Repeated superficial wrist cuts after quarrels, intense fear of abandonment, stormy relationships that swing from idealising to hating partners, chronic emptiness and impulsive spending have marked a college student's last five years. She has no sustained mood episode. Which psychological treatment has the best evidence for her condition?

Exposure and response prevention

Psychoanalytic free association

Two people seek help at a medical college. The first, assigned male at birth, has since childhood felt that she is a woman, is distressed by her beard and genitals, and wants hormones and surgery. The second, a married man who identifies as male, becomes sexually aroused by wearing women's clothes and feels guilty about it. Which pairing of diagnoses is correct?

First: gender dysphoria; second: transvestic disorder

First: body dysmorphic disorder; second: fetishistic disorder

First: transvestic disorder; second: gender dysphoria

A village astrologer is brought to the OPD by his brother, who says he has always been odd. He dresses in mismatched layers, believes he can sense people's thoughts through the wind, speaks in vague, roundabout phrases and has no close friends outside the family. He has never had hallucinations or sustained delusions, and works steadily. Which diagnosis fits him best?

Schizotypal personality disorder

Personality, eating, sleep and sexual disorders

33 NEET-PG practice questions on Personality, eating, sleep and sexual disorders, part of Psychiatry. The first 25 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
Escitalopram has kept a teacher's depression in remission for 8 months, but she reports loss of interest in sex and delayed orgasm that are straining her marriage. She does not want to stop treatment. Which change is most likely to relieve this while keeping her mood stable?
1. ASwitch to venlafaxine
2. BSwitch to paroxetine
3. CAdd clomipramine
4. DSwitch to bupropion
Show answerHide answer
Answer: D · Switch to bupropion
SSRIs commonly cause reduced desire, delayed orgasm and anorgasmia. Bupropion (a noradrenaline-dopamine reuptake inhibitor) and mirtazapine have little sexual side effect, so switching to or adding bupropion is a standard strategy. Paroxetine, clomipramine and venlafaxine all have strong serotonergic effects and cause at least as much sexual dysfunction. Key point: Bupropion or mirtazapine are preferred when SSRI-induced sexual dysfunction troubles the patient.
- A: Venlafaxine causes sexual dysfunction similar to SSRIs.
- B: Paroxetine has among the highest rates of sexual dysfunction.
- C: Clomipramine is strongly serotonergic and worsens orgasmic delay.
Question 2 · Medium
Under the Transgender Persons (Protection of Rights) Act 2019: 1. A transgender person may apply for a certificate of identity to the District Magistrate. 2. A medical or psychiatric examination is required for the first certificate. 3. Discrimination in education, employment and healthcare is prohibited. 4. A revised certificate showing male or female needs proof of surgery. Which statements are correct?
1. A2, 3 and 4 only
2. B1 and 3 only
3. C1, 2 and 3 only
4. D1, 3 and 4 only
Show answerHide answer
Answer: D · 1, 3 and 4 only
The Act lets a transgender person apply to the District Magistrate for a certificate of identity as transgender without any medical or psychological examination, so statement 2 is wrong. It prohibits discrimination in education, employment, healthcare and other services. A person who later undergoes surgery to change sex may apply for a revised certificate as male or female, with a certificate from the treating hospital's medical superintendent or chief medical officer. Key point: The 2019 Act gives a District Magistrate certificate of identity without any medical examination.
- A: Statement 2 is wrong and correct statement 1 is omitted.
- B: Statement 4 is also correct: surgery proof is needed for a revised male or female certificate.
- C: Statement 2 is wrong: no medical or psychiatric examination is needed.
Question 3 · Medium
Repeated superficial wrist cuts after quarrels, intense fear of abandonment, stormy relationships that swing from idealising to hating partners, chronic emptiness and impulsive spending have marked a college student's last five years. She has no sustained mood episode. Which psychological treatment has the best evidence for her condition?
