressive decline in cognitive function, primarily affecting **memory, language, and problem-solving abilities**, without a primary disturbance of consciousness. - While it involves cognitive impairment, its onset is typically gradual, and it lacks the acute fluctuations and prominent consciousness alterations seen in delirium. *Depression* - Depression is a **mood disorder** characterized by persistent sadness, loss of interest, and other emotional and physical symptoms, which can affect concentration and memory. - It does not involve a primary alteration in consciousness or the acute, global cognitive dysfunction characteristic of delirium. *Acute anxiety* - Acute anxiety is a state of intense fear or uneasiness, often accompanied by physical symptoms like palpitations and shortness of breath. - While it can interfere with focus and concentration, it does not represent a global cerebral dysfunction or an alteration in consciousness in the way that delirium does.

Question 426: Not a part of Kübler-Ross stages of impending death is:

A. Anger
B. Aggression (Correct Answer)
C. Denial
D. Bargaining

Explanation: ***Aggression*** - **Aggression** is not listed as one of the five stages in **Kübler-Ross's model of grief**, which outlines psychological reactions to impending death or loss. - The five stages described by Kübler-Ross are **denial**, **anger**, **bargaining**, **depression**, and **acceptance** (DABDA). - While anger may manifest with aggressive behaviors, "aggression" itself is not a distinct stage. *Anger* - **Anger** is the **second stage** in Kübler-Ross's five-stage model. - It often manifests as frustration, irritation, or rage directed at oneself, others, or higher powers, as the individual struggles with the reality of their situation. *Denial* - **Denial** is the **first stage** in Kübler-Ross's framework. - It involves an initial shock and refusal to believe the reality of the situation, serving as a defense mechanism to cope with overwhelming news. *Bargaining* - **Bargaining** is the **third stage** in Kübler-Ross's model. - It involves attempts to negotiate with a higher power or fate, often characterized by "If only..." or "What if..." statements in an effort to postpone or reverse the inevitable.

Question 427: Which of the following feature differentiates delirium from dementia?

A. Progressive memory impairment
B. Visual or auditory hallucinations
C. Impaired communication due to cognitive decline
D. Acute confusional state (Correct Answer)

Explanation: ***Acute confusional state*** - Delirium is characterized by an **acute or subacute onset** of fluctuating attention and cognition, indicating a sudden and often reversible change in mental status. - This contrasts sharply with dementia, which typically involves a **gradual and progressive decline** over months to years. *Progressive memory impairment* - This is a hallmark feature of **dementia**, where memory loss gradually worsens over time as the disease progresses. - While memory can be impaired in delirium, its onset is acute and severe memory impairment typically only occurs in cases of **severe delirium**, not as a primary defining feature. *Visual or auditory hallucinations* - While hallucinations can occur in both delirium and dementia, they are more **prominent and vivid** in delirium, often fluctuating and contributing to the acute confusional state. - In dementia, hallucinations are usually less frequent and tend to be **more persistent**, but not typically as variable as in delirium. *Impaired communication due to cognitive decline* - Both conditions can cause difficulty with communication due to cognitive deficits, but in dementia, this impairment is **gradual and pervasive**, reflecting a chronic decline in language and executive function. - In delirium, communication difficulties arise from the **acute disturbance of attention** and can fluctuate significantly depending on the patient's level of arousal and confusion.

Question 428: Which of the following behavioral problems would suggest an organic brain lesion?

A. Auditory hallucinations
B. Formal thought disorder
C. Depression
D. Visual hallucinations (Correct Answer)

Explanation: ***Visual hallucinations*** - While visual hallucinations can occur in primary psychiatric disorders, they are *more commonly* associated with **organic brain lesions** (e.g., tumors, delirium, dementia, substance withdrawal) compared to auditory hallucinations. - They often indicate **neurological dysfunction** and warrant further investigation for an underlying physical cause. *Auditory hallucinations* - **Auditory hallucinations** are a hallmark symptom of **psychotic disorders** such as **schizophrenia**, and are less specific for organic brain lesions unless they are complex and multimodal. - While possible in organic conditions (e.g., temporal lobe epilepsy), they are more strongly linked to functional psychiatric illness than visual hallucinations. *Formal thought disorder* - **Formal thought disorder** (e.g., loosening of associations, word salad, tangentiality) is a core symptom of **schizophrenia** and other primary psychotic disorders. - It is a disturbance in the *form* of thought rather than its content, and is primarily a **psychiatric phenomenon**. *Depression* - **Depression** is a common mood disorder with diverse etiologies, including psychosocial stressors and neurochemical imbalances, but it is not typically indicative of a focal **organic brain lesion**. - Although depression can coexist with neurological conditions, it is not a direct behavioral symptom of a localized brain injury.

Question 429: Which of the following is not a paraphilia?

A. Necrophilia
B. Adultery (Correct Answer)
C. Fetishism
D. Paedophilia

Explanation: ***Adultery*** - **Adultery** refers to consensual sexual activity between a married person and someone who is not their spouse. - While it may involve **moral** or **social transgression**, it does not inherently involve **unusual sexual fantasies** or **non-consenting partners** that define paraphilias. *Necrophilia* - **Necrophilia** is a paraphilia defined by sexual attraction to or sexual acts with **corpses**. - It involves a **deviation from typical sexual arousal** patterns towards a non-living object. *Fetishism* - **Fetishism** is a paraphilia characterized by recurrent, intense **sexual arousal from inanimate objects** (e.g., shoes, clothing) or specific non-genital body parts. - The object or body part is essential for **sexual gratification**. *Paedophilia* - **Paedophilia** is a paraphilia involving recurrent, intense sexual attraction to **prepubescent children**. - This paraphilia is characterized by the **sexual targeting of children**, which falls outside of typical sexual behaviors and is illegal.

Question 430: Most common type of intellectual disability –

A. Mild (Correct Answer)
B. Severe
C. Profound
D. Moderate

Explanation: ***Mild*** - **Mild intellectual disability** is the most prevalent type, accounting for approximately **85%** of all cases. - Individuals with mild intellectual disability can often achieve academic skills up to a **sixth-grade level** and live relatively independently with appropriate support. *Severe* - **Severe intellectual disability** is less common, affecting about **3-4%** of individuals with intellectual disability. - These individuals typically require **daily supervision** and support in structured environments. *Profound* - **Profound intellectual disability** is the least common type, affecting only **1-2%** of individuals with intellectual disability. - Individuals with profound intellectual disability require **intensive support** for all aspects of daily living and often have significant physical impairments. *Moderate* - **Moderate intellectual disability** accounts for about **10%** of all cases. - Individuals with moderate intellectual disability can often develop communication skills and manage basic self-care, but require **ongoing supervision** and support.

Practice by Chapter

Clinical Interview Techniques

Practice Questions

Mental Status Examination

Practice Questions

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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