Drugs in Psychiatric Disorders — MCQs

Drugs in Psychiatric Disorders Indian Medical PG Practice Questions and MCQs

Question 281: Second line drug in Enuresis is

A. Haloperidol
B. Chlorpromazine
C. Diazepam
D. Imipramine (Correct Answer)

Explanation: ***Imipramine*** - **Imipramine** is a tricyclic antidepressant (TCA) and is the established **second-line pharmacological treatment** for **nocturnal enuresis** when first-line therapies (like desmopressin or behavioral interventions) are ineffective. - TCAs like imipramine work by increasing bladder capacity, reducing sleep arousal threshold (making it easier to wake up), and having anticholinergic effects that relax the detrusor muscle. - Imipramine is specifically approved for enuresis and has the most evidence among TCAs for this indication. *Haloperidol* - **Haloperidol** is a typical antipsychotic primarily used to treat psychotic disorders such as schizophrenia and Tourette's syndrome. - It is not indicated for the treatment of **enuresis** and has significant extrapyramidal side effects. *Chlorpromazine* - **Chlorpromazine** is another typical antipsychotic, known for its sedative and antiemetic properties, and is used in conditions like schizophrenia and bipolar disorder. - It is not used for **enuresis** and carries risks of sedation and various neurological side effects. *Diazepam* - **Diazepam** is a benzodiazepine primarily used for anxiety, muscle spasms, and seizures due to its anxiolytic, sedative, muscle relaxant, and anticonvulsant properties. - It is not an appropriate treatment for **enuresis** and could worsen it due to its sedative effects, which might reduce arousal in sleep.

Question 282: A patient with nocturnal enuresis and depressive symptoms was started on an antidepressant. What is the drug?

A. clomipramine
B. sertraline
C. amitriptyline
D. imipramine (Correct Answer)

Explanation: ***Imipramine*** - **Imipramine (Tofranil)** is a **tricyclic antidepressant (TCA)** [1] historically used for **nocturnal enuresis** due to its anticholinergic and alpha-adrenergic effects, which increase bladder capacity and sphincter tone. While it treats **depressive symptoms** [2], its use in enuresis has declined due to newer therapies with fewer side effects. *Clomipramine* - **Clomipramine (Anafranil)** is primarily used for **obsessive-compulsive disorder (OCD)** but also has antidepressant effects. While it shares some properties with imipramine as a TCA, it is **not the primary choice for nocturnal enuresis** and is more known for its serotonin reuptake inhibition. *Sertraline* - **Sertraline (Zoloft)** is a **selective serotonin reuptake inhibitor (SSRI)** commonly used for depression, anxiety disorders, and OCD. It **does not have a recognized role in treating nocturnal enuresis** and can sometimes even worsen urinary symptoms or cause nocturnal polyuria. *Amitriptyline* - **Amitriptyline (Elavil)** is a TCA effective for **depression**, **neuropathic pain**, and **migraine prophylaxis**. While it has strong anticholinergic properties that could theoretically affect bladder function, it is **not the preferred TCA for nocturnal enuresis**; imipramine has a more established history for this indication.

Question 283: Nocturnal enuresis is commonly treated with:

A. Haloperidol
B. Chlordiazepoxide
C. Chlorpromazine
D. Imipramine (Correct Answer)

Explanation: **Imipramine** - **Imipramine**, a tricyclic antidepressant, is known to reduce the depth of sleep, decrease the volume of urine produced at night, and increase bladder capacity, making it an effective treatment for **nocturnal enuresis**. - Its mechanism involves both anticholinergic effects on the bladder and direct effects on the central nervous system to reduce arousal threshold. *Haloperidol* - **Haloperidol** is a typical antipsychotic primarily used to treat psychotic disorders like schizophrenia and acute delirium. - It is not indicated for the management of nocturnal enuresis and could potentially have severe neurological side effects. *Chlordiazepoxide* - **Chlordiazepoxide** is a benzodiazepine used for anxiety, alcohol withdrawal, and muscle spasms. - It acts as a central nervous system depressant and would likely worsen enuresis by further relaxing bladder control and increasing sleep depth. *Chlorpromazine* - **Chlorpromazine** is another typical antipsychotic, also used as an antiemetic and for severe behavioral problems. - It has no role in the treatment of nocturnal enuresis and can cause significant side effects such as sedation and extrapyramidal symptoms.

