Reactive Attachment Disorder — MCQs
A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?
All of the following are classified under Pervasive Developmental Disorders except?
A 6 year old child who does not interact with other children of his age group and prefers playing alone with repetitive behaviors, is likely to be suffering from:
What is considered the most effective treatment for Borderline Personality Disorder?
A 3-year-old child with delayed speech development, prefers to play alone and is not making friends. The likely diagnosis is
A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?
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?
A 24-year-old female complains of suicidal ideation following the loss of her family in a car accident. She has had problems focusing on her work and has been making errors due to poor judgment, leading to her layoff. She has been rescued from suicidal attempts multiple times and has been prescribed electroconvulsive therapy. What is the intravenous anesthetic of choice for electroconvulsive therapy?
Which of the following is NOT a symptom of Post-Traumatic Stress Disorder (PTSD)?
Reactive Attachment Disorder Indian Medical PG Practice Questions and MCQs
Question 1: A 10 year old boy was brought to the psychiatrist by parents with complaints of not following the rules of school, arguing with teachers and fellow students. The parents report that he misbehaves with them too and at times tries to provoke them. What is the likely diagnosis?
- A. Conduct disorder
- B. Oppositional defiant disorder (Correct Answer)
- C. Autism spectrum disorder
- D. Attention deficit hyperactivity disorder
Explanation: **Oppositional defiant disorder** - The boy's behaviors of **not following rules**, arguing with teachers and students, and **provoking parents** are characteristic features of ODD. - ODD is defined by a pattern of **angry/irritable mood**, argumentative/defiant behavior, or vindictiveness. *Conduct disorder* - Conduct disorder involves more serious violations of the **rights of others** or major **societal norms**, such as aggression towards people or animals, destruction of property, deceitfulness, or theft. - The scenario describes defiant and argumentative behavior, not the severe actions typical of conduct disorder. *Autism spectrum disorder* - ASD is characterized by persistent deficits in **social communication and interaction** across multiple contexts, and **restricted, repetitive patterns of behavior, interests, or activities.** - The provided symptoms do not align with the core diagnostic criteria for autism spectrum disorder. *Attention deficit hyperactivity disorder* - ADHD involves a persistent pattern of **inattention** and/or **hyperactivity-impulsivity** that interferes with functioning or development. - While some defiant behavior can coexist with ADHD, the primary presentation here is one of opposition and defiance, not predominantly inattention or hyperactivity.
Question 2: All of the following are classified under Pervasive Developmental Disorders except?
- A. Childhood Disintegrative Disorder
- B. Down Syndrome (Correct Answer)
- C. Asperger Syndrome
- D. Rett Syndrome
Explanation: ***Down Syndrome*** - **Down syndrome** is a **chromosomal disorder** (Trisomy 21) causing intellectual disability and distinctive physical features, not a pervasive developmental disorder. - Pervasive developmental disorders (PDDs) are characterized by difficulties in **social interaction**, **communication**, and repetitive behaviors, which are distinct from the genetic origin of Down syndrome. *Childhood Disintegrative Disorder* - **Childhood disintegrative disorder** (CDD) is a rare PDD characterized by a significant loss of previously acquired skills in multiple developmental areas after at least two years of normal development. - It involves severe regression in social, communication, and motor skills, aligning with the criteria for a PDD. *Asperger Syndrome* - **Asperger syndrome** was previously classified as a PDD, characterized by difficulties in social interaction and nonverbal communication, alongside restricted and repetitive patterns of behavior and interests. - Individuals with Asperger syndrome typically have average or above-average intelligence and no significant delay in language development. *Rett Syndrome* - **Rett syndrome** is a neurodevelopmental disorder classified as a PDD, almost exclusively affecting females, characterized by normal early development followed by a period of regression. - It involves the loss of purposeful hand movements, development of stereotypical hand movements, and severe impairments in language and motor skills.
Question 3: A 6 year old child who does not interact with other children of his age group and prefers playing alone with repetitive behaviors, is likely to be suffering from:
- A. ADHD
- B. Autism (Correct Answer)
- C. Depression
- D. Bipolar disorder
Explanation: ***Autism*** - Difficulties in **social interaction** and **communication**, along with **repetitive behaviors** and restricted interests, are core diagnostic features of **Autism Spectrum Disorder (ASD)**. - The child's preference for playing alone and lack of interaction with peers are hallmark signs of **social deficits** in ASD. *ADHD* - **Attention-Deficit/Hyperactivity Disorder (ADHD)** primarily involves difficulties with **inattention**, **hyperactivity**, and **impulsivity**. - While children with ADHD may struggle socially, repetitive behaviors and a complete lack of interest in peer interaction are not typical primary symptoms. *Depression* - **Depression** in children often presents with **sadness**, **loss of interest** in previously enjoyed activities, changes in sleep or appetite, and irritability. - Social withdrawal in depression is usually due to low mood or anhedonia, rather than a fundamental difficulty in social understanding or a preference for repetitive play. *Bipolar disorder* - **Bipolar disorder** in children involves distinct episodes of **mania** (elevated mood, increased energy, decreased need for sleep) and **depression**. - The symptoms described do not align with the characteristic mood swings and episodic nature of bipolar disorder.
