INI-CET 2025 — Psychiatry

Q: Which of the following is not an ICD-10 diagnostic criterion for depression?

Persistent worry about everyday matters. ***Persistent worry about everyday matters*** - This is a core feature of **Generalized Anxiety Disorder (GAD)**, not a diagnostic criterion for depression in ICD-10. - While anxiety and worry can coexist with depression, persistent excessive worry about multiple everyday events is characteristic of GAD (F41.1), not listed as a criterion for Depressive Episode (F32). - The ICD-10 criteria for depression focus on mood, interest, energy, and associated symptoms like guilt, sleep disturbance, and suicidal thoughts - not persistent worry. *Incorrect: Low energy levels* - This is one of the **three core (typical) symptoms** for Depressive Episode in ICD-10 (F32). - Described as "reduced energy or increased fatigability" and is essential for diagnosis. - Patients often report feeling tired, lacking vitality, or having diminished activity levels. *Incorrect: Low mood for most of the day* - This is the primary **core (typical) symptom** required for diagnosing a Depressive Episode in ICD-10. - Must be "depressed mood to a degree that is definitely abnormal for the individual, present for most of the day and almost every day, largely uninfluenced by circumstances." - Required for at least 2 weeks for diagnosis. *Incorrect: Loss of interest in pleasurable things* - Known as **anhedonia**, this is one of the **three core (typical) symptoms** for Depressive Episode in ICD-10. - Described as "loss of interest or pleasure in activities that are normally pleasurable." - A hallmark feature distinguishing depression from normal sadness. [Practice more Psychiatry PYQs on OnCourse]

Q: A patient with schizophrenia says, "Lord Hanuman was celibate, I am celibate too, so I am Lord Hanuman." Which thought abnormality is present in this patient?

Autistic thinking. ***Autistic thinking*** - This term, introduced by **Eugen Bleuler**, refers to **preoccupation with an internal private world** (fantasy and delusion) and ignoring external reality, leading to illogical and idiosyncratic thought processes. - The patient's statement is an example of **paralogical thinking** where two unrelated or loosely related concepts (celibacy and being Lord Hanuman) are equated based on a forced, self-referential interpretation. *Verbigeration* - This refers to the **meaningless, often rhythmic, repetition of specific words or phrases**, similar to a verbal tic. - It is a disorder of speech (not primarily content) and does not explain the illogical content or structure of the patient's statement. *Neologism* - This involves the **creation of new words** or the appropriation of existing words to mean something entirely new, which is incomprehensible to others. - The patient's statement uses existing words and is structurally a complete (though illogical) sentence, not a newly coined word. *Loosening of association* - This refers to a **disturbance in the logical progression of thought** where there is a lack of connection between successive ideas, often leading to derailment or tangentiality. - While the statement is illogical, the central idea (faulty identification) is maintained; the primary pathology lies in the content and structure of the thought (faulty logic = **autistic thinking**), not the sequence of ideas. [Practice more Psychiatry PYQs on OnCourse]

Q: Which of the following drugs are used in the management of acute mania?

1, 2 & 3 (Lithium, Valproate & Haloperidol). ***Correct: 1, 2 & 3 (Lithium, Valproate & Haloperidol)*** **Drugs used in acute mania management:** **Lithium** - First-line mood stabilizer with proven efficacy in acute mania. It reduces manic symptoms and prevents recurrence. Therapeutic level: 0.8-1.2 mEq/L for acute phase. **Valproate (Sodium valproate/Divalproex)** - First-line mood stabilizer, particularly effective for mixed episodes and rapid cycling. Often preferred when rapid control is needed due to faster onset than lithium. **Haloperidol** - Typical antipsychotic effective for acute manic episodes, especially when rapid tranquilization is required for agitation and psychotic symptoms. Second-generation antipsychotics (olanzapine, risperidone, quetiapine) are also commonly used. *Incorrect: Amitriptyline* Amitriptyline is a **tricyclic antidepressant (TCA)** that is **contraindicated in acute mania**. Antidepressants can precipitate or worsen manic episodes, induce rapid cycling, and destabilize mood in bipolar disorder. They should only be used (if at all) in the depressive phase of bipolar disorder, and always with a mood stabilizer. **Clinical Pearl:** The acute management of mania typically involves mood stabilizers (lithium, valproate, carbamazepine) and/or antipsychotics. Antidepressants are avoided as they can trigger manic switching. [Practice more Psychiatry PYQs on OnCourse]

Q: Which among the following psychoactive substances has antidepressant properties?

Ketamine. ***Correct: Ketamine*** - Ketamine, traditionally an anesthetic, exhibits rapid and potent **antidepressant properties**, particularly effective in treatment-resistant depression (TRD). - It primarily acts as an **NMDA receptor antagonist**, increasing **glutamate** release, which subsequently causes a surge in neurotrophic factors (like BDNF) crucial for synaptic plasticity. - Esketamine (S-ketamine) nasal spray is FDA-approved for treatment-resistant depression. *Incorrect: Bupropion* - Bupropion is an antidepressant that acts as a **norepinephrine-dopamine reuptake inhibitor (NDRI)**, but it is **not classified as a psychoactive substance of abuse** in the same context as the other options. - It is a prescription medication clinically used for depression and **smoking cessation**, often preferred due to minimal sexual side effects. - While it has antidepressant properties, it is not a "psychoactive substance" in the classical sense used in this question. *Incorrect: Cannabidiol* - Cannabidiol (CBD) is a non-psychoactive component of cannabis used for various conditions, showing promise for **anxiety** and certain seizure disorders (FDA-approved Epidiolex for specific epilepsies). - While some studies hint at potential antidepressant effects, evidence is limited and inconsistent. - It is primarily researched for its anxiolytic and anticonvulsant properties, not as a primary or fast-acting antidepressant like ketamine. *Incorrect: Mephedrone* - Mephedrone is a synthetic substituted cathinone, often illegally used as a recreational drug with potent **stimulant** and **euphoric** effects. - It primarily acts as a **dopamine** and **serotonin** releasing agent, posing high risks of addiction, neurotoxicity, and cardiovascular complications. - It has no recognized clinical antidepressant use and carries significant abuse potential. [Practice more Psychiatry PYQs on OnCourse]

5 Previous Year Questions with Answers & Explanations

Questions

Which of the following is not an ICD-10 diagnostic criterion for depression?

All of the following statements are correct except:

A patient with schizophrenia says, "Lord Hanuman was celibate, I am celibate too, so I am Lord Hanuman." Which thought abnormality is present in this patient?

Which of the following drugs are used in the management of acute mania?

Which among the following psychoactive substances has antidepressant properties?

INI-CET 2025 - Psychiatry INI-CET Practice Questions and MCQs

Question 1: Which of the following is not an ICD-10 diagnostic criterion for depression?

A. Low energy levels
B. Low mood for most of the day
C. Loss of interest in pleasurable things
D. Persistent worry about everyday matters (Correct Answer)

Explanation: ***Persistent worry about everyday matters*** - This is a core feature of **Generalized Anxiety Disorder (GAD)**, not a diagnostic criterion for depression in ICD-10. - While anxiety and worry can coexist with depression, persistent excessive worry about multiple everyday events is characteristic of GAD (F41.1), not listed as a criterion for Depressive Episode (F32). - The ICD-10 criteria for depression focus on mood, interest, energy, and associated symptoms like guilt, sleep disturbance, and suicidal thoughts - not persistent worry. *Incorrect: Low energy levels* - This is one of the **three core (typical) symptoms** for Depressive Episode in ICD-10 (F32). - Described as "reduced energy or increased fatigability" and is essential for diagnosis. - Patients often report feeling tired, lacking vitality, or having diminished activity levels. *Incorrect: Low mood for most of the day* - This is the primary **core (typical) symptom** required for diagnosing a Depressive Episode in ICD-10. - Must be "depressed mood to a degree that is definitely abnormal for the individual, present for most of the day and almost every day, largely uninfluenced by circumstances." - Required for at least 2 weeks for diagnosis. *Incorrect: Loss of interest in pleasurable things* - Known as **anhedonia**, this is one of the **three core (typical) symptoms** for Depressive Episode in ICD-10. - Described as "loss of interest or pleasure in activities that are normally pleasurable." - A hallmark feature distinguishing depression from normal sadness.

Question 2: All of the following statements are correct except:

A. Opioid withdrawal is rarely fatal
B. Buprenorphine can be used for the management of opioid withdrawal
C. Flumazenil is used for the management of long-term alcohol dependence syndrome (Correct Answer)
D. Cannabis withdrawal is associated with minimal physical symptoms

Explanation: ***Flumazenil is used for the management of long-term alcohol dependence syndrome*** - This statement is incorrect because **Flumazenil** is a **GABA-A receptor antagonist** specifically used to reverse the effects of **benzodiazepine overdose** (acute intoxication or sedation), not for the management of chronic alcohol dependence syndrome. - Management of long-term alcohol dependence typically involves medications like **naltrexone, acamprosate, or disulfiram**, along with psychosocial therapies. ***Opioid withdrawal is rarely fatal*** - This statement is correct. While opioid withdrawal is highly distressing and uncomfortable (**flu-like symptoms, diarrhea, vomiting**), it is **not life-threatening** except in very rare cases due to severe dehydration or aspiration. - The primary concern in opioid dependence is the risk of **fatal overdose** upon relapse, especially after a period of abstinence. ***Buprenorphine can be used for the management of opioid withdrawal*** - This statement is correct. **Buprenorphine**, a **partial opioid agonist**, is a standard treatment for both acute opioid withdrawal and long-term maintenance treatment (Opioid Substitution Therapy). - It helps alleviate withdrawal symptoms and cravings while posing a lower risk of respiratory depression compared to full agonists like methadone. ***Cannabis withdrawal is associated with minimal physical symptoms*** - This statement is correct. Cannabis withdrawal primarily manifests as **psychological symptoms** such as irritability, anxiety, insomnia, and depressed mood. - Physical symptoms are generally mild, limited to temporary decreases in appetite, stomach pain, or tremors, and are **not medically significant** compared to alcohol or opioid withdrawal.

Question 3: A patient with schizophrenia says, "Lord Hanuman was celibate, I am celibate too, so I am Lord Hanuman." Which thought abnormality is present in this patient?

A. Autistic thinking (Correct Answer)
B. Verbigeration
C. Neologism
D. Loosening of association

Explanation: ***Autistic thinking*** - This term, introduced by **Eugen Bleuler**, refers to **preoccupation with an internal private world** (fantasy and delusion) and ignoring external reality, leading to illogical and idiosyncratic thought processes. - The patient's statement is an example of **paralogical thinking** where two unrelated or loosely related concepts (celibacy and being Lord Hanuman) are equated based on a forced, self-referential interpretation. *Verbigeration* - This refers to the **meaningless, often rhythmic, repetition of specific words or phrases**, similar to a verbal tic. - It is a disorder of speech (not primarily content) and does not explain the illogical content or structure of the patient's statement. *Neologism* - This involves the **creation of new words** or the appropriation of existing words to mean something entirely new, which is incomprehensible to others. - The patient's statement uses existing words and is structurally a complete (though illogical) sentence, not a newly coined word. *Loosening of association* - This refers to a **disturbance in the logical progression of thought** where there is a lack of connection between successive ideas, often leading to derailment or tangentiality. - While the statement is illogical, the central idea (faulty identification) is maintained; the primary pathology lies in the content and structure of the thought (faulty logic = **autistic thinking**), not the sequence of ideas.

Question 4: Which of the following drugs are used in the management of acute mania?

A. Only 1 (Lithium)
B. 1, 2 & 3 (Lithium, Valproate & Haloperidol) (Correct Answer)
C. 1, 2 & 4 (Lithium, Valproate & Amitriptyline)
D. 2 & 4 (Valproate & Amitriptyline)

Explanation: ***Correct: 1, 2 & 3 (Lithium, Valproate & Haloperidol)*** **Drugs used in acute mania management:** **Lithium** - First-line mood stabilizer with proven efficacy in acute mania. It reduces manic symptoms and prevents recurrence. Therapeutic level: 0.8-1.2 mEq/L for acute phase. **Valproate (Sodium valproate/Divalproex)** - First-line mood stabilizer, particularly effective for mixed episodes and rapid cycling. Often preferred when rapid control is needed due to faster onset than lithium. **Haloperidol** - Typical antipsychotic effective for acute manic episodes, especially when rapid tranquilization is required for agitation and psychotic symptoms. Second-generation antipsychotics (olanzapine, risperidone, quetiapine) are also commonly used. *Incorrect: Amitriptyline* Amitriptyline is a **tricyclic antidepressant (TCA)** that is **contraindicated in acute mania**. Antidepressants can precipitate or worsen manic episodes, induce rapid cycling, and destabilize mood in bipolar disorder. They should only be used (if at all) in the depressive phase of bipolar disorder, and always with a mood stabilizer. **Clinical Pearl:** The acute management of mania typically involves mood stabilizers (lithium, valproate, carbamazepine) and/or antipsychotics. Antidepressants are avoided as they can trigger manic switching.

Question 5: Which among the following psychoactive substances has antidepressant properties?

A. Cannabidiol
B. Mephedrone
C. Bupropion
D. Ketamine (Correct Answer)

Explanation: ***Correct: Ketamine*** - Ketamine, traditionally an anesthetic, exhibits rapid and potent **antidepressant properties**, particularly effective in treatment-resistant depression (TRD). - It primarily acts as an **NMDA receptor antagonist**, increasing **glutamate** release, which subsequently causes a surge in neurotrophic factors (like BDNF) crucial for synaptic plasticity. - Esketamine (S-ketamine) nasal spray is FDA-approved for treatment-resistant depression. *Incorrect: Bupropion* - Bupropion is an antidepressant that acts as a **norepinephrine-dopamine reuptake inhibitor (NDRI)**, but it is **not classified as a psychoactive substance of abuse** in the same context as the other options. - It is a prescription medication clinically used for depression and **smoking cessation**, often preferred due to minimal sexual side effects. - While it has antidepressant properties, it is not a "psychoactive substance" in the classical sense used in this question. *Incorrect: Cannabidiol* - Cannabidiol (CBD) is a non-psychoactive component of cannabis used for various conditions, showing promise for **anxiety** and certain seizure disorders (FDA-approved Epidiolex for specific epilepsies). - While some studies hint at potential antidepressant effects, evidence is limited and inconsistent. - It is primarily researched for its anxiolytic and anticonvulsant properties, not as a primary or fast-acting antidepressant like ketamine. *Incorrect: Mephedrone* - Mephedrone is a synthetic substituted cathinone, often illegally used as a recreational drug with potent **stimulant** and **euphoric** effects. - It primarily acts as a **dopamine** and **serotonin** releasing agent, posing high risks of addiction, neurotoxicity, and cardiovascular complications. - It has no recognized clinical antidepressant use and carries significant abuse potential.