Psychopharmacology Practice Questions

Q: A 4-year-old boy is brought to the physician by his parents for episodes of waking in the middle of the night screaming. The parents state that when they get to the boy's room during one of these episodes, they find him in his bed, thrashing wildly, with his eyes wide open. He pushes them away when they try to comfort him. After 2 minutes, the boy suddenly falls asleep and the next day has no memory of the episode. Which of the following medications is used to treat this disorder?

Diazepam. ### Explanation **Diagnosis: Sleep Terrors (Pavor Nocturnus)** The clinical presentation of a child with sudden nocturnal screaming, autonomic arousal (tachycardia/tachypnea), thrashing, and **complete amnesia** of the event the next morning is classic for **Sleep Terrors**. These occur during **Stage N3 (Slow-wave sleep)**, typically in the first third of the night. **Why Diazepam is Correct:** Sleep terrors occur during deep, slow-wave sleep (N3). **Benzodiazepines (like Diazepam)** are the treatment of choice for severe, persistent cases because they **suppress Stage N3 sleep**. By reducing the time spent in this deep sleep stage, the frequency and intensity of the episodes are diminished. Most cases are self-limiting and require only reassurance, but pharmacotherapy is indicated if the episodes are frequent or pose a risk of injury. **Analysis of Incorrect Options:** * **A. Haloperidol:** An antipsychotic used for schizophrenia or acute psychosis; it has no role in treating NREM parasomnias and may worsen sleep architecture. * **C. Methylphenidate:** A CNS stimulant used for ADHD and Narcolepsy. It would likely worsen sleep disturbances and cause insomnia. * **D. Amitriptyline:** A TCA sometimes used for enuresis or depression. While it affects REM sleep, it is not the first-line treatment for sleep terrors. **NEET-PG High-Yield Pearls:** * **Sleep Terrors vs. Nightmares:** * **Sleep Terrors:** Occur in **N3 (NREM)**; No memory of the dream; Difficult to arouse/comfort. * **Nightmares:** Occur in **REM sleep**; Vivid memory of the dream; Child is easily comforted. * **Age Group:** Most common in children aged 4–12 years. * **Management:** Reassurance is the first step. If medication is needed, low-dose Benzodiazepines (Diazepam/Clonazepam) are preferred.

Q: A 41-year-old man has been treated with haloperidol for his schizophrenia for the past 15 years. He begins to notice subtle involuntary movements of his hands, feet, lips, and tongue. Since he had been stable for over 1 year, his physician decided to decrease the dose. What would the physician tell the patient about the movement disorder?

It will increase initially as the medication is decreased.. **Explanation:** The patient is presenting with **Tardive Dyskinesia (TD)**, a late-onset extrapyramidal side effect caused by long-term use of first-generation antipsychotics like Haloperidol. **Why Option B is correct:** The underlying pathophysiology of TD involves **dopamine receptor supersensitivity**. Chronic blockade of $D_2$ receptors by haloperidol leads to an upregulation (increase in number and sensitivity) of these receptors in the nigrostriatal pathway. When the antipsychotic dose is decreased or discontinued, the "masking" effect of the drug is removed. This allows dopamine to act on these supersensitive receptors, which paradoxically **worsens or unmasks** the involuntary movements initially. This phenomenon is sometimes referred to as "withdrawal dyskinesia." **Why other options are incorrect:** * **Option A & D:** These are incorrect because decreasing the dose does not lead to immediate disappearance. In fact, symptoms often persist for months or may become permanent (irreversible) in many patients. * **Option C:** The movements rarely remain unchanged; they typically fluctuate in intensity following dosage adjustments due to the change in receptor occupancy. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Old age, female gender, and long-term use of typical antipsychotics. * **Clinical Feature:** Characterized by orofacial dyskinesia (tongue protrusion, lip-smacking, chewing) and choreoathetoid movements of limbs. * **Management:** 1. Prevention is key (use lowest effective dose). 2. Switch to **Clozapine** (the antipsychotic with the lowest risk of TD). 3. **VMAT-2 inhibitors** (e.g., Valbenazine, Deutetrabenazine) are now the first-line FDA-approved treatments for TD. * **Note:** Anticholinergics (like Trihexyphenidyl) **worsen** Tardive Dyskinesia, unlike other extrapyramidal symptoms.

Q: Which of the following is not an anxiolytic agent?

Risperidone. **Explanation:** The core of this question lies in distinguishing between drugs that primarily treat psychosis versus those that manage anxiety disorders. **1. Why Risperidone is the Correct Answer:** **Risperidone** is a **Second-Generation (Atypical) Antipsychotic**. Its primary mechanism involves potent antagonism of Dopamine (D2) and Serotonin (5-HT2A) receptors. It is indicated for Schizophrenia, Bipolar Disorder, and irritability in Autism. While it may have secondary calming effects, it is not classified as an anxiolytic agent. **2. Analysis of Incorrect Options:** * **SSRI (Selective Serotonin Reuptake Inhibitors):** These are currently the **first-line pharmacological treatment** for most chronic anxiety disorders, including Panic Disorder, GAD, and Social Anxiety Disorder. * **Clonazepam:** This is a **Benzodiazepine** (BZD). BZDs act as GABA-A receptor agonists, providing rapid relief of acute anxiety symptoms. They are the most commonly used "classical" anxiolytics. * **Buspirone:** This is a **non-benzodiazepine anxiolytic** that acts as a partial agonist at the **5-HT1A receptor**. It is specifically used for Generalized Anxiety Disorder (GAD) and lacks the sedative or addictive potential of BZDs. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC) for GAD:** SSRIs (Long-term); Benzodiazepines (Short-term/Acute). * **Buspirone** takes 2–4 weeks to show anxiolytic effects; it is ineffective for "as-needed" (PRN) use. * **Propranolol** (Beta-blocker) is the drug of choice for **Performance Anxiety** (Stage fright). * **Antidote for Benzodiazepine overdose:** Flumazenil (Competitive antagonist).

Q: Which of the following statements is true regarding Clozapine?

It can cause agranulocytosis.. **Explanation:** **Clozapine** is the prototype of **Atypical Antipsychotics** (Second Generation Antipsychotics). It is uniquely effective but carries a significant side-effect profile that requires strict monitoring. **Why Option B is correct:** The most serious and life-threatening adverse effect of Clozapine is **agranulocytosis** (a severe decrease in white blood cell count, specifically neutrophils), occurring in approximately 1% of patients. Due to this risk, mandatory hematological monitoring (ANC - Absolute Neutrophil Count) is required weekly for the first 6 months, biweekly for the next 6 months, and monthly thereafter. **Why other options are incorrect:** * **Option A:** Clozapine is an **Atypical** antipsychotic, not traditional. Unlike traditional drugs (like Haloperidol), it has a higher affinity for D4 and 5-HT2A receptors than D2 receptors, leading to fewer Extrapyramidal Side Effects (EPS). * **Option C:** Clozapine is administered **orally**. There is no standard parenteral (injectable) formulation used in clinical practice. * **Option D:** Clozapine is the **Gold Standard** and the drug of choice for **Treatment-Resistant Schizophrenia** (defined as failure to respond to at least two other antipsychotic trials). **High-Yield Clinical Pearls for NEET-PG:** * **Seizures:** Clozapine has a dose-dependent risk of seizures (highest among antipsychotics). * **Sialorrhea:** Paradoxical hypersalivation is a common, highly characteristic side effect. * **Metabolic Syndrome:** It causes significant weight gain, dyslipidemia, and diabetes. * **Myocarditis:** A rare but fatal complication; monitor for chest pain or tachycardia. * **Benefit:** It is the only antipsychotic proven to **reduce the risk of suicide** in schizophrenic patients.

Q: All of the following are characteristic features of Neuroleptic Malignant Syndrome EXCEPT:

Decreased creatine phosphokinase (CPK) levels. **Explanation:** Neuroleptic Malignant Syndrome (NMS) is a life-threatening idiosyncratic reaction to antipsychotic drugs (neuroleptics), primarily caused by potent dopamine (D2) receptor blockade in the nigrostriatal pathway and hypothalamus. **Why Option A is the Correct Answer:** In NMS, there is intense, generalized muscular rigidity (often described as "lead-pipe rigidity"). This extreme muscle contraction leads to rhabdomyolysis (muscle breakdown), which causes a significant **increase in serum Creatine Phosphokinase (CPK) levels**, not a decrease. Elevated CPK is a hallmark laboratory finding in NMS and is used to gauge the severity of muscle damage. **Analysis of Incorrect Options:** * **B. Myoclonus:** While "lead-pipe" rigidity is the classic sign, various movement abnormalities including myoclonus, tremors, and choreoathetosis can occur due to basal ganglia dysfunction. * **C. Hyperthermia:** This is a core diagnostic criterion. Central dopamine blockade in the hypothalamus disrupts thermoregulation, leading to high-grade fever (often >38°C/100.4°F). * **D. Increased blood pressure:** Autonomic instability is a key feature of NMS. This manifests as labile blood pressure (hypertension or hypotension), tachycardia, tachypnea, and diaphoresis. **NEET-PG Clinical Pearls:** * **Mnemonic (FEVER):** **F**ever, **E**ncephalopathy (altered sensorium), **V**itals unstable, **E**levated enzymes (CPK), **R**igidity. * **Drug of Choice:** **Dantrolene** (muscle relaxant) or **Bromocriptine** (dopamine agonist). * **NMS vs. Serotonin Syndrome:** NMS is characterized by "lead-pipe" rigidity and bradyreflexia, whereas Serotonin Syndrome presents with hyperreflexia and clonus. * **Most common offending agent:** Haloperidol (High-potency typical antipsychotic).

Q: What is the drug of choice for rapid cyclers in manic-depressive psychosis?

Valproate. **Explanation:** **Valproate** is the drug of choice for **rapid cyclers** (defined as ≥4 episodes of mania or depression per year) and **mixed episodes** in Bipolar Affective Disorder (BPAD). While Lithium remains the gold standard for classic bipolar disorder, it is notably less effective in patients with rapid cycling patterns. Valproate’s superior efficacy in these cases is attributed to its multi-modal mechanism, including GABA enhancement and modulation of glutamate and sodium channels. **Analysis of Options:** * **Valproate (Correct):** Preferred for rapid cycling, mixed states, and patients who do not respond to Lithium. * **Lithium (Incorrect):** Though the first-line agent for typical mania and prophylaxis, it has a high failure rate in rapid cyclers. * **Carbamazepine (Incorrect):** Used as a second-line mood stabilizer or in refractory cases, but it is not the primary drug of choice for rapid cycling. It is also a potent enzyme inducer, complicating its side-effect profile. * **Phenytoin (Incorrect):** This is an anti-epileptic drug with no established role as a mood stabilizer in psychiatric practice. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Window:** Lithium has a narrow therapeutic index (0.8–1.2 mEq/L for acute mania; 0.5–0.8 mEq/L for maintenance). * **Teratogenicity:** Lithium causes **Ebstein’s Anomaly** (tricuspid valve defect), while Valproate is associated with **Neural Tube Defects** (Spina Bifida). * **Drug of Choice Summary:** * Classic Mania: Lithium * Rapid Cyclers/Mixed Mania: Valproate * Bipolar Depression: Quetiapine, Lurasidone, or Lamotrigine.

Q: Depression is not a known side effect of which of the following medications?

Flupenthixol. **Explanation** The correct answer is **Flupenthixol**. **1. Why Flupenthixol is the correct answer:** Flupenthixol is a typical antipsychotic of the thioxanthene class. Unlike many other antipsychotics that can cause "neuroleptic-induced deficit syndrome" (mimicking depression), flupenthixol is unique because, at **low doses (0.5 mg – 3 mg)**, it exerts **antidepressant and anxiolytic effects**. It is frequently used clinically in the management of mild-to-moderate depression and dysthymia, often in combination with melitracen. Therefore, it is a treatment for depression rather than a cause. **2. Analysis of incorrect options:** * **Propranolol:** Beta-blockers (especially lipophilic ones like propranolol) are classically associated with depressive symptoms, fatigue, and sleep disturbances due to their ability to cross the blood-brain barrier and interfere with central adrenergic signaling. * **Oral Contraceptives (OCPs):** Hormonal fluctuations caused by OCPs can lead to mood changes. Progestogen-only components, in particular, have been linked to an increased risk of developing depressive symptoms in susceptible individuals. * **Reserpine:** This is a classic "textbook" cause of depression. It works by irreversibly inhibiting the Vesicular Monoamine Transporter (VMAT), leading to the depletion of norepinephrine, serotonin, and dopamine. This observation historically contributed to the "Monoamine Hypothesis" of depression. **3. NEET-PG High-Yield Pearls:** * **Drugs causing depression:** Steroids (most common), Isotretinoin, Interferon-alpha, Methyldopa, L-dopa, and Ethionamide. * **Flupenthixol dosage:** Low dose = Antidepressant; High dose = Antipsychotic. * **Reserpine-induced depression** is often used as an animal model to test new antidepressant drugs.

