Mood Stabilizers — MCQs
Most common anomaly seen in a fetus of a mother taking lithium carbonate is:
Which class of drugs is primarily used for the treatment of schizophrenia?
Which of the following statements about lamotrigine is correct?
What is the treatment for extrapyramidal side effects induced by Haloperidol?
Which is not used in status epilepticus?
A 40-year-old man presents with persistently elevated mood, increased energy, and decreased need for sleep for the past week. What is the most likely diagnosis?
Which of the following is the most prevalent psychiatric disorder in the general population?
What is the treatment of choice for akathisia?
Who is known as the father of modern psychiatry?
Clozapine is used in:
Mood Stabilizers Indian Medical PG Practice Questions and MCQs
Question 1: Most common anomaly seen in a fetus of a mother taking lithium carbonate is:
- A. Limb reduction
- B. Neural tube defect
- C. Cardiac deformities (Correct Answer)
- D. Genitourinary deformity
Explanation: Detailed assessment of fetal risk indicates that the most significant and well-known teratogenic effect of **lithium carbonate** in utero is congenital **cardiac deformities**, particularly **Ebstein's anomaly** [2]. **Ebstein's anomaly** involves the downward displacement of the tricuspid valve, leading to tricuspid regurgitation and right heart failure [2]. *Limb reduction* - **Limb reduction defects** are typically associated with medications like **thalidomide** or vascular disruptions, not commonly with lithium exposure. - While various drug exposures can cause limb abnormalities, lithium's primary teratogenic risk lies elsewhere. *Neural tube defect* - **Neural tube defects (NTDs)** like spina bifida and anencephaly are most commonly associated with **folate deficiency** and certain antiepileptic drugs like valproic acid [1]. - Lithium has no established association with an increased risk of neural tube defects. *Genitourinary deformity* - While some medications can affect genitourinary development, **lithium carbonate** is not primarily linked to genitourinary deformities. - Its teratogenic effects are predominantly on the cardiovascular system.
Question 2: Which class of drugs is primarily used for the treatment of schizophrenia?
- A. Mood stabilizers
- B. Antihistamines
- C. Antipsychotic medications (Correct Answer)
- D. Antidepressants
Explanation: ***Antipsychotic medications*** - **Antipsychotic medications** primarily target **dopamine receptors** in the brain, which are implicated in the positive symptoms of schizophrenia like **hallucinations** and **delusions**. - They also have effects on other neurotransmitter systems, such as **serotonin**, contributing to their efficacy in managing negative and cognitive symptoms. *Mood stabilizers* - **Mood stabilizers** are primarily used for conditions characterized by extreme mood swings, such as **bipolar disorder**. - While they may be used adjunctively in some cases of schizophrenia to manage mood symptoms, they are not the primary treatment class. *Antihistamines* - **Antihistamines** are primarily used to treat **allergic reactions**, **insomnia**, or **nausea**. - They do not address the core neurochemical imbalances associated with schizophrenia and are not indicated for its treatment. *Antidepressants* - **Antidepressants** are primarily used to treat **depressive disorders** by modulating neurotransmitters like serotonin and norepinephrine. - While depression can co-occur with schizophrenia, antidepressants are not the primary treatment for the psychotic symptoms of schizophrenia and may even exacerbate psychosis in some individuals.
Question 3: Which of the following statements about lamotrigine is correct?
- A. Is the first choice for absence seizures.
- B. Has a half-life of approximately 24 hours. (Correct Answer)
- C. Is not significantly metabolized in the liver.
- D. Has decreased efficacy in treating depressive episodes.
Explanation: ***Has a half-life of approximately 24 hours.*** - Lamotrigine's **half-life** is typically around **24 to 33 hours** in adults, which allows for once or twice-daily dosing. - This relatively long half-life is advantageous for maintaining **stable plasma concentrations** and improving patient adherence. *Is the first choice for absence seizures.* - **Ethosuximide** or **valproate** are generally considered first-line treatments for **absence seizures**. - Lamotrigine is not the preferred initial therapy due to its **slower titration** and occasional lack of efficacy in this seizure type. *Is not significantly metabolized in the liver.* - Lamotrigine is **significantly metabolized** in the liver, primarily through **glucuronidation** by the **UGT1A4 enzyme**. - This hepatic metabolism explains many of its **drug interactions**, particularly with other antiepileptic drugs affecting UGT enzymes. *Has decreased efficacy in treating depressive episodes.* - Lamotrigine is known for its **mood-stabilizing properties** and is effective in treating and preventing **depressive episodes**, particularly in **bipolar disorder**. - Its efficacy in depression is a key distinguishing feature, making it a valuable option for patients with comorbid mood disorders.
Question 4: What is the treatment for extrapyramidal side effects induced by Haloperidol?
- A. Barbiturates
- B. SSRIs
- C. Benzodiazepines
- D. Anticholinergic drugs (Correct Answer)
Explanation: ***Anticholinergic drugs (effective treatment)*** - **Anticholinergic medications**, such as **benztropine** or **diphenhydramine**, are the primary treatment for **acute extrapyramidal symptoms (EPS)** like dystonia and parkinsonism induced by antipsychotics like haloperidol. - They work by **blocking muscarinic acetylcholine receptors**, helping to restore the balance between dopamine and acetylcholine in the basal ganglia. *Benzodiazepines (used for anxiety and muscle relaxation)* - While benzodiazepines can offer some relief for **akathisia** (a form of EPS characterized by restlessness) due to their sedative and muscle relaxant properties, they are **not the first-line treatment for other acute EPS** such as dystonia or parkinsonism. - They primarily enhance **GABAergic transmission** and are effective for anxiety and seizure control rather than direct antagonism of EPS mechanisms. *Barbiturates (used as sedative-hypnotic drugs)* - **Barbiturates** are strong central nervous system depressants used for sedation, anesthesia, and seizure control, but are **not indicated for the treatment of EPS**. - Their significant **sedative and addictive potential**, along with a narrow therapeutic index, makes them unsuitable for this purpose. *SSRIs (used for depression and anxiety)* - **SSRIs (Selective Serotonin Reuptake Inhibitors)** are antidepressants that work by increasing serotonin levels in the brain and are used to treat depression, anxiety, and obsessive-compulsive disorder. - They **do not have a direct role** in ameliorating dopamine-acetylcholine imbalance responsible for haloperidol-induced EPS.
Question 5: Which is not used in status epilepticus?
- A. Lorazepam
- B. Phenytoin
- C. Phenobarbitone
- D. Metformin (Correct Answer)
Explanation: ***Metformin*** - **Metformin** is an **oral hypoglycemic agent** used to treat **type 2 diabetes mellitus** and has no role in the management of seizures or status epilepticus. - Its primary mechanism involves decreasing **hepatic glucose production** and improving **insulin sensitivity**. *Lorazepam* - **Lorazepam** is a first-line treatment for **status epilepticus** due to its rapid onset of action and efficacy in terminating seizures. - It enhances the effect of **GABA** (gamma-aminobutyric acid) at the GABA-A receptor, leading to neuronal hyperpolarization and reduced excitability. *Phenytoin* - **Phenytoin** is a common second-line agent used in status epilepticus, administered after benzodiazepines, to maintain seizure control. - It works by blocking **voltage-gated sodium channels**, thereby stabilizing neuronal membranes and preventing repetitive firing. *Phenobarbitone* - **Phenobarbitone** (phenobarbital) is an effective antiepileptic drug, often considered as a second or third-line agent in status epilepticus, especially when other treatments fail. - It acts primarily by enhancing the activity of **GABA** at the GABA-A receptor, similar to benzodiazepines, but with a longer duration of action.
Question 6: A 40-year-old man presents with persistently elevated mood, increased energy, and decreased need for sleep for the past week. What is the most likely diagnosis?
