Psychopharmacology Practice Questions

Q: Clozapine therapy should be stopped when the WBC count falls lower than what value?

3000 / mm3. **Explanation:** Clozapine is an atypical antipsychotic reserved for treatment-resistant schizophrenia. Its most serious side effect is **agranulocytosis** (a life-threatening drop in white blood cell count), which occurs in approximately 0.8–1% of patients. To mitigate this risk, strict hematological monitoring is mandatory. **Why Option A is correct:** According to standard clinical guidelines (and frequently tested NEET-PG protocols), Clozapine therapy must be **immediately interrupted** if the **Total Leukocyte Count (WBC) falls below 3000/mm³** or if the **Absolute Neutrophil Count (ANC) falls below 1500/mm³**. This threshold acts as a safety buffer to prevent progression to severe agranulocytosis. **Analysis of Incorrect Options:** * **Option B (1500 / mm³):** This is the threshold for the **ANC (Absolute Neutrophil Count)**, not the total WBC count. Confusing WBC and ANC values is a common examiner trap. * **Option C (2000 / mm³):** While this indicates moderate leukopenia, the protocol mandates stopping the drug earlier (at 3000) to ensure patient safety. * **Option D (1000 / mm³):** An ANC below 500–1000/mm³ is defined as severe agranulocytosis. Waiting for the count to reach this level before stopping the drug would put the patient at extreme risk of fatal sepsis. **High-Yield Clinical Pearls for NEET-PG:** * **Monitoring Schedule:** Weekly for the first 6 months, every 2 weeks for the next 6 months, and monthly thereafter. * **Other Side Effects:** Sialorrhea (hypersalivation), sedation, weight gain, and lowering of the seizure threshold (dose-dependent). * **Drug of Choice:** Clozapine is the gold standard for **treatment-resistant schizophrenia** and for reducing **suicidal behavior** in schizophrenic patients. * **Note:** Clozapine is the only antipsychotic that does *not* cause Tardive Dyskinesia and has minimal Extrapyramidal Side Effects (EPS).

Q: A 30-year-old man with schizophrenia has been very withdrawn and apathetic for more than 10 years. He is currently taking an antipsychotic agent that is helping him to be more outgoing and sociable. However, the patient is experiencing seizures and agranulocytosis. Which antipsychotic agent is this patient most likely to be taking?

clozapine. **Explanation:** The patient is most likely taking **Clozapine**, which is the "gold standard" for treatment-resistant schizophrenia. **Why Clozapine is the Correct Answer:** 1. **Efficacy on Negative Symptoms:** The patient has been "withdrawn and apathetic" (negative symptoms) for 10 years. Clozapine is highly effective in improving social withdrawal and treatment-refractory cases where other antipsychotics have failed. 2. **Agranulocytosis:** This is the most characteristic and life-threatening side effect of Clozapine (occurring in ~1% of patients). It necessitates mandatory weekly WBC monitoring for the first six months. 3. **Seizures:** Clozapine significantly lowers the seizure threshold in a dose-dependent manner. **Why Other Options are Incorrect:** * **Risperidone (A):** An atypical antipsychotic commonly causing hyperprolactinemia and extrapyramidal symptoms (EPS) at higher doses, but not typically associated with agranulocytosis. * **Thioridazine (B):** A typical antipsychotic known for causing pigmentary retinopathy and QTc prolongation. While it can lower the seizure threshold, it does not cause agranulocytosis. * **Olanzapine (C):** Closely related to clozapine but lacks the risk of agranulocytosis. Its primary side effects are significant weight gain and metabolic syndrome. **NEET-PG High-Yield Pearls:** * **Clozapine** is the only antipsychotic proven to reduce **suicidal behavior** in schizophrenia. * **Side Effect Profile:** Sialorrhea (excessive salivation), weight gain, myocarditis, and constipation (can lead to paralytic ileus). * **Monitoring:** Absolute Neutrophil Count (ANC) must be >1500/mm³ to initiate therapy. * It has the **least potential** for causing Extrapyramidal Symptoms (EPS) and Tardive Dyskinesia.

Q: Which of the following drugs is used for anorexia nervosa?

