Trauma and Stress-Related Disorders Practice Questions

Q: Which of the following stressors most often leads to psychological impairment that could be diagnosed as an adjustment disorder?

Loss of job. ### Explanation **1. Why "Loss of Job" is Correct:** Adjustment Disorder is defined by the development of emotional or behavioral symptoms in response to an **identifiable stressor** that is within the range of **common human experience**. The stressor is typically non-catastrophic, such as financial difficulties, marital problems, or the **loss of a job**. The symptoms must occur within 3 months of the stressor and cause significant distress or functional impairment, but they do not meet the full criteria for Major Depressive Disorder or PTSD. **2. Why Other Options are Incorrect:** * **Options A (Rape) and B (Plane accident):** These are considered **catastrophic or traumatic stressors**. According to DSM-5 and ICD-11 criteria, exposure to actual or threatened death, serious injury, or sexual violence typically leads to a diagnosis of **Post-Traumatic Stress Disorder (PTSD)** or **Acute Stress Disorder (ASD)**, rather than Adjustment Disorder. While an adjustment disorder *can* follow a trauma, the standard classification distinguishes "common life stressors" (Adjustment Disorder) from "extreme/traumatic stressors" (PTSD/ASD). **3. Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms must start within **3 months** of the stressor and must resolve within **6 months** once the stressor (or its consequences) has terminated. * **Subtypes:** DSM-5 specifies subtypes based on predominant symptoms: with depressed mood, with anxiety, with mixed anxiety and depressed mood, with disturbance of conduct, or mixed disturbance of emotions and conduct. * **Treatment of Choice:** **Psychotherapy** (Crisis intervention or Brief Dynamic Psychotherapy) is the gold standard. Pharmacotherapy is only used for symptomatic relief (e.g., insomnia). * **Distinction:** If the symptoms meet the criteria for Major Depressive Disorder (MDD) following a stressor, the diagnosis is MDD, not Adjustment Disorder.

Q: Delayed onset PTSD is diagnosed if symptoms appear after how many months?

6 months. **Explanation:** Post-Traumatic Stress Disorder (PTSD) is characterized by a constellation of symptoms (intrusion, avoidance, negative alterations in cognition/mood, and hyperarousal) following exposure to a traumatic event. According to the **DSM-5**, the specifier **"with delayed expression"** (commonly referred to as delayed-onset PTSD) is used if the full diagnostic criteria are not met until **at least 6 months** after the traumatic event. It is important to note that some symptoms may appear immediately, but the complete syndrome required for diagnosis manifests after this 6-month threshold. **Analysis of Options:** * **A. 1 month:** This is the minimum duration required to diagnose PTSD. If symptoms last less than 1 month, the diagnosis is **Acute Stress Disorder (ASD)**. * **B. 3 months:** In previous versions (DSM-IV), PTSD was classified as "chronic" if symptoms lasted longer than 3 months, but this is not the criteria for delayed onset. * **C. 6 months (Correct):** This is the standardized timeframe for the "delayed expression" specifier in DSM-5. * **D. 1 year:** While symptoms can certainly appear after a year, the diagnostic threshold for the "delayed" label is established at the 6-month mark. **High-Yield NEET-PG Pearls:** * **Timeframe Rule:** 1 month = PTSD. * **First-line Treatment:** Trauma-focused Cognitive Behavioral Therapy (CBT) and SSRIs (e.g., Sertraline, Paroxetine). * **Prazosin:** A high-yield drug used specifically to treat **PTSD-related nightmares** (alpha-1 blocker). * **Delayed Onset:** Often triggered by a subsequent stressful life event or a "reminder" of the original trauma.

Q: What is the diagnostic feature that differentiates PTSD from other disorders that occur following a stressful incident?