- A. Schizophrenia
- B. Mania (Correct Answer)
- C. Hypomania
- D. Depression
Explanation: ***Mania*** - **Elevated mood**, **increased energy**, and **decreased need for sleep** are classic symptoms of a manic episode. - This presentation, lasting for **at least a week**, meets the **diagnostic criteria for mania** (DSM-5 requires ≥7 days or any duration if hospitalization needed). - The distinct period of persistently elevated, expansive, or irritable mood with increased goal-directed activity distinguishes this from other conditions. *Schizophrenia* - Characterized primarily by **psychotic symptoms** such as hallucinations, delusions, and disorganized thought/speech, which are not described here. - While agitation can occur, the core symptoms of elevated mood and increased energy are not typical of an acute schizophrenic episode. *Hypomania* - Hypomania presents with similar symptoms (elevated mood, increased energy, decreased sleep) but is **less severe** and of **shorter duration** (requires only 4 consecutive days). - Hypomanic episodes do **not cause marked impairment** in social or occupational functioning and do not require hospitalization. - The question states symptoms have lasted "for the past week" which, if causing significant functional impairment, would suggest mania rather than hypomania. *Depression* - Depression is characterized by a **depressed mood**, **loss of interest or pleasure (anhedonia)**, **low energy**, and often **increased need for sleep** or insomnia with early morning awakening. - The patient's symptoms of elevated mood and increased energy are the opposite of what is seen in depression.
Question 7: Which of the following is the most prevalent psychiatric disorder in the general population?
- A. Schizophrenia
- B. Mania
- C. Anxiety disorder (Correct Answer)
- D. Depression
Explanation: ***Anxiety disorder*** - **Anxiety disorders** are collectively the most prevalent psychiatric disorders in the general population, affecting approximately **10-30% of individuals** during their lifetime. - This category includes **specific phobias, social anxiety disorder, panic disorder, generalized anxiety disorder, and others**, which together have the highest prevalence among all psychiatric conditions. - Epidemiological studies consistently show that **anxiety disorders surpass depression** in terms of overall prevalence in community samples. *Depression* - **Major depressive disorder** is highly prevalent (lifetime prevalence approximately 10-15%) and is the **leading cause of disability worldwide**. - While extremely common and clinically significant, it is slightly less prevalent than anxiety disorders when considering community-based epidemiological data. - Depression often occurs **co-morbidly with anxiety disorders**, further emphasizing the importance of both conditions. *Schizophrenia* - **Schizophrenia** is a severe chronic mental illness with a much lower prevalence, affecting approximately **0.3-0.7%** of the general population. - Despite its significant impact on affected individuals and families, its overall prevalence is relatively low compared to mood and anxiety disorders. *Mania* - **Mania** is a mood state characteristic of **bipolar disorder**, which has a prevalence of approximately **1-2%** of the population. - This is considerably lower than the prevalence of both anxiety disorders and major depressive disorder.
Question 8: What is the treatment of choice for akathisia?
- A. Benztropine
- B. Propranolol (Correct Answer)
- C. Dantrolene
- D. Lithium
Explanation: ***Propranolol*** - **Beta-blockers** like propranolol are considered first-line treatment for akathisia due to their ability to reduce central as well as peripheral noradrenergic hyperactivity and anxiety. - They are particularly effective in alleviating the subjective feeling of **inner restlessness** and the objective motor symptoms, especially when the akathisia is induced by antipsychotics. *Benztropine* - This is an **anticholinergic** medication primarily used to treat other extrapyramidal symptoms like **dystonia** and **pseudoparkinsonism**. - While it might provide some relief for certain motor aspects, it is generally less effective for the subjective feeling of restlessness in akathisia and can have significant side effects. *Dantrolene* - **Dantrolene** is a direct-acting **skeletal muscle relaxant** used primarily in the treatment of **neuroleptic malignant syndrome (NMS)** and malignant hyperthermia. - It is not indicated for the management of extrapyramidal symptoms like akathisia. *Lithium* - **Lithium** is a mood stabilizer used predominantly in the treatment of **bipolar disorder**. - It has no role in the direct treatment of akathisia; however, it can ironically sometimes induce or worsen akathisia as a side effect itself.