Q: Which of the following is a relative contraindication for Electroconvulsive Therapy (ECT)?

Raised intracranial tension. **Explanation:** **Electroconvulsive Therapy (ECT)** is a highly effective treatment for severe psychiatric disorders. While it has no absolute contraindications, certain conditions pose significant risks. **Why Raised Intracranial Tension (ICT) is the correct answer:** Raised ICT is considered the most significant **relative contraindication** for ECT. During the seizure induced by ECT, there is a transient but sharp increase in cerebral blood flow and blood pressure. In a patient with already elevated ICT (e.g., due to a space-occupying lesion), this surge can lead to **brain herniation**, which is potentially fatal. **Analysis of Incorrect Options:** * **Vascular Dementia:** ECT is not contraindicated here; in fact, it is often used to treat "pseudodementia" or severe depression in elderly patients with cognitive decline. * **Diabetic Retinopathy:** While severe hypertension during ECT could theoretically risk retinal hemorrhage, it is not a standard contraindication. Modern anesthesia and blood pressure management mitigate this risk. * **Peripheral Neuropathy:** This condition involves nerve damage in the limbs and has no physiological interaction with the central seizure or the muscle relaxants used during ECT. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** Officially, there are **none**; however, many textbooks list recent Myocardial Infarction (within 4–6 weeks) and raised ICT as the highest-risk conditions. * **Most Common Side Effect:** Retrograde amnesia (memory loss). * **Most Common Cause of Death:** Cardiovascular complications (arrhythmias or MI). * **Pre-ECT Workup:** Always includes a fundoscopy to rule out papilledema (a sign of raised ICT). * **Drug of Choice:** Methohexital (Anesthetic) and Succinylcholine (Muscle relaxant).

Q: Which mood stabilizer is used in the management of drug-induced neutropenia?

Lithium. **Explanation:** The correct answer is **Lithium**. **1. Why Lithium is correct:** Lithium is unique among mood stabilizers because it induces **leukocytosis** (specifically neutrophilia). It stimulates the production of granulocyte colony-stimulating factor (G-CSF) in the bone marrow, leading to an increase in the absolute neutrophil count (ANC). While this is technically a side effect, it is utilized therapeutically to counteract drug-induced neutropenia, most notably that caused by **Clozapine**. In patients who develop mild to moderate neutropenia on Clozapine, Lithium can be "co-prescribed" to boost white blood cell counts and allow the continuation of antipsychotic therapy. **2. Why the other options are incorrect:** * **Valproate:** While generally bone-marrow neutral, it can occasionally cause dose-related thrombocytopenia (low platelets), but it does not treat neutropenia. * **Carbamazepine:** This is a high-yield "distractor" because it is actually a **cause** of blood dyscrasias. It can cause benign leukopenia and, in rare cases, life-threatening **aplastic anemia** or agranulocytosis. It is contraindicated if the baseline WBC is low. * **Lamotrigine:** Primarily associated with dermatological side effects (SJS/TEN); it has no significant effect on increasing neutrophil counts. **3. High-Yield Clinical Pearls for NEET-PG:** * **Lithium-induced Leukocytosis:** It is a reversible, non-malignant increase in WBCs (typically 10,000–15,000/mm³). * **Monitoring:** When using Lithium for this purpose, clinicians must ensure they are not masking a true infection or a worsening Clozapine-induced agranulocytosis. * **Other Lithium Side Effects:** Ebstein’s anomaly (teratogenicity), Nephrogenic Diabetes Insipidus, Hypothyroidism, and Fine Tremors. * **Drug of Choice:** Lithium remains the gold standard for classic Bipolar Disorder (Manic-Depressive Illness).

Q: Sudden development of a severe throbbing headache is a characteristic side effect of which psychotropic medication?