Cyproheptadine. ### **Explanation: Pharmacotherapy in Anorexia Nervosa** **Correct Option: A. Cyproheptadine** Cyproheptadine is a first-generation antihistamine with potent **5-HT2 receptor antagonist** properties. In the context of Anorexia Nervosa (AN), it is used primarily as an **appetite stimulant**. By blocking serotonin receptors in the hypothalamus, it helps counteract the satiety signals that contribute to restrictive eating patterns. It is particularly beneficial in the **restrictive type** of AN to promote weight gain, though it does not address the underlying body image distortion. **Analysis of Incorrect Options:** * **B. Haloperidol & D. Pimozide:** These are high-potency typical antipsychotics. While they may be used off-label in severe, refractory cases to manage delusional body image or extreme agitation, they are not first-line treatments and carry a high risk of extrapyramidal side effects (EPS). * **C. Chlorpromazine:** This is a low-potency typical antipsychotic. While it was historically used for its sedative and weight-gain side effects, it is rarely used today due to the risk of lowering the seizure threshold and causing orthostatic hypotension in malnourished patients. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Treatment:** Nutritional rehabilitation and **Psychotherapy** (Family-Based Therapy/Maudsley Approach for adolescents; CBT for adults) are the mainstays. * **Fluoxetine (SSRI):** It is the drug of choice for **Bulimia Nervosa**. In Anorexia Nervosa, SSRIs are generally **ineffective** until the patient is weight-restored, as tryptophan (serotonin precursor) levels are low during starvation. * **Olanzapine:** Currently the most preferred atypical antipsychotic for AN due to its side effect of significant weight gain and its ability to reduce obsessive thoughts about food. * **Contraindication:** **Bupropion** is strictly contraindicated in all eating disorders due to an increased risk of seizures.

Q: A 30-year-old male patient with mania was prescribed haloperidol three months ago. For the last two days, he has become restless and kept pacing in his room for a day. On examination, he was found to have tremors of the hand. He is most likely suffering from:

Akathisia. ### Explanation **Correct Option: D. Akathisia** The patient is presenting with **Akathisia**, the most common Extrapyramidal Side Effect (EPS) associated with typical antipsychotics like Haloperidol. Akathisia is characterized by a subjective feeling of inner restlessness and an objective inability to sit still, often manifesting as constant pacing, foot-tapping, or shifting weight. While tremors are classic for drug-induced parkinsonism, they frequently co-exist with akathisia in patients on long-term high-potency neuroleptics. **Analysis of Incorrect Options:** * **A. Anhedonia:** This refers to the inability to feel pleasure, a negative symptom of schizophrenia or a feature of depression, not a motor side effect. * **B. Dystonia:** Acute dystonia involves sudden, involuntary muscle spasms (e.g., torticollis, oculogyric crisis). It typically occurs within hours to days of starting therapy, not after three months. * **C. Restless Leg Syndrome (RLS):** While clinically similar, RLS typically occurs at rest or during the night and is often associated with iron deficiency. In the context of antipsychotic use, motor restlessness is specifically termed akathisia. **NEET-PG High-Yield Pearls:** * **Timeline of EPS:** 1. **Acute Dystonia:** Hours to days (Treatment: Centrally acting anticholinergics like Benztropine/Promethazine). 2. **Akathisia:** Days to weeks (Treatment: **Propranolol** is the drug of choice; Benzodiazepines are second-line). 3. **Drug-induced Parkinsonism:** Weeks to months (Treatment: Trihexyphenidyl). 4. **Tardive Dyskinesia:** Months to years (Treatment: Valbenazine/Deutetrabenazine; switch to Clozapine). * **Mechanism:** EPS is caused by the blockade of **D2 receptors** in the **nigrostriatal pathway**. High-potency drugs (Haloperidol, Fluphenazine) have a higher incidence of EPS compared to low-potency drugs (Chlorpromazine).

Q: Electroconvulsive therapy is currently advocated as a line of treatment in the following conditions except -

Obsessive-compulsive disorder. **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry, primarily indicated for conditions requiring a rapid clinical response or where medications have failed. **Why OCD is the correct answer:** Obsessive-Compulsive Disorder (OCD) is **not** a primary indication for ECT. The first-line treatments for OCD are Selective Serotonin Reuptake Inhibitors (SSRIs) and Cognitive Behavioral Therapy (CBT), specifically Exposure and Response Prevention (ERP). ECT is generally ineffective for the core symptoms of OCD unless it is comorbid with severe, treatment-resistant depression. **Analysis of other options:** * **Catatonic Schizophrenia:** ECT is a first-line treatment for catatonia (regardless of the underlying cause) if benzodiazepines (Lorazepam) fail. It provides rapid relief from life-threatening stupor or excitement. * **Severe Depression with Psychosis:** ECT is considered the "gold standard" for severe depression, especially when associated with psychotic features, high suicide risk, or refusal to eat/drink. * **Manic-Depressive Disorder (Bipolar Disorder):** ECT is indicated for both severe mania (especially delirious mania) and severe bipolar depression when pharmacological interventions are contraindicated or ineffective. **High-Yield NEET-PG Pearls:** * **Absolute Contraindication:** There are no absolute contraindications to ECT, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde amnesia (usually transient). * **Mortality Rate:** Approximately 0.01% (similar to minor general anesthesia). * **Electrode Placement:** Bilateral ECT is more effective but has more cognitive side effects; Unilateral (d'Elia placement) has fewer side effects.

Q: What is the antidepressant agent most likely to cause persistent erections (priapism) in a 40-year-old male patient?

Trazodone. **Explanation:** The correct answer is **Trazodone**. **Mechanism and Rationale:** Trazodone is a Serotonin Antagonist and Reuptake Inhibitor (SARI). The occurrence of priapism (a prolonged, painful erection lasting >4 hours) is a classic, high-yield side effect associated with Trazodone, often colloquially referred to by the mnemonic **"Trazodone stays up all night."** The underlying medical concept involves its potent **alpha-1 adrenergic receptor antagonism**. By blocking alpha-1 receptors, Trazodone prevents the sympathetic nervous system from mediating detumescence (the return of the penis to a flaccid state), leading to venous congestion and persistent erection. This is considered a medical emergency as it can lead to permanent erectile dysfunction if not treated promptly. **Analysis of Incorrect Options:** * **A. Venlafaxine:** An SNRI that typically causes sexual dysfunction in the form of decreased libido or delayed ejaculation, rather than priapism. * **B. Tranylcypromine:** A non-selective MAO inhibitor. While it has many side effects (like hypertensive crisis with tyramine), priapism is not a characteristic feature. * **C. Doxepin:** A Tricyclic Antidepressant (TCA). While TCAs have anticholinergic effects, they are rarely associated with priapism compared to Trazodone. **High-Yield Clinical Pearls for NEET-PG:** * **Trazodone** is frequently used off-label for **insomnia** due to its sedative properties (H1 blockade). * **Management of Priapism:** Initial treatment often involves intracavernosal injection of an alpha-agonist (e.g., **Phenylephrine**). * Other drugs causing priapism: Antipsychotics (especially Chlorpromazine), Sildenafil, and Alprostadil. * In the context of antidepressants and sexual side effects, **Bupropion** is the drug of choice for patients wishing to *avoid* sexual dysfunction.

Q: What is the best drug therapy for paranoid schizophrenia in a thin-built 21-year-old young male?

Olanzapine. **Explanation:** The core clinical challenge in this scenario is managing schizophrenia in a **thin-built** patient. In psychiatry, the side-effect profile of a drug is often utilized as a therapeutic advantage. **Why Olanzapine is the correct answer:** Olanzapine is a highly effective Second-Generation Antipsychotic (SGA). Its most significant side effect is **marked weight gain** and metabolic syndrome (due to H1 and 5HT2C blockade). In a "thin-built" patient, this side effect is clinically desirable to help the patient reach a healthier BMI. Furthermore, as an SGA, it has a lower risk of Extrapyramidal Symptoms (EPS) compared to typical antipsychotics, making it a preferred first-line choice for a young patient. **Analysis of Incorrect Options:** * **Chlorpromazine:** A low-potency typical antipsychotic. It is rarely a first-line choice due to significant sedation, alpha-blockade (orthostatic hypotension), and anticholinergic side effects. * **Risperidone:** A potent SGA. While effective, it is the SGA most likely to cause **Hyperprolactinemia** (leading to gynecomastia/galactorrhea) and EPS at higher doses, which may be less ideal for a young male compared to Olanzapine. * **Quetiapine:** While it also causes weight gain, it is generally less potent than Olanzapine for acute psychosis and is frequently associated with significant sedation, often requiring slow titration. **NEET-PG High-Yield Pearls:** * **Weight Gain Potential:** Clozapine > Olanzapine > Quetiapine > Risperidone. * **Metabolic Neutrality:** Ziprasidone and Aripiprazole are the preferred SGAs if the patient is already obese or has diabetes. * **Drug of Choice:** For treatment-resistant schizophrenia, the answer is always **Clozapine**. * **Young Patients:** Always prioritize SGAs to minimize the risk of Tardive Dyskinesia and acute dystonias associated with older drugs like Haloperidol.

Q: A 21-year-old female presents with auditory and persecutory delusions for one month, including beliefs about neighbors recording her activities and making vulgar comments. Her mother denies hearing any such sounds or conspiracies. The patient is diagnosed with schizophrenia and treated with risperidone 3 mg/day, showing symptomatic improvement. However, she subsequently develops a milky discharge from her nipples. Which brain pathway is primarily responsible for this side effect?

