Psychosocial Interventions — MCQs
A 55-year-old drug addict from California presents with euphoria, altered time perception, and conjunctival injection, along with impairment of judgment. The most likely cause of this is addiction to which substance?
CAGE questionnaire is used in:
Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
Which of the following is true regarding the treatment of cocaine withdrawal symptoms?
The term 'cocaine bugs' refers to:
Which of the following dependence-causing drugs is most commonly abused worldwide?
An alcoholic patient presents with psychosis and memory loss. What is the probable diagnosis?
Methadone is used to treat withdrawal symptoms of which substance?
Jet black pigmentation of the tongue with tactile hallucinations is a feature of which substance use?
Dissociative Fugue is characterised by
Psychosocial Interventions Indian Medical PG Practice Questions and MCQs
Question 1: A 55-year-old drug addict from California presents with euphoria, altered time perception, and conjunctival injection, along with impairment of judgment. The most likely cause of this is addiction to which substance?
- A. Marijuana (Correct Answer)
- B. Cocaine
- C. Phencyclidine
- D. Benzodiazepine
Explanation: ***Marijuana*** - **Euphoria**, altered time perception, and **conjunctival injection** are classic symptoms associated with marijuana use. - Impairment of judgment and coordination are also common effects of **cannabis intoxication**. *Cocaine* - Cocaine intoxication typically presents with **psychomotor agitation**, **tachycardia**, **hypertension**, and **dilated pupils**, not conjunctival injection. - While it causes euphoria and altered perception, the specific combination of symptoms points away from cocaine. *Phencyclidine* - **Phencyclidine (PCP)** often causes **nystagmus**, violence, and **dissociative symptoms** like derealization and depersonalization, which are not described. - It can also lead to severe agitation and unpredictable behavior, distinct from the patient's presentation. *Benzodiazepine* - Benzodiazepine intoxication or abuse typically leads to **sedation**, ataxia, and **respiratory depression**, rather than euphoria and conjunctival injection. - The effects are more consistent with central nervous system depression.
Question 2: CAGE questionnaire is used in:
- A. Opiate poisoning
- B. Alcohol dependence (Correct Answer)
- C. Dhatura poisoning
- D. Barbiturate poisoning
Explanation: ***Alcohol dependence*** - The **CAGE questionnaire** is a widely used screening tool for identifying potential **alcohol problems** and dependence. - The acronym CAGE stands for Cutting down, Annoyance by criticism, Guilty feelings, and Eye-openers, all related to drinking habits. *Opiate poisoning* - Screening for opiate use or poisoning typically involves asking about **drug use history**, conducting **urine drug screens**, and observing specific clinical signs like **pinpoint pupils** and **respiratory depression**. - The CAGE questionnaire is not designed to screen for opiate use. *Dhatura poisoning* - **Dhatura poisoning** is characterized by anticholinergic symptoms like **dilated pupils**, **dry mouth**, **tachycardia**, and **delirium**. - Diagnosis relies on clinical presentation and a history of exposure, not a specific questionnaire like CAGE. *Barbiturate poisoning* - **Barbiturate poisoning** presents with central nervous system depression, including **sedation**, **respiratory depression**, and **hypotension**. - Diagnosis involves a clinical assessment, history of barbiturate use, and toxicology screens, not the CAGE questionnaire.
Question 3: Provision of the Mental Health Act 2017, based on WHO guidelines, includes all, except:
- A. Social support
- B. Screening family members (Correct Answer)
- C. Human rights
- D. Communication regarding care and treatment
Explanation: ***Screening family members*** - The Mental Health Act 2017 focuses on the **rights, treatment, and support of individuals with mental illness**, not routine screening of their family members. - The Act does not contain provisions mandating **screening of asymptomatic family members**, though family history may be relevant for clinical assessment. - This is **not a provision** outlined in the Act based on WHO guidelines. *Human rights* - The Act is explicitly grounded in the **protection and promotion of human rights** for persons with mental illness (Chapter I). - Ensures care with **dignity, respect, and freedom from discrimination** as core principles. - Aligns with WHO's mental health action plan and human rights framework. *Communication regarding care and treatment* - **Section 4** emphasizes the right to information and **informed consent** for all treatment decisions. - Patients must receive clear communication about their **diagnosis, treatment options, and care plans**. - Includes provisions for **advance directives** and involvement in treatment decisions. *Social support* - **Chapter V** addresses rehabilitation and community-based services, emphasizing the role of **social support systems**. - Promotes **community integration** and access to social resources for recovery. - Recognizes family and community support as essential for long-term mental health management.
Question 4: Which of the following is true regarding the treatment of cocaine withdrawal symptoms?
- A. Fluoxetine
- B. Antidepressants
- C. No specific drug (Correct Answer)
- D. Benzodiazepines
Explanation: ***No specific drug*** - Currently, there is **no FDA-approved pharmacotherapy** for the treatment of cocaine withdrawal symptoms or for preventing relapse in cocaine dependence. - Management primarily focuses on **supportive care**, **psychotherapy** (cognitive behavioral therapy, contingency management), and addressing **co-occurring mental health disorders**. - Unlike alcohol or opioid withdrawal, cocaine withdrawal is not life-threatening and does not require specific medication. *Fluoxetine* - Fluoxetine is a **selective serotonin reuptake inhibitor (SSRI)** primarily used to treat depression and anxiety disorders. - While depression can be a symptom of cocaine withdrawal, fluoxetine has **not been shown to be effective** for reducing cocaine use or treating cocaine withdrawal specifically. - Multiple clinical trials have failed to demonstrate benefit for cocaine dependence treatment. *Antidepressants* - While various antidepressants (including desipramine, bupropion) have been investigated, there is **no strong evidence** to support their routine use as primary treatment for cocaine withdrawal or dependence. - Their effectiveness in this context is **limited and inconsistent** across studies. - They may be used to treat **co-occurring depressive disorders** but not as primary cocaine withdrawal treatment. *Benzodiazepines* - Benzodiazepines are primarily used to manage **acute anxiety and seizures** during withdrawal from GABAergic substances like **alcohol and sedatives**. - They are generally **not recommended** for cocaine withdrawal as cocaine withdrawal does not cause seizures or dangerous autonomic instability. - May be used only for **severe agitation** or **co-occurring alcohol withdrawal**, but carry their own dependence potential and do not address cocaine withdrawal itself.
Question 5: The term 'cocaine bugs' refers to:
- A. Othello syndrome
- B. Ekbom's syndrome (Correct Answer)
- C. Cotard's syndrome
- D. De Clérambault syndrome
Explanation: ***Ekbom's syndrome*** - The term **"cocaine bugs"** refers to **formication** - tactile hallucinations of insects crawling on or under the skin, commonly experienced during cocaine intoxication or withdrawal. - While formication itself is a **hallucination** (false sensory perception), chronic cocaine users may develop **Ekbom's syndrome (delusional parasitosis)** - a fixed false belief of being infested by parasites. - Among the given options, Ekbom's syndrome is the most closely associated with the phenomenon of "cocaine bugs," though technically the term specifically describes the tactile hallucinations rather than the delusional disorder itself. *Othello syndrome* - This is a form of **delusional jealousy**, where an individual falsely believes their partner is unfaithful without any real evidence. - It is not associated with tactile hallucinations or the sensation of insects crawling on the skin. *Cotard's syndrome* - This is a rare mental disorder in which a person holds the **nihilistic delusion** that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. - It is distinct from the tactile hallucinations or parasitosis delusions described as "cocaine bugs." *De Clérambault syndrome* - Also known as **erotomania**, this is a delusion in which an individual believes that another person, usually of higher social status, is in love with them. - This condition does not involve tactile hallucinations or the sensation of parasitic infestation.
Question 6: Which of the following dependence-causing drugs is most commonly abused worldwide?
- A. Cannabis (Correct Answer)
- B. Heroin
- C. Amphetamine
- D. Cocaine
Explanation: ***Cannabis*** - **Cannabis** is the most widely cultivated and consumed illicit drug globally, with the highest prevalence of past-year use. - Its widespread availability, relatively lower perception of harm compared to other drugs, and varied forms of consumption (smoking, edibles) contribute to its extensive abuse. *Heroin* - **Heroin** is a highly addictive opioid that causes severe physical dependence and withdrawal symptoms, but its global prevalence is significantly lower than that of cannabis. - Its high cost, illicit nature, and significant health risks, including overdose, limit its abuse to a smaller, though critically affected, population. *Amphetamine* - **Amphetamines**, including methamphetamine, are potent central nervous system stimulants with a significant abuse potential, leading to psycho-behavioral and physical dependence. - While prevalent in certain regions and among specific populations, their overall global abuse statistics are lower than those for cannabis. *Cocaine* - **Cocaine** is a powerful stimulant derived from the coca plant, known for its strong psychological dependence and significant health consequences. - Its abuse is concentrated in specific geographical areas and demographic groups, making its global prevalence of abuse lower than that of cannabis.
Question 7: An alcoholic patient presents with psychosis and memory loss. What is the probable diagnosis?
- A. Wernicke's encephalopathy
- B. Wernicke-Korsakoff syndrome (Correct Answer)
- C. Acute psychosis
- D. None of the above
Explanation: **Explanation:** The patient presents with the classic clinical picture of **Wernicke-Korsakoff Syndrome (WKS)**, which is a spectrum of neurological disorders caused by **Thiamine (Vitamin B1) deficiency**, most commonly seen in chronic alcoholics. **1. Why Wernicke-Korsakoff Syndrome is correct:** WKS represents the progression from an acute phase (Wernicke’s Encephalopathy) to a chronic phase (Korsakoff Psychosis). The presence of **memory loss** (specifically anterograde and retrograde amnesia) and **psychosis** (often manifesting as **confabulation**—filling memory gaps with fabricated stories) are the hallmark features of the Korsakoff component. Pathologically, this is associated with lesions in the **mammillary bodies** and the dorsomedial nucleus of the thalamus. **2. Why other options are incorrect:** * **Wernicke's Encephalopathy:** This is the acute, reversible phase characterized by a classic triad: **Ophthalmoplegia** (ataxia), **Global Confusion**, and **Ataxia**. While it is part of the spectrum, it does not typically include the permanent memory deficits or confabulation seen in this patient. * **Acute Psychosis:** While the patient has psychotic symptoms, "Acute Psychosis" is a broad psychiatric descriptor. In the context of alcoholism and memory loss, a nutritional/organic cause (WKS) is the specific medical diagnosis. **Clinical Pearls for NEET-PG:** * **The Triad of Wernicke:** Confusion, Ataxia, Ophthalmoplegia (nystagmus). * **The Pentad of WKS:** The triad + Amnesia and Confabulation. * **Treatment Rule:** Always administer **Thiamine before Glucose** in an alcoholic patient. Giving glucose first can precipitate Wernicke’s by consuming the remaining B1 stores during glycolysis. * **MRI Finding:** High signal intensity in the mammillary bodies.
Question 8: Methadone is used to treat withdrawal symptoms of which substance?
- A. Cocaine
- B. Heroin (Correct Answer)
- C. Amphetamine
- D. Barbiturate
Explanation: **Explanation:** **Correct Answer: B. Heroin** Methadone is a **synthetic, long-acting mu-opioid receptor full agonist**. In the management of Opioid Use Disorder (Heroin), it works through "cross-tolerance." Because it has a much longer half-life (24–36 hours) than heroin, it prevents withdrawal symptoms and reduces "drug hunger" (craving) without producing the significant euphoria or "rush" associated with illicit opioids. It is used both for acute detoxification and long-term maintenance therapy. **Why other options are incorrect:** * **A & C (Cocaine & Amphetamines):** These are CNS stimulants. There is no specific FDA-approved pharmacological replacement therapy for stimulant withdrawal. Management is primarily supportive, focusing on psychological interventions and treating symptoms like depression or agitation. * **D (Barbiturates):** These are sedative-hypnotics. Withdrawal is life-threatening (similar to alcohol) and is managed by a slow taper of the drug itself or by substituting with a long-acting benzodiazepine (like Diazepam) or Phenobarbital. **High-Yield Clinical Pearls for NEET-PG:** * **Buprenorphine:** A partial mu-opioid agonist and kappa antagonist; it has a "ceiling effect" on respiratory depression, making it safer than methadone. * **Naltrexone:** An opioid antagonist used for relapse prevention *after* detoxification is complete (patient must be opioid-free for 7–10 days). * **Clonidine:** An alpha-2 agonist used to treat the autonomic symptoms of opioid withdrawal (tachycardia, hypertension, sweating) but does not reduce cravings. * **Lofexidine:** The first non-opioid drug specifically approved for managing opioid withdrawal symptoms.
Question 9: Jet black pigmentation of the tongue with tactile hallucinations is a feature of which substance use?
- A. Heroin
- B. Cannabis
- C. Cocaine (Correct Answer)
- D. LSD
Explanation: **Explanation:** The correct answer is **Cocaine**. This question tests the recognition of specific physical and psychological markers associated with stimulant abuse. **1. Why Cocaine is Correct:** * **Jet Black Tongue (Melanoglossia):** Chronic smoking of "crack" cocaine can lead to a characteristic black discoloration of the dorsal surface of the tongue. This is attributed to the deposition of carbonaceous combustion products or thermal injury to the filiform papillae. * **Tactile Hallucinations:** Cocaine intoxication frequently causes **Formication** (also known as "Cocaine bugs" or Magnan’s symptom). Patients experience a distressing sensation of insects crawling under or on their skin, often leading to skin picking and excoriations. **2. Analysis of Incorrect Options:** * **Heroin (Opioid):** Typically presents with miosis (pinpoint pupils), respiratory depression, and track marks. It does not cause tongue pigmentation or tactile hallucinations. * **Cannabis:** Characterized by conjunctival injection (red eyes), increased appetite (munchies), and dry mouth. While it can cause paranoia, it is not associated with black tongue. * **LSD (Hallucinogen):** Primarily causes **visual** hallucinations, synesthesia (seeing sounds/hearing colors), and mydriasis. It does not typically produce the specific tactile hallucinations or oral findings seen with cocaine. **3. Clinical Pearls for NEET-PG:** * **Magnan’s Symptom:** A specific term for tactile hallucinations in cocaine users. * **Cocaine & Pupils:** Causes **Mydriasis** (dilated pupils), unlike Heroin (Miosis). * **Cocaine & CVS:** It is a potent vasoconstrictor; look for history of MI or perforated nasal septum in clinical stems. * **Withdrawal:** Cocaine withdrawal is characterized by "crashing" (dysphoria, hypersomnia, and intense craving) but is not life-threatening.
Question 10: Dissociative Fugue is characterised by
- A. Wandering away from home (Correct Answer)
- B. Irreversible amnesia
- C. Gradual recovery
- D. Normal recall
Explanation: **Explanation:** **Dissociative Fugue** (now classified under Dissociative Amnesia in DSM-5) is a dissociative disorder characterized by a sudden, unexpected travel away from one’s home or place of daily activities, accompanied by an inability to recall some or all of one's past. 1. **Why Option A is correct:** The hallmark of a fugue state is **purposeful wandering**. Patients often adopt a new identity and are unable to remember their previous life during the episode. The "wandering" is not aimless (like in delirium) but appears organized to an outside observer. 2. **Why Options B, C, and D are incorrect:** * **B & C:** Recovery from dissociative fugue is typically **sudden and rapid**, not gradual. Furthermore, the amnesia is **reversible**; once the fugue state ends, the individual usually recovers their original identity and memories of their past life (though they may then have amnesia for the events that occurred *during* the fugue). * **D:** **Normal recall** is absent during the episode. The patient suffers from selective or generalized amnesia regarding their identity and history. **High-Yield Clinical Pearls for NEET-PG:** * **Trigger:** Usually precipitated by severe psychosocial stressors (e.g., marital discord, financial ruin, or wartime trauma). * **Identity:** A patient in a fugue state may assume a completely new name, occupation, and personality. * **Differential Diagnosis:** Must be distinguished from **Complex Partial Seizures** (where wandering is semi-purposeful and brief) and **Transient Global Amnesia** (which lacks identity loss). * **Management:** The primary goal is to establish safety. Psychotherapy and "abreaction" (using hypnosis or barbiturates to recover memories) are traditional treatment modalities.
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