Re-experiencing and avoidance of trauma. ### Explanation Post-Traumatic Stress Disorder (PTSD) is characterized by a specific constellation of symptoms following exposure to a life-threatening event. While many psychiatric conditions involve anxiety, the **pathognomonic hallmark** of PTSD is the combination of **re-experiencing** (intrusive memories, flashbacks) and **persistent avoidance** of trauma-related stimuli. #### Why the Correct Answer is Right: According to DSM-5 and ICD-11, PTSD is defined by four symptom clusters: **Intrusion** (re-experiencing), **Avoidance**, **Negative alterations in cognition/mood**, and **Hyperarousal**. While anxiety is common to many disorders, the specific psychological "reliving" of the event coupled with active efforts to avoid reminders is what differentiates PTSD from Generalized Anxiety Disorder or simple Phobias. #### Why Other Options are Wrong: * **A. Episodic occurrence:** PTSD symptoms are generally persistent (lasting >1 month) rather than episodic. Episodic symptoms are more characteristic of Panic Disorder or Bipolar Disorder. * **B. Severe anxiety and autonomic arousal:** These are non-specific features found in Panic Disorder, Phobias, and Acute Stress Disorder. They do not uniquely identify PTSD. * **D. Nightmares:** While a common symptom of PTSD, nightmares occur in various conditions (REM sleep behavior disorder, nightmare disorder) and are only one subset of the "re-experiencing" cluster. #### NEET-PG High-Yield Pearls: * **Timeline:** If symptoms last ** 1 month**, it is **PTSD**. * **First-line Treatment:** Trauma-focused Psychotherapy (CBT/EMDR) and **SSRIs** (Sertraline, Paroxetine). * **Prazosin:** An alpha-1 blocker specifically used to reduce trauma-related nightmares. * **Complex PTSD:** A newer ICD-11 category involving disturbances in self-organization, often following prolonged/repeated trauma (e.g., childhood abuse).

Question 1

A 22-year-old female presents with a 2-day history of speech loss after being slapped by her husband. On examination, her cough reflex and laryngeal reflex are normal. What is the most probable diagnosis?

Accepted Answer

Conversion disorder

Answer

Somatization disorder

Answer

Dissociative fugue

Answer

Depersonalization

Question 2

Which of the following stressors most often leads to psychological impairment that could be diagnosed as an adjustment disorder?

Accepted Answer

Loss of job

Answer

Rape

Answer

Plane accident

Answer

All of the above

Question 3

A young female presented with hallucinations, abdominal pain, and amnesia. She is likely suffering from which of the following?

Accepted Answer

Dissociative disorder

Answer

Conversion disorder

Answer

Depersonalization disorder

Answer

Mania

Question 4

Delayed onset PTSD is diagnosed if symptoms appear after how many months?

Accepted Answer

6 months

Answer

1 month

Answer

3 months

Answer

1 year

Question 5

Nightmares are seen in which of the following conditions?

Accepted Answer

Post-Traumatic Stress Disorder

Answer

Adjustment disorder

Answer

Dissociative disorder

Answer

Obsessive-Compulsive Disorder

Question 6

A 65-year-old woman whose husband died one week ago reports that she cries much of the time and has difficulty sleeping. She also states that she briefly saw her husband walking down the street yesterday. What is the most appropriate first action by her physician?

Accepted Answer

Provide support and reassurance

Answer

Recommend a vacation

Answer

Prescribe antipsychotic medication

Answer

Prescribe antidepressant medication

Question 7

Which of the following is NOT true for Post-Traumatic Stress Disorder (PTSD)?

Accepted Answer

PTSD can occur in individuals with high intellectual capacity.

Answer

A past history of psychiatric illness is a risk factor.

Answer

Women are more predisposed to developing PTSD.

Answer

Emotional numbing is a common symptom.

Question 8

A man, whose wife died 6 months prior, reports that his wife appeared to him and asked him to join her. What is the most likely diagnosis?

Accepted Answer

Normal grief

Answer

Grief psychosis

Answer

Bereavement reaction

Answer

Supernatural phenomenon

Question 9

A person missing from home is found wandering purposefully. He is well-groomed and denies having any amnesia. What is the most likely diagnosis?

Accepted Answer

Dissociative fugue

Answer

Dementia

Answer

Dissociative amnesia

Answer

Schizophrenia

Question 10

What is the diagnostic feature that differentiates PTSD from other disorders that occur following a stressful incident?

Accepted Answer

Re-experiencing and avoidance of trauma

Answer

Episodic occurrence of symptoms

Answer

Severe anxiety and autonomic arousal

Answer

Nightmares about the event

Trauma and Stress-Related Disorders — MCQs

Trauma and Stress-Related Disorders — MCQs

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