Psychoneuroimmunology — MCQs
Which of the following produces neuropsychiatric symptoms?
Due to fear which of the following hormones increases rapidly?
All are first rank symptoms of schizophrenia, except:
All of the following are increased in Acute stress except
Choose the correctly matched pairs regarding the drugs used in schizophrenia: 1. D2 antagonism: Reduces positive symptoms 2. 5HT2A antagonism: Reduces negative symptoms 3. 5HT1A agonism: Weight loss 4. Muscarinic antagonism: Reduces extrapyramidal symptoms
Which of the following neurotransmitters is NOT suspected to be involved in the pathophysiology of schizophrenia?
A 45-year-old male's blood test shows an increase in Homovanillic acid (HVA). Which of the following conditions is this finding most likely associated with?
Increased suicidal tendency is associated with which neurochemical imbalance?
Which of the following features is NOT commonly associated with 22q11.2 deletion syndrome?
Which chromosome is associated with bipolar disease?
Psychoneuroimmunology Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following produces neuropsychiatric symptoms?
- A. Cephalosporin
- B. Ethambutol
- C. Cyclosporine
- D. Cycloserine (Correct Answer)
Explanation: ***Cycloserine*** - **Cycloserine** is an antimicrobial agent that can cause a wide array of neuropsychiatric symptoms, including **headache**, **anxiety**, **depression**, **psychosis**, **seizures**, and **peripheral neuropathy**. - Its mechanism of action involves interfering with cell wall synthesis, but it also crosses the **blood-brain barrier**, leading to central nervous system effects. *Cephalosporin* - While some **cephalosporins** (especially at high doses or in patients with renal impairment) can cause CNS effects like **seizures**, they are not typically associated with a broad range of neuropsychiatric symptoms to the same extent as cycloserine. - The primary side effects of cephalosporins are usually **gastrointestinal disturbances** and **allergic reactions**. *Ethambutol* - **Ethambutol** is known for its ocular toxicity, specifically **optic neuritis**, which can lead to reduced visual acuity and **color blindness**. - It does not typically cause the generalized neuropsychiatric symptoms seen with cycloserine. *Cyclosporine* - **Cyclosporine**, an immunosuppressant, can cause neurological side effects such as **tremor**, **headache**, and **seizures**, and rarely **posterior reversible encephalopathy syndrome (PRES)**. - However, it is not primarily associated with the broad spectrum of psychiatric symptoms like depression or psychosis, unlike cycloserine.
Question 2: Due to fear which of the following hormones increases rapidly?
- A. Growth hormones
- B. Thyroid hormone
- C. Corticosteroid
- D. Epinephrine (Correct Answer)
Explanation: ***Epinephrine*** - **Epinephrine**, also known as adrenaline, is a hormone and neurotransmitter involved in the **"fight or flight" response** to stress, fear, or excitement. - When faced with fear, the **adrenal medulla** releases epinephrine, leading to rapid physiological changes like increased heart rate, blood pressure, and energy availability to prepare the body for immediate action. *Growth hormones* - **Growth hormone (GH)** primarily regulates growth, metabolism, and body composition. - While stress can influence GH secretion, a rapid increase in direct response to acute fear is not its primary function. *Thyroid hormone* - **Thyroid hormones (T3 and T4)** regulate metabolism, energy balance, and body temperature over a longer term. - Their primary role is not in the immediate, rapid physiological response to acute fear. *Corticosteroid* - **Corticosteroids**, such as cortisol, are released in response to stress, but their increase is typically more prolonged than the instant surge of epinephrine. - They play a role in modulating immune response and metabolism during stress but are not responsible for the immediate "fight or flight" reactions.
Question 3: All are first rank symptoms of schizophrenia, except:
- A. Audible thoughts
- B. Thought broadcasting
- C. Voice arguing or discussing or both
- D. Perplexity (Correct Answer)
Explanation: ***Perplexity*** - **Perplexity** is a state of severe confusion, bewilderment, or puzzlement, which can be seen in various psychiatric conditions but is not specifically classified as a **first-rank symptom of schizophrenia** by Kurt Schneider. - While it may be present in schizophrenia, it is a non-specific symptom, meaning it can occur in conditions other than schizophrenia. *Audible thoughts* - **Audible thoughts** (Gedankenlautwerden in German) refers to the patient hearing their own thoughts spoken aloud, often as if by another voice. - This is considered a **first-rank symptom** as described by Kurt Schneider, highly indicative of schizophrenia. *Thought broadcasting* - **Thought broadcasting** is the delusional belief that one's thoughts are escaping from their mind and are somehow accessible to others. - This symptom is also a **first-rank symptom** of schizophrenia according to Schneider's criteria. *Voice arguing or discussing or both* - **Voices arguing or discussing** are a specific type of auditory hallucination where two or more voices are perceived to be talking to each other, often about the patient. - This phenomenon is considered a classic **first-rank symptom** of schizophrenia.
Question 4: All of the following are increased in Acute stress except
- A. Growth hormone
- B. Epinephrine
- C. Glucagon
- D. Insulin (Correct Answer)
Explanation: ***Insulin*** - During acute stress, **insulin secretion is actively suppressed** by catecholamines (epinephrine and norepinephrine) acting on **alpha-2 adrenergic receptors** on pancreatic beta cells. - This suppression is crucial for the stress response, as it allows **unopposed action of counter-regulatory hormones** to mobilize glucose and raise blood glucose levels. - The body prioritizes **immediate energy availability** (high blood glucose) over storage, making insulin the hormone that is **decreased, not increased**, during acute stress. *Growth hormone* - **Growth hormone** is a counter-regulatory hormone that **increases during acute stress** to mobilize energy stores, particularly by promoting lipolysis and gluconeogenesis. - Its actions contribute to the stress-induced elevation of **blood glucose levels**. *Epinephrine* - **Epinephrine** (adrenaline) is a primary catecholamine released during acute stress, leading to a rapid **fight or flight response**. - It significantly **increases heart rate**, blood pressure, and **glucose mobilization** through glycogenolysis and gluconeogenesis. *Glucagon* - **Glucagon** is a key hormone involved in **maintaining glucose homeostasis** and is significantly **increased during acute stress**. - It primarily acts on the liver to **stimulate glycogenolysis** and **gluconeogenesis**, thereby raising blood glucose levels to provide energy.
Question 5: Choose the correctly matched pairs regarding the drugs used in schizophrenia: 1. D2 antagonism: Reduces positive symptoms 2. 5HT2A antagonism: Reduces negative symptoms 3. 5HT1A agonism: Weight loss 4. Muscarinic antagonism: Reduces extrapyramidal symptoms
- A. 1,4
- B. 1,2,4
- C. 1,2,3,4
- D. 1,2 (Correct Answer)
Explanation: ***1,2*** - **D2 antagonism** is the primary mechanism by which antipsychotics reduce **positive symptoms** of schizophrenia, such as hallucinations and delusions. - **5HT2A antagonism** is a key mechanism of atypical antipsychotics contributing to the reduction of **negative symptoms** (e.g., apathy, anhedonia, flat affect) and cognitive deficits, while also reducing the risk of extrapyramidal symptoms. *1,2,3,4* - This option is incorrect because **5HT1A agonism** is not associated with **weight loss**. While 5HT1A partial agonism (as seen with aripiprazole and brexpiprazole) may improve negative symptoms, anxiety, and cognitive function, it does not directly cause weight loss. - Additionally, **muscarinic antagonism** does not reduce extrapyramidal symptoms as a primary mechanism. Rather, anticholinergic (muscarinic antagonist) drugs like benztropine are used to **treat** EPS after it occurs. The reduction of EPS in atypical antipsychotics primarily comes from 5HT2A antagonism and lower D2 binding affinity. *1,2,4* - This option is incorrect because **muscarinic antagonism** is not a mechanism that reduces EPS. Anticholinergic agents are used therapeutically to counteract EPS caused by dopamine blockade, but anticholinergic effects themselves do not prevent or reduce EPS. - The reduction of EPS with atypical antipsychotics is mainly due to **5HT2A antagonism** balancing dopaminergic blockade, selective limbic over striatal binding, and fast D2 dissociation kinetics. *1,4* - This option is incorrect because it omits **5HT2A antagonism**, which is crucial for reducing **negative symptoms** in schizophrenia. - It also incorrectly includes muscarinic antagonism as a mechanism that reduces EPS, when in reality anticholinergics are used to treat EPS rather than prevent it.
Question 6: Which of the following neurotransmitters is NOT suspected to be involved in the pathophysiology of schizophrenia?
- A. Ascorbic acid (Correct Answer)
- B. Serotonin (5-HT)
- C. Norepinephrine
- D. Glutamate
Explanation: ***Ascorbic acid*** - **Ascorbic acid (Vitamin C)** is an important antioxidant and cofactor, but it is **not a neurotransmitter**. - While it may have neuroprotective roles, there is **no significant theory** suggesting ascorbic acid dysregulation is involved in the core pathophysiology of schizophrenia. - Unlike the other options, ascorbic acid is not part of any major neurotransmitter hypothesis of schizophrenia. *Serotonin (5-HT)* - The **serotonin hypothesis** of schizophrenia suggests an imbalance in serotonergic activity, particularly involving **5-HT2A receptors**. - Serotonin is targeted by **atypical antipsychotics** (e.g., risperidone, olanzapine) which block 5-HT2A receptors. - Serotonin dysregulation is believed to contribute to both **positive and negative symptoms** of schizophrenia. *Norepinephrine* - Dysregulation of **norepinephrine** has been implicated in the **cognitive and negative symptoms** of schizophrenia. - Alterations in noradrenergic systems contribute to deficits in **attention, working memory, and motivation** in affected individuals. - The prefrontal cortex noradrenergic system is particularly relevant to schizophrenia pathophysiology. *Glutamate* - The **NMDA receptor hypofunction hypothesis** is a major theory in schizophrenia pathophysiology. - **Glutamate** dysfunction, particularly involving NMDA receptors, can explain positive, negative, and cognitive symptoms. - NMDA receptor antagonists (like PCP and ketamine) can **induce psychotic symptoms** similar to schizophrenia, supporting this hypothesis.
Question 7: A 45-year-old male's blood test shows an increase in Homovanillic acid (HVA). Which of the following conditions is this finding most likely associated with?
- A. Phenylketonuria (PKU)
- B. Schizophrenia (Correct Answer)
- C. Depression
- D. Parkinson's disease
Explanation: **Explanation:** The correct answer is **Schizophrenia**. This question tests your knowledge of neurotransmitter metabolites and their clinical significance in psychiatric disorders. **1. Why Schizophrenia is correct:** **Homovanillic acid (HVA)** is the primary metabolic byproduct of **Dopamine**. According to the **Dopamine Hypothesis of Schizophrenia**, the disorder is characterized by dopaminergic hyperactivity, particularly in the mesolimbic pathway. Increased turnover of dopamine leads to elevated levels of HVA in the blood, cerebrospinal fluid (CSF), and urine. Monitoring HVA levels is often used in research to gauge central dopamine activity. **2. Why the other options are incorrect:** * **Phenylketonuria (PKU):** This is a metabolic disorder caused by a deficiency of phenylalanine hydroxylase. It leads to an accumulation of Phenylalanine, not HVA. * **Depression:** Depression is primarily associated with decreased levels of **5-HIAA** (5-Hydroxyindoleacetic acid), which is the metabolite of Serotonin. While dopamine can be involved, HVA is not a diagnostic marker for depression. * **Parkinson’s Disease:** This condition involves the degeneration of dopaminergic neurons in the substantia nigra. Therefore, one would expect a **decrease** in HVA levels due to dopamine deficiency, rather than an increase. **High-Yield Clinical Pearls for NEET-PG:** * **Dopamine → HVA** (Homovanillic Acid) * **Serotonin → 5-HIAA** (Decreased in suicide attempts and impulsive aggression) * **Norepinephrine → VMA** (Vanillylmandelic Acid) and **MHPG** (3-methoxy-4-hydroxyphenylglycol). * **VMA** is a crucial marker for diagnosing **Pheochromocytoma** and **Neuroblastoma**. * In Schizophrenia, HVA levels often correlate with the severity of positive symptoms (hallucinations/delusions).
Question 8: Increased suicidal tendency is associated with which neurochemical imbalance?
- A. Increased Noradrenaline
- B. Decreased Serotonin (Correct Answer)
- C. Decreased Dopamine
- D. Increased GABA
Explanation: **Explanation:** The neurobiology of suicidal behavior is most strongly linked to the **Serotonergic system**. Research consistently shows that low levels of **Serotonin (5-HT)** and its primary metabolite, **5-HIAA (5-hydroxyindoleacetic acid)**, in the cerebrospinal fluid (CSF) are associated with increased impulsivity, aggression, and completed suicide. This finding holds true across various psychiatric diagnoses, including depression and schizophrenia. **Analysis of Options:** * **Decreased Serotonin (Correct):** Low 5-HT levels in the ventromedial prefrontal cortex are linked to a failure in "top-down" inhibition, leading to impulsive-aggressive behaviors and suicidal acts. * **Increased Noradrenaline (Incorrect):** While noradrenergic dysregulation is seen in stress responses and anxiety disorders, it is not the primary neurochemical marker for suicidal tendency. * **Decreased Dopamine (Incorrect):** Low dopamine is primarily associated with anhedonia and motor symptoms (as seen in Parkinson’s or depression), but it is not as specific a predictor for suicide as serotonin. * **Increased GABA (Incorrect):** GABA is the brain's primary inhibitory neurotransmitter. Increased GABA activity is generally associated with sedation and reduced anxiety, not increased suicidality. **NEET-PG High-Yield Pearls:** * **CSF Marker:** The most high-yield fact is that **low CSF 5-HIAA** is the strongest biochemical predictor of violent suicide attempts. * **Post-mortem findings:** Studies of suicide victims often show decreased serotonin receptor binding in the prefrontal cortex. * **Genetics:** The Tryptophan Hydroxylase (TPH) gene mutation, which affects serotonin synthesis, is often studied in relation to suicidal behavior. * **Clinical Correlation:** Antidepressants (SSRIs) may initially increase the risk of suicide in young adults by increasing energy before improving mood (the "activation syndrome").
Question 9: Which of the following features is NOT commonly associated with 22q11.2 deletion syndrome?
- A. Mental retardation (Correct Answer)
- B. Schizophrenia
- C. ADHD
- D. Congenital heart defects
Explanation: **Explanation:** **22q11.2 Deletion Syndrome** (also known as DiGeorge or Velocardiofacial Syndrome) is the most common microdeletion syndrome in humans. The correct answer is **Mental retardation (Option A)** because, while patients frequently exhibit borderline intellectual functioning or learning disabilities, global "mental retardation" (moderate to severe intellectual disability) is **not** a defining or universal feature of the syndrome. Most patients have an IQ in the 70–85 range. **Analysis of Incorrect Options:** * **Schizophrenia (Option B):** This is a hallmark psychiatric association. Approximately 25–30% of individuals with this deletion develop schizophrenia, making it one of the strongest known genetic risk factors for the disorder. * **ADHD (Option C):** Neurodevelopmental disorders are highly prevalent; ADHD is the most common psychiatric diagnosis in children with 22q11.2 deletion, affecting roughly 30–40% of patients. * **Congenital heart defects (Option D):** These are classic physical manifestations, particularly conotruncal defects (e.g., Tetralogy of Fallot, interrupted aortic arch), occurring in about 75% of cases. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic (CATCH-22):** **C**ardiac defects, **A**bnormal facies, **T**hymic hypoplasia (T-cell deficiency), **C**left palate, **H**ypocalcemia (hypoparathyroidism), due to **22**q11 deletion. * **Psychiatry Link:** It is often tested as the "genetic link to schizophrenia." * **Diagnosis:** Confirmed via **FISH** (Fluorescence In Situ Hybridization) or chromosomal microarray. * **Key Gene:** The **TBX1** gene is primarily responsible for the physical phenotypes.
Question 10: Which chromosome is associated with bipolar disease?
- A. Chromosome 16
- B. Chromosome 13 (Correct Answer)
- C. Chromosome 14
- D. Chromosome 11
Explanation: **Explanation:** Bipolar Disorder (BD) is a highly heritable psychiatric condition with a complex polygenic inheritance pattern. Genetic linkage studies have consistently identified specific loci associated with an increased susceptibility to the disorder. **1. Why Chromosome 13 is Correct:** Chromosome **13q** (specifically the 13q32 locus) is one of the most strongly linked regions to Bipolar Disorder. This region contains the **G72 (DAOA)** gene, which is involved in glutamatergic neurotransmission. Mutations or polymorphisms in this area are associated with both Bipolar Disorder and Schizophrenia, suggesting a shared genetic vulnerability between psychotic and mood disorders. **2. Analysis of Incorrect Options:** * **Chromosome 16 (Option A):** While some studies suggest minor links to various psychiatric traits, it is not a primary or high-yield locus specifically associated with Bipolar Disorder in standard medical curricula. * **Chromosome 14 (Option B):** This chromosome is most famously associated with **Early-onset Alzheimer’s Disease** (Presenilin-1 gene located at 14q24.3). * **Chromosome 11 (Option D):** Chromosome 11 is significant in psychiatry for the **BDNF** (Brain-Derived Neurotrophic Factor) gene and the **DRD4** gene, but Chromosome 13 remains the more classic "textbook" answer for linkage studies in Bipolar Disorder. **Clinical Pearls for NEET-PG:** * **Other Linked Chromosomes:** Besides 13q, Chromosomes **18q, 21q, and 22q** are frequently cited in association with Bipolar Disorder. * **Heritability:** Bipolar Disorder has the highest heritability among major psychiatric disorders (approx. 80-85%). * **Twin Studies:** If one monozygotic twin has Bipolar I disorder, there is a **40-70%** chance the other twin will also be affected. * **First-degree relatives:** They have a 5-10 times higher risk of developing the disorder compared to the general population.
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