Adjustment Disorders — MCQs
A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:
A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
The disability adjusted life years (DALYs) lost due to neuropsychiatric disorders are highest in -
To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
Post-traumatic stress disorder is characterized by all except:
A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
Derealization and depersonalization are symptoms of which type of disorder?
Elisabeth Kübler-Ross proposed five stages of:
A 14-year-old girl presented with sudden-onset blindness for the past 4 hours. However, on history taking, it is noted that she is not concerned about it. However, she is concerned that her mother passed away recently and that she should have spent more time with her. Physical examination findings are normal. Which of the following is true about the condition?
Adjustment Disorders Indian Medical PG Practice Questions and MCQs
Question 1: A 41 year old married female presented with headache for the last 6 months. She had several consultations. All her investigations were found to be within normal limits. She still insists that there is something wrong in her head and seeks another consultation. The most likely diagnosis is:
- A. Illness Anxiety Disorder (Correct Answer)
- B. Phobia
- C. Psychogenic headache
- D. Depression
Explanation: ***Illness Anxiety Disorder*** - This patient exhibits persistent **preoccupation with having a serious illness** despite **repeated medical evaluations** showing no underlying pathology. - She continues to **seek multiple consultations**, demonstrating **excessive health-related behaviors** characteristic of health anxiety. - Despite reassurance and normal investigations, she **insists something is wrong**, which is the core feature of this disorder. - Note: The presence of headache doesn't exclude this diagnosis; the key is the **disproportionate anxiety and health-seeking behavior** relative to the symptom. *Phobia* - Phobias involve an **intense, irrational fear** of a specific object or situation (e.g., agoraphobia, social phobia). - The patient's concern is about having an illness and physical symptoms, not a fear of a specific trigger or situation. *Psychogenic headache* - This is a **symptom description**, not a psychiatric disorder diagnosis. - While the headache may have psychological factors, the question asks for the **disorder** that best explains the overall clinical picture. - The primary pathology here is the **persistent health anxiety and reassurance-seeking behavior**, not just the headache itself. *Depression* - Although **depression can present with somatic symptoms** like headaches, the **core features of major depression** are not mentioned (e.g., persistent low mood, anhedonia, sleep/appetite changes, hopelessness). - The patient's **preoccupation with having a disease** despite medical reassurance is more characteristic of Illness Anxiety Disorder than depression alone.
Question 2: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?
- A. Schizophrenia
- B. Major depressive disorder plus psychosis (Correct Answer)
- C. Schizoaffective disorder
- D. Schizotypal personality disorder
Explanation: ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.
Question 3: The disability adjusted life years (DALYs) lost due to neuropsychiatric disorders are highest in -
- A. Panic disorders
- B. Obsessive compulsive disorder
- C. Bipolar affective disorders
- D. Unipolar depressive disorders (Correct Answer)
Explanation: ***Unipolar depressive disorders*** - **Unipolar depressive disorders** are the leading cause of DALYs lost among neuropsychiatric conditions globally. - This is due to their **high prevalence**, **early age of onset**, and significant impact on **functional capacity** and quality of life. *Panic disorders* - While panic disorders significantly impair an individual's quality of life, their **prevalence** and **disability burden** are generally lower than that of unipolar depressive disorders. - They tend to cause episodic, intense distress rather than chronic, pervasive functional impairment to the same extent as severe depression. *Obsessive compulsive disorder* - **OCD** can be severely disabling, but its **prevalence** is lower than that of unipolar depressive disorders. - The impact on DALYs, while substantial for affected individuals, does not reach the global burden attributed to depression. *Bipolar affective disorders* - **Bipolar affective disorders** contribute significantly to DALYs due to their chronic nature and severe episodes of mood disturbance. - However, their **prevalence** is lower compared to unipolar depressive disorders, resulting in a lower overall DALY burden globally.
Question 4: To diagnose post-traumatic stress disorder, the symptoms should persist for more than ______
- A. 1 month (Correct Answer)
- B. 2 days
- C. 3 months
- D. 6 months
Explanation: ***1 month*** - According to the **DSM-5 criteria**, for a diagnosis of **Post-Traumatic Stress Disorder (PTSD)**, the symptoms must persist for **more than one month**. - If symptoms last for less than one month, but meet other criteria, the diagnosis is typically **Acute Stress Disorder**. *2 days* - Symptoms lasting only **2 days** following a traumatic event are too short for a diagnosis of PTSD. - Such a brief duration may align with an **acute stress reaction**, which is a normal response to trauma and usually resolves quickly. *3 months* - While symptoms lasting **3 months** would certainly qualify for PTSD in terms of duration, this is not the minimum duration required. - The **minimum duration** for PTSD diagnosis is specifically defined as more than one month. *6 months* - Symptoms persisting for **6 months** or longer clearly meet the duration criteria for PTSD, but this is not the minimal period. - Setting the minimum at 6 months would lead to **underdiagnosis** of PTSD in individuals whose symptoms are significant and disabling after one month but before six months.
Question 5: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. OCD
- D. Adjustment disorder
Explanation: ***PTSD*** - Patients with **Post-Traumatic Stress Disorder (PTSD)** frequently experience **intrusive memories**, **flashbacks**, and **nightmares** related to a traumatic event. - The fear and avoidance of places associated with the trauma are characteristic symptoms, consistent with the patient's reluctance to revisit the accident site. *Anxiety disorder* - While anxiety is a component of PTSD, an **isolated anxiety disorder** would not fully explain the presence of specific **recurrent dreams** and **flashbacks** directly linked to a past traumatic event. - Generalized anxiety often involves **persistent worry about various aspects of life**, rather than focused re-experiencing of a trauma. *OCD* - **Obsessive-Compulsive Disorder (OCD)** is characterized by **recurrent, intrusive thoughts (obsessions)** and **repetitive behaviors (compulsions)** performed to reduce anxiety. - The patient's symptoms of re-experiencing an accident and avoiding the site do not align with the typical presentation of obsessions and compulsions. *Adjustment disorder* - **Adjustment disorder** involves emotional or behavioral symptoms in response to an identifiable stressor, usually resolving within 6 months after the stressor or its consequences have ended. - The described symptoms of **dreams, flashbacks, and specific avoidance** after two months are more intense and prolonged than typically seen in adjustment disorder, pointing towards a more severe trauma-related condition like PTSD.
Question 6: Post-traumatic stress disorder is characterized by all except:
- A. Flashback and nightmare
- B. Re-experiencing stressful events
- C. Exposure to traumatic events
- D. It doesn't develop after 6 months of stress (Correct Answer)
Explanation: ***It doesn't develop after 6 months of stress*** - This statement is **FALSE** and is therefore the correct answer to this "EXCEPT" question. - **PTSD can develop at any time** following a traumatic event, including months or even years later - there is no upper time limit for symptom onset. - The **DSM-5 includes a "delayed expression" specifier** for cases where full diagnostic criteria are not met until at least 6 months after the trauma. - While most cases develop within **3 months of the traumatic event**, delayed onset is well-documented and clinically recognized. - This distinguishes PTSD from **Acute Stress Disorder**, which by definition occurs within 3 days to 4 weeks after trauma exposure. *Flashback and nightmare* - **Flashbacks** (dissociative reactions where the person feels the traumatic event is recurring) and **nightmares** are core symptoms of PTSD. - These belong to the **re-experiencing/intrusion symptom cluster** (Criterion B in DSM-5). - These involuntary recollections cause significant distress and are hallmark features of the disorder. *Re-experiencing stressful events* - **Re-experiencing symptoms** are one of the four main symptom clusters required for PTSD diagnosis. - This includes intrusive memories, traumatic nightmares, flashbacks, and intense psychological/physiological reactions to trauma reminders. - These symptoms reflect the **inability to integrate the traumatic memory** properly, leading to involuntary reactivation. *Exposure to traumatic events* - **Criterion A: Exposure to actual or threatened death, serious injury, or sexual violence** is the essential prerequisite for PTSD diagnosis. - This exposure can be through direct experience, witnessing, learning it happened to a close other, or repeated/extreme exposure to aversive details. - Without documented trauma exposure, PTSD cannot be diagnosed regardless of symptom presentation.
Question 7: A patient with a history of RTA before 2 months presents with complaints of dreams of accidents. He is able to visualize the same scene whenever he visits the place. Hence is afraid to go back to the accident site. Identify the type of disorder that he might be suffering from?