1. AExposure and response prevention
2. BSystematic desensitisation
3. CDialectical behaviour therapy
4. DPsychoanalytic free association
Show answerHide answer
Answer: C · Dialectical behaviour therapy
Unstable relationships, abandonment fears, self-harm, impulsivity and emptiness are borderline personality disorder. Dialectical behaviour therapy (Linehan) combines CBT with mindfulness and teaches emotion regulation, distress tolerance and interpersonal skills; it reduces self-harm and suicide attempts. Mentalisation-based therapy also has good evidence. Medicines treat only target symptoms. Key point: Dialectical behaviour therapy is the best-evidenced treatment for borderline personality disorder.
- A: Exposure and response prevention treats OCD.
- B: Systematic desensitisation treats phobias.
- D: Classical free association is not an evidence-based treatment for borderline personality disorder.
Question 4 · Hard
Two people seek help at a medical college. The first, assigned male at birth, has since childhood felt that she is a woman, is distressed by her beard and genitals, and wants hormones and surgery. The second, a married man who identifies as male, becomes sexually aroused by wearing women's clothes and feels guilty about it. Which pairing of diagnoses is correct?
1. AFirst: gender dysphoria; second: transvestic disorder
2. BFirst: body dysmorphic disorder; second: fetishistic disorder
3. CFirst: transvestic disorder; second: gender dysphoria
4. DBoth: gender dysphoria
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Answer: A · First: gender dysphoria; second: transvestic disorder
Gender dysphoria is distress from a marked, persistent mismatch between experienced gender and the sex assigned at birth, with a wish to live as and be treated as the other gender; ICD-11 calls it gender incongruence and moves it out of the mental disorders chapter. Transvestic disorder is a paraphilia: sexual arousal from cross-dressing in a person whose gender identity matches his sex, causing distress. Cross-dressing alone does not mean gender dysphoria. Key point: Gender dysphoria concerns identity; transvestic disorder is sexual arousal from cross-dressing with an intact identity.
- B: Body dysmorphic disorder concerns perceived flaws, not gender identity; fetishism involves objects.
- C: The pairing is reversed.
- D: The second person identifies as male, so this is not gender dysphoria.
Question 5 · Medium
A village astrologer is brought to the OPD by his brother, who says he has always been odd. He dresses in mismatched layers, believes he can sense people's thoughts through the wind, speaks in vague, roundabout phrases and has no close friends outside the family. He has never had hallucinations or sustained delusions, and works steadily. Which diagnosis fits him best?
1. ASchizotypal personality disorder
2. BParanoid schizophrenia
3. CSchizoid personality disorder
4. DAvoidant personality disorder
Show answerHide answer
Answer: A · Schizotypal personality disorder
Lifelong eccentric behaviour and appearance, magical thinking, odd speech and few close relationships, without frank psychosis, is schizotypal personality disorder, a cluster A disorder genetically linked with schizophrenia. ICD-11 places schizotypal disorder with the schizophrenia spectrum rather than with personality disorders. Schizoid people are detached but not eccentric in thinking. Key point: Schizotypal disorder means eccentricity and magical thinking without sustained psychosis.
- B: Schizophrenia needs persistent delusions, hallucinations or disorganisation.
- C: Schizoid people are aloof and emotionally cold but lack magical thinking and odd speech.
- D: Avoidant people want relationships but fear rejection; they are not eccentric.
Question 6 · Medium
Ejaculation within about a minute of penetration on almost every occasion for over a year distresses a newly married software tester and his wife. He has normal erections and no medical illness. Besides behavioural methods such as the squeeze technique, which drug class is used?
1. ASelective serotonin reuptake inhibitors
2. BAlpha-1 agonists
3. CPhosphodiesterase-5 inhibitors alone
4. DDopamine agonists
Answer and explanation in LearnFree account
Question 7 · Medium
Cognitive behavioural therapy has been started for a nursing student with bulimia nervosa who binges and vomits about five times a week. She also wants medicine. Which drug and dose has the best evidence in bulimia?
1. AFluoxetine 60 mg/day
2. BFluoxetine 10 mg/day
3. CLithium 900 mg/day
4. DOlanzapine 5 mg/day
Answer and explanation in LearnFree account
Question 8 · Medium
On DSM-5 personality clusters: 1. Paranoid personality disorder is in cluster A. 2. Histrionic personality disorder is in cluster B. 3. Avoidant personality disorder is in cluster C. 4. Schizoid personality disorder is in cluster B. Which pairings are correct?
1. A1, 3 and 4 only
2. B1, 2 and 3 only
3. C1 and 2 only
4. D2, 3 and 4 only
Answer and explanation in LearnFree account
Question 9 · Medium
Ward nurses complain that a patient with borderline personality disorder calls one nurse 'the only person who understands me' and another 'cruel and useless', and the two nurses have started arguing over her care. Which defence mechanism is she mainly using?
1. AProjection
2. BDenial
3. CReaction formation
4. DSplitting
Answer and explanation in LearnFree account
Question 10 · Easy
Sudden loss of muscle tone in the knees and jaw whenever he laughs at a joke, while staying fully conscious, has been happening for a year in a college student who also falls asleep in every lecture despite 8 hours of sleep at night. What is the most likely diagnosis?
1. AAtonic epilepsy
2. BIdiopathic hypersomnia
3. CNarcolepsy type 1
4. DObstructive sleep apnoea
Answer and explanation in LearnFree account
Question 11 · Medium
About 90 minutes after falling asleep, a 5-year-old boy sits up screaming, sweating and with a racing heart, cannot be comforted, and next morning remembers nothing. In which sleep stage do these episodes arise?
1. AStage N1 sleep
2. BREM sleep
3. CWakefulness at sleep onset
4. DDeep NREM sleep (stage N3)
Answer and explanation in LearnFree account
Question 12 · Medium
Pitolisant, a newer drug for daytime sleepiness in narcolepsy, works by which mechanism?
1. ADopamine reuptake inhibition
2. BH3 receptor inverse agonism
3. COrexin receptor antagonism
4. DGABA-B receptor agonism
Answer and explanation in LearnFree account
Question 13 · Medium
About the DSM-5 criteria for anorexia nervosa: 1. Amenorrhoea is no longer a required criterion. 2. Severity is graded by BMI. 3. A BMI under 15 kg/m2 is classed as extreme. 4. Binge-eating or purging in the last 3 months defines the binge-purge type. Which statements are correct?
1. A1, 2, 3 and 4
2. B2, 3 and 4 only
3. C1, 2 and 4 only
4. D1 and 4 only
Answer and explanation in LearnFree account
Question 14 · Easy
Who developed sensate focus therapy for sexual dysfunction?
1. AAlfred Kinsey
2. BMasters and Johnson
3. CSigmund Freud
4. DHelen Singer Kaplan
Answer and explanation in LearnFree account
Question 15 · Hard
A man with stable angina, on isosorbide mononitrate 30 mg daily and aspirin, asks at the cardiology clinic for treatment of erectile dysfunction. His exercise tolerance is good. His friend has given him sildenafil tablets. What is the most appropriate advice?
1. ATake sildenafil 50 mg, but skip the nitrate that morning
2. BTake tadalafil, as it is safe with nitrates
3. CDo not take sildenafil while on any nitrate; discuss alternatives such as alprostadil
4. DTake sildenafil 25 mg, as low doses are safe with nitrates
Answer and explanation in LearnFree account
Question 16 · Easy
BMI is 14.8 kg/m2 in a class 11 student from Kochi who has lost 12 kg over 8 months by eating only salad and running daily. She fears gaining weight, believes her thighs are fat and checks her body in the mirror many times a day. She does not binge or vomit. What is the most likely diagnosis?
1. AAnorexia nervosa, restricting type
2. BMajor depressive disorder
3. CBulimia nervosa
4. DAvoidant/restrictive food intake disorder
Answer and explanation in LearnFree account
Question 17 · Hard
A DEXA scan shows a lumbar spine Z-score of -2.6 in a 22-year-old woman with anorexia nervosa of 5 years; BMI is 15.4 kg/m2 and she has had no periods for 2 years. She has had a stress fracture of the metatarsal. Her gynaecologist plans combined oral contraceptive pills to protect her bones. What is the most effective way to improve her bone density?
1. AOral alendronate
2. BWeight restoration with return of menses
3. CCombined oral contraceptive pills
4. DHigh-dose calcium and vitamin D alone
Answer and explanation in LearnFree account
Question 18 · Medium
A woman with bulimia nervosa who binges and vomits several times a week also has low mood and wants to stop smoking. Her GP suggests a single tablet to help both depression and smoking. Which antidepressant is contraindicated in her?
1. ABupropion
2. BFluoxetine
3. CEscitalopram
4. DSertraline
Answer and explanation in LearnFree account
Question 19 · Hard
His wife reports that for two years a retired railway guard has punched and kicked in his sleep, usually in the early hours of the morning, shouting as if fighting robbers, and once fell out of bed and cut his forehead; when woken he is alert at once and describes a matching dream. He takes no antidepressant and drinks rarely. Polysomnography shows loss of normal muscle atonia during REM sleep. Neurological examination today is normal apart from reduced sense of smell. What is he at most risk of developing over the next decade?
1. ALate-onset Alzheimer disease
2. BNarcolepsy with cataplexy
3. CObstructive sleep apnoea
4. DParkinson disease or Lewy body dementia
Answer and explanation in LearnFree account
Question 20 · Medium
Binge eating twice a week for a year, with loss of control and eating until uncomfortably full, troubles an obese bank clerk with BMI 33 kg/m2. She feels disgusted afterwards but never vomits, fasts or uses laxatives. Which drug is approved for this disorder?
1. ABupropion
2. BLisdexamfetamine
3. CTopiramate
4. DOrlistat
Answer and explanation in LearnFree account
Question 21 · Easy
For chronic insomnia in an otherwise healthy adult, what is the first-line treatment?
1. AAlprazolam at bedtime
2. BLow-dose amitriptyline at night
3. CZolpidem every night
4. DCBT for insomnia
Answer and explanation in LearnFree account
Question 22 · Medium
Under DSM-5, antisocial personality disorder can be diagnosed only when the person is at least 18 years old and there is evidence of which earlier condition?
1. AOppositional defiant disorder before 8 years
2. BConduct disorder with onset before 15 years
3. CADHD with onset before 12 years
4. DJuvenile court conviction before 16 years
Answer and explanation in LearnFree account
Question 23 · Easy
In the OPD, a 26-year-old woman arrives in striking clothes, calls the doctor 'darling', describes her headache in vivid but vague terms, cries and laughs within minutes, and is upset when attention turns to another patient. Her relationships are many but shallow. Which personality disorder is most likely?
1. AHistrionic personality disorder
2. BNarcissistic personality disorder
3. CBorderline personality disorder
4. DDependent personality disorder
Answer and explanation in LearnFree account
Question 24 · Hard
Sleep study results for a bus conductor who has dozed off on duty several times in the last year, and was referred from the depot clinic for daytime sleepiness despite 7-8 hours in bed nightly: overnight polysomnography shows total sleep 7 h, apnoea-hypopnoea index 3/h and no limb movements. The multiple sleep latency test next day shows a mean sleep latency of 4 minutes, with REM sleep in 3 of 5 naps. He denies any episodes of weakness with emotion. CSF hypocretin has not been tested. What is the most likely diagnosis?
1. AIdiopathic hypersomnia
2. BObstructive sleep apnoea
3. CNarcolepsy type 2
4. DNarcolepsy type 1
Answer and explanation in LearnFree account
Question 25 · Medium
An accounts officer's wife complains that he has made home life rigid: he insists on cleaning schedules, rewrites lists until they are perfect, cannot delegate, will not throw anything away and misses deadlines because every report must be flawless. He sees nothing wrong with his ways and has no intrusive thoughts he tries to resist. What is the most likely diagnosis?
1. AAutism spectrum disorder
2. BObsessive-compulsive personality disorder
3. CGeneralised anxiety disorder
4. DObsessive-compulsive disorder
Answer and explanation in LearnFree account

