Psychopharmacology Practice Questions

Q: Atypical depression is managed with:

MAOI. ***MAOI*** - **MAOIs** (Monoamine Oxidase Inhibitors) are the **most effective treatment** for atypical depression, as demonstrated by multiple clinical studies including the landmark Columbia study. - They show **superior efficacy** compared to other antidepressants for the characteristic features of atypical depression: **mood reactivity**, **increased appetite/weight gain**, **hypersomnia**, **leaden paralysis**, and **rejection sensitivity**. - While requiring **dietary restrictions** (avoiding tyramine-rich foods) and careful monitoring for drug interactions, MAOIs remain the **gold standard treatment** when treating atypical depression specifically. - Examples include phenelzine and tranylcypromine. *SSRI* - **SSRIs** are commonly used as **first-line treatment in clinical practice** due to their favorable safety profile and ease of use. - However, they are **less effective than MAOIs** for atypical depression specifically, though they are still beneficial and widely prescribed due to tolerability. - Preferred when safety, tolerability, and patient compliance are prioritized over maximal efficacy. *SNRI* - **SNRIs** (Serotonin-Norepinephrine Reuptake Inhibitors) are effective for various forms of depression but are not the most effective option for atypical depression. - May be beneficial for patients with **comorbid pain** or **fatigue symptoms** due to their dual mechanism of action. *NDRI* - **NDRIs** (Norepinephrine-Dopamine Reuptake Inhibitors), such as bupropion, are useful for depression with **low energy** or **anhedonia**. - Not specifically indicated for the characteristic features of atypical depression like **mood reactivity** or **leaden paralysis**. - Often chosen when avoiding sexual side effects or weight gain is important.

Q: Which class of drugs is primarily used for the treatment of schizophrenia?

Antipsychotic medications. ***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.

Q: A 43-year-old lady presents to the emergency department with an acute attack of anxiety, accompanied by physical symptoms such as hyperventilation, increased heart rate, and sweating, and is diagnosed with an acute panic attack. Which of the following is the most suitable drug for this patient?

Alprazolam. ***Alprazolam*** - **Alprazolam** is a **fast-acting benzodiazepine** with a quick onset of action, making it ideal for the immediate relief of acute panic attack symptoms. - It works by enhancing the effect of **GABA**, leading to rapid central nervous system depression and swift reduction of anxiety. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** that is effective for long-term management of panic disorder. - However, its **therapeutic effects** take several weeks to manifest, making it unsuitable for acute symptom relief. *Propranolol* - **Propranolol** is a **beta-blocker** that can help manage the physical symptoms of anxiety like palpitations and tremor. - It does not directly address the psychological component of **anxiety** or **panic attacks** effectively. *Eszopiclone* - **Eszopiclone** is a **non-benzodiazepine hypnotic** primarily used for the treatment of insomnia. - It is not indicated for the management of **acute anxiety** or **panic attacks**.

Q: The patient presented with a contraction of the neck, describing it as painful, which started after an injection given at the psychiatry hospital for his psychosis. What type of side effect was caused by the drug?

dystonia. ***Dystonia*** - **Dystonia** involves sustained or repetitive muscle contractions, often causing twisting and repetitive movements or abnormal fixed postures. - An acute onset of painful neck contraction (like **torticollis**) following an injection of antipsychotics points to an acute dystonic reaction. *Neuroleptic Malignant Syndrome* - **Neuroleptic Malignant Syndrome (NMS)** is characterized by **fever**, **muscle rigidity**, **altered mental status**, and **autonomic instability**. - While serious, NMS presents with a constellation of symptoms far beyond just a neck contraction. *Akathisia* - **Akathisia** is a subjective feeling of inner restlessness and the need to move, often manifesting as pacing or fidgeting. - It does not typically involve painful, fixed muscle contractions as described in the patient's presentation. *Tardive Dyskinesia* - **Tardive dyskinesia** involves involuntary, repetitive movements, most often of the face and mouth (e.g., lip smacking, grimacing). - It typically develops after **prolonged exposure** to antipsychotics and is generally not an acute reaction to a single injection.

Q: In obsessive-compulsive disorder, which medication is least likely to be prescribed?

Haloperidol. ***Haloperidol*** - **Haloperidol** is a **first-generation antipsychotic** primarily used to treat psychotic disorders like schizophrenia or severe agitation, not OCD as a primary treatment. - Antipsychotics are generally not indicated for OCD unless used as an **adjunctive treatment** in very severe, treatment-resistant cases, or if there's comorbidity with a psychotic disorder. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that is a potent serotonin reuptake inhibitor. - It is one of the **oldest and most effective medications** specifically approved for the treatment of OCD. *Sertraline* - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)** and is a first-line treatment for OCD due to its efficacy and favorable side-effect profile. - It is commonly prescribed to increase **serotonin levels** in the brain, which helps reduce obsessive thoughts and compulsive behaviors. *Fluoxetine* - **Fluoxetine** is also an **SSRI** and is a first-line medication for OCD. - It is widely used to manage OCD symptoms by enhancing **serotonergic neurotransmission**.

