Drugs in Psychiatric Disorders — MCQs

Drugs in Psychiatric Disorders Indian Medical PG Practice Questions and MCQs

Question 301: A patient with severe anxiety requires long-term management. Which class of antidepressants, known for its efficacy in treating anxiety disorders, should be considered?

A. Tricyclic antidepressants
B. Monoamine oxidase inhibitors
C. Atypical antipsychotics
D. Selective serotonin reuptake inhibitors (SSRIs) (Correct Answer)

Explanation: ***Selective serotonin reuptake inhibitors (SSRIs)*** - SSRIs are considered **first-line agents** for the long-term management of most anxiety disorders due to their efficacy and generally favorable side-effect profile. - They work by increasing the concentration of **serotonin** in the synaptic cleft, helping to regulate mood and anxiety. - Evidence supports their use in generalized anxiety disorder, panic disorder, social anxiety disorder, and other anxiety conditions. *Tricyclic antidepressants* - While effective for some anxiety disorders, **TCAs** have a less favorable side-effect profile, including anticholinergic effects, sedation, and cardiac toxicity. - They are generally reserved for cases where SSRIs are ineffective or contraindicated. *Monoamine oxidase inhibitors* - **MAOIs** are highly effective but carry a significant risk of **hypertensive crisis** when consumed with tyramine-rich foods or certain medications. - Their strict dietary restrictions and drug interactions limit their use to **refractory cases** of anxiety. *Atypical antipsychotics* - **Atypical antipsychotics** are primarily used for psychotic disorders and severe mood disorders, sometimes as an augmentation strategy for anxiety. - They are not considered a first-line or long-term monotherapy for general anxiety due to potential side effects like metabolic syndrome and extrapyramidal symptoms.

Question 302: Which class of drugs is commonly used to treat anxiety by enhancing the effects of GABA?

A. Benzodiazepines (Correct Answer)
B. Selective serotonin reuptake inhibitors
C. Tricyclic antidepressants
D. Monoamine oxidase inhibitors

Explanation: ***Benzodiazepines*** - **Benzodiazepines** act as positive **allosteric modulators** of the **GABA-A receptor**, increasing the frequency of **chloride channel opening**. - This enhanced **GABAergic transmission** leads to a **hyperpolarization** of neurons, resulting in reduced neuronal excitability, which exerts **anxiolytic**, sedative, and muscle relaxant effects. *Selective serotonin reuptake inhibitors* - **SSRIs** primarily increase the concentration of **serotonin** in the **synaptic cleft** by inhibiting its reuptake, rather than directly acting on GABA. - While effective for anxiety, their mechanism of action is distinct from GABA potentiation, and their therapeutic effects typically have a **delayed onset**. *Tricyclic antidepressants* - **TCAs** primarily inhibit the **reuptake of norepinephrine** and **serotonin**, and also block various receptors like **histaminic**, **cholinergic**, and **adrenergic receptors**. - They do not directly enhance **GABAergic activity**, and their use can be limited by a wide range of side effects due to their broad receptor blockade. *Monoamine oxidase inhibitors* - **MAOIs** prevent the enzymatic degradation of **norepinephrine**, **serotonin**, and **dopamine** by inhibiting the enzyme **monoamine oxidase**, thereby increasing their synaptic concentrations. - Their mechanism is focused on **monoamine neurotransmitters**, and they do not directly modulate **GABAergic transmission**.

Question 303: A patient being treated with an antipsychotic drug develops tardive dyskinesia. Which class of antipsychotic drugs is most commonly associated with this condition?

A. Dopamine partial agonists
B. Anticholinergic drugs
C. Atypical antipsychotics
D. Typical antipsychotics (Correct Answer)

Explanation: ***Typical antipsychotics*** - **First-generation antipsychotics**, also known as typical antipsychotics, are commonly associated with **tardive dyskinesia** due to their strong **D2 dopamine receptor blockade**. - Prolonged use leads to postsynaptic dopamine receptor hypersensitivity, resulting in involuntary movements. *Atypical antipsychotics* - **Second-generation antipsychotics** (atypical) have a **lower risk** of tardive dyskinesia due to their weaker D2 blockade and strong 5-HT2A serotonin receptor antagonism. - While the risk is present, it is significantly less compared to typical antipsychotics. *Dopamine partial agonists* - Drugs like **aripiprazole** (a dopamine partial agonist) have an even **lower risk of dyskinesia** because they modulate dopamine activity rather than completely blocking it. - They act as functional antagonists in areas with high dopamine and functional agonists in areas with low dopamine. *Anticholinergic drugs* - **Anticholinergic drugs** are sometimes used to treat **acute extrapyramidal symptoms** (like parkinsonism) caused by antipsychotics, but they do not cause or prevent tardive dyskinesia. - In some cases, discontinuing anticholinergics can unmask or worsen tardive dyskinesia.

Question 304: A 30-year-old man presents with symptoms of depression. He is prescribed a selective serotonin reuptake inhibitor (SSRI). Which of the following drugs is he most likely taking?