8 more Personality, eating, sleep and sexual disorders questions

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Study Psychiatry

Personality, eating, sleep and sexual disorders

Escitalopram has kept a teacher's depression in remission for 8 months, but she reports loss of interest in sex and delayed orgasm that are straining her marriage. She does not want to stop treatment. Which change is most likely to relieve this while keeping her mood stable?

Ejaculation within about a minute of penetration on almost every occasion for over a year distresses a newly married software tester and his wife. He has normal erections and no medical illness. Besides behavioural methods such as the squeeze technique, which drug class is used?

Cognitive behavioural therapy has been started for a nursing student with bulimia nervosa who binges and vomits about five times a week. She also wants medicine. Which drug and dose has the best evidence in bulimia?

On DSM-5 personality clusters: 1. Paranoid personality disorder is in cluster A. 2. Histrionic personality disorder is in cluster B. 3. Avoidant personality disorder is in cluster C. 4. Schizoid personality disorder is in cluster B. Which pairings are correct?

Ward nurses complain that a patient with borderline personality disorder calls one nurse 'the only person who understands me' and another 'cruel and useless', and the two nurses have started arguing over her care. Which defence mechanism is she mainly using?

Sudden loss of muscle tone in the knees and jaw whenever he laughs at a joke, while staying fully conscious, has been happening for a year in a college student who also falls asleep in every lecture despite 8 hours of sleep at night. What is the most likely diagnosis?

About 90 minutes after falling asleep, a 5-year-old boy sits up screaming, sweating and with a racing heart, cannot be comforted, and next morning remembers nothing. In which sleep stage do these episodes arise?

Pitolisant, a newer drug for daytime sleepiness in narcolepsy, works by which mechanism?

About the DSM-5 criteria for anorexia nervosa: 1. Amenorrhoea is no longer a required criterion. 2. Severity is graded by BMI. 3. A BMI under 15 kg/m2 is classed as extreme. 4. Binge-eating or purging in the last 3 months defines the binge-purge type. Which statements are correct?

Who developed sensate focus therapy for sexual dysfunction?

A man with stable angina, on isosorbide mononitrate 30 mg daily and aspirin, asks at the cardiology clinic for treatment of erectile dysfunction. His exercise tolerance is good. His friend has given him sildenafil tablets. What is the most appropriate advice?

BMI is 14.8 kg/m2 in a class 11 student from Kochi who has lost 12 kg over 8 months by eating only salad and running daily. She fears gaining weight, believes her thighs are fat and checks her body in the mirror many times a day. She does not binge or vomit. What is the most likely diagnosis?

A woman with bulimia nervosa who binges and vomits several times a week also has low mood and wants to stop smoking. Her GP suggests a single tablet to help both depression and smoking. Which antidepressant is contraindicated in her?

Binge eating twice a week for a year, with loss of control and eating until uncomfortably full, troubles an obese bank clerk with BMI 33 kg/m2. She feels disgusted afterwards but never vomits, fasts or uses laxatives. Which drug is approved for this disorder?

For chronic insomnia in an otherwise healthy adult, what is the first-line treatment?

Under DSM-5, antisocial personality disorder can be diagnosed only when the person is at least 18 years old and there is evidence of which earlier condition?