Obsessive-Compulsive and Related Disorders Practice Questions

Q: Body dysmorphic disorder can be associated with all except

Mania. ***Mania*** - **Mania** is a state of elevated, expansive, or irritable mood that is distinct from the persistent preoccupation with perceived bodily defects seen in **body dysmorphic disorder (BDD)**. - While agitation can occur in BDD, the core symptom profile of **mania**, including decreased need for sleep, grandiosity, and racing thoughts, is not a typical associated feature. *Bulimia nervosa* - **Bulimia nervosa** can co-occur with BDD, particularly when the perceived defects relate to body weight, shape, or specific body parts. - Both disorders involve intense preoccupation with body image and often lead to harmful behaviors to attempt to "correct" perceived flaws. *OCD* - **Obsessive-compulsive disorder (OCD)** shares strong phenomenological similarities with BDD, including intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - BDD is often conceptualized as part of the **OCD spectrum**, with both disorders involving obsessive thoughts and repetitive behaviors related to specific concerns. *Anxiety* - **Anxiety disorders** are highly comorbid with BDD, as individuals often experience significant distress, fear of judgment, and social avoidance due to their perceived flaws. - The constant preoccupation and efforts to conceal or fix perceived defects can lead to chronic anxiety and panic attacks.

Q: An irresistible urge to perform repetitive behaviors is characteristic of

Obsessive - compulsive disorder. ***Obsessive - compulsive disorder*** - This disorder is characterized by the presence of **obsessions** (recurrent and persistent thoughts, urges, or images) and/or **compulsions** (repetitive behaviors or mental acts that an individual feels driven to perform). - The "irresistible urge to do a thing repeatedly" perfectly describes a **compulsion**, which is aimed at reducing anxiety or preventing a dreaded event. *Schizophrenia* - This is a chronic mental disorder characterized by disturbances in thought processes, perception, emotion, and behavior, leading to **psychosis**. - Symptoms include **hallucinations**, **delusions**, disorganization of speech and behavior, and negative symptoms, which are distinct from repetitive urges. *Depression* - Depression is a mood disorder characterized by persistent sadness, loss of interest or pleasure, and a range of other emotional, cognitive, and physical symptoms. - While it can involve repetitive negative thoughts (**rumination**), it does not typically manifest as an "irresistible urge" to perform specific repetitive behaviors. *Schizoaffective disorder* - This disorder involves a combination of symptoms of **schizophrenia** (such as hallucinations or delusions) and **mood disorder** symptoms (either depression or bipolar disorder). - While it has psychotic features, it does not primarily involve irresistible repetitive urges as a core diagnostic criterion.

Q: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?

Carbamazepine. ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder. - It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**. *Fluoxetine* - **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD. - SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**. *Cognitive Behaviour Therapy* - **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD. - It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**. - It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.

Q: In OCD, if the patient tries to resist obsession, then patient develops?

Anxiety. ***Anxiety*** - In **Obsessive-Compulsive Disorder (OCD)**, attempts to resist obsessions or compulsions typically lead to a significant increase in **anxiety** and distress. - This heightened anxiety is a primary driver for individuals to engage in ritualistic compulsions, as these acts provide a temporary reduction in the uncomfortable feeling. *Delusion* - A **delusion** is a fixed, false belief that is impervious to reason or evidence, which is characteristic of psychotic disorders, not typically seen as a direct consequence of resisting obsessions in OCD. - While OCD can sometimes have poor insight, the core issue is intrusive thoughts and behaviors, not a break from reality. *Depression* - **Depression** is a mood disorder characterized by persistent sadness and loss of interest, and while it often co-occurs with OCD due to the chronic stress and impairment, it's not the immediate, direct consequence of resisting an obsession. - The immediate response to resistance is anxiety, which can contribute to depression over time. *Mania* - **Mania** is a state of abnormally elevated arousal, affect, and energy level often associated with bipolar disorder. - It is not a symptom or a direct outcome of attempting to resist obsessions in OCD.

Q: A 20 year old female has thoughts of cutting her fingers, and imagines doing it but never actually does it. She says she is not having any guilt of having such thought. And also says the thoughts are distressing her and she is unable to control them. Which of the following is the likely cause?

Obsession. ***Obsession*** - The patient experiences **recurrent, persistent, and intrusive thoughts** (cutting fingers) that she finds **distressing and uncontrollable**. - These thoughts are **ego-dystonic** (unwanted and inconsistent with her sense of self), which is characteristic of obsessions. - The **absence of guilt** is consistent with obsessions in OCD, where the patient recognizes the thoughts as irrational and distressing rather than feeling guilty about them. - She **imagines the act but never performs it**, distinguishing obsessions from compulsions or impulsive behavior. - This presentation fits the criteria for an **obsession** as seen in **Obsessive-Compulsive Disorder (OCD)**. *Forced thinking* - This refers to a phenomenon where an individual feels their thoughts are being **controlled or imposed by an external force** (thought control). - It is a **passivity phenomenon** seen in schizophrenia where the patient attributes the source of thoughts to external agents. - The patient in this case recognizes the thoughts as her own (ego-dystonic but self-generated), not externally imposed. *Crowding of thoughts* - This involves a subjective experience of having **too many thoughts occurring simultaneously**, leading to mental overload (pressure of thoughts). - Seen in **manic episodes** where there is flight of ideas and accelerated thinking. - The patient describes **specific, repetitive intrusive thoughts** rather than a general overwhelming volume of thoughts. *Thought insertion* - This is a **first-rank symptom of schizophrenia** where the patient believes that **thoughts are being placed into their mind by an external agent**. - It is a **delusion of control** and represents a loss of ego boundary. - The patient describes the thoughts as originating from within herself (though unwanted), not being inserted by an external entity.

Q: All of the following are OCD related disorders except:

Temper tantrums. ***Temper tantrums*** - **Temper tantrums** are outbursts of anger and frustration, common in young children, and are not classified as an **OCD-related disorder**. - They are typically associated with developmental stages or underlying emotional regulation difficulties, rather than **obsessive thoughts** or **compulsive behaviors**. *Hoarding disorder* - **Hoarding disorder** is characterized by persistent difficulty discarding or parting with possessions, regardless of their actual value, due to a perceived need to save them. - It is classified under the **Obsessive-Compulsive and Related Disorders** category in the DSM-5 due to the compulsive nature of acquiring and retaining items. *Hair pulling disorder* - Also known as **trichotillomania**, this disorder involves repetitive, irresistible urges to pull out one's hair, resulting in noticeable hair loss. - It is an impulse control disorder categorized within the **Obsessive-Compulsive and Related Disorders** spectrum because of its repetitive, body-focused compulsive behavior. *Skin picking* - Also known as **excoriation disorder**, skin picking involves repetitive and compulsive picking of one's own skin, often leading to skin lesions. - This disorder is recognized as a **body-focused repetitive behavior** and is included in the **Obsessive-Compulsive and Related Disorders** category.

Q: Areas of brain involved in OCD include:

Basal ganglia. ***Basal ganglia*** - The **basal ganglia**, particularly the **caudate nucleus**, are a core component of the **cortico-striato-thalamo-cortical (CSTC) circuit**, which is the primary neurobiological model for OCD. - The CSTC circuit involves: **Orbitofrontal cortex → Caudate nucleus → Thalamus → back to cortex**. - Hyperactivity in the **caudate nucleus** is consistently found in OCD patients and correlates with symptom severity. - The basal ganglia's role in **habit formation, motor planning, and behavioral inhibition** directly relates to the compulsive behaviors and ritualistic patterns in OCD. - **Functional neuroimaging** (PET, fMRI) consistently shows increased metabolic activity in the caudate nucleus in OCD patients, which normalizes with successful treatment. *Temporal lobe* - The temporal lobe is **not a primary region** in the classical neurobiology of OCD. - While some studies show volumetric changes, it is not part of the core CSTC circuit. - The primary cortical areas in OCD are the **orbitofrontal cortex and anterior cingulate cortex**, not the temporal lobe. *Cerebellum* - The cerebellum has emerging evidence for involvement in cognitive and affective processing. - However, it is **not a core component** of the established CSTC circuit model for OCD. - Its role appears to be supplementary rather than primary in OCD pathophysiology. *All of the options* - This is incorrect because **temporal lobe is not a primary area** involved in OCD. - The core circuit is the **CSTC loop** involving orbitofrontal cortex, anterior cingulate cortex, basal ganglia (caudate), and thalamus.

Q: In psychoanalytic terms, obsessive-compulsive disorder is fixed at -

Anal stage. ***Anal stage*** - In psychoanalytic theory, **obsessive-compulsive disorder (OCD)** is often conceptualized as a fixation at the **anal stage** of psychosexual development. - The anal stage (ages 1-3) is associated with issues of **control, orderliness, cleanliness, and defiance**, which parallel many symptoms seen in OCD, such as excessive neatness, rigid routines, and fear of contamination. *Oral stage* - The oral stage (birth to 1 year) is associated with behaviors like **smoking, overeating, nail-biting, and dependency**, stemming from unmet oral needs. - Fixation at this stage typically leads to issues related to **dependency** and **trust**, not the control and orderliness seen in OCD. *Genital stage* - The genital stage (puberty onwards) represents mature sexual interests and healthy psychological functioning, where conflicts from earlier stages are hopefully resolved. - Fixation at this stage is not typically associated with specific neurotic disorders like OCD but rather with overall difficulty in forming mature relationships. *Oedipal stage* - The Oedipal stage refers to the **phallic stage** (ages 3-6), characterized by the **Oedipus complex** (or Electra complex for girls), where children develop sexual desires for the opposite-sex parent and rivalry with the same-sex parent. - Fixation at this stage is linked to issues of **gender identity, authority problems**, and **sexual inhibition**, not the specific symptoms of OCD.

Q: All are used in OCD except:

ECT. ***ECT*** - **Electroconvulsive therapy (ECT)** is a treatment primarily used for severe depression that has not responded to other treatments, **schizophrenia**, and **bipolar disorder with psychotic features**, not for OCD. - While it can be considered for very severe, refractory OCD in rare cases under specific guidelines, it is not a routine or primary treatment. *Behavioural therapy* - **Exposure and response prevention (ERP)**, a type of behavioral therapy, is considered the **gold standard non-pharmacological treatment** for OCD. - ERP involves gradually exposing the individual to feared situations or thoughts and preventing them from performing ritualistic compulsions. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that is well-established as an effective pharmacotherapy for OCD. - It has potent serotonin reuptake inhibition properties, making it particularly useful in treating OCD symptoms. *SSRIs* - **Selective serotonin reuptake inhibitors (SSRIs)** are considered **first-line pharmacological treatments** for OCD. - They work by increasing the levels of serotonin in the brain, helping to reduce obsessive thoughts and compulsive behaviors.

Question 1

All of the following statements are true about obsession except:

Accepted Answer

Patient believes that the images or thoughts are imposed by others

Answer

It is a repetitive thought or image

Answer

Patient gets disturbed when unable to remove the thoughts or images

Answer

Content of obsession can be about sex or god

Question 2

Body dysmorphic disorder can be associated with all except

Accepted Answer

Mania

Answer

Bulimia nervosa

Answer

OCD

Answer

Anxiety

Question 3

An irresistible urge to perform repetitive behaviors is characteristic of

Accepted Answer

Obsessive - compulsive disorder

Answer

Schizophrenia

Answer

Depression

Answer

Schizoaffective disorder

Question 4

Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?

Accepted Answer

Carbamazepine

Answer

Fluoxetine

Answer

Cognitive Behaviour Therapy

Answer

Clomipramine

Question 5

In OCD, if the patient tries to resist obsession, then patient develops?

Accepted Answer

Anxiety

Answer

Delusion

Answer

Depression

Answer

Mania

Question 6

A 20 year old female has thoughts of cutting her fingers, and imagines doing it but never actually does it. She says she is not having any guilt of having such thought. And also says the thoughts are distressing her and she is unable to control them. Which of the following is the likely cause?

Accepted Answer

Obsession

Answer

Forced thinking

Answer

Crowding of thoughts.

Answer

Thought insertion

Question 7

All of the following are OCD related disorders except:

Accepted Answer

Temper tantrums

Answer

Hoarding disorder

Answer

Hair pulling disorder

Answer

Skin picking

Question 8

Areas of brain involved in OCD include:

Accepted Answer

Basal ganglia

Answer

Temporal lobe

Answer

All of the options

Answer

Cerebellum

Question 9

In psychoanalytic terms, obsessive-compulsive disorder is fixed at -

Accepted Answer

Anal stage

Answer

Oral stage

Answer

Genital stage

Answer

Oedipal stage

Question 10

All are used in OCD except:

Accepted Answer

ECT

Answer

Behavioural therapy

Answer

Clomipramine

Answer

SSRIs

Obsessive-Compulsive and Related Disorders — MCQs

Obsessive-Compulsive and Related Disorders — MCQs

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