Question 284: Which of the following drugs used for obsessive-compulsive disorder has maximum anticholinergic effect?

A. Fluvoxamine
B. Buspirone
C. Sertraline
D. Clomipramine (Correct Answer)

Explanation: ***Clomipramine*** - **Clomipramine** is a **tricyclic antidepressant (TCA)** with potent efficacy in OCD treatment. - It has **strong anticholinergic effects** including dry mouth, blurred vision, constipation, urinary retention, and cognitive impairment. - Among all medications used for OCD, clomipramine has the **maximum anticholinergic burden** due to its action on muscarinic receptors. - While effective for OCD, its significant side effect profile often limits its use to refractory cases. *Fluvoxamine* - **Fluvoxamine** is a **selective serotonin reuptake inhibitor (SSRI)** with FDA approval for OCD. - SSRIs have **minimal anticholinergic effects** compared to TCAs. - It selectively targets serotonin reuptake with little affinity for muscarinic cholinergic receptors. *Buspirone* - **Buspirone** is a **5-HT1A partial agonist** used primarily for **generalized anxiety disorder**. - It is **not a standard or approved treatment for OCD** - this makes it an inappropriate choice regardless of side effect profile. - It has negligible anticholinergic effects but lacks efficacy in OCD. *Sertraline* - **Sertraline** is an **SSRI** with FDA approval for OCD treatment. - Like other SSRIs, it has **very low affinity for muscarinic receptors** and minimal anticholinergic effects. - It is a first-line agent for OCD with a favorable side effect profile.

Question 285: Atomoxetine is used in the management of which of the following conditions?

A. Bipolar disorder
B. Schizophrenia
C. Depression
D. ADHD (Correct Answer)

Explanation: ***Correct: ADHD*** * **Atomoxetine** is a **selective norepinephrine reuptake inhibitor (SNRI)** primarily used in the management of **Attention-Deficit/Hyperactivity Disorder (ADHD)**. * It is a **non-stimulant** medication, making it a suitable alternative for patients who do not respond to or cannot tolerate traditional stimulant medications for ADHD. * FDA-approved in 2002, atomoxetine remains an important treatment option, particularly for patients with concerns about stimulant abuse potential or those with comorbid anxiety disorders. *Incorrect: Bipolar disorder* * **Bipolar disorder** is typically treated with mood stabilizers (e.g., lithium, valproate), antipsychotics, and sometimes antidepressants, but atomoxetine is not a first-line or common treatment option. * While some ADHD symptoms can overlap with bipolar disorder, atomoxetine is specifically designed for ADHD and lacks the broad mood-stabilizing effects needed for bipolar disorder. *Incorrect: Schizophrenia* * **Schizophrenia** is a severe mental disorder treated primarily with **antipsychotic medications** that target dopamine and serotonin systems. * Atomoxetine does not have efficacy in treating the positive or negative symptoms of schizophrenia and is not indicated for this condition. *Incorrect: Depression* * While atomoxetine affects **norepinephrine**, some SNRIs (e.g., venlafaxine, duloxetine) are used for depression. However, atomoxetine's primary indication and efficacy profile are not for treating **major depressive disorder**. * Its mechanism of action is more specifically tailored to the neurochemical imbalances seen in ADHD rather than the broader neurotransmitter dysregulation in depression.

Question 286: Fingernail hypoplasia is a complication of which of the following drugs?

A. risperidone
B. lithium
C. olanzapine
D. carbamazepine (Correct Answer)

Explanation: ***Carbamazepine*** - **Fingernail hypoplasia** (underdevelopment of nails) is a known teratogenic effect associated with first-trimester exposure to **carbamazepine**, part of the **fetal anticonvulsant syndrome**. - Other features of this syndrome include characteristic facial dysmorphism, microcephaly, developmental delay, and skeletal abnormalities. *Risperidone* - Risperidone is an **atypical antipsychotic** and its primary teratogenic risks are related to neonatal adaptation syndrome, such as withdrawal symptoms, rather than structural defects like fingernail hypoplasia. - While all antipsychotics should be used with caution during pregnancy, specific associations with structural malformations are less common and less severe than with some antiepileptic drugs. *Lithium* - Lithium is associated with a specific cardiac malformation, **Ebstein's anomaly**, when taken during the first trimester of pregnancy. - It is not typically linked to limb or nail hypoplasia. *Olanzapine* - Olanzapine is another **atypical antipsychotic** whose use in pregnancy is primarily linked to risks like **gestational diabetes** and **neonatal withdrawal symptoms**. - There is no strong evidence linking olanzapine to structural malformations like fingernail hypoplasia.

Question 287: Donepezil is used in treatment of:

A. Alzheimer's dementia (Correct Answer)
B. Anxiety disorder
C. Schizophrenia
D. Parkinson's disease

Explanation: ***Alzheimer's dementia*** - **Donepezil** is a **cholinesterase inhibitor** that increases the availability of **acetylcholine** in the brain, improving **cognitive function** in patients with Alzheimer's. - It is one of the primary medications approved for the symptomatic treatment of **mild to moderate** Alzheimer's disease. *Anxiety disorder* - **Anxiety disorders** are typically treated with **selective serotonin reuptake inhibitors (SSRIs)**, **benzodiazepines**, or psychotherapy. - Donepezil has no established role or efficacy in the treatment of anxiety disorders. *Schizophrenia* - **Schizophrenia** is managed with **antipsychotic medications** that primarily target **dopamine** and **serotonin** systems in the brain. - Donepezil's mechanism of action, increasing acetylcholine, is not relevant to the pathology or treatment of schizophrenia. *Parkinson's disease* - **Parkinson's disease** is primarily characterized by the degeneration of **dopaminergic neurons** and motor symptoms are treated with medications like **levodopa**. - While **rivastigmine** (another cholinesterase inhibitor) is approved for Parkinson's disease dementia, **donepezil** is specifically indicated for **Alzheimer's disease**, not Parkinson's disease.

Question 288: How does fluoxetine help in treating depression?

A. Increases serotonin reuptake
B. Increases GABA levels
C. Inhibits serotonin reuptake (Correct Answer)
D. Blocks dopamine receptors

Explanation: ***Inhibits serotonin reuptake*** - Fluoxetine is a **selective serotonin reuptake inhibitor (SSRI)**, meaning it blocks the reabsorption of serotonin into presynaptic neurons. - This action leads to increased concentrations of serotonin in the **synaptic cleft**, enhancing serotonergic neurotransmission and alleviating depressive symptoms. *Increases serotonin reuptake* - This statement is incorrect as increasing serotonin reuptake would **reduce serotonin availability** in the synapse, worsening depressive symptoms rather than improving them. - Antidepressants like fluoxetine aim to **increase serotonin levels**, not decrease them through increased reuptake. *Increases GABA levels* - Medications that increase **GABA (gamma-aminobutyric acid)** levels are typically anxiolytics or anticonvulsants (e.g., benzodiazepines), not primary antidepressants. - While GABAergic pathways can influence mood, fluoxetine's primary mechanism is specifically on **serotonin**. *Blocks dopamine receptors* - Blocking dopamine receptors is the mechanism of action for many **antipsychotic medications**, which are used to treat conditions like schizophrenia or bipolar disorder. - This action is generally **not the primary mechanism** by which antidepressants like fluoxetine exert their effects; in fact, blocking dopamine can sometimes worsen depression.

Question 289: Which antipsychotic is most likely to cause metabolic syndrome?

