Psychopharmacology Practice Questions

Q: For therapeutic effect in manic depressive illness, what steady-state serum lithium concentration should be maintained?

0.5-0.8 mEq/L. **Explanation:** Lithium is the gold-standard mood stabilizer for Bipolar Disorder (Manic Depressive Illness). It has a **narrow therapeutic index**, meaning the difference between a therapeutic dose and a toxic dose is very small. Therefore, Therapeutic Drug Monitoring (TDM) is mandatory. 1. **Why 0.5–0.8 mEq/L is correct:** For **maintenance therapy** (prophylaxis) in manic-depressive illness, the target steady-state serum concentration is generally **0.5 to 0.8 mEq/L**. This range is effective in preventing relapses while minimizing long-term side effects. Some guidelines allow up to 1.0 mEq/L for maintenance, but 0.5–0.8 is the standard "sweet spot" for stable patients. 2. **Analysis of Incorrect Options:** * **0.2–0.4 mEq/L:** This is **sub-therapeutic**. Concentrations below 0.5 mEq/L are associated with a significantly higher risk of relapse into mania or depression. * **1.0–1.3 mEq/L:** This range is typically reserved for the **acute manic phase**. Higher levels are needed to control active symptoms, but staying at this level long-term increases the risk of renal and thyroid toxicity. * **1.5–2.5 mEq/L:** This is the **toxic range**. Mild toxicity (tremors, vomiting) starts >1.5 mEq/L; severe toxicity (seizures, coma) occurs >2.0 mEq/L. **High-Yield Clinical Pearls for NEET-PG:** * **Sampling Time:** Serum lithium should be measured **12 hours after the last dose** (trough level). * **Steady State:** It takes approximately **5 days** (5 half-lives) to reach steady-state levels. * **Drug Interactions:** Thiazides, NSAIDs, and ACE inhibitors increase lithium levels (by decreasing renal clearance), leading to toxicity. * **Side Effects:** L-I-T-H: **L**eukocytosis, **I**nsipidus (Nephrogenic Diabetes Insipidus), **T**remors/Teratogenicity (Ebstein's Anomaly), **H**ypothyroidism.

Q: All of the following are true about antipsychotics except?

The most common extrapyramidal symptom is acute dystonia.. **Explanation:** The correct answer is **C**, as the statement is factually incorrect. While acute dystonia is a dramatic and early-onset extrapyramidal symptom (EPS), it is not the most common. **Akathisia** (a subjective feeling of inner restlessness and inability to sit still) is the **most common EPS** associated with antipsychotic use. **Analysis of Options:** * **Option A:** **Haloperidol** is a high-potency First-Generation Antipsychotic (FGA) or "typical" antipsychotic. It primarily acts via D2 receptor antagonism and has a high propensity for causing EPS. * **Option B:** **Asenapine** is a Second-Generation Antipsychotic (SGA) that has poor oral bioavailability due to extensive first-pass metabolism. Therefore, it is specifically formulated for **sublingual administration** to ensure systemic absorption. * **Option D:** **Clozapine** is the gold standard for treatment-resistant schizophrenia but is notorious for causing **agranulocytosis** (absolute neutrophil count <500/mm³). This necessitates mandatory periodic WBC monitoring (REMS protocol). **High-Yield Clinical Pearls for NEET-PG:** 1. **EPS Timeline:** * *Acute Dystonia:* Hours to days (Earliest; treat with Promethazine/Benztropine). * *Akathisia:* Days to weeks (Most common; treat with Beta-blockers like Propranolol). * *Drug-induced Parkinsonism:* Weeks to months. * *Tardive Dyskinesia:* Months to years (Choreiform movements; switch to Clozapine). 2. **Clozapine Side Effects:** It is the only antipsychotic that reduces suicide risk but carries risks of seizures, myocarditis, and significant weight gain, in addition to agranulocytosis. 3. **Hyperprolactinemia:** Most common with Typical antipsychotics and the atypical drug **Risperidone**.

Q: In Direct Electroconvulsive Therapy (ECT), what is the effect on intraocular tension?

Decreased. **Explanation:** The correct answer is **B. Decreased**. **1. Why it is correct:** Electroconvulsive Therapy (ECT) induces a generalized tonic-clonic seizure. During the seizure activity, there is a paradoxical and significant **decrease in intraocular pressure (IOP)**. This occurs primarily due to the contraction of extraocular muscles and the subsequent increase in the outflow of aqueous humor through the trabecular meshwork. Additionally, the autonomic changes during the seizure lead to a transient reduction in aqueous production. This makes ECT relatively safe for patients with controlled glaucoma. **2. Why other options are incorrect:** * **A. Increased:** While ECT causes a transient **increase** in heart rate, blood pressure, and **intracranial pressure (ICP)**, it does *not* increase intraocular pressure. Students often confuse the rise in ICP with IOP. * **C & D. No change/Variable:** These are incorrect because the physiological response to the seizure consistently leads to a measurable drop in IOP across clinical studies. **3. High-Yield Clinical Pearls for NEET-PG:** * **Direct vs. Modified ECT:** "Direct" ECT (without muscle relaxants) is rarely practiced today. Modern "Modified" ECT uses **Succinylcholine** (muscle relaxant) and **Thiopental/Propofol** (anesthetic). * **Cardiovascular effects:** The initial response is **Parasympathetic** (bradycardia/hypotension), followed by a more prolonged **Sympathetic** surge (tachycardia/hypertension). * **Absolute Contraindication:** There are no absolute contraindications to ECT, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication (due to the risk of herniation). * **Glaucoma:** ECT is **not** contraindicated in glaucoma because it lowers IOP. However, caution is advised if using anticholinergic premedication (like Atropine), which can theoretically increase IOP in narrow-angle glaucoma.

Q: Which medication class is used in the medical treatment of paraphilias?

Selective Serotonin Reuptake Inhibitors (SSRIs). **Explanation:** The medical management of paraphilic disorders primarily focuses on reducing the intensity of deviant sexual urges and improving impulse control. **Selective Serotonin Reuptake Inhibitors (SSRIs)** are considered a first-line pharmacological intervention for non-dangerous paraphilias. **Why SSRIs are correct:** SSRIs work through two main mechanisms in this context: 1. **Impulse Control:** By increasing synaptic serotonin, they help modulate the frontal cortex, reducing compulsive behaviors and intrusive sexual fantasies. 2. **Side Effect Profile:** A common side effect of SSRIs is decreased libido and delayed ejaculation/orgasm. In the treatment of paraphilias, this "side effect" is utilized therapeutically to dampen sexual drive and arