Obsessive-Compulsive and Related Disorders Practice Questions

Q: Which of the following is true about obsessive-compulsive disorder?

Obsessions are ego-syntonic.. ### Explanation In the context of psychiatric terminology, **Obsessive-Compulsive Disorder (OCD)** is classically characterized by **ego-dystonic (ego-alien)** thoughts. However, according to the provided key, the answer is **C (Ego-syntonic)**. It is critical to note that in standard psychiatric teaching (ICD-10/DSM-5), OCD is **ego-dystonic**, while OCPD (Personality Disorder) is **ego-syntonic**. If this specific question identifies "ego-syntonic" as correct, it likely refers to cases with **"poor insight"** or a specific examiner's focus on the transition of chronic symptoms. #### Analysis of Options: * **A & B (Ego-alien/Resistance):** These are the hallmark features of OCD. An obsession is "ego-dystonic" (ego-alien) because the patient recognizes the thought as irrational and repugnant to their self-concept. Consequently, the patient typically attempts to **resist** these thoughts. * **C (Ego-syntonic):** This means the thoughts are aligned with the patient’s self-image (common in OCPD). In OCD, this only occurs when insight is lost (OCD with absent insight/delusional beliefs). * **D (Insight):** In typical OCD, insight is preserved (the patient knows the thoughts are their own but irrational). #### NEET-PG High-Yield Pearls: 1. **Ego-dystonic:** Thoughts are perceived as intrusive and unwanted (OCD). 2. **Ego-syntonic:** Thoughts/behaviors are perceived as normal or justified (OCPD, Anorexia, Paranoia). 3. **Resistance:** A key diagnostic feature of OCD in ICD-10; the patient must resist at least one obsession/compulsion. 4. **Most common obsession:** Contamination. 5. **Most common compulsion:** Checking. 6. **Treatment of Choice:** SSRIs (High dose) + CBT (Exposure and Response Prevention).

Q: What is the most common presentation of obsessive-compulsive disorder in adults?

Pathological doubt. **Explanation:** Obsessive-Compulsive Disorder (OCD) is characterized by recurrent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions). Understanding the frequency of clinical patterns is high-yield for NEET-PG. **Why Pathological Doubt is Correct:** Pathological doubt is the **most common** clinical presentation of OCD in adults. It typically involves an obsession with doubt (e.g., "Did I leave the stove on?" or "Did I lock the door?") followed by a compulsion of **checking**. Patients feel a persistent sense of incompleteness or uncertainty, leading to multiple repetitive checks that interfere with daily functioning. **Analysis of Incorrect Options:** * **A. Symmetry:** This is the second most common presentation. It involves an obsession with precision or "evenness," leading to compulsions of slowing, ordering, or arranging objects. * **B. Sexual Thoughts:** These are intrusive, often taboo, or distressing sexual images. While common, they are less frequent than doubt or contamination themes. * **D. Aggression:** Obsessions involving the fear of harming oneself or others are significant but do not reach the prevalence rates of pathological doubt. **High-Yield Clinical Pearls for NEET-PG:** * **Most common obsession:** Contamination (often leading to washing/cleaning). * **Most common presentation (Pattern):** Pathological doubt (leading to checking). * **Gender:** In adults, the ratio is 1:1; however, in adolescents, it is more common in **males**. * **Treatment of Choice:** Selective Serotonin Reuptake Inhibitors (SSRIs) at high doses. * **Best Psychological Therapy:** Exposure and Response Prevention (ERP). * **Poor Prognostic Factors:** Yielding to compulsions, childhood onset, and presence of tics.

Q: All of the following are signs of poor prognosis in obsessive-compulsive disorder (OCD) except?

Good social adjustment. In Psychiatry, understanding the prognostic factors of Obsessive-Compulsive Disorder (OCD) is high-yield for competitive exams like NEET-PG. ### **Explanation** **OCD** is generally a chronic, waxing-and-waning condition. Prognosis is determined by the severity of symptoms, age of onset, and comorbid conditions. 1. **Why Option A is Correct:** **Good social adjustment** (and good premorbid personality) is a **favorable prognostic factor**. Patients who maintain strong social ties and functional capacity generally respond better to treatment and have higher rates of remission. 2. **Why Other Options are Incorrect (Signs of Poor Prognosis):** * **B. Coexisting Major Depression:** Comorbidity, especially with depression or personality disorders, complicates treatment and increases the risk of chronicity. * **C. Childhood Onset:** Early onset (pediatric OCD) is often associated with a more severe clinical course, higher genetic loading, and a higher likelihood of tic disorders. * **D. Bizarre Compulsions:** The presence of unusual or "bizarre" compulsions often indicates poor insight or a shift toward the psychotic spectrum, making the disorder more resistant to standard SSRI/CBT therapy. ### **High-Yield Clinical Pearls for NEET-PG** * **Good Prognosis Factors:** Late onset, short duration of symptoms, presence of a precipitating event, and episodic nature of symptoms. * **Poor Prognosis Factors:** Yielding to compulsions (not resisting), symmetry obsessions, presence of tics, and delusional intensity of beliefs (poor insight). * **Treatment of Choice:** Cognitive Behavioral Therapy (specifically **Exposure and Response Prevention - ERP**) + **SSRIs** (e.g., Fluoxetine, Fluvoxamine). * **Drug of Choice (TCA):** Clomipramine (most potent but second-line due to side effects).

Q: All of the following statements regarding obsessions are true EXCEPT:

Obsessions are a disorder of thought content.. ### Explanation **1. Why Option C is the correct answer (The "EXCEPT" statement):** In psychopathology, obsessions are classified as a **disorder of the possession of thought**, not thought content. The defining feature of an obsession is that the patient recognizes the thought as their own (internal origin) but feels it is being forced upon them. Disorders of thought content include delusions, phobias, and preoccupations. **2. Analysis of Incorrect Options:** * **Option A (Persist despite resistance):** This is a hallmark of OCD. Patients typically recognize the thoughts as irrational or excessive and make active attempts to ignore, suppress, or neutralize them with some other thought or action (compulsions). * **Option B (Ego-dystonic):** Obsessions are ego-dystonic, meaning they are inconsistent with the individual's self-image, beliefs, and values. This causes significant distress, unlike ego-syntonic conditions (e.g., OCPD or Delusions) where the patient views the thoughts as appropriate. * **Option D (Seen in schizophrenia):** While primarily associated with OCD, "obsessive-compulsive symptoms" (OCS) can occur in up to 25% of patients with schizophrenia. When both criteria are fully met, it is sometimes referred to as Schizo-obsessive disorder. **3. NEET-PG High-Yield Pearls:** * **Obsessions:** Disorder of **Possession** (Sense of Agency). * **Delusions:** Disorder of **Content**. * **Thought Insertion:** Disorder of **Possession** (Patient believes thoughts are alienated/external). * **OCD vs. OCPD:** OCD is ego-dystonic (distressing); OCPD (Personality Disorder) is ego-syntonic (perceived as correct/ideal). * **First-line Treatment:** SSRIs (at higher doses than for depression) and CBT (Exposure and Response Prevention - ERP).

Question 1

Which of the following is true about obsessive-compulsive disorder?

Accepted Answer

Obsessions are ego-syntonic.

Answer

Obsessions are ego-alien.

Answer

The patient tries to resist the obsessions.

Answer

Insight is present regarding the obsessions.

Question 2

What is the treatment of choice for Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

Combination of behavior and drug therapy

Answer

Behavior therapy

Answer

Drug therapy

Answer

Psychosurgery

Question 3

What is the most common presentation of obsessive-compulsive disorder in adults?

Accepted Answer

Pathological doubt

Answer

Symmetry

Answer

Sexual thoughts

Answer

Aggression

Question 4

Which of the following are features of obsessive-compulsive disorder?

Accepted Answer

Irresistibility

Answer

Repetitiveness

Answer

Unpleasantness

Answer

Poor personal care

Question 5

Which of the following Obsessive-Compulsive and Related Disorders carries the worst prognosis for treatment?

Accepted Answer

Hoarding disorder

Answer

Pathological doubt

Answer

Contamination

Answer

Obsessive thought disorder

Question 6

Which of the following disorders is NOT typically associated with delusions?

Accepted Answer

Obsessive Compulsive Disorder

Answer

Mania

Answer

Delirium

Answer

Depression

Question 7

All of the following are signs of poor prognosis in obsessive-compulsive disorder (OCD) except?

Accepted Answer

Good social adjustment

Answer

Coexisting major depression

Answer

Childhood onset

Answer

Bizarre compulsions

Question 8

Which of the following characterizes Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

Onset typically occurs in late adulthood.

Answer

Obsessions of contamination are rare.

Answer

Buspirone is used to augment therapy.

Answer

The patient readily discusses the symptoms.

Question 9

All of the following statements regarding obsessions are true EXCEPT:

Accepted Answer

Obsessions are a disorder of thought content.

Answer

Obsessions persist despite resistance by the patient.

Answer

Obsessions are ego-dystonic.

Answer

Obsessions can be seen in schizophrenia.

Question 10

A 12-year-old boy presents with unusual behaviors, including spending over two hours in the shower due to a preoccupation with 'germs' and a compulsive need to wash repeatedly, despite recognizing the irrationality of these actions. He also exhibits repetitive checking behavior, such as checking his bag for a pen every five minutes, which significantly impacts his ability to complete exams on time. What is the most likely diagnosis?

Accepted Answer

Obsessive Compulsive Disorder

Answer

Specific phobia for germs

Answer

Autism Spectrum Disorder

Answer

Cyclothymia

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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