Obsessive-Compulsive and Related Disorders Practice Questions

Q: Which of the following conditions is associated with obsessive-compulsive disorder?

Depression. **Explanation:** **1. Why Depression is the Correct Answer:** Obsessive-Compulsive Disorder (OCD) and Major Depressive Disorder (MDD) share a high degree of comorbidity. Approximately **60-80%** of patients with OCD will experience a major depressive episode at some point in their lifetime, and about one-third are depressed at the time of initial presentation. This association is linked to shared neurobiological pathways, particularly involving **serotonergic dysregulation**. In many cases, the chronic distress and functional impairment caused by obsessions and compulsions lead to "secondary depression." **2. Analysis of Incorrect Options:** * **A. Mania:** While OCD can coexist with Bipolar Disorder, it is not the most characteristic association. In fact, SSRIs used to treat OCD can sometimes trigger a manic switch in predisposed individuals. * **C. Delusion:** By definition, OCD involves **obsessions**, which are recognized by the patient as their own thoughts (ego-dystonic) and are resisted. Delusions are fixed, false beliefs held with absolute certainty (ego-syntonic). If an obsession becomes a fixed belief, it is termed "OCD with poor/absent insight," but it remains distinct from primary delusional disorders. * **D. Schizophrenia:** Although "Schizo-obsessive" presentations exist, the prevalence is significantly lower than the association with depression. **3. Clinical Pearls for NEET-PG:** * **First-line Treatment:** SSRIs (at higher doses than used for depression) and CBT (Exposure and Response Prevention - ERP). * **Gold Standard Drug:** Clomipramine (a TCA with potent serotonin reuptake inhibition). * **Neuroanatomy:** OCD is associated with structural/functional abnormalities in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical or CSTC circuit). * **PANDAS:** Consider this diagnosis in children with sudden-onset OCD following a Group A Streptococcal infection.

Q: A 30-year-old lady is diagnosed with Obsessive-Compulsive Disorder (OCD). Which of the following statements is not true about her condition?

Ego syntonic. **Explanation:** The core concept tested here is the distinction between **Ego-dystonic (Ego-alien)** and **Ego-syntonic** symptoms. **Why "Ego-syntonic" is the correct answer (The "Not True" statement):** Obsessive-Compulsive Disorder (OCD) is characterized by **Ego-dystonic** (or Ego-alien) thoughts. This means the obsessions are inconsistent with the individual’s self-perception, values, and desires. The patient views these thoughts as intrusive, irrational, and distressing. In contrast, **Ego-syntonic** means the symptoms are perceived as compatible with the self-concept (seen in Obsessive-Compulsive *Personality* Disorder or OCPD). Therefore, calling OCD "Ego-syntonic" is factually incorrect. **Analysis of Incorrect Options:** * **A. Ego alien:** This is a synonym for Ego-dystonic. The patient feels the thoughts are "foreign" to their nature. This is a hallmark of OCD. * **B. Insight is present:** Most OCD patients have good or fair insight; they recognize that their obsessions and compulsions are unreasonable or excessive. (Note: ICD-11 and DSM-5 now allow for a "with poor insight" specifier, but the classic description remains "insight present"). * **C. Failure to resist:** By definition, OCD involves an attempt to resist the obsessions or compulsions, which leads to rising anxiety. When the patient "fails to resist," they perform the compulsion to neutralize the distress. **High-Yield Clinical Pearls for NEET-PG:** * **OCD vs. OCPD:** OCD is Ego-dystonic (distressing symptoms); OCPD is Ego-syntonic (perfectionism is seen as a virtue). * **First-line Treatment:** SSRIs (at higher doses than for depression) and CBT (specifically Exposure and Response Prevention - ERP). * **Drug of Choice (TCA):** Clomipramine (most serotonin-selective TCA). * **Neurobiology:** Associated with overactivity in the **Orbitofrontal Cortex, Anterior Cingulate Cortex, and Caudate Nucleus** (Cortico-striato-thalamo-cortical circuit).

Q: For severe intractable obsessional neurosis, which psychosurgery is the treatment of choice?

Cingulotomy. **Explanation:** **Bilateral Cingulotomy** is the most common and preferred psychosurgical procedure for severe, treatment-resistant **Obsessive-Compulsive Disorder (OCD)** and chronic refractory depression. The procedure involves creating a lesion in the anterior cingulate cortex, effectively interrupting the circuit between the limbic system and the frontal lobes (the "worry circuit"). It is reserved for patients who have failed multiple trials of high-dose SSRIs, Clomipramine, and intensive Cognitive Behavioral Therapy (CBT/ERP). **Analysis of Options:** * **Bifrontal Tractotomy:** This involves lesioning the white matter tracts (subcaudate tractotomy) beneath the head of the caudate nucleus. While used for OCD and depression, it is generally considered a second-line surgical option compared to cingulotomy. * **Amygdalotomy:** This procedure targets the amygdala and is primarily indicated for the management of **intractable aggression** or violent behavior, not typically for obsessional neurosis. * **Temporal Lobe Lesion:** Surgical interventions in the temporal lobe (like anterior temporal lobectomy) are standard treatments for **refractory temporal lobe epilepsy**, but they have no established role in treating OCD. **High-Yield Pearls for NEET-PG:** * **Target Site:** The "Cingulate Gyrus" is the primary target for OCD psychosurgery. * **Alternative Modern Approach:** **Deep Brain Stimulation (DBS)** is increasingly preferred over ablative surgery because it is reversible and adjustable. The most common DBS target for OCD is the **Internal Capsule (Ventral Capsule/Ventral Striatum)**. * **Legal Aspect:** Under the Mental Healthcare Act (2017), psychosurgery in India requires approval from a designated State Mental Health Authority.

Q: Which of the following conditions is classified under anxiety disorders according to DSM-III?

Obsessive compulsive disorder. **Explanation:** The classification of psychiatric disorders has evolved significantly across different versions of the DSM. In **DSM-III (1980)** and **DSM-IV**, **Obsessive-Compulsive Disorder (OCD)** was categorized as an **Anxiety Disorder**. This was based on the clinical observation that patients with OCD experience intense anxiety when they resist their compulsions or are exposed to triggers. However, in the current **DSM-5**, OCD has been moved to its own dedicated category: *"Obsessive-Compulsive and Related Disorders."* **Analysis of Options:** * **A. Obsessive Compulsive Disorder (Correct):** As per DSM-III and DSM-IV, it was grouped under Anxiety Disorders along with Panic Disorder, Phobias, and PTSD. * **B. Depression:** Classified under **Mood Disorders** (DSM-III/IV) or Depressive Disorders (DSM-5). * **C. Schizophrenia:** Classified under **Psychotic Disorders** (or Schizophrenia Spectrum Disorders in DSM-5). * **D. Bipolar Disorder:** Classified under **Mood Disorders** (DSM-III/IV) and now occupies its own chapter in DSM-5 between Schizophrenia and Depressive Disorders. **High-Yield Clinical Pearls for NEET-PG:** * **DSM-5 Change:** The most important takeaway is that **OCD and PTSD** are **no longer** classified as Anxiety Disorders in DSM-5. * **OCD Neurobiology:** Associated with abnormalities in the **Orbitofrontal cortex, Anterior Cingulate Cortex, and Caudate nucleus** (CSTC circuit). * **Treatment of Choice:** The first-line pharmacological treatment for OCD is **SSRIs** (often requiring higher doses than in depression), and the psychological treatment of choice is **Exposure and Response Prevention (ERP)**.

Question 1

A person has recurrent intrusive thoughts which he thinks are irrational and wants to stop is:

Accepted Answer

Obsession

Answer

Compulsion

Answer

Delusion

Answer

Hallucination

Question 2

A feeling of uncertainty and an excessive sense of responsibility is characteristic of which condition?

Accepted Answer

Obsessive-compulsive disorder

Answer

Generalized anxiety disorder

Answer

Phobia

Answer

Personality disorder

Question 3

Which of the following conditions is associated with obsessive-compulsive disorder?

Accepted Answer

Depression

Answer

Mania

Answer

Delusion

Answer

Schizophrenia

Question 4

An anxiety reaction in which the mind is preoccupied with certain thoughts and ideas that cannot be driven away is known as what?

Accepted Answer

Obsession

Answer

Impulse

Answer

Phobia

Answer

Confabulation

Question 5

Which of the following is true regarding Trichotillomania?

Accepted Answer

It involves repetitive hair pulling driven by increasing tension.

Answer

It is not an impulse control disorder.

Answer

It involves repetitive hair pulling without preceding tension.

Answer

No hair loss is seen.

Question 6

A 30-year-old lady is diagnosed with Obsessive-Compulsive Disorder (OCD). Which of the following statements is not true about her condition?

Accepted Answer

Ego syntonic

Answer

Ego alien

Answer

Insight is present

Answer

Failure to resist

Question 7

For severe intractable obsessional neurosis, which psychosurgery is the treatment of choice?

Accepted Answer

Cingulotomy

Answer

Bifrontal tractotomy

Answer

Amygdalotomy

Answer

Temporal lobe lesion

Question 8

Which of the following features is characteristic of Obsessive-Compulsive Disorder (OCD)?

Accepted Answer

Egosyntonic

Answer

Irrational thought

Answer

Resisting the idea

Answer

Persistence of idea

Question 9

All of the following brain areas are involved with Obsessive compulsive disorder except?

Accepted Answer

Claustrum

Answer

Orbitofrontal cortex

Answer

Basal ganglia

Answer

Head of caudate nucleus

Question 10

Which of the following conditions is classified under anxiety disorders according to DSM-III?

Accepted Answer

Obsessive compulsive disorder

Answer

Depression

Answer

Schizophrenia

Answer

Bipolar disorder

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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