Introduction to Psychiatry Practice Questions

Q: A 35-year-old woman presents with a persistent lack of interest in sexual activity for the past year. She reports an absence of sexual thoughts and fantasies, which is causing significant distress in her relationship. There is no history of substance use, and her medical workup is unremarkable. Which of the following is the most appropriate diagnosis?

Hypoactive sexual desire disorder. ***Hypoactive sexual desire disorder*** - This is characterized by a **persistent or recurrent deficiency** (or absence) of sexual thoughts, fantasies, and desire for sexual activity. - It causes **marked distress or interpersonal difficulty** and is not better explained by another mental disorder, medication, or medical condition. *Paraphilic disorder* - These are characterized by **recurrent, intense sexual urges, fantasies, or behaviors** that involve unusual objects, situations, or individuals. - The key differentiator is the **presence of distress or impairment** due to these urges or behaviors, or the involvement of non-consenting individuals. *Sexual dysfunction* - This is a broad category encompassing various difficulties experienced by an individual or a couple during any stage of a normal sexual activity. - **Hypoactive sexual desire disorder** is a *specific type* of sexual dysfunction, making "sexual dysfunction" too general an answer if a more specific one is available. *Gender dysphoria* - This involves a **marked incongruence** between an individual's experienced/expressed gender and their assigned gender. - It is characterized by significant distress or impairment associated with this incongruence, and it is **not primarily a disorder of sexual desire or function**.

Q: Psychodynamic model of disease explains the psychopathologic cause of all mental illness to be

Unconscious conflict. **Correct: Unconscious conflict** - The **psychodynamic model**, largely based on Freudian theory, posits that psychopathology arises from unresolved **unconscious conflicts** or repressed urges and experiences. - These conflicts typically stem from early childhood experiences and defense mechanisms used to cope with them, leading to symptomatic behavior. - This is the fundamental explanatory mechanism of the psychodynamic framework. *Incorrect: Structural and functional defect in CNS* - This explanation aligns with the **biomedical model**, which attributes mental illness to biological factors like **neurotransmitter imbalances**, genetic predispositions, or brain abnormalities. - While biological factors are crucial in understanding some mental illnesses, they are not the primary explanatory mechanism in the psychodynamic framework. *Incorrect: Maladaptive* - While psychopathology often involves **maladaptive behaviors** or thought patterns, the psychodynamic model views these as symptoms or manifestations of the underlying unconscious conflict, rather than the root cause itself. - Other models, like **behavioral psychology**, focus more directly on maladaptive learning as the primary cause. *Incorrect: Cognition difficulties* - **Cognitive difficulties** and distortions are central to the **cognitive model** of psychopathology, which suggests that mental illness results from faulty thinking patterns or dysfunctional schemas. - The psychodynamic model acknowledges intellectual functions, but it primarily sees disturbances in cognition as driven by deeper, unconscious emotional processes.

Q: A pilot whose plane is about to crash, spends five minutes explaining the technical details of the engine malfunction to his copilot. The defense mechanism that the pilot is using is?

Intellectualization. ***Intellectualization*** - This defense mechanism involves **overthinking** and focusing on the **intellectual and technical details** of a stressful situation, rather than acknowledging the emotional impact. - The pilot is using an academic approach to manage anxiety by concentrating on the mechanical aspects of the malfunction, thereby avoiding the overwhelming fear of crashing. *Sublimation* - **Sublimation** is a mature defense mechanism where unacceptable urges or feelings are unconsciously transformed into socially acceptable behaviors. - It involves channeling potentially harmful impulses into constructive activities, which is not what the pilot is doing in this critical situation. *Dissociation* - **Dissociation** involves a detachment from one's immediate surroundings, thoughts, or feelings, often as a response to trauma. - The pilot is actively engaged and focused on the problem, rather than experiencing a disconnection from reality. *Repression* - **Repression** is an unconscious mechanism that keeps disturbing or threatening thoughts, memories, or feelings out of conscious awareness. - The pilot is actively processing and verbalizing information about the malfunction, indicating that the threatening situation is very much in his conscious awareness, not being pushed away.