Phenelzine. **Explanation:** The correct answer is **Phenelzine**. The sudden development of a severe throbbing headache in a patient taking Phenelzine is a classic presentation of a **Hypertensive Crisis** (also known as the "Cheese Reaction"). **1. Why Phenelzine is correct:** Phenelzine is a non-selective **Monoamine Oxidase Inhibitor (MAOI)**. MAO is the enzyme responsible for breaking down tyramine in the gut. When a patient on MAOIs consumes tyramine-rich foods (e.g., aged cheese, red wine, smoked meats), tyramine enters the systemic circulation and acts as an indirect sympathomimetic, causing a massive release of stored norepinephrine. This leads to severe hypertension, characterized by a sudden, "explosive" occipital headache, palpitations, and neck stiffness. **2. Why other options are incorrect:** * **Lithium carbonate:** Common side effects include tremors, polyuria (nephrogenic diabetes insipidus), and hypothyroidism. While toxicity can cause neurological symptoms, a sudden throbbing headache is not characteristic. * **Diazepam:** As a benzodiazepine, its primary side effects are sedation, ataxia, and respiratory depression in overdose. It is actually used to *treat* anxiety-related tension, not cause acute headaches. * **Thioridazine:** This low-potency antipsychotic is most famous for causing **retinitis pigmentosa** (at high doses) and QTc prolongation. **Clinical Pearls for NEET-PG:** * **Antidote:** The drug of choice for an MAOI-induced hypertensive crisis is **Phentolamine** (an alpha-blocker). * **Dietary Restriction:** Patients must follow a low-tyramine diet for at least 2 weeks after stopping MAOIs. * **Drug Interaction:** Avoid combining MAOIs with SSRIs or Pethidine to prevent **Serotonin Syndrome**.

Question 1

A 4-year-old boy is brought to the physician by his parents for episodes of waking in the middle of the night screaming. The parents state that when they get to the boy's room during one of these episodes, they find him in his bed, thrashing wildly, with his eyes wide open. He pushes them away when they try to comfort him. After 2 minutes, the boy suddenly falls asleep and the next day has no memory of the episode. Which of the following medications is used to treat this disorder?

Accepted Answer

Diazepam

Answer

Haloperidol

Answer

Methylphenidate

Answer

Amitriptyline

Question 2

A 41-year-old man has been treated with haloperidol for his schizophrenia for the past 15 years. He begins to notice subtle involuntary movements of his hands, feet, lips, and tongue. Since he had been stable for over 1 year, his physician decided to decrease the dose. What would the physician tell the patient about the movement disorder?

Accepted Answer

It will increase initially as the medication is decreased.

Answer

It will disappear as soon as the medication is decreased.

Answer

It will remain unchanged.

Answer

It will disappear in his hands but not his feet as soon as the medication is decreased.

Question 3

Which of the following is not an anxiolytic agent?

Accepted Answer

Risperidone

Answer

SSRI

Answer

Clonazepam

Answer

Buspirone

Question 4

Which of the following statements is true regarding Clozapine?

Accepted Answer

It can cause agranulocytosis.

Answer

It is a traditional antipsychotic.

Answer

It is given parenterally.

Answer

It is not useful in resistant schizophrenia.

Question 5

All of the following are characteristic features of Neuroleptic Malignant Syndrome EXCEPT:

Accepted Answer

Decreased creatine phosphokinase (CPK) levels

Answer

Myoclonus

Answer

Hyperthermia

Answer

Increased blood pressure

Question 6

What is the drug of choice for rapid cyclers in manic-depressive psychosis?

Accepted Answer

Valproate

Answer

Carbamazepine

Answer

Phenytoin

Answer

Lithium

Question 7

Depression is not a known side effect of which of the following medications?

Accepted Answer

Flupenthixol

Answer

Propranolol

Answer

Oral contraceptives

Answer

Reserpine

Question 8

Which of the following is a relative contraindication for Electroconvulsive Therapy (ECT)?

Accepted Answer

Raised intracranial tension

Answer

Vascular dementia

Answer

Diabetic retinopathy

Answer

Peripheral neuropathy

Question 9

Which mood stabilizer is used in the management of drug-induced neutropenia?

Accepted Answer

Lithium

Answer

Valproate

Answer

Carbamazepine

Answer

Lamotrigine

Question 10

Sudden development of a severe throbbing headache is a characteristic side effect of which psychotropic medication?

Accepted Answer

Phenelzine

Answer

Lithium carbonate

Answer

Diazepam

Answer

Thioridazine

Psychopharmacology — MCQs

Psychopharmacology — MCQs

On this page

Practice by Chapter

Want unlimited practice?