Question 9: Who is known as the father of modern psychiatry?
- A. Bleuler
- B. Freud
- C. Kraepelin
- D. Philippe Pinel (Correct Answer)
Explanation: ***Philippe Pinel*** - **Philippe Pinel** is widely regarded as the **father of modern psychiatry** due to his revolutionary reforms in the treatment of the mentally ill in the late 18th and early 19th centuries - He advocated for a more humane approach, removing chains from patients and emphasizing **moral treatment**, which laid the foundation for modern psychiatric care - His work at Bicêtre Hospital (1793) and Salpêtrière Hospital marked a paradigm shift from custodial care to therapeutic intervention *Bleuler* - **Eugen Bleuler** is known for coining the term **"schizophrenia"** (1911) and describing its fundamental symptoms (the "four A's": associations, affect, ambivalence, autism) - While his contributions were significant in understanding and classifying mental illness, he built upon the foundations of humane psychiatric care already laid by Pinel *Freud* - **Sigmund Freud** is considered the **father of psychoanalysis**, a distinct therapeutic approach and theory of personality - His work focused on the unconscious mind, defense mechanisms, and psychosexual development, which are central to psychoanalytic theory but not the foundational shift in psychiatric care management that Pinel initiated *Kraepelin* - **Emil Kraepelin** is often referred to as the **father of modern psychiatric classification** due to his systematic approach to categorizing mental disorders based on their clinical course and outcome (dementia praecox vs manic-depressive illness) - His work profoundly influenced the development of diagnostic manuals like the DSM, but his focus was on nosology and classification rather than the initial humane treatment reform
Question 10: Clozapine is used in:
- A. Depression
- B. Resistant schizophrenia (Correct Answer)
- C. Mania
- D. Delirium
Explanation: **Explanation:** **Clozapine** is an atypical (second-generation) antipsychotic and is considered the **gold standard** for the management of **Treatment-Resistant Schizophrenia (TRS)**. 1. **Why Option B is Correct:** Resistance in schizophrenia is defined as a lack of satisfactory clinical improvement despite the use of adequate doses of at least two different antipsychotics (including one atypical) for a duration of 6–8 weeks each. Clozapine is uniquely effective in these cases due to its complex receptor profile (low D2 affinity, high 5-HT2A, D4, and alpha-adrenergic blockade). It is the only antipsychotic proven to reduce suicidal behavior in schizophrenic patients. 2. **Why Other Options are Incorrect:** * **A. Depression:** First-line treatments are SSRIs/SNRIs. While some atypicals (like Quetiapine or Aripiprazole) are used as adjuncts in resistant depression, Clozapine is not used due to its side-effect profile. * **C. Mania:** Acute mania is treated with Lithium, Valproate, or standard antipsychotics (e.g., Olanzapine, Risperidone). Clozapine is reserved only for ultra-resistant cases, not as a standard indication. * **D. Delirium:** Low-dose Haloperidol is the drug of choice. Clozapine is contraindicated in delirium because its strong anticholinergic properties can worsen the confusional state. **High-Yield Clinical Pearls for NEET-PG:** * **Agranulocytosis:** The most dreaded side effect (occurs in ~1%). Mandatory **WBC monitoring** is required (weekly for the first 6 months). * **Seizures:** Clozapine carries a dose-dependent risk of seizures. * **Sialorrhea:** Paradoxical hypersalivation is a common, bothersome side effect. * **Myocarditis:** A rare but fatal side effect; monitor for tachycardia and chest pain. * **Metabolic Syndrome:** High risk of weight gain and diabetes (similar to Olanzapine).
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