Q: One of the important defense mechanisms is:

Repression. ***Repression*** - **Repression** is a primary ego defense mechanism where unacceptable thoughts, feelings, or memories are unconsciously excluded from conscious awareness. - It plays a crucial role in protecting the individual from psychological distress and maintaining the ego's integrity by pushing disturbing content into the **unconscious mind**. - Considered one of the most **important and fundamental** defense mechanisms in psychoanalytic theory, forming the basis for neurotic symptom formation. *Alienation* - **Alienation** refers to a feeling of being isolated, estranged, or disconnected from oneself, others, or society. - While it can be a psychological state or response to stress, it is not considered a **defense mechanism** in the psychoanalytic sense. *Confabulation* - **Confabulation** is the act of producing distorted or fabricated memories without the conscious intention to deceive. - It is often seen in conditions like **Korsakoff's syndrome** and is a symptom of memory impairment rather than a defense mechanism. *Suppression* - **Suppression** is the conscious, voluntary decision to push unwanted thoughts or feelings out of immediate awareness. - Unlike **repression**, which operates unconsciously, suppression involves **deliberate effort** and awareness. - While suppression is also classified as a defense mechanism (a mature one), **repression** is considered more fundamental and "important" as it operates at the unconscious level and is central to psychoanalytic theory.

Q: Mental Health Care Act of India was passed in the year:

2017. ***2017*** - The **Mental Health Care Act of India** was specifically enacted in **2017**, introducing a comprehensive rights-based approach to mental healthcare. - This act replaced the outdated **Mental Health Act 1987** and focuses on protecting the rights of persons with mental illness while ensuring quality care. *1948* - This year marks the **Universal Declaration of Human Rights** globally, but no mental health legislation was enacted in India. - India's mental health framework was still governed by the colonial-era **Indian Lunacy Act of 1912** during this period. *2007* - No significant mental health legislation was passed in India during this year. - The **Mental Health Act 1987** remained in effect, and the new Mental Health Care Act was still a decade away. *1987* - The **Mental Health Act 1987** (without "Care" in the title) was passed in this year, not the Mental Health Care Act. - This act provided the legal framework for mental health services but lacked the comprehensive **rights-based approach** later introduced in 2017.

Q: On voluntary admission, the maximum number of days a person can be admitted as per mental health care act is:

30 days. ***30 days*** - As per the **Mental Healthcare Act, 2017**, under **Section 89 (Independent Admission)**, a person can be admitted independently for a **maximum period of 30 days**. - After 30 days, the person must either be discharged or the admission must be converted to voluntary or involuntary admission with appropriate procedures. - This provision allows for independent treatment-seeking without requiring a caregiver's involvement initially. *48 hours* - **48 hours** is not related to voluntary or independent admission duration. - This timeframe relates to the period within which a voluntary patient must be discharged after they request to leave (unless there are grounds for involuntary admission). *60 days* - **60 days** is not specified in the Mental Healthcare Act, 2017 for any category of admission. - This is neither the duration for voluntary, independent, nor involuntary admission procedures. *90 days* - **90 days** is not the correct maximum period for voluntary or independent admission. - While voluntary admission can continue indefinitely with ongoing consent, **independent admission** specifically has a **30-day limit** as per Section 89 of the Act.

Q: SPIKES protocol is used for:

Communication with patients/attendants regarding bad news. ***Communication with patients/attendants regarding bad news*** - The **SPIKES protocol** provides a structured framework for delivering difficult or "bad" news sensitively and effectively to patients and their families. - It ensures that the communication is **patient-centered**, empathetic, and allows for understanding and emotional support. *RCT* - **Randomized Controlled Trials (RCTs)** are study designs used to evaluate the efficacy and safety of medical interventions. - They involve randomizing participants to different treatment groups and are not related to breaking bad news. *Triage* - **Triage** is the process of prioritizing patients based on the severity of their condition, typically used in emergency settings. - Its purpose is to allocate resources efficiently and save lives, not to guide difficult conversations. *Writing death certificate* - **Writing a death certificate** is a legal and administrative task that involves documenting the cause and circumstances of a person's death. - While it follows a death, the SPIKES protocol is for the *process of conveying* difficult news, such as a terminal diagnosis or death, rather than the administrative task afterward.

