Psychopharmacology Practice Questions

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: A 30-year-old female, married for one year, presents with hyperactivity for two weeks. A diagnosis of mania is made. She has had three prior episodes of mania in the last five years, and each time her symptoms resolved after medication. Her urine pregnancy test is positive. Which is the preferred drug for the management of this patient?

Haloperidol. **Explanation:** The patient is a 30-year-old pregnant female presenting with an acute episode of mania. The management of bipolar disorder during pregnancy requires balancing maternal stability with fetal safety. **1. Why Haloperidol is the correct answer:** In acute mania during pregnancy, **First-Generation Antipsychotics (FGAs)** like **Haloperidol** are considered the first-line treatment. Haloperidol has a long-standing safety record in pregnancy; it is not associated with significant teratogenic risks (unlike mood stabilizers) and effectively controls hyperactivity and psychotic symptoms. It is the preferred agent when rapid stabilization is required in a pregnant patient. **2. Why the other options are incorrect:** * **Lithium:** While highly effective for mania, Lithium is associated with **Ebstein’s anomaly** (a cardiac malformation) if used during the first trimester. It is generally avoided in the initial management of a newly diagnosed pregnancy unless other options fail. * **Clonazepam:** Benzodiazepines can be used as adjuncts for sedation, but they are not primary anti-manic agents. There are also concerns regarding "floppy infant syndrome" and cleft palate with high-dose use in pregnancy. * **Promethazine:** This is an antihistamine with sedative properties, often used for morning sickness or mild sedation, but it has no efficacy in treating the core symptoms of mania. **Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC) for Mania in Pregnancy:** Haloperidol. * **Teratogenicity:** Lithium (Ebstein’s Anomaly), Valproate (Neural Tube Defects - highest risk), Carbamazepine (Neural Tube Defects). * **Safe Mood Stabilizer:** If a mood stabilizer must be used later in pregnancy, Lithium is safer than Valproate. * **ECT in Pregnancy:** Electroconvulsive therapy is considered safe and highly effective for severe, refractory mania or depression during pregnancy.

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: What is akathisia?

An inner sense of restlessness and anxiety. **Explanation:** **Akathisia** is the most common extrapyramidal side effect (EPS) associated with antipsychotic medications (especially first-generation antipsychotics). It is characterized by a subjective **inner sense of restlessness** and an objective need to move. Patients often describe it as "jumping out of their skin" or an inability to sit still. * **Why Option A is correct:** Akathisia is unique among movement disorders because it has both a **sensory component** (internal tension/anxiety) and a **motor component** (pacing, shifting weight, or foot tapping). The core diagnostic feature is this subjective distress. **Analysis of Incorrect Options:** * **Option B:** The **bucco-linguo-masticatory triad** (lip-smacking, tongue protrusion, and chewing motions) is the classic presentation of **Tardive Dyskinesia**, a late-onset EPS due to dopamine receptor supersensitivity. * **Option C:** Involuntary distal limb movements (like "pill-rolling" tremors) are characteristic of **Drug-Induced Parkinsonism**. Akathisia involves voluntary movements performed to relieve an involuntary sensation. * **Option D:** While anxiety is present, "worthlessness" is a cognitive symptom of depression, not a component of a motor side effect. **NEET-PG High-Yield Pearls:** 1. **Management:** The first-line treatment for akathisia is **Beta-blockers (Propranolol)**. Centrally acting anticholinergics or Benzodiazepines are second-line. 2. **Clinical Risk:** Akathisia is strongly associated with an increased risk of **suicidality** and treatment non-compliance due to the extreme distress it causes. 3. **Timeline:** It typically develops within days to weeks of starting or increasing the dose of an antipsychotic.

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).

Q: Hyperthermia is seen in:

Malignant neuroleptic syndrome. **Explanation:** **Neuroleptic Malignant Syndrome (NMS)** is a life-threatening idiosyncratic reaction to antipsychotic drugs (neuroleptics). It is characterized by a "tetrad" of clinical features: **Hyperthermia** (often >38°C), severe muscular "lead-pipe" rigidity, autonomic instability (tachycardia, hypertension), and altered mental status. The underlying pathophysiology involves massive dopamine blockade in the hypothalamus (disrupting thermoregulation) and the basal ganglia (causing rigidity and secondary heat production). **Analysis of Incorrect Options:** * **Cannabis Poisoning:** Typically presents with tachycardia, conjunctival injection, increased appetite, and dry mouth. It does not cause significant hyperthermia. * **Opium Intoxication:** Characterized by the "Opioid Triad" of CNS depression (coma), miosis (pinpoint pupils), and respiratory depression. It typically causes **hypothermia**, not hyperthermia. * **Hypothyroidism:** Leads to a generalized slowing of metabolic processes, resulting in **hypothermia** and cold intolerance. Hyperthermia is instead a hallmark of Hyperthyroidism (Thyroid Storm). **Clinical Pearls for NEET-PG:** * **Key Lab Finding:** Elevated **Creatine Phosphokinase (CPK)** levels due to muscle rigidity and rhabdomyolysis. * **Treatment of Choice:** Immediate cessation of the offending agent, supportive care, and pharmacotherapy with **Dantrolene** (muscle relaxant) or **Bromocriptine** (dopamine agonist). * **Differential Diagnosis:** Distinguish NMS from **Serotonin Syndrome**, which presents with hyperreflexia and myoclonus rather than lead-pipe rigidity.

Q: Which of the following statements is true regarding transcranial magnetic stimulation (TMS)?

All of the above. **Explanation:** Transcranial Magnetic Stimulation (TMS) is a non-invasive neuromodulation technique used primarily in treatment-resistant depression. It works on the principle of **electromagnetic induction**, where a coil placed against the scalp generates rapidly changing magnetic fields. these fields pass through the skull and induce electrical currents in specific cortical regions (usually the dorsolateral prefrontal cortex). **Why Option D is correct:** * **Option A (No General Anesthesia):** Unlike Electroconvulsive Therapy (ECT), TMS does not cause systemic convulsions or loss of consciousness. Therefore, it is an outpatient procedure that requires no anesthesia or muscle relaxants. * **Option B (Seizures not required):** The therapeutic mechanism of TMS is the modulation of neuronal firing and neuroplasticity, not the induction of a generalized seizure. In fact, a seizure is considered a rare adverse effect of TMS, not a goal. * **Option C (Non-invasive CNS stimulant):** TMS is non-invasive as it does not require surgery or electrode implantation. High-frequency TMS (>5 Hz) typically acts as a stimulant to the underlying cortical neurons. **High-Yield Clinical Pearls for NEET-PG:** * **FDA Approval:** Major Depressive Disorder (MDD), OCD, Migraine with aura, and Smoking Cessation. * **Most Common Side Effect:** Headache and scalp discomfort at the site of stimulation. * **Most Serious Side Effect:** Accidental induction of a seizure (rare). * **Contraindication:** Presence of metallic implants in or near the head (e.g., cochlear implants, aneurysm clips, or pacemakers) due to the magnetic field. * **Comparison with ECT:** TMS is less effective than ECT for severe/psychotic depression but has a superior cognitive safety profile (no memory loss).

Q: Which of the following antidepressants is also known by the brand name Zyban?

Bupropion. **Explanation:** **Bupropion (Option B)** is the correct answer. It is a unique antidepressant that acts as a **Norepinephrine-Dopamine Reuptake Inhibitor (NDRI)**. It is marketed under two primary brand names: **Wellbutrin** (for Major Depressive Disorder) and **Zyban** (specifically indicated as an aid for **smoking cessation**). By increasing dopamine levels in the reward pathway, it helps reduce nicotine cravings and withdrawal symptoms. **Analysis of Incorrect Options:** * **Amitriptyline (Option A):** A classic Tricyclic Antidepressant (TCA). Common brand names include Elavil and Tryptomer. It is primarily used for depression, neuropathic pain, and migraine prophylaxis. * **Fluoxetine (Option C):** A prototype Selective Serotonin Reuptake Inhibitor (SSRI). Its most famous brand name is **Prozac**. It is known for its long half-life and active metabolite (norfluoxetine). * **Mianserin (Option D):** A tetracyclic antidepressant (TeCA) that acts as an alpha-2 antagonist. It is less commonly used today due to the risk of agranulocytosis. **High-Yield Clinical Pearls for NEET-PG:** 1. **Seizure Risk:** Bupropion is contraindicated in patients with **epilepsy** or **eating disorders** (bulimia/anorexia) as it lowers the seizure threshold. 2. **Sexual Dysfunction:** Unlike SSRIs, Bupropion does **not** cause sexual dysfunction or significant weight gain, making it a preferred choice for patients concerned about these side effects. 3. **ADHD:** It is sometimes used off-label for ADHD due to its effect on dopamine and norepinephrine. 4. **Mechanism:** It lacks significant activity at serotonin receptors, which explains its unique side effect profile.