Tubero-infundibular tract. ### Explanation The patient is experiencing **galactorrhea** (milky nipple discharge), a common side effect of antipsychotic medications like Risperidone. This occurs due to the blockade of dopamine receptors in the **Tubero-infundibular tract**. **1. Why the Correct Answer is Right:** In the Tubero-infundibular pathway, dopamine acts as a **prolactin-inhibiting factor**. Under normal conditions, dopamine secreted by the hypothalamus travels to the anterior pituitary to suppress prolactin release. Antipsychotics (D2 receptor antagonists) block this inhibitory effect, leading to **hyperprolactinemia**. Elevated prolactin levels result in galactorrhea, gynecomastia, and menstrual irregularities. **2. Analysis of Incorrect Options:** * **Mesolimbic tract:** Overactivity here is associated with **positive symptoms** of schizophrenia (hallucinations, delusions). Blockade here provides the therapeutic effect. * **Mesocortical tract:** Underactivity here is associated with **negative symptoms** (apathy, withdrawal) and cognitive deficits. * **Corticostriatal tract:** This is not a primary dopaminergic pathway involved in antipsychotic side effects. The **Nigrostriatal tract** (not listed) is the pathway responsible for Extrapyramidal Symptoms (EPS) like parkinsonism and dystonia. **3. NEET-PG High-Yield Pearls:** * **Risperidone** is the atypical antipsychotic most notorious for causing hyperprolactinemia. * **Aripiprazole** (a partial D2 agonist) is often used to manage antipsychotic-induced hyperprolactinemia because it can lower prolactin levels. * **Tubero-infundibular pathway:** Connects the hypothalamus to the pituitary gland. * **Mnemonic for Dopamine Pathways:** * **M**esolimbic = **M**ind (Positive symptoms) * **M**esocortical = **M**ute (Negative symptoms) * **N**igrostriatal = **N**ode/Movement (EPS) * **T**ubero-infundibular = **T**its (Galactorrhea/Prolactin)

Question 1

Clozapine therapy should be stopped when the WBC count falls lower than what value?

Accepted Answer

3000 / mm3

Answer

1500 / mm3

Answer

2000 / mm3

Answer

1000 / mm3

Question 2

A 30-year-old man with schizophrenia has been very withdrawn and apathetic for more than 10 years. He is currently taking an antipsychotic agent that is helping him to be more outgoing and sociable. However, the patient is experiencing seizures and agranulocytosis. Which antipsychotic agent is this patient most likely to be taking?

Accepted Answer

clozapine

Answer

risperidone

Answer

thioridazine

Answer

olanzapine

Question 3

Which of the following drugs is used for anorexia nervosa?

Accepted Answer

Cyproheptadine

Answer

Haloperidol

Answer

Chlorpromazine

Answer

Pimozide

Question 4

A 30-year-old male patient with mania was prescribed haloperidol three months ago. For the last two days, he has become restless and kept pacing in his room for a day. On examination, he was found to have tremors of the hand. He is most likely suffering from:

Accepted Answer

Akathisia

Answer

Anhedonia

Answer

Dystonia

Answer

Restless leg syndrome

Question 5

Electroconvulsive therapy is currently advocated as a line of treatment in the following conditions except -

Accepted Answer

Obsessive-compulsive disorder

Answer

Catatonic schizophrenia

Answer

Severe depression with psychosis

Answer

Manic-depressive disorder

Question 6

Which of the following statements are true regarding lithium treatment in mania?

Accepted Answer

Lithium is 90% protein bound.

Answer

Commonest neurological side effect is tremor.

Answer

Toxic level is less than 1.5 mg/dL serum level.

Answer

Amiloride is the drug of choice for lithium-induced diabetes insipidus.

Question 7

What is the antidepressant agent most likely to cause persistent erections (priapism) in a 40-year-old male patient?

Accepted Answer

Trazodone

Answer

Venlafaxine

Answer

Tranylcypromine

Answer

Doxepin

Question 8

What is the best drug therapy for paranoid schizophrenia in a thin-built 21-year-old young male?

Accepted Answer

Olanzapine

Answer

Chlorpromazine

Answer

Risperidone

Answer

Quetiapine

Question 9

A patient presents with non-stop talking, singing, uncontrollable behavior, and an apparent loss of contact with reality, diagnosed as acute mania. Which of the following is the most suitable drug for rapid control of his symptoms?

Accepted Answer

Haloperidol

Answer

Lithium carbonate

Answer

Phenobarbitone

Answer

Valproic acid

Question 10

A 21-year-old female presents with auditory and persecutory delusions for one month, including beliefs about neighbors recording her activities and making vulgar comments. Her mother denies hearing any such sounds or conspiracies. The patient is diagnosed with schizophrenia and treated with risperidone 3 mg/day, showing symptomatic improvement. However, she subsequently develops a milky discharge from her nipples. Which brain pathway is primarily responsible for this side effect?

Accepted Answer

Tubero-infundibular tract

Answer

Mesolimbic tract

Answer

Mesocortical tract

Answer

Corticostriatal tract

Psychopharmacology — MCQs

Psychopharmacology — MCQs

On this page

Practice by Chapter

Want unlimited practice?