Q: As per Mental Healthcare Act, an individual with a known psychotic disorder on treatment and is not a minor, can decide the caretaker and the course of treatment. This is called:

Advance directive. ***Advance directive*** - An **advance directive** allows individuals with mental illness who are not minors to make decisions about their future care, including appointing a caretaker and outlining treatment preferences, while they are still capable. - This legal document ensures that a person's wishes regarding their mental health treatment are respected even if they later lose the capacity to make those decisions. *Future directive* - While "future directive" might seem semantically similar, it is not the specific legal or medical term used in the context of the **Mental Healthcare Act** for outlining future treatment choices. - This term is less precise and does not carry the same legal weight or established definition as "advance directive." *Treatment directive* - "Treatment directive" specifically refers to choices about treatment, but it doesn't encompass the full scope of appointing a **caretaker** or the broader legal framework of an advance directive under the act. - It's a more general term that might be used to describe instructions for current or future treatment, but it's not the legally recognized term for comprehensive pre-planned care in mental health. *Mental will* - "Mental will" is not a recognized legal or medical term under the **Mental Healthcare Act** or generally in healthcare planning. - The concept of a "will" typically applies to the distribution of property after death, not to ongoing healthcare decisions or the appointment of caretakers for mental health.

Q: Which defense mechanism involves unconsciously eliminating feelings associated with a stressful event?

Repression. ***Repression*** - **Repression** is an unconscious defense mechanism where unacceptable thoughts, feelings, or memories are pushed out of conscious awareness. - It involves the involuntary blocking of threatening impulses or traumatic experiences from consciousness to protect the ego from distress. *Reaction formation* - This defense mechanism involves replacing an unacceptable impulse with its **opposite acceptable impulse**. - For example, showing excessive friendliness towards someone you intensely dislike. *Rationalization* - **Rationalization** involves creating logical, but false, explanations for one's actions, feelings, or thoughts. - It is used to justify behaviors that might otherwise be considered unacceptable or irrational. *Projection* - **Projection** is a defense mechanism where an individual attributes their own unacceptable thoughts or feelings to another person. - For instance, accusing someone else of being angry when you are in fact feeling angry yourself.

Question 1

A 35-year-old woman presents with a persistent lack of interest in sexual activity for the past year. She reports an absence of sexual thoughts and fantasies, which is causing significant distress in her relationship. There is no history of substance use, and her medical workup is unremarkable. Which of the following is the most appropriate diagnosis?

Accepted Answer

Hypoactive sexual desire disorder

Answer

Paraphilic disorder

Answer

Sexual dysfunction

Answer

Gender dysphoria

Question 2

Psychodynamic model of disease explains the psychopathologic cause of all mental illness to be

Accepted Answer

Unconscious conflict

Answer

Structural and functional defect in CNS

Answer

Maladaptive

Answer

Cognition difficulties

Question 3

A pilot whose plane is about to crash, spends five minutes explaining the technical details of the engine malfunction to his copilot. The defense mechanism that the pilot is using is?

Accepted Answer

Intellectualization

Answer

Sublimation

Answer

Dissociation

Answer

Repression

Question 4

One of the important defense mechanisms is:

Accepted Answer

Repression

Answer

Alienation

Answer

Confabulation

Answer

Suppression

Question 5

Mental Health Care Act of India was passed in the year:

Accepted Answer

2017

Answer

1948

Answer

2007

Answer

1987

Question 6

Frotteurism is:

Accepted Answer

Sexual gratification by rubbing against a non-consenting person

Answer

Sexual practice involving three people

Answer

Sexual pleasure in watching people getting undressed

Answer

Sexual pleasure obtained by witnessing urination

Question 7

On voluntary admission, the maximum number of days a person can be admitted as per mental health care act is:

Accepted Answer

30 days

Answer

48 hours

Answer

60 days

Answer

90 days

Question 8

SPIKES protocol is used for:

Accepted Answer

Communication with patients/attendants regarding bad news

Answer

RCT

Answer

Triage

Answer

Writing death certificate

Question 9

As per Mental Healthcare Act, an individual with a known psychotic disorder on treatment and is not a minor, can decide the caretaker and the course of treatment. This is called:

Accepted Answer

Advance directive

Answer

Future directive

Answer

Treatment directive

Answer

Mental will

Question 10

Which defense mechanism involves unconsciously eliminating feelings associated with a stressful event?

Accepted Answer

Repression

Answer

Rationalization

Answer

Reaction formation

Answer

Projection

Introduction to Psychiatry — MCQs

Introduction to Psychiatry — MCQs

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