Psychopharmacology Practice Questions

Q: Which antipsychotic medication is associated with decreased weight?

Ziprasidone. ### Explanation The metabolic profile of antipsychotics is a high-yield topic for NEET-PG. Antipsychotic-induced weight gain is primarily linked to the blockade of **Histamine (H1)** and **Serotonin (5-HT2C)** receptors. **Why Ziprasidone is Correct:** **Ziprasidone** (along with Aripiprazole and Lurasidone) is considered **metabolically neutral**. It has a low affinity for H1 and 5-HT2C receptors, making it associated with minimal weight gain or even slight weight loss when switching from other agents. It is the preferred choice for patients with obesity or metabolic syndrome. **Analysis of Incorrect Options:** * **Clozapine (Option D):** This is the **worst offender**. It causes the most significant weight gain, dyslipidemia, and risk of Type 2 Diabetes Mellitus. * **Olanzapine (Option A):** Closely follows Clozapine in terms of metabolic side effects. It is notorious for rapid and significant weight gain. * **Quetiapine (Option B):** Associated with moderate weight gain. While less severe than Clozapine/Olanzapine, it still poses a higher metabolic risk than Ziprasidone. **High-Yield Clinical Pearls for NEET-PG:** * **Weight Gain Hierarchy:** Clozapine > Olanzapine > Quetiapine > Risperidone > Ziprasidone/Aripiprazole. * **Ziprasidone Warning:** It is uniquely associated with **QTc interval prolongation**; therefore, a baseline ECG is recommended. It must be taken **with food** (at least 500 calories) for adequate absorption. * **Monitoring:** According to the ADA/APA protocol, patients on second-generation antipsychotics (SGAs) must have their BMI, waist circumference, blood pressure, and fasting glucose/lipids monitored regularly.

Q: What is an important side effect of ECT?

Retrograde amnesia. **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective treatment in psychiatry, but it is associated with specific cognitive side effects. **Why Retrograde Amnesia is the correct answer:** The most common and significant side effect of ECT is **cognitive impairment**, specifically memory loss. This typically manifests as **retrograde amnesia** (loss of memory for events occurring shortly before the treatment) and **anterograde amnesia** (difficulty forming new memories immediately following treatment). While anterograde amnesia usually resolves rapidly, retrograde amnesia can persist for a longer duration, making it a major clinical concern. **Analysis of Incorrect Options:** * **B, C, and D (Death, Respiratory failure, Cardiac failure):** While these represent potential risks of any procedure involving general anesthesia and muscle relaxants (like Succinylcholine), they are **extremely rare** in modern ECT. The mortality rate of ECT is approximately 2 per 100,000 treatments, which is comparable to minor surgical procedures. Therefore, they are not considered "common" or "characteristic" side effects like memory loss. **High-Yield NEET-PG Pearls:** * **Absolute Contraindication:** Increased intracranial pressure (ICP). * **Most common side effect:** Confusion (post-ictal) and Headache. * **Most common cause of death:** Cardiovascular complications (arrhythmias/MI). * **Technique to reduce memory loss:** Using **unilateral** electrode placement (non-dominant hemisphere) and **brief-pulse** stimulation instead of bilateral or sine-wave stimulation. * **Drug of choice for induction:** Methohexital (Barbiturate). * **Muscle relaxant used:** Succinylcholine (to prevent fractures).

Q: Which of the following groups of drugs is known to cause neurogenic dislocation?

Antipsychotic drugs. **Explanation:** The correct answer is **Antipsychotic drugs**. **Mechanism and Concept:** Neurogenic dislocation (specifically of the temporomandibular joint or TMJ) is a rare but documented complication of **Acute Dystonia**, which is an Extrapyramidal Side Effect (EPS) caused by antipsychotic medications. Antipsychotics, particularly first-generation (typical) agents like Haloperidol, work by blocking Dopamine (D2) receptors in the nigrostriatal pathway. This blockade leads to a relative excess of cholinergic activity, resulting in involuntary, sustained muscle contractions. When these spasms involve the muscles of mastication (like the lateral pterygoid), the force can be strong enough to pull the condyle out of the glenoid fossa, leading to a "neurogenic" dislocation of the jaw. **Analysis of Incorrect Options:** * **Anxiolytics:** These drugs (e.g., Benzodiazepines) are muscle relaxants and are actually used to *treat* acute dystonic reactions, not cause them. * **Antiparkinsonism drugs:** These agents (e.g., Levodopa or Anticholinergics like Trihexyphenidyl) aim to increase dopamine or decrease acetylcholine. They do not cause acute dystonia; in fact, anticholinergics are the drug of choice to manage antipsychotic-induced dystonia. **NEET-PG High-Yield Pearls:** * **Acute Dystonia** is the earliest EPS to appear (usually within hours to days of starting treatment). * **Risk Factors:** Young males and high-potency antipsychotics. * **Common Presentations:** Torticollis (neck), Oculogyric crisis (eyes), and Trismus/TMJ dislocation (jaw). * **Management:** Immediate treatment involves parenteral **Promethazine** or **Benztropine** (anticholinergics).