Q: A psychiatric patient taking medication develops a tremor, thyroid enlargement, and leucocytosis. Which drug is most likely implicated?

Lithium. **Explanation:** The clinical triad of **tremor, thyroid enlargement (goiter), and leucocytosis** is a classic presentation of **Lithium** side effects. Lithium is the gold standard mood stabilizer used for Bipolar Affective Disorder (BPAD). * **Why Lithium is correct:** 1. **Tremors:** Fine tremors are the most common side effect of Lithium. (Coarse tremors indicate toxicity). 2. **Thyroid Enlargement:** Lithium inhibits the release of thyroid hormones ($T_3$ and $T_4$) by interfering with thyroglobulin iodination, leading to compensatory TSH rise and goiter/hypothyroidism. 3. **Leucocytosis:** Lithium stimulates granulopoiesis in the bone marrow, causing a harmless increase in the White Blood Cell (WBC) count. This is sometimes used therapeutically in Felty’s syndrome. **Analysis of Incorrect Options:** * **Clomipramine:** A Tricyclic Antidepressant (TCA). While it can cause tremors, it is more commonly associated with anticholinergic effects (dry mouth, blurred vision) and cardiac arrhythmias. * **Haloperidol:** A typical antipsychotic. It causes Extrapyramidal Symptoms (EPS) like dystonia and parkinsonism (resting tremor), but does not cause goiter or leucocytosis. * **Olanzapine:** An atypical antipsychotic. Its primary side effects are significant weight gain, metabolic syndrome, and sedation. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Index:** Lithium has a narrow therapeutic index (0.6–1.2 mEq/L). * **Renal Effects:** Causes Nephrogenic Diabetes Insipidus (treated with Amiloride). * **Teratogenicity:** Associated with **Ebstein’s Anomaly** (atrialization of the right ventricle). * **Drug Interactions:** Thiazides, NSAIDs, and ACE inhibitors increase Lithium levels, potentially leading to toxicity.

Question 1

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 2

A 30-year-old female, married for one year, presents with hyperactivity for two weeks. A diagnosis of mania is made. She has had three prior episodes of mania in the last five years, and each time her symptoms resolved after medication. Her urine pregnancy test is positive. Which is the preferred drug for the management of this patient?

Accepted Answer

Haloperidol

Answer

Promethazine

Answer

Clonazepam

Answer

Lithium

Question 3

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

Accepted Answer

Rivastigmine

Answer

Chlordiazepoxide

Answer

Trifluoperazine

Answer

Clozapine

Question 4

What is akathisia?

Accepted Answer

An inner sense of restlessness and anxiety

Answer

A bucco-linguo-masticatory triad

Answer

Involuntary distal limb movements

Answer

An increased sensation of worthlessness and anxiety

Question 5

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

Accepted Answer

Thiopentone

Answer

Ketamine

Answer

Amiodarone

Answer

Labetalol

Question 6

Hyperthermia is seen in:

Accepted Answer

Malignant neuroleptic syndrome

Answer

Cannabis poisoning

Answer

Opium intoxication

Answer

Hypothyroidism

Question 7

Which of the following statements is true regarding transcranial magnetic stimulation (TMS)?

Accepted Answer

All of the above

Answer

Does not require general anesthesia.

Answer

Seizures are not required for therapeutic effects.

Answer

It is a non-invasive central nervous system stimulant.

Question 8

Which of the following antidepressants is also known by the brand name Zyban?

Accepted Answer

Bupropion

Answer

Amitriptyline

Answer

Fluoxetine

Answer

Mianserin

Question 9

A female patient presented with depressed mood, loss of appetite, insomnia, and no interest in her surroundings for the past one year. The onset of depression was preceded by a history of business loss. Which of the following statements regarding the management of this patient is true?

Accepted Answer

Start SSRI treatment based on the side effect profile.

Answer

No treatment is necessary as the symptoms are due to business loss.

Answer

SSRI is the most efficacious of the available antidepressant drugs.

Answer

Combination therapy of two antidepressant drugs is indicated.

Question 10

A psychiatric patient taking medication develops a tremor, thyroid enlargement, and leucocytosis. Which drug is most likely implicated?

Accepted Answer

Lithium

Answer

Clomipramine

Answer

Haloperidol

Answer

Olanzapine

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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