- A. PTSD (Correct Answer)
- B. Anxiety disorder
- C. Obsessive-Compulsive Disorder (OCD)
- D. Adjustment disorder
Explanation: ***PTSD*** - The patient's symptoms, including **recurrent dreams** of the accident, **intrusive memories** triggered by the accident site, and **avoidance** of the location, are classic diagnostic criteria for **Post-Traumatic Stress Disorder (PTSD)**. - PTSD often develops after exposure to a **traumatic event** like a car accident, with symptoms lasting for more than one month. *Anxiety disorder* - While anxiety is a prominent feature of PTSD, **Generalized Anxiety Disorder** typically involves excessive worry about everyday events rather than a specific traumatic incident. - Other anxiety disorders like **panic disorder** involve sudden, intense fear without the specific re-experiencing and avoidance symptoms seen here. *Obsessive-Compulsive Disorder (OCD)* - OCD is characterized by repetitive, unwanted thoughts (**obsessions**) and ritualistic behaviors (**compulsions**) performed to reduce anxiety, which are not described in this patient's presentation. - The patient's distress stems from a past trauma, not from obsessions or compulsions. *Adjustment disorder* - An adjustment disorder occurs in response to a **stressor**, but the symptoms are typically less severe and do not include the full constellation of **re-experiencing, avoidance, and hyperarousal** seen in PTSD. - An adjustment disorder resolves within 6 months of the stressor or its consequences, however, the persistence and nature of the symptoms here point to a more severe trauma-related condition.
Question 8: Derealization and depersonalization are symptoms of which type of disorder?
- A. Dissociative disorder (Correct Answer)
- B. Personality disorders
- C. Mania
- D. Anxiety disorders
Explanation: ***Dissociative disorder*** - **Derealization** involves experiencing the outside world as unreal or dreamlike - **Depersonalization** is the experience of feeling detached from one's own body or mental processes - These are hallmark symptoms of **dissociative disorders**, specifically depersonalization-derealization disorder in DSM-5 *Personality disorders* - Characterized by enduring, maladaptive patterns of inner experience and behavior - While some personality disorders (e.g., **borderline personality disorder**) may display transient dissociative symptoms under stress, derealization and depersonalization are not core diagnostic features *Mania* - A state of abnormally elevated mood and energy, involving **racing thoughts**, **decreased need for sleep**, and **impulsive behavior** - Does not typically involve consistent derealization or depersonalization as core features *Anxiety disorders* - Depersonalization can occur transiently during **panic attacks** or severe anxiety - However, when derealization and depersonalization are the primary, persistent symptoms, they indicate a **dissociative disorder** rather than an anxiety disorder
Question 9: Elisabeth Kübler-Ross proposed five stages of:
- A. Grief (Correct Answer)
- B. Delusion
- C. Schizophrenia
- D. None of the options
Explanation: ***Grief*** - Elisabeth Kübler-Ross is renowned for her work on the **five stages of grief**, a model describing emotional responses to terminal illness or significant loss. - These stages are **denial, anger, bargaining, depression, and acceptance**, which individuals may experience when facing their own death or the death of a loved one. - This model was introduced in her seminal 1969 book **"On Death and Dying"**. *Delusion* - Delusions are **fixed, false beliefs** that are not in keeping with the individual's cultural background, often seen in psychotic disorders like schizophrenia. - Kübler-Ross's work does not focus on specific cognitive distortions like delusions. *Schizophrenia* - Schizophrenia is a severe psychiatric disorder characterized by **distortions of thought, perception, emotions, language, sense of self, and behavior**. - While schizophrenia can involve significant psychological distress, it is a **distinct clinical entity** not directly related to Kübler-Ross's stages of grief. *None of the options* - This option is incorrect because the work of Elisabeth Kübler-Ross is directly associated with the **five stages of grief**, which describe the emotional process individuals experience when facing terminal illness or loss.
Question 10: A 14-year-old girl presented with sudden-onset blindness for the past 4 hours. However, on history taking, it is noted that she is not concerned about it. However, she is concerned that her mother passed away recently and that she should have spent more time with her. Physical examination findings are normal. Which of the following is true about the condition?
- A. In adults, equally among males and females
- B. In children, it occurs more in females than in males (Correct Answer)
- C. In children, equally among males and females
- D. In adults, it occurs more in males than in females
Explanation: **In children, it occurs more in females than in males** - **Conversion disorders** (functional neurological symptom disorder) are more prevalent in **females** across childhood, adolescence, and adulthood. - The patient's **sudden-onset blindness** without medical cause, coupled with a lack of concern (**la belle indifférence**) and a psychological stressor (mother's death), points to a conversion disorder, which aligns with higher female prevalence in this age group. *In adults, equally among males and females* - This statement is incorrect as conversion disorders, including sudden-onset blindness, are generally more common in **adult females** than males. - The prevalence in adults is not equal; there is a clear gender disparity, with women being more affected. *In children, equally among males and females* - While it can occur in both sexes, the prevalence of conversion disorder in children is not equal; it is observed more frequently in **females**. - Studies consistently report a female-to-male ratio greater than 1 in pediatric populations. *In adults, it occurs more in males than in females* - This statement is incorrect; in adults, conversion disorders are significantly more common in **females**. - The classic presentation, as seen in this case, fits the typical profile observed in female patients experiencing significant psychological distress.
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