Q: What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?

Folate. ***Folate*** - **Folate (vitamin B9) deficiency** is strongly linked to depression and is a well-established cause of relapse in patients treated with antidepressants. - Folate plays a crucial role in the **one-carbon metabolism pathway**, which is essential for the synthesis of monoamine neurotransmitters including **serotonin, norepinephrine, and dopamine**. - Studies show that **low folate levels** are associated with poor response to SSRIs and TCAs, and folate supplementation can improve antidepressant efficacy. - Approximately **30% of depressed patients** have folate deficiency, making it a clinically significant factor in treatment resistance and relapse. *Cobalamin* - **Cobalamin (vitamin B12)** deficiency can cause neuropsychiatric symptoms including depression and cognitive impairment. - While B12 is important for myelin formation and neurotransmitter synthesis, it is less specifically implicated in antidepressant relapse compared to folate. - B12 deficiency more commonly presents with **cognitive and neurological symptoms** rather than pure mood symptoms. *Pyridoxine* - **Pyridoxine (vitamin B6)** is a cofactor in neurotransmitter synthesis, including serotonin and dopamine. - While B6 deficiency can contribute to mood disturbances, it is not commonly implicated as a primary cause of relapse in antidepressant-treated depression. *Ascorbate* - **Ascorbate (vitamin C)** is an antioxidant with some role in neurotransmitter metabolism. - Severe vitamin C deficiency (scurvy) can have psychiatric manifestations, but it is not typically associated with relapse in patients treated with SSRIs or TCAs.

Q: Best use of lithium is in:

Prophylaxis of bipolar mood disorder. ***Prophylaxis of bipolar mood disorder*** - **Lithium** is a highly effective mood stabilizer primarily used for the **long-term prevention of both manic and depressive episodes** in bipolar disorder. - Its prophylactic benefits include reducing the **frequency and severity of mood swings**, thereby improving overall stability and functioning. *Treatment of schizophrenia* - While lithium can sometimes be used as an **adjunctive treatment** in schizophrenia, it is not a primary agent and is not the best use. - **Antipsychotics** are the first-line treatment for schizophrenia. *Treatment of recurrent depression* - Lithium can be used as an **augmentation strategy** for recurrent unipolar depression that hasn't responded to antidepressants. - However, for unipolar depression, it is not considered the **best or primary treatment**, which typically involves antidepressants. *Treatment of first depressive episode* - For a first depressive episode, **antidepressants** are the first-line pharmacotherapy. - Lithium is generally not indicated as a primary treatment for initial episodes of unipolar depression.

Q: A patient is experiencing subtle involuntary movements of his hands, feet, lips, and tongue. What is the expected response of these symptoms during the tapering of antipsychotic medication?

It will initially increase as the medication is decreased.. ***It will initially increase as the medication is decreased.*** - The involuntary movements described are characteristic of **tardive dyskinesia**, a side effect of long-term antipsychotic use. - When antipsychotic medication is tapered or discontinued, the **dopamine receptors**, which have been chronically blocked, become hypersensitive, leading to an initial worsening or unmasking of dyskinetic movements due to temporary dopamine overdrive. *It will resolve immediately after the medication is decreased.* - Tardive dyskinesia symptoms rarely resolve immediately upon antipsychotic reduction or discontinuation; instead, they often become **more pronounced** as receptor sensitivity changes. - The withdrawal of the medication unmasks the underlying dopamine receptor hypersensitivity, leading to an initial increase rather than immediate resolution. *It will remain the same.* - The dynamic nature of dopamine receptor hypersensitivity means that symptoms of tardive dyskinesia are unlikely to remain stable during changes in antipsychotic dosage. - **Dopamine receptor sensitivity** is altered by the change in medication levels, leading to a noticeable shift in symptom severity. *It will resolve in his hands but not in his feet.* - Tardive dyskinesia typically affects muscle groups globally, often including movements of the **face, trunk, and extremities**, rather than resolving in some areas and not others. - The pathophysiology involving **widespread dopamine receptor changes** does not usually manifest with selective resolution in specific body parts.