Q: What is the treatment for lithium-induced tremor?

Propranolol. **Explanation:** Lithium-induced tremor is a common side effect, typically presenting as a fine, symmetric, postural tremor of the hands. **1. Why Propranolol is the Correct Answer:** The primary management for lithium-induced tremor is the use of **beta-blockers**, specifically **Propranolol**. The underlying mechanism involves the blockade of peripheral beta-2 adrenergic receptors in the skeletal muscles, which reduces the amplitude of the tremor. It is the gold-standard treatment when dose reduction of Lithium is not feasible. **2. Analysis of Incorrect Options:** * **Amiloride:** This is a potassium-sparing diuretic used specifically to treat **Lithium-induced Nephrogenic Diabetes Insipidus (NDI)**. It works by blocking the epithelial sodium channels (ENaC) in the collecting duct, preventing lithium from entering and interfering with ADH action. * **Modafinil:** This is a wakefulness-promoting agent used for narcolepsy or shift-work sleep disorder; it has no role in managing tremors. * **Trihexyphenidyl:** This is an anticholinergic used for **Extrapyramidal Side Effects (EPS)** like parkinsonism or acute dystonia caused by antipsychotics. Lithium tremors are not mediated by the dopamine-acetylcholine imbalance, so anticholinergics are ineffective. **3. Clinical Pearls for NEET-PG:** * **Tremor Characteristics:** Lithium causes a **fine** tremor (therapeutic levels). A **coarse** tremor is a red flag indicating **Lithium Toxicity**. * **First Step:** Always check serum lithium levels first to rule out toxicity. * **Management Ladder:** 1. Reduce dose (if possible) → 2. Eliminate caffeine → 3. Add Propranolol (20–120 mg/day). * **Other Side Effects:** Remember "LITHIUM" mnemonic: **L**eukocytosis, **I**nsipidus (NDI), **T**remor/Teratogenicity (Ebstein’s Anomaly), **H**ypothyroidism, **I**nsulin resistance, **U**rine (polyuria), **M**others (avoid in pregnancy).

Q: Which antipsychotic medication is known to cause cataracts?

Ziprasidone. **Explanation:** The association between antipsychotics and ocular side effects is a high-yield topic in psychopharmacology. Among the atypical (second-generation) antipsychotics, **Ziprasidone** is uniquely associated with an increased risk of lens opacities or **cataracts**. During its early clinical development, preclinical studies in animals suggested a potential for cataract formation, leading to recommendations for periodic slit-lamp examinations (though this is less strictly enforced in current clinical practice compared to Quetiapine). **Analysis of Options:** * **Ziprasidone (Correct):** Beyond cataracts, it is most famous for causing **QTc interval prolongation**, necessitating caution in patients with cardiac arrhythmias. It is weight-neutral but must be taken with food (at least 500 calories) for optimal absorption. * **Aripiprazole:** Known as a "dopamine system stabilizer" (partial agonist). It is least likely to cause metabolic side effects or cataracts but is frequently associated with **akathisia**. * **Olanzapine:** Primarily associated with significant **weight gain**, dyslipidemia, and metabolic syndrome. It does not have a documented specific association with cataracts. * **Risperidone:** Notable for causing **hyperprolactinemia** (leading to gynecomastia or galactorrhea) and extrapyramidal symptoms (EPS) at higher doses. **NEET-PG High-Yield Pearls:** 1. **Quetiapine** is the other major antipsychotic historically linked to cataracts; always check for it if Ziprasidone is not in the options. 2. **Chlorpromazine** (Typical) is famous for causing **lenticular deposits** (star-shaped) and epithelial keratopathy. 3. **Thioridazine** (Typical) is associated with **retinitis pigmentosa** (brownish discoloration of vision) at doses >800mg/day. 4. **Ziprasidone** has the highest risk of QTc prolongation among second-generation antipsychotics.

Q: Which of the following is a known side effect of bupropion?

Seizures. **Explanation:** **Correct Answer: B. Seizures** Bupropion is an atypical antidepressant that acts as a **Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)**. Its most significant and dose-dependent side effect is a **reduction in the seizure threshold**. The risk is particularly high (approx. 0.4%) at doses exceeding 450 mg/day or in patients with pre-existing risk factors. Consequently, bupropion is strictly **contraindicated** in patients with epilepsy and eating disorders (Anorexia or Bulimia nervosa) due to the high incidence of electrolyte imbalances which further increase seizure risk. **Analysis of Incorrect Options:** * **A. Relapse of smoking:** Incorrect. Bupropion is actually FDA-approved for **smoking cessation**. It reduces nicotine cravings and withdrawal symptoms by increasing dopamine levels in the reward pathway. * **C. Impaired attention:** Incorrect. Due to its pro-dopaminergic and pro-noradrenergic effects, bupropion is often used off-label to **improve attention** and focus in ADHD and is considered an "activating" antidepressant. * **D. Decreased sexual desire:** Incorrect. Unlike SSRIs, bupropion does **not** cause sexual dysfunction (it lacks serotonergic activity). It is often used as an add-on or alternative to SSRIs to reverse sexual side effects. **High-Yield Clinical Pearls for NEET-PG:** * **Weight Neutrality:** Bupropion is one of the few antidepressants that causes weight loss rather than weight gain. * **Contraindications:** Always screen for a history of head injury, seizures, or eating disorders before prescribing. * **Mechanism:** It does not inhibit MAO or affect serotonin reuptake, making it unique among common antidepressants.

Q: A 23-year-old male with schizophrenia is stable on risperidone for the past 2 months. What is the recommended duration of treatment for this patient?

2 years. **Explanation:** The management of schizophrenia requires a strategic approach to maintenance therapy to prevent relapse. For a patient experiencing their **first episode of psychosis** who has achieved stability (as in this 23-year-old male), the standard clinical guideline is to continue antipsychotic medication for **1 to 2 years**. **Why 2 years is correct:** Current psychiatric guidelines (including APA and Maudsley) recommend that after the first episode of schizophrenia, medication should be continued for at least 12–24 months. Since the goal is to minimize the high risk of relapse—which is greatest in the first year following an acute episode—**2 years** is the most appropriate clinical benchmark among the given options for a stable first-episode patient. **Analysis of Incorrect Options:** * **6 months (B) & 12 months (D):** These durations are generally considered too short for schizophrenia. While 6–12 months might be appropriate for a single episode of *Depressive Disorder*, stopping antipsychotics this early in schizophrenia significantly increases the risk of a psychotic break. * **5 years (A):** This duration is typically reserved for patients who have experienced **multiple episodes** (recurrent schizophrenia) or those who have a history of violent behavior or severe relapses. **High-Yield NEET-PG Pearls:** * **First Episode:** Treat for 1–2 years. * **Second/Multiple Episodes:** Treat for at least 5 years. * **Chronic/Severe Relapses:** May require indefinite (life-long) therapy. * **Risperidone:** A second-generation antipsychotic (SGA) known for causing hyperprolactinemia and extrapyramidal symptoms (EPS) at higher doses (>6mg). * **Relapse Rate:** Approximately 80% of patients will relapse within 5 years if medication is discontinued after the first episode.

Q: Which of the following drugs are used in the treatment of schizophrenia?

Rivastigmine. **Explanation:** The question asks to identify which drug is **NOT** used in the treatment of schizophrenia (noting that the checkmark indicates the "except" or "incorrect" option in this context). **1. Why Rivastigmine is the Correct Answer (The Exception):** Rivastigmine is a **reversible acetylcholinesterase inhibitor** used primarily in the treatment of Alzheimer’s disease and Parkinson’s disease dementia. It works by increasing acetylcholine levels in the synaptic cleft. It has no antipsychotic properties and is not used to treat the core symptoms of schizophrenia. **2. Analysis of Incorrect Options (Antipsychotics):** * **Trifluoperazine:** A **Typical (First-generation) Antipsychotic** belonging to the Piperazine class. It is a high-potency D2 receptor antagonist used to treat positive symptoms of schizophrenia. * **Clozapine:** An **Atypical (Second-generation) Antipsychotic**. It is the "Gold Standard" for **treatment-resistant schizophrenia**. It acts on D2, 5-HT2A, and various other receptors. * **Chlordiazepoxide:** While primarily a Benzodiazepine used for alcohol withdrawal and anxiety, it is frequently used as an **adjuvant** in schizophrenia to manage acute agitation, insomnia, or catatonic features, although it is not a primary antipsychotic. **High-Yield Clinical Pearls for NEET-PG:** * **Clozapine** is the only antipsychotic proven to reduce **suicidal behavior** in schizophrenia but requires mandatory WBC monitoring due to the risk of **agranulocytosis**. * **Drug of choice for Schizophrenia:** Generally Atypical Antipsychotics (e.g., Risperidone, Olanzapine) due to lower risk of Extrapyramidal Side Effects (EPS). * **Negative symptoms** of schizophrenia are better addressed by Atypical Antipsychotics than Typical ones.