Question 4: What is considered the most effective treatment for Borderline Personality Disorder?
- A. Combination of DBT and pharmacotherapy
- B. Cognitive Behavioural Therapy (CBT)
- C. Pharmacotherapy alone
- D. Dialectical Behaviour Therapy (DBT) (Correct Answer)
Explanation: ***Dialectical Behaviour Therapy (DBT)*** - **DBT** is the **gold standard** and most evidence-based psychotherapy specifically developed for Borderline Personality Disorder - Developed by **Marsha Linehan** specifically to target the core symptoms of BPD including emotional dysregulation, impulsivity, and interpersonal difficulties - Combines **cognitive-behavioral techniques** with mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills - Has the **strongest research evidence** for reducing suicidal behavior, self-harm, and improving overall functioning in BPD patients - Multiple RCTs demonstrate DBT's superiority in treating BPD compared to standard care *Cognitive Behavioural Therapy (CBT)* - While **CBT** is effective for many mental health conditions and can help with certain BPD symptoms, it was not specifically designed for BPD - DBT is actually a specialized adaptation of CBT tailored for BPD, making it more targeted and effective for this specific condition - Generic CBT may help with co-occurring conditions like depression or anxiety but lacks the comprehensive approach needed for core BPD features *Combination of DBT and pharmacotherapy* - This combination is clinically useful, especially when treating **co-morbid conditions** like depression, anxiety, or severe mood instability - However, psychotherapy (particularly DBT) remains the **cornerstone** of BPD treatment, with medications serving an adjunctive role - The question asks for the single most effective treatment, which is DBT alone *Pharmacotherapy alone* - **No medication** is FDA-approved specifically for BPD - Pharmacotherapy may help manage specific symptoms (mood swings, impulsivity, brief psychotic episodes) but does not address the core **personality pathology** - Generally not recommended as monotherapy for BPD; should always be combined with psychotherapy
Question 5: A 3-year-old child with delayed speech development, prefers to play alone and is not making friends. The likely diagnosis is
- A. Autism (Correct Answer)
- B. Specific learning disability
- C. Rett's syndrome
- D. ADHD
Explanation: ***Autism*** - **Delayed speech development**, a preference for playing alone, and difficulty making friends are classic diagnostic criteria for **Autism Spectrum Disorder (ASD)**. - ASD is characterized by persistent deficits in **social communication and social interaction** across multiple contexts, along with restricted, repetitive patterns of behavior, interests, or activities. *Specific learning disability* - A specific learning disability primarily affects academic skills (e.g., **reading, writing, arithmetic**) in individuals with otherwise average intelligence. - While it can impact social interactions due to frustration or self-esteem issues, its core features are not primarily related to delayed speech or intrinsic difficulties in social engagement. *Rett's syndrome* - Rett's syndrome is a rare **neurodevelopmental disorder** that almost exclusively affects females and is caused by mutations in the MECP2 gene. - It is characterized by initial normal development followed by a regression of skills, including **purposeful hand movements**, speech, and gait, often presenting with stereotypic hand-wringing. - The clinical presentation here shows early developmental concerns without regression, making ASD more likely. *ADHD* - **Attention-deficit/hyperactivity disorder (ADHD)** is characterized by symptoms of **inattention, hyperactivity, and impulsivity**. - While children with ADHD may have difficulty with social interactions due to impulsivity or inattention, delayed speech development and a consistent preference for solitary play are not primary diagnostic features.
Question 6: A first-grade teacher is concerned about a 6-year-old girl in her class who has not spoken a single word since school started. The little girl participates appropriately in the class activities and uses gestures, drawings, nods, and shakes her head to communicate. The parents report that the little girl talks only at home and only in the presence of her closest relatives. Which of the following is the most appropriate diagnosis?
- A. Autism
- B. Selective mutism (Correct Answer)
- C. Expressive language disorder
- D. School phobia
Explanation: ***Selective mutism*** - This condition is characterized by a **consistent failure to speak in specific social situations** (e.g., school) despite speaking in other situations (e.g., at home with close family). - The child's **appropriate participation in class activities** and use of alternative communication methods (gestures, drawings) are typical features. *Autism* - Children with autism spectrum disorder often exhibit **deficits in social-emotional reciprocity** and may have **restricted, repetitive patterns of behavior or interests**. - While they may have communication challenges, the selective nature of the mutism and otherwise appropriate social engagement in the classroom argue against autism. *Expressive language disorder* - This disorder involves difficulty **producing spoken language**, regardless of the setting. - The fact that the child speaks normally at home suggests her expressive language abilities are intact, making this diagnosis unlikely. *School phobia* - School phobia, now often referred to as **school refusal**, is characterized by symptoms of anxiety or panic when attending or anticipating school. - While the child might be anxious, her ability to participate in class activities and communicate nonverbally suggests the primary issue is not an avoidance of school itself but a selective inability to speak.