Q: A 22-year-old woman presents with complaints of an intense urge to shower, spending hours in the shower and finding it difficult to exit. She follows a rigid sequence of actions while bathing, scrubbing each body part three times in the same order. Although aware that this behavior is abnormal, she becomes anxious if she attempts to deviate from this pattern. Her work as a receptionist is frequently disrupted due to her tardiness, yet she gets along well with her coworkers. What is the most appropriate first-line pharmacological treatment for her condition?

Fluvoxamine. ***Fluvoxamine*** - The patient's symptoms of intense urges, compulsive showering rituals, and significant anxiety upon deviation are characteristic of **Obsessive-Compulsive Disorder (OCD)**. - **SSRIs** (Selective Serotonin Reuptake Inhibitors), such as fluvoxamine, are considered the first-line pharmacologic treatment for OCD due to their efficacy in reducing obsessive thoughts and compulsive behaviors. *Buspirone* - Buspirone is an **anxiolytic** primarily used for generalized anxiety disorder, but it has limited efficacy in treating the core symptoms of OCD. - It works as a **serotonin 5-HT1A receptor partial agonist** and does not target the specific neurochemical imbalances associated with OCD. *Haloperidol* - Haloperidol is a **first-generation antipsychotic** used to treat psychotic disorders (e.g., schizophrenia) and severe behavioral disturbances. - It is not indicated for OCD as a primary treatment and its side effects, including **extrapyramidal symptoms**, make it unsuitable for this condition unless there are comorbid psychotic features. *Quetiapine* - Quetiapine is a **second-generation antipsychotic** used for conditions like schizophrenia, bipolar disorder, and as an adjunct for major depressive disorder. - While sometimes used **off-label as an augmentation strategy** in refractory OCD, it is not considered a first-line treatment and carries a risk of metabolic side effects.

Question 1

Atypical depression is managed with:

Accepted Answer

MAOI

Answer

NDRI

Answer

SSRI

Answer

SNRI

Question 2

Which class of drugs is primarily used for the treatment of schizophrenia?

Accepted Answer

Antipsychotic medications

Answer

Mood stabilizers

Answer

Antihistamines

Answer

Antidepressants

Question 3

A 43-year-old lady presents to the emergency department with an acute attack of anxiety, accompanied by physical symptoms such as hyperventilation, increased heart rate, and sweating, and is diagnosed with an acute panic attack. Which of the following is the most suitable drug for this patient?

Accepted Answer

Alprazolam

Answer

Sertraline

Answer

Propranolol

Answer

Eszopiclone

Question 4

The patient presented with a contraction of the neck, describing it as painful, which started after an injection given at the psychiatry hospital for his psychosis. What type of side effect was caused by the drug?

Accepted Answer

dystonia

Answer

neuroleptic malignant syndrome

Answer

tardive dyskinesia

Answer

akathisia

Question 5

In obsessive-compulsive disorder, which medication is least likely to be prescribed?

Accepted Answer

Haloperidol

Answer

Sertraline

Answer

Clomipramine

Answer

Fluoxetine

Question 6

What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?

Accepted Answer

Folate

Answer

Pyridoxine

Answer

Cobalamin

Answer

Ascorbate

Question 7

A patient is brought to the casualty in a state of altered sensorium, having been treated with lithium for an affective disorder. On examination, the patient exhibits tremors, increased deep tendon reflexes, urinary incontinence, and has experienced an episode of epileptic fits. The patient had an episode of severe gastroenteritis two days prior. The patient's serum lithium level is 1.95 mmol/L. What is the direct cause of the patient's current clinical presentation?

Accepted Answer

Elevated serum lithium level

Answer

Dehydration due to gastroenteritis

Answer

Manic episode

Answer

Depressive stupor

Question 8

Best use of lithium is in:

Accepted Answer

Prophylaxis of bipolar mood disorder

Answer

Treatment of schizophrenia

Answer

Treatment of recurrent depression

Answer

Treatment of first depressive episode

Question 9

A patient is experiencing subtle involuntary movements of his hands, feet, lips, and tongue. What is the expected response of these symptoms during the tapering of antipsychotic medication?

Accepted Answer

It will initially increase as the medication is decreased.

Answer

It will resolve immediately after the medication is decreased.

Answer

It will remain the same.

Answer

It will resolve in his hands but not in his feet.

Question 10

A 22-year-old woman presents with complaints of an intense urge to shower, spending hours in the shower and finding it difficult to exit. She follows a rigid sequence of actions while bathing, scrubbing each body part three times in the same order. Although aware that this behavior is abnormal, she becomes anxious if she attempts to deviate from this pattern. Her work as a receptionist is frequently disrupted due to her tardiness, yet she gets along well with her coworkers. What is the most appropriate first-line pharmacological treatment for her condition?

Accepted Answer

Fluvoxamine

Answer

Haloperidol

Answer

Quetiapine

Answer

Buspirone

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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