Q: Which of the following medications is used in Electroconvulsive Therapy (ECT)?

Thiopentone. **Explanation:** In Electroconvulsive Therapy (ECT), the goal is to induce a generalized therapeutic seizure while ensuring patient safety through anesthesia and muscle relaxation. **A. Thiopentone (Correct):** Traditionally, Thiopentone sodium (an ultra-short-acting barbiturate) has been the "gold standard" induction agent for ECT. It provides rapid loss of consciousness and has a well-established safety profile. While **Methohexital** is now often preferred due to a shorter recovery time and less seizure-suppressing effect, Thiopentone remains a classic and correct choice in the context of standard medical examinations. **B. Ketamine:** Although Ketamine has antidepressant properties and increases the seizure threshold (making seizures easier to induce), it is rarely used as a first-line agent in ECT because it can cause post-ictal emergence delirium and significant sympathetic stimulation (hypertension/tachycardia). **C. Amiodarone:** This is a Class III antiarrhythmic used for ventricular arrhythmias. It has no role in the induction of anesthesia or seizure management in ECT. **D. Labetalol:** This is a beta-blocker used to manage the transient hypertensive surge that occurs during ECT. While it may be used as an *adjunct* in patients with cardiovascular risk, it is not the primary medication used to perform the procedure itself. **High-Yield Clinical Pearls for NEET-PG:** * **Ideal Induction Agent:** Methohexital (due to minimal anticonvulsant activity). * **Muscle Relaxant of Choice:** Succinylcholine (short-acting, prevents musculoskeletal injury). * **Pre-medication:** Atropine or Glycopyrrolate (to prevent vagally-mediated bradycardia and reduce secretions). * **Seizure Duration:** A therapeutic seizure should ideally last **25–60 seconds**. * **Absolute Contraindication:** Increased intracranial pressure (ICP).

Question 1

Which antipsychotic medication is associated with decreased weight?

Accepted Answer

Ziprasidone

Answer

Olanzapine

Answer

Quetiapine

Answer

Clozapine

Question 2

What is an important side effect of ECT?

Accepted Answer

Retrograde amnesia

Answer

Death

Answer

Respiratory failure

Answer

Cardiac failure

Question 3

Which of the following groups of drugs is known to cause neurogenic dislocation?

Accepted Answer

Antipsychotic drugs

Answer

Anxiolytics

Answer

Antiparkinsonism drugs

Answer

None of the above

Question 4

What is the treatment for lithium-induced tremor?

Accepted Answer

Propranolol

Answer

Amiloride

Answer

Modafinil

Answer

Trihexyphenidyl

Question 5

Which antipsychotic medication is known to cause cataracts?

Accepted Answer

Ziprasidone

Answer

Aripiprazole

Answer

Olanzapine

Answer

Risperidone

Question 6

Which of the following is a known side effect of bupropion?

Accepted Answer

Seizures

Answer

Relapse of smoking

Answer

Impaired attention

Answer

Decreased sexual desire

Question 7

A 23-year-old male with schizophrenia is stable on risperidone for the past 2 months. What is the recommended duration of treatment for this patient?

Accepted Answer

2 years

Answer

5 years

Answer

6 months

Answer

12 months

Question 8

What is the maximum benefit of Electroconvulsive Therapy (ECT)?

Accepted Answer

Depression with suicidal tendency

Answer

Hysteria

Answer

Mania

Answer

Chronic Schizophrenia

Question 9

Which of the following drugs are used in the treatment of schizophrenia?

Accepted Answer

Rivastigmine

Answer

Chlordiazepoxide

Answer

Trifluoperazine

Answer

Clozapine

Question 10

Which of the following medications is used in Electroconvulsive Therapy (ECT)?

Accepted Answer

Thiopentone

Answer

Ketamine

Answer

Amiodarone

Answer

Labetalol

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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