A. Fluoxetine (Correct Answer)
B. Amitriptyline
C. Venlafaxine
D. Mirtazapine

Explanation: ***Fluoxetine*** - **Fluoxetine** is a prototypical **selective serotonin reuptake inhibitor (SSRI)**, commonly prescribed for depression. - SSRIs function by **blocking the reuptake of serotonin** in the presynaptic neuron, increasing its concentration in the synaptic cleft. *Amitriptyline* - **Amitriptyline** is a **tricyclic antidepressant (TCA)**, not an SSRI. - TCAs have a broader spectrum of action, blocking the reuptake of both **serotonin and norepinephrine**, and also affecting other receptors (e.g., muscarinic acetylcholine, histamine H1), leading to more side effects. *Venlafaxine* - **Venlafaxine** is a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, not an SSRI. - SNRIs block the reuptake of both **serotonin and norepinephrine**, providing a dual mechanism of action that can be effective for some forms of depression or anxiety. *Mirtazapine* - **Mirtazapine** is an **atypical antidepressant** that primarily acts as an **alpha-2 adrenergic receptor antagonist**, which enhances noradrenergic and serotonergic transmission. - It also blocks 5-HT2 and 5-HT3 serotonin receptors and H1 histamine receptors, which contributes to its unique side effect profile (e.g., sedation, increased appetite).

Question 305: What is the most common electrolyte imbalance associated with lithium treatment?

A. Hyperkalemia (high potassium levels)
B. Hypercalcemia (high calcium levels) (Correct Answer)
C. Hypokalemia (low potassium levels)
D. Hypernatremia (high sodium levels)

Explanation: ***Hypercalcemia (high calcium levels)*** - **Hypercalcemia** is the most commonly reported electrolyte abnormality with chronic lithium therapy, occurring in **10-15% of patients**. - Lithium can cause **hyperparathyroidism** by affecting parathyroid gland function, leading to increased PTH secretion and subsequent elevation of serum calcium levels [2]. - This effect can develop after **months to years** of lithium treatment and may persist even after lithium discontinuation. - Regular monitoring of serum calcium and PTH levels is recommended during long-term lithium therapy. *Hypernatremia (high sodium levels)* - **Hypernatremia** is not a direct or common electrolyte imbalance from lithium itself. - While lithium can cause **nephrogenic diabetes insipidus (NDI)** leading to polyuria and polydipsia, patients typically maintain normal sodium levels if they have adequate water access [1], [3]. - Hypernatremia may occur as a **secondary complication** if patients with lithium-induced NDI become dehydrated, but this is not the primary electrolyte abnormality. *Hyperkalemia (high potassium levels)* - **Hyperkalemia** is not typically associated with lithium treatment. - Lithium's effects on renal function do not consistently lead to significant alterations in potassium homeostasis. *Hypokalemia (low potassium levels)* - **Hypokalemia** is not a characteristic electrolyte imbalance with lithium therapy. - Lithium primarily affects water handling and calcium metabolism rather than potassium balance.

Question 306: Which of the following conditions is NOT a contraindication for the use of Tricyclic Antidepressants (TCAs)?

A. Narrow angle glaucoma
B. Prostate hypertrophy
C. Impaired renal function (Correct Answer)
D. A patient on MAO inhibitors

Explanation: ***Impaired renal function*** - While **Tricyclic Antidepressants (TCAs)** are metabolized in the liver and excreted by the kidneys, **impaired renal function** alone is generally not considered an absolute contraindication but necessitates **dose adjustments** and careful monitoring. - The primary concern with renal impairment is the **accumulation of active metabolites**, which can increase the risk of side effects, but it doesn't preclude their use entirely. *Narrow angle glaucoma* - TCAs have **anticholinergic properties** that can cause mydriasis (pupil dilation), which can precipitate an acute attack in individuals with **narrow-angle glaucoma**. - This is an important contraindication due to the risk of **irreversible vision loss**. *Prostate hypertrophy* - The **anticholinergic effects** of TCAs can worsen urinary retention in patients with **prostate hypertrophy** by relaxing the detrusor muscle and contracting the bladder sphincter. - This can lead to increased discomfort and potentially acute urinary retention. *A patient on MAO inhibitors* - Concomitant use of TCAs with **MAO inhibitors** is an absolute contraindication due to the risk of **hypertensive crisis** and **hyperpyrexia** from potentiation of noradrenergic effects. - This dangerous interaction can lead to severe and potentially fatal symptoms such as hyperthermia, severe hypertension, seizures, and cardiovascular collapse. A washout period of at least 2 weeks is required when switching between these medications.

Question 307: Which of the following is a side effect of quetiapine?

A. Sudden cardiac death
B. Dyspepsia
C. Dry mouth (Correct Answer)
D. Hair loss

Explanation: ***Dry mouth*** - **Quetiapine** is an atypical antipsychotic that commonly causes **anticholinergic side effects**, including **dry mouth (xerostomia)**. - This symptom results from the drug's antagonistic activity at **muscarinic acetylcholine receptors**. - Dry mouth is a **frequent and well-recognized side effect** occurring in a significant proportion of patients, making it the best answer among the options provided. *Sudden cardiac death* - Quetiapine can cause **QT interval prolongation**, particularly at higher doses or in susceptible individuals, which may increase the risk of **fatal cardiac arrhythmias**. - However, sudden cardiac death is a **rare but serious adverse event**, not a common side effect seen in routine clinical practice. - While this is a documented risk requiring monitoring, **dry mouth is far more frequently encountered** in patients taking quetiapine. *Dyspepsia* - **Dyspepsia (indigestion)** can occur with various medications, but it is not a particularly prominent or characteristic side effect of **quetiapine**. - The more notable side effects of quetiapine include **sedation, weight gain, metabolic effects, and anticholinergic symptoms** rather than gastrointestinal upset. *Hair loss* - **Hair loss (alopecia)** is not a recognized or documented side effect of **quetiapine**. - This is not typically associated with atypical antipsychotics and would not be expected with quetiapine therapy.

Question 308: What is the drug of choice (DOC) for a schizophrenic patient with poor oral absorption?

A. Fluphenazine (Correct Answer)
B. Clozapine
C. Sulpride
D. Penfluridol

Explanation: ***Fluphenazine*** - **Fluphenazine** is available as a **long-acting injectable** (LAI) formulation, specifically **fluphenazine decanoate**, making it an ideal choice for patients with **poor oral absorption** or adherence issues. - Its **depot injection** bypasses the need for oral intake, ensuring therapeutic drug levels are maintained over several weeks. *Clozapine* - **Clozapine** is an **oral antipsychotic** and requires consistent oral intake for efficacy. - It is often reserved for **treatment-resistant schizophrenia** and is not available in a long-acting injectable form suitable for poor oral absorption. *Sulpride* - **Sulpride** is primarily an **oral antipsychotic** and its administration relies on adequate oral absorption. - It is not available in a formulation that would circumvent issues of poor oral absorption. *Penfluridol* - **Penfluridol** is an **oral long-acting antipsychotic**, but it still requires oral administration. - While long-acting, its efficacy depends on the patient's ability to absorb the drug orally, which is compromised in this scenario.

Question 309: What is the primary use of Acamprosate in medical treatment?

A. Alcohol abstinence (Correct Answer)
B. Nicotine abstinence
C. Opioid abstinence
D. Cocaine abstinence

Explanation: ***Alcohol abstinence*** - **Acamprosate** is primarily used to maintain **abstinence from alcohol** in patients recovering from alcohol dependence. - It works by restoring the balance of **neurotransmitters** in the brain, particularly **GABA** and **glutamate**, which are often disrupted by chronic alcohol use. *Nicotine abstinence* - Medications for **nicotine abstinence** typically include **varenicline**, bupropion, or nicotine replacement therapies. - **Acamprosate** does not have a primary indication or established efficacy for smoking cessation. *Opioid abstinence* - **Opioid dependence** is commonly treated with medications such as **methadone**, **buprenorphine**, or naltrexone for maintenance and relapse prevention. - **Acamprosate** is not indicated for the management of opioid withdrawal or opioid use disorder. *Cocaine abstinence* - There are currently no FDA-approved medications specifically for treating **cocaine dependence**. - Treatment typically involves behavioral therapies, and **acamprosate** has not shown efficacy in this context.

Question 310: Which of the following is true about ziprasidone?

A. Has anti-depressant properties
B. Not safe in cardiac patients due to QT prolongation risk
C. Lower risk of extrapyramidal symptoms compared to typical antipsychotics (Correct Answer)
D. Commonly causes significant weight gain

Explanation: ***Lower risk of extrapyramidal symptoms compared to typical antipsychotics*** - **Ziprasidone** is an **atypical antipsychotic**, which generally carries a **lower risk of extrapyramidal symptoms (EPS)** compared to older, first-generation (typical) antipsychotics. - This is primarily due to its different receptor binding profile, including weaker **D2 dopamine receptor antagonism** and significant **5-HT2A serotonin receptor antagonism**. *Commonly causes significant weight gain* - **Incorrect**: Ziprasidone is considered one of the most **weight-neutral antipsychotics**, causing minimal weight gain. - Unlike **olanzapine** and **clozapine**, which are associated with significant weight gain and metabolic side effects, ziprasidone has a favorable metabolic profile. - This makes it a preferred option when weight gain is a concern. *Has anti-depressant properties* - While ziprasidone can be used as adjunctive therapy in **bipolar depression**, it is not classified as a primary antidepressant. - Its efficacy in mood symptoms is attributed to **serotonin** and **dopamine** modulation, but it lacks the direct mechanism of action of true antidepressants. - It is primarily indicated for **schizophrenia** and **bipolar disorder**, not major depressive disorder. *Not safe in cardiac patients due to QT prolongation risk* - **Partially true but too absolute**: Ziprasidone does carry a dose-dependent risk of **QT interval prolongation**. - However, it is not completely contraindicated in cardiac patients; rather, it requires **careful cardiac monitoring**, **baseline ECG**, and avoidance in patients with known QT prolongation. - With appropriate precautions and patient selection, it can be used safely under medical supervision.

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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