Question 7: 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 8: 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.
Question 9: A 24-year-old female complains of suicidal ideation following the loss of her family in a car accident. She has had problems focusing on her work and has been making errors due to poor judgment, leading to her layoff. She has been rescued from suicidal attempts multiple times and has been prescribed electroconvulsive therapy. What is the intravenous anesthetic of choice for electroconvulsive therapy?
- A. Thiopentone
- B. Ketamine
- C. Methohexital (Correct Answer)
- D. Fentanyl
Explanation: **Explanation:** The patient is presenting with severe depression and suicidal ideation following a traumatic event, necessitating **Electroconvulsive Therapy (ECT)**. The primary goal of anesthesia in ECT is to provide rapid induction and recovery while minimizing interference with seizure activity. **Why Methohexital is the Correct Answer:** **Methohexital** (a short-acting barbiturate) is considered the **"gold standard"** and the anesthetic of choice for ECT. Its superiority lies in its pharmacological profile: it has a rapid onset, a short duration of action, and, most importantly, it has the **least inhibitory effect on seizure threshold and duration** compared to other agents. Since the therapeutic efficacy of ECT depends on the quality and duration of the induced seizure, Methohexital ensures an optimal treatment outcome. **Analysis of Incorrect Options:** * **Thiopentone (Option A):** While previously common, it has a higher tendency to raise the seizure threshold and shorten seizure duration compared to methohexital. It also has a longer recovery time. * **Ketamine (Option B):** Though it has intrinsic antidepressant properties and increases seizure duration, it is not the first choice due to side effects like emergence delirium, hypertension, and tachycardia. * **Fentanyl (Option D):** This is an opioid analgesic. While it can be used as an adjunct to blunt the hemodynamic response to ECT, it is not an induction anesthetic agent. **High-Yield Clinical Pearls for NEET-PG:** * **Muscle Relaxant of Choice:** Succinylcholine (due to rapid onset and brief duration). * **Gold Standard Anesthetic:** Methohexital (0.5–1.0 mg/kg). * **Alternative if Methohexital is unavailable:** Propofol (though it significantly shortens seizure duration). * **Absolute Contraindication for ECT:** Increased intracranial pressure (ICP). * **Most Common Side Effect:** Retrograde amnesia and post-ictal confusion.
Question 10: Which of the following is NOT a symptom of Post-Traumatic Stress Disorder (PTSD)?
- A. Emotional numbing
- B. Hallucinations
- C. Hyperarousal
- D. Vivid dreams (Correct Answer)
Explanation: **Explanation:** Post-Traumatic Stress Disorder (PTSD) is characterized by a specific triad of symptom clusters following exposure to a traumatic event: **Intrusion, Avoidance, and Hyperarousal.** **Why "Vivid Dreams" is the correct answer:** While PTSD patients frequently experience **nightmares** (distressing dreams that replay the trauma), "vivid dreams" is a non-specific term and is not a formal diagnostic criterion. In the context of this question, the other three options represent the core diagnostic pillars of PTSD. It is a common "distractor" in exams; remember that PTSD involves *reliving* the trauma, not just having vivid or colorful dreams. **Analysis of Incorrect Options:** * **A. Emotional Numbing:** This is a core feature of the **Avoidance/Negative Cognition** cluster. Patients often feel detached from others, lose interest in previously enjoyed activities (anhedonia), and experience an inability to feel positive emotions. * **B. Hallucinations:** While not a primary symptom, **dissociative flashbacks** are a hallmark of PTSD. During these episodes, the patient may lose touch with reality and act as if the trauma is re-occurring. These are considered "pseudo-hallucinations" or part of the dissociative subtype of PTSD. * **C. Hyperarousal:** This includes symptoms like an exaggerated startle response, irritability, difficulty sleeping, and hypervigilance (constantly scanning the environment for threats). **NEET-PG High-Yield Pearls:** * **Duration:** Symptoms must last for **>1 month**. If symptoms last <1 month, the diagnosis is **Acute Stress Disorder**. * **First-line Treatment:** SSRIs (e.g., Sertraline, Paroxetine) and Trauma-focused Cognitive Behavioral Therapy (CBT). * **Prazosin:** An alpha-1 blocker specifically used to reduce the frequency and intensity of **nightmares** in PTSD. * **Key Symptom Clusters:** 1. Re-experiencing (Flashbacks/Nightmares), 2. Avoidance, 3. Negative alterations in cognition/mood, 4. Hyperarousal.
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