Drugs in Psychiatric Disorders — MCQs
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Which of the following is a tricyclic antidepressant?
Which amino acid-derived neurotransmitter is primarily targeted in the pharmacological treatment of depression?
Which of the following is a selective serotonin and norepinephrine reuptake inhibitor?
Which of the following is not a selective serotonin reuptake inhibitor?
An SSRI antidepressant, such as fluoxetine, will be prescribed for an adult patient. You should advise him or her that two of the most likely side effects or adverse responses that may eventually occur at therapeutic blood levels are which of the following?
Which of the following is NOT a common effect of tricyclic antidepressants?
Which of the following is not classified as a traditional anxiolytic?
Which of the following antidepressant drugs is used in the treatment of nocturnal enuresis?
Which of the following is an atypical antipsychotic?
Which of the following antipsychotic medications is most commonly used in depot preparation?
Drugs in Psychiatric Disorders Indian Medical PG Practice Questions and MCQs
Question 331: Which of the following is a tricyclic antidepressant?
- A. Fluoxetine
- B. Citalopram
- C. Doxepin (Correct Answer)
- D. Venlafaxine
Explanation: ***Doxepin*** - **Doxepin** is a **tricyclic antidepressant (TCA)** that inhibits the reuptake of **serotonin** and **norepinephrine**, and also has significant **histaminergic** and **cholinergic** blocking effects. - TCAs, including doxepin, are commonly used for treating **depression**, **anxiety**, and certain pain conditions. *Venlafaxine* - **Venlafaxine** is a **serotonin-norepinephrine reuptake inhibitor (SNRI)**, not a tricyclic antidepressant. - SNRIs selectively block the reuptake of both **serotonin** and **norepinephrine**, but lack the broad receptor affinity of TCAs. *Fluoxetine* - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)**, which specifically targets serotonin reuptake. - SSRIs are generally considered a first-line treatment for depression due to a more favorable side effect profile compared to TCAs. *Citalopram* - **Citalopram** is also a **selective serotonin reuptake inhibitor (SSRI)**, much like fluoxetine. - It works by increasing the levels of **serotonin** in the brain by blocking its reuptake, differentiating it from tricyclic antidepressants.
Question 332: Which amino acid-derived neurotransmitter is primarily targeted in the pharmacological treatment of depression?
- A. Histamine
- B. None of the options
- C. Serotonin (Correct Answer)
- D. Acetylcholine
Explanation: ***Serotonin*** - **Serotonin** is an amino acid-derived neurotransmitter (from **tryptophan**) known to play a crucial role in mood regulation, sleep, appetite, and other functions, making it a primary target for **antidepressant medications**. - Medications like **Selective Serotonin Reuptake Inhibitors (SSRIs)** increase serotonin levels in the brain to alleviate symptoms of depression. *Histamine* - **Histamine** is an amino acid-derived neurotransmitter (from **histidine**) primarily involved in allergic reactions, inflammation, and regulating wakefulness. - While it has some central nervous system effects, its primary role is not directly in the treatment of **depression**. *Acetylcholine* - **Acetylcholine** is a neurotransmitter involved in muscle contraction, learning, memory, and attention, and is not derived from amino acids; it is synthesized from **choline** and acetyl-CoA. - It is not directly used for treating **depression**, although imbalances can play a role in cognitive aspects of some psychiatric disorders. *None of the options* - This option is incorrect because **Serotonin** is indeed an amino acid-derived neurotransmitter (from tryptophan) targeted for treating **depression**. - Many antidepressant drugs work by modulating **serotonergic pathways**.
Question 333: Which of the following is a selective serotonin and norepinephrine reuptake inhibitor?
- A. Fluoxetine
- B. Venlafaxine (Correct Answer)
- C. Sertraline
- D. Aripiprazole
Explanation: ***Venlafaxine*** - **Venlafaxine** is a commonly used antidepressant that inhibits the reuptake of both **serotonin** and **norepinephrine**, making it an SNRI. - Its dual mechanism of action can be effective for a broad range of depressive and anxiety disorders. *Fluoxetine* - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)**, primarily affecting serotonin levels in the brain. - It does not significantly inhibit norepinephrine reuptake and, thus, is not classified as an SNRI. *Sertraline* - **Sertraline** is another widely prescribed antidepressant that is also a **selective serotonin reuptake inhibitor (SSRI)**. - It works mainly by increasing serotonin availability in the synaptic cleft. *Aripiprazole* - **Aripiprazole** is an **atypical antipsychotic** medication, often used as an adjunct therapy for depression, but its primary mechanism is partial agonism at dopamine D2 and serotonin 5-HT1A receptors, and antagonism at serotonin 5-HT2A receptors. - It is not classified as a selective serotonin and norepinephrine reuptake inhibitor.
Question 334: Which of the following is not a selective serotonin reuptake inhibitor?
- A. Buspirone (Correct Answer)
- B. Citalopram
- C. Fluoxetine
- D. Fluvoxamine
Explanation: ***Buspirone*** - **Buspirone** is an anxiolytic that primarily acts as a **serotonin 5-HT1A receptor partial agonist**, not an SSRI. - It does not significantly affect the reuptake of serotonin, distinguishing it from SSRIs. *Fluoxetine* - **Fluoxetine** is a well-known and widely used **SSRI**. - It works by selectively inhibiting the reuptake of serotonin, thereby increasing its concentration in the synaptic cleft. *Fluvoxamine* - **Fluvoxamine** is another antidepressant classified as an **SSRI**. - It is often used for the treatment of **obsessive-compulsive disorder (OCD)** due to its strong serotonin reuptake inhibition. *Citalopram* - **Citalopram** is an **SSRI** frequently prescribed for depression and anxiety disorders. - Its mechanism involves potent and selective inhibition of **serotonin reuptake**.
Question 335: An SSRI antidepressant, such as fluoxetine, will be prescribed for an adult patient. You should advise him or her that two of the most likely side effects or adverse responses that may eventually occur at therapeutic blood levels are which of the following?
- A. Sexual dysfunction and sleep disturbances (Correct Answer)
- B. Sexual dysfunction and nausea
- C. Headache and diarrhea
- D. Tremor and weight gain
Explanation: ***Sexual dysfunction and sleep disturbances*** - **Sexual dysfunction** is one of the most common and persistent adverse effects of SSRIs, affecting 40-65% of patients and continuing throughout treatment at therapeutic levels [2], [3]. - **Sleep disturbances** (insomnia or altered sleep architecture) can persist during long-term SSRI therapy and are among the eventual side effects patients experience [1], [2], [3]. - Both effects are characteristic of chronic SSRI use and significantly impact patient compliance and quality of life. *Sexual dysfunction and nausea* - While **sexual dysfunction** is indeed very common and persistent, **nausea** is typically a transient side effect that occurs during the first 1-2 weeks of treatment and usually resolves with continued use [2]. - The question specifically asks about *eventual* occurrence at therapeutic levels over time, making nausea less appropriate as it is not a chronic issue. *Tremor and weight gain* - **Tremor** is not among the most common side effects of SSRIs and occurs less frequently than sexual dysfunction or sleep disturbances. - **Weight gain** can occur with some SSRIs (particularly paroxetine), but fluoxetine is actually considered weight-neutral or may even cause weight loss in some patients, making this combination less likely for fluoxetine specifically [1]. *Headache and diarrhea* - Both **headache** and **diarrhea** are common initial side effects when starting SSRIs but typically improve or resolve within the first few weeks of treatment [1]. - These are transient effects rather than eventual persistent side effects that characterize long-term therapeutic use.
Question 336: Which of the following is NOT a common effect of tricyclic antidepressants?
- A. Prolongation of QRS complexes
- B. Myoclonic jerks
- C. Metabolic alkalosis (Correct Answer)
- D. Coma
Explanation: ***Metabolic alkalosis*** - **Tricyclic antidepressants (TCAs)** do not typically cause metabolic alkalosis. Their overdose or therapeutic use is not associated with this acid-base imbalance. - While TCAs can disrupt various physiological processes, **metabolic alkalosis** is not a characteristic adverse effect or sign of overdose. *Prolongation of QRS complexes* - **TCAs block sodium channels** in the myocardium, which can lead to widening of the **QRS complex**, indicating delayed ventricular depolarization. - This is a significant cardiac toxicity of TCA overdose, increasing the risk of **ventricular arrhythmias**. *Myoclonic jerks* - **TCA overdose** can manifest with **neurological symptoms**, including involuntary muscle contractions like **myoclonic jerks**. - These are often part of the **seizure activity** that can occur with severe TCA toxicity. *Coma* - **Central nervous system depression** is a common and serious effect of TCA overdose, often leading to **coma**. - This is due to the broad **anticholinergic** and **sedative effects** of these drugs at high doses.
Question 337: Which of the following is not classified as a traditional anxiolytic?
- A. Fluoxetine (Correct Answer)
- B. Buspirone
- C. Diazepam
- D. Nitrazepam
Explanation: ***Fluoxetine*** - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** primarily used as an antidepressant, not a traditional anxiolytic. - While SSRIs are now used to treat anxiety disorders, they are not classified as traditional anxiolytics, which historically refer to benzodiazepines and related compounds. - Traditional anxiolytics work primarily through GABAergic mechanisms, whereas fluoxetine works through serotonin reuptake inhibition. *Buspirone* - **Buspirone** is a non-benzodiazepine anxiolytic that acts as a partial agonist at 5-HT1A serotonin receptors. - It is specifically indicated and FDA-approved for the treatment of generalized anxiety disorder. - Though it has a different mechanism from benzodiazepines, it is classified as an anxiolytic agent. *Diazepam* - **Diazepam** is a **benzodiazepine** that enhances the effect of the neurotransmitter **GABA** at the **GABA-A receptor**, leading to sedative, hypnotic, anxiolytic, anticonvulsant, and muscle relaxant properties. - It is a classic and widely recognized traditional anxiolytic, representing the prototypical benzodiazepine anxiolytic. *Nitrazepam* - **Nitrazepam** is a **benzodiazepine**, primarily indicated as a **hypnotic** for the treatment of severe insomnia. - As a benzodiazepine, it belongs to the traditional anxiolytic drug class and possesses anxiolytic properties through GABAergic mechanisms. - Despite being primarily used as a hypnotic, it is still considered part of the traditional anxiolytic class (benzodiazepines).
Question 338: Which of the following antidepressant drugs is used in the treatment of nocturnal enuresis?
- A. Imipramine (Correct Answer)
- B. Fluoxetine
- C. Trazodone
- D. Sertraline
Explanation: ***Imipramine*** - **Imipramine**, a **tricyclic antidepressant (TCA)**, is effective in treating nocturnal enuresis, particularly in children. - Its mechanism of action in this context is thought to involve anticholinergic effects, leading to **increased bladder capacity**, and alpha-adrenergic effects, causing **contraction of the internal urethral sphincter**. *Fluoxetine* - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** primarily used to treat depression, anxiety disorders, and obsessive-compulsive disorder. - It does not have a primary indication or established efficacy for the treatment of nocturnal enuresis. *Trazodone* - **Trazodone** is an **antidepressant** with sedative properties, often used for insomnia and depression. - While it modulates serotonin, it is not a first-line or established treatment for nocturnal enuresis. *Sertraline* - **Sertraline** is another **selective serotonin reuptake inhibitor (SSRI)** commonly prescribed for depression, anxiety, and panic disorder. - Like other SSRIs, it is not indicated for and has no significant role in the management of nocturnal enuresis.
Question 339: Which of the following is an atypical antipsychotic?
- A. Clozapine (Correct Answer)
- B. Chlorpromazine
- C. Thiothixene
- D. Haloperidol
Explanation: ***Clozapine*** - **Clozapine** is an **atypical antipsychotic** characterized by its efficacy in treating **refractory schizophrenia** and a lower risk of **extrapyramidal symptoms (EPS)** compared to typical antipsychotics. - Its mechanism involves antagonism of **dopamine D2** and **serotonin 5-HT2A** receptors, as well as several other receptor types. *Chlorpromazine* - **Chlorpromazine** is a **typical (first-generation) antipsychotic**, known for its strong **D2 blockade** and higher incidence of **extrapyramidal side effects**. - It was one of the first antipsychotics developed and is also used for its **antiemetic** properties. *Thiothixene* - **Thiothixene** is a **typical (first-generation) antipsychotic** that primarily acts by blocking **dopamine D2 receptors**. - It is associated with a higher risk of **extrapyramidal symptoms** and other side effects characteristic of typical antipsychotics. *Haloperidol* - **Haloperidol** is a **high-potency typical (first-generation) antipsychotic** with potent **D2 receptor antagonism**. - It is often used for acute psychosis and delirium but carries a significant risk of **extrapyramidal side effects** and **tardive dyskinesia**.
Question 340: Which of the following antipsychotic medications is most commonly used in depot preparation?
- A. Haloperidol (Correct Answer)
- B. Olanzapine
- C. Fluphenazine
- D. Risperidone
Explanation: ***Haloperidol*** - **Haloperidol decanoate** is the **most commonly used** depot antipsychotic preparation worldwide - It has been available since the **1970s** and remains the **gold standard** for long-acting injectable antipsychotics - Advantages include **long history of use**, **well-established efficacy**, **wide availability**, and **low cost** - Administered as **intramuscular injection** typically every **2-4 weeks** - Main limitation is higher risk of **extrapyramidal symptoms (EPS)** compared to second-generation depot antipsychotics *Risperidone* - **Risperidone** is available in depot formulations (**Risperdal Consta** - microspheres, **Risperdal Sustenna** - extended-release) - While widely used, it is **not the most common** depot preparation globally - Advantages include being a **second-generation antipsychotic** with lower EPS risk than haloperidol - More expensive than haloperidol decanoate, limiting its use in resource-constrained settings *Olanzapine* - **Olanzapine pamoate** is available as a **long-acting injectable** formulation - Requires mandatory **3-hour post-injection observation** due to risk of **post-injection delirium/sedation syndrome (PDSS)** - This monitoring requirement limits its practical use compared to other depot preparations - Less commonly used than haloperidol or risperidone depot formulations *Fluphenazine* - **Fluphenazine decanoate** is another first-generation antipsychotic available in depot form - Has been used since the 1960s-70s for maintenance therapy in schizophrenia - Similar to haloperidol in terms of EPS risk but less commonly used in current practice
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
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Drug-Induced Psychiatric Symptoms
Practice Questions
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