A. Olanzapine
B. Haloperidol
C. Clozapine (Correct Answer)
D. Risperidone

Explanation: ***Clozapine*** - **Clozapine** has the **highest risk** of causing **metabolic syndrome** among all antipsychotics, characterized by significant **weight gain**, **dyslipidemia**, **insulin resistance**, and **new-onset diabetes mellitus**. - Multiple meta-analyses consistently show clozapine causes the **most severe metabolic disturbances**, with weight gain often exceeding 5-10 kg in the first year of treatment. - The mechanism involves potent antagonism of **5-HT2C receptors**, **histamine H1 receptors**, and effects on **leptin signaling** and **glucose metabolism**. - Its use requires careful **metabolic monitoring** including baseline and periodic measurement of weight, BMI, waist circumference, fasting glucose, and lipid profile. - Despite these risks, clozapine remains the gold standard for **treatment-resistant schizophrenia**, but its metabolic effects necessitate risk-benefit consideration. *Olanzapine* - **Olanzapine** has the **second-highest risk** for metabolic syndrome after clozapine, also causing significant weight gain and metabolic disturbances. - Like clozapine, it has potent **5-HT2C** and **H1 antagonism**, leading to increased appetite and altered glucose-lipid metabolism. - The metabolic risk is substantial but generally slightly less severe than clozapine in head-to-head comparisons. *Haloperidol* - **Haloperidol** is a first-generation (typical) antipsychotic with a **significantly lower risk** of metabolic syndrome compared to clozapine or olanzapine. - Its primary adverse effects are **extrapyramidal symptoms** (akathisia, dystonia, parkinsonism) and **hyperprolactinemia** rather than metabolic disturbances. - It causes minimal weight gain and has low risk for diabetes or dyslipidemia. *Risperidone* - **Risperidone** has an **intermediate metabolic risk** among atypical antipsychotics, lower than clozapine or olanzapine but higher than some others like aripiprazole or ziprasidone. - While it can cause weight gain and metabolic changes, the magnitude is generally more modest. - Its more prominent side effect is **hyperprolactinemia** due to potent D2 antagonism.

Question 290: How do SSRIs alleviate symptoms of depression?

A. By increasing synaptic serotonin levels (Correct Answer)
B. By inhibiting GABA receptors
C. By increasing norepinephrine degradation
D. By decreasing dopamine release

Explanation: ***By increasing synaptic serotonin levels*** - **Selective Serotonin Reuptake Inhibitors (SSRIs)** block the reabsorption (reuptake) of **serotonin** by neurons, leading to higher concentrations of serotonin in the synaptic cleft. - Increased **synaptic serotonin** availability is believed to enhance neuronal communication and mood regulation, thus alleviating symptoms of depression. *By inhibiting GABA receptors* - Inhibiting **GABA receptors** would typically lead to increased neuronal excitability, potentially worsening anxiety or causing seizures, rather than alleviating depression. - Medications that act on GABA receptors, such as **benzodiazepines**, are primarily used for anxiety and sedation, not as first-line antidepressants. *By increasing norepinephrine degradation* - Increasing **norepinephrine degradation** would reduce the levels of norepinephrine, a neurotransmitter associated with alertness and mood, which would likely worsen depressive symptoms. - Many antidepressants, such as **SNRIs**, aim to *increase* norepinephrine levels, not degrade them. *By decreasing dopamine release* - Decreasing **dopamine release** would likely lead to symptoms of anhedonia, lack of motivation, and other features of depression, or even extrapyramidal symptoms if significantly reduced. - **Dopamine** is often associated with reward and pleasure pathways, and increasing its availability can be beneficial in some forms of depression.

Practice by Chapter

Antipsychotics: Typical and Atypical

Practice Questions

Antidepressants: SSRIs and SNRIs

Practice Questions

Tricyclic Antidepressants

Practice Questions

MAO Inhibitors

Practice Questions

Mood Stabilizers

Practice Questions

Anxiolytics

Practice Questions

Drugs for ADHD

Practice Questions

Drugs for Sleep Disorders

Practice Questions

Drugs for Dementia

Practice Questions

Drug-Induced Psychiatric Symptoms

Practice Questions

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