NEET-PG 2020 — Psychiatry

Q: A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

Discontinue Imipramine and start Valproate. ***Discontinue Imipramine and start Valproate*** - The patient's symptoms (increased excitement, colorful clothes, increased talking) after starting an antidepressant like **Imipramine** suggest a **manic switch**, indicating undiagnosed **bipolar disorder**. - **Imipramine** should be discontinued as it can exacerbate mania, and a mood stabilizer like **Valproate** is necessary to treat the manic episode. *Continue Imipramine alone* - Continuing Imipramine would likely worsen the manic symptoms, leading to increased agitation and potential harm. - Antidepressants can trigger or worsen manic episodes in individuals with underlying bipolar disorder. *Manage with Valproate alone* - While Valproate is an appropriate treatment for acute mania, simply managing with Valproate alone without discontinuing the offending antidepressant would be suboptimal. - The continued presence of Imipramine would counteract the mood-stabilizing effects of Valproate. *Antipsychotic with Imipramine continued* - Adding an antipsychotic might manage some acute manic symptoms, but continuing Imipramine would maintain the driving force behind the manic switch. - The primary action should be to remove the causative agent (Imipramine) and replace it with a mood stabilizer. [Practice more Psychiatry PYQs on OnCourse]

Q: What is the most common illicit drug that causes dependence?

Cannabis. ***Cannabis*** - **Cannabis** is the most widely used illicit drug globally, and despite common misconceptions, it can certainly lead to **cannabis use disorder** characterized by dependence. - The high prevalence of its use contributes to it being the illicit drug that most commonly causes clinical dependence, as a larger user base means more individuals will develop problematic use patterns. *Cocaine* - While cocaine is known for its **highly addictive potential** and rapid development of dependence, its overall prevalence of use is lower than cannabis. - The intense psychological dependence associated with cocaine can lead to severe withdrawal symptoms and compulsive drug-seeking behavior. *Heroin* - **Heroin**, an opioid, is highly addictive, causing both **physical and psychological dependence** very quickly due to its potent effects on the brain's reward system. - However, its illicit use is less widespread compared to cannabis, making it responsible for fewer overall cases of dependence. *Amphetamine* - **Amphetamines** also have a high potential for **psychological dependence**, leading to compulsive use and significant withdrawal symptoms upon cessation. - Like cocaine and heroin, the overall number of people who use amphetamines illicitly is significantly lower than those who use cannabis. [Practice more Psychiatry PYQs on OnCourse]

Q: On voluntary admission, the maximum number of days a person can be admitted as per mental health care act is:

30 days. ***30 days*** - As per the **Mental Healthcare Act, 2017**, under **Section 89 (Independent Admission)**, a person can be admitted independently for a **maximum period of 30 days**. - After 30 days, the person must either be discharged or the admission must be converted to voluntary or involuntary admission with appropriate procedures. - This provision allows for independent treatment-seeking without requiring a caregiver's involvement initially. *48 hours* - **48 hours** is not related to voluntary or independent admission duration. - This timeframe relates to the period within which a voluntary patient must be discharged after they request to leave (unless there are grounds for involuntary admission). *60 days* - **60 days** is not specified in the Mental Healthcare Act, 2017 for any category of admission. - This is neither the duration for voluntary, independent, nor involuntary admission procedures. *90 days* - **90 days** is not the correct maximum period for voluntary or independent admission. - While voluntary admission can continue indefinitely with ongoing consent, **independent admission** specifically has a **30-day limit** as per Section 89 of the Act. [Practice more Psychiatry PYQs on OnCourse]

Q: Magnan's symptom is seen in:

Cocaine. ***Cocaine*** - **Magnan's symptom**, also known as **formication**, is a tactile hallucination where an individual perceives insects crawling under their skin, commonly associated with chronic cocaine use. - This symptom is a manifestation of **cocaine-induced psychosis** or severe intoxication, leading to paranoid delusions and abnormal sensory experiences. *Datura* - **Datura** intoxication primarily causes anticholinergic effects, such as **dry mouth**, **dilated pupils**, confusion, and visual hallucinations, but not typically Magnan's symptom. - The hallucinations associated with Datura are often described as vivid and florid, but distinct from the tactile formication seen with cocaine. *Cannabis* - **Cannabis** use can induce altered perceptions, euphoria, anxiety, and sometimes paranoia, but it is not typically associated with tactile hallucinations like Magnan's symptom. - While high doses can lead to psychotic-like symptoms, **formication** is not a characteristic feature of cannabis intoxication. *Opium* - **Opium** and other opioids primarily cause central nervous system depression, leading to euphoria, sedation, pinpoint pupils, and respiratory depression. - Opioid use is not linked to tactile hallucinations such as **formication** or Magnan's symptom. [Practice more Psychiatry PYQs on OnCourse]

Q: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

Major depressive disorder plus psychosis. ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here. [Practice more Psychiatry PYQs on OnCourse]

9 Previous Year Questions with Answers & Explanations

Questions

A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

What is the most common illicit drug that causes dependence?

On voluntary admission, the maximum number of days a person can be admitted as per mental health care act is:

Magnan's symptom is seen in:

A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

Which of the following dependence-causing drugs is most commonly abused worldwide?

The most widely used substance causing dependence worldwide is:

Which of the following is a technique based on behavior sciences methods?

NEET-PG 2020 - Psychiatry NEET-PG Practice Questions and MCQs

Question 1: A patient with depression was given Imipramine for 2 weeks. Relatives noticed increased excitement, colorful clothes, and increased talking. What is the next step in management?

A. Continue Imipramine alone
B. Manage with Valproate alone
C. Discontinue Imipramine and start Valproate (Correct Answer)
D. Antipsychotic with Imipramine continued

Explanation: ***Discontinue Imipramine and start Valproate*** - The patient's symptoms (increased excitement, colorful clothes, increased talking) after starting an antidepressant like **Imipramine** suggest a **manic switch**, indicating undiagnosed **bipolar disorder**. - **Imipramine** should be discontinued as it can exacerbate mania, and a mood stabilizer like **Valproate** is necessary to treat the manic episode. *Continue Imipramine alone* - Continuing Imipramine would likely worsen the manic symptoms, leading to increased agitation and potential harm. - Antidepressants can trigger or worsen manic episodes in individuals with underlying bipolar disorder. *Manage with Valproate alone* - While Valproate is an appropriate treatment for acute mania, simply managing with Valproate alone without discontinuing the offending antidepressant would be suboptimal. - The continued presence of Imipramine would counteract the mood-stabilizing effects of Valproate. *Antipsychotic with Imipramine continued* - Adding an antipsychotic might manage some acute manic symptoms, but continuing Imipramine would maintain the driving force behind the manic switch. - The primary action should be to remove the causative agent (Imipramine) and replace it with a mood stabilizer.

Question 2: What is the most common illicit drug that causes dependence?

A. Cannabis (Correct Answer)
B. Cocaine
C. Heroin
D. Amphetamine

Explanation: ***Cannabis*** - **Cannabis** is the most widely used illicit drug globally, and despite common misconceptions, it can certainly lead to **cannabis use disorder** characterized by dependence. - The high prevalence of its use contributes to it being the illicit drug that most commonly causes clinical dependence, as a larger user base means more individuals will develop problematic use patterns. *Cocaine* - While cocaine is known for its **highly addictive potential** and rapid development of dependence, its overall prevalence of use is lower than cannabis. - The intense psychological dependence associated with cocaine can lead to severe withdrawal symptoms and compulsive drug-seeking behavior. *Heroin* - **Heroin**, an opioid, is highly addictive, causing both **physical and psychological dependence** very quickly due to its potent effects on the brain's reward system. - However, its illicit use is less widespread compared to cannabis, making it responsible for fewer overall cases of dependence. *Amphetamine* - **Amphetamines** also have a high potential for **psychological dependence**, leading to compulsive use and significant withdrawal symptoms upon cessation. - Like cocaine and heroin, the overall number of people who use amphetamines illicitly is significantly lower than those who use cannabis.

Question 3: On voluntary admission, the maximum number of days a person can be admitted as per mental health care act is:

A. 30 days (Correct Answer)
B. 48 hours
C. 60 days
D. 90 days

Explanation: ***30 days*** - As per the **Mental Healthcare Act, 2017**, under **Section 89 (Independent Admission)**, a person can be admitted independently for a **maximum period of 30 days**. - After 30 days, the person must either be discharged or the admission must be converted to voluntary or involuntary admission with appropriate procedures. - This provision allows for independent treatment-seeking without requiring a caregiver's involvement initially. *48 hours* - **48 hours** is not related to voluntary or independent admission duration. - This timeframe relates to the period within which a voluntary patient must be discharged after they request to leave (unless there are grounds for involuntary admission). *60 days* - **60 days** is not specified in the Mental Healthcare Act, 2017 for any category of admission. - This is neither the duration for voluntary, independent, nor involuntary admission procedures. *90 days* - **90 days** is not the correct maximum period for voluntary or independent admission. - While voluntary admission can continue indefinitely with ongoing consent, **independent admission** specifically has a **30-day limit** as per Section 89 of the Act.

Question 4: Magnan's symptom is seen in:

A. Cocaine (Correct Answer)
B. Datura
C. Cannabis
D. Opium

Explanation: ***Cocaine*** - **Magnan's symptom**, also known as **formication**, is a tactile hallucination where an individual perceives insects crawling under their skin, commonly associated with chronic cocaine use. - This symptom is a manifestation of **cocaine-induced psychosis** or severe intoxication, leading to paranoid delusions and abnormal sensory experiences. *Datura* - **Datura** intoxication primarily causes anticholinergic effects, such as **dry mouth**, **dilated pupils**, confusion, and visual hallucinations, but not typically Magnan's symptom. - The hallucinations associated with Datura are often described as vivid and florid, but distinct from the tactile formication seen with cocaine. *Cannabis* - **Cannabis** use can induce altered perceptions, euphoria, anxiety, and sometimes paranoia, but it is not typically associated with tactile hallucinations like Magnan's symptom. - While high doses can lead to psychotic-like symptoms, **formication** is not a characteristic feature of cannabis intoxication. *Opium* - **Opium** and other opioids primarily cause central nervous system depression, leading to euphoria, sedation, pinpoint pupils, and respiratory depression. - Opioid use is not linked to tactile hallucinations such as **formication** or Magnan's symptom.

Question 5: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

A. Schizophrenia
B. Major depressive disorder plus psychosis (Correct Answer)
C. Schizoaffective disorder
D. Schizotypal personality disorder

Explanation: ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.

Question 6: A 1st year medical student presents with recurrent episodes of choking sensation, breathlessness, intense sweating along with feeling of impending doom. Usually the episodes occur prior to exams. What is the most likely diagnosis?

A. Panic attack (Correct Answer)
B. Acute stress disorder
C. Generalised anxiety disorder
D. Phobia

Explanation: ***Panic attack (Panic Disorder)*** - The sudden onset of intense fear or discomfort, along with symptoms like **choking sensation**, **breathlessness**, **sweating**, and **feeling of impending doom**, are characteristic of a **panic attack**. - The **recurrent episodes** occurring prior to exams indicate **Panic Disorder**, which is defined by recurrent unexpected panic attacks followed by persistent concern about future attacks. - The situational trigger (exams) suggests a pattern consistent with panic disorder, where attacks may be situationally predisposed. *Acute stress disorder* - This condition occurs within **one month of exposure to a traumatic event** and involves dissociative symptoms, intrusions, avoidance, and arousal symptoms. - The patient describes recurrent episodes tied to exams, not a single acute traumatic event with subsequent stress response. *Generalised anxiety disorder* - Characterized by excessive and **uncontrollable worry** about various events or activities for **at least six months**. - While anxiety is present, the sudden, intense, **episodic nature** of symptoms with a distinct "feeling of impending doom" points away from the chronic, pervasive worry of GAD. - GAD presents with chronic anxiety rather than discrete panic episodes. *Phobia* - A phobia is an **irrational and intense fear** of a specific object or situation (e.g., specific phobia) or social situations (social anxiety disorder). - While exam-related anxiety can be severe, the description points to a **full-blown panic response** with multiple autonomic symptoms (choking, breathlessness, sweating) and psychological distress (impending doom). - Unlike a phobia where avoidance is the primary feature, this patient experiences discrete panic episodes with characteristic somatic symptoms.

Question 7: Which of the following dependence-causing drugs is most commonly abused worldwide?

A. Cannabis (Correct Answer)
B. Heroin
C. Amphetamine
D. Cocaine

Explanation: ***Cannabis*** - **Cannabis** is the most widely cultivated and consumed illicit drug globally, with the highest prevalence of past-year use. - Its widespread availability, relatively lower perception of harm compared to other drugs, and varied forms of consumption (smoking, edibles) contribute to its extensive abuse. *Heroin* - **Heroin** is a highly addictive opioid that causes severe physical dependence and withdrawal symptoms, but its global prevalence is significantly lower than that of cannabis. - Its high cost, illicit nature, and significant health risks, including overdose, limit its abuse to a smaller, though critically affected, population. *Amphetamine* - **Amphetamines**, including methamphetamine, are potent central nervous system stimulants with a significant abuse potential, leading to psycho-behavioral and physical dependence. - While prevalent in certain regions and among specific populations, their overall global abuse statistics are lower than those for cannabis. *Cocaine* - **Cocaine** is a powerful stimulant derived from the coca plant, known for its strong psychological dependence and significant health consequences. - Its abuse is concentrated in specific geographical areas and demographic groups, making its global prevalence of abuse lower than that of cannabis.

Question 8: The most widely used substance causing dependence worldwide is:

A. Cocaine
B. Cannabis
C. Amphetamines
D. Alcohol (Correct Answer)

Explanation: ***Alcohol*** - **Alcohol** is the most widely consumed psychoactive substance globally, leading to a significant burden of dependence and related health issues. - Its widespread availability, social acceptance, and addictive properties contribute to its high rates of dependence across diverse populations. *Cocaine* - While **cocaine** is a powerful and highly addictive stimulant, its use and dependence are not as prevalent globally as alcohol. - The geographical distribution and historical context of cocaine use are more concentrated compared to the ubiquitous nature of alcohol consumption. *Cannabis* - **Cannabis** is one of the most commonly used illicit drugs worldwide, and it can cause dependence, but its overall prevalence of dependence is lower than that of alcohol. - The perception of lower harm and increased legalization in some regions have led to higher rates of use, but alcohol still surpasses it in terms of global dependence rates. *Amphetamines* - **Amphetamines**, including methamphetamine, are potent stimulants known for their high potential for dependence. - However, their global usage and rates of dependence, while significant in certain regions, do not reach the broad societal impact and prevalence seen with alcohol.

Question 9: Which of the following is a technique based on behavior sciences methods?

A. Systems analysis
B. Decision making
C. Network analysis
D. Management by objective (Correct Answer)

Explanation: ***Management by objective*** - **Management by objective (MBO)** is a strategic management model that aims to improve organizational performance by clearly defining **objectives** that are agreed to by both management and employees. - It is based on **behavioral science principles** because it emphasizes employee participation, motivation, and goal setting to achieve desired outcomes. *Systems analysis* - **Systems analysis** is a problem-solving technique that involves breaking down a complex system into its component parts to study how they interact. - It is primarily an engineering and computer science discipline, focused on **optimizing processes** and **information flow**, rather than explicit behavioral methods. *Decision making* - **Decision making** is a cognitive process of selecting a course of action from various alternatives. - While influenced by human behavior, it is a broad concept that encompasses various analytical and intuitive approaches, and is not solely a behavior sciences method. *Network analysis* - **Network analysis** is a method for visualizing and analyzing interconnected nodes (e.g., people, organizations) and their relationships. - It is often used in **sociology, epidemiology, and computer science** to understand structures and interactions, but it is not inherently a technique based on behavioral sciences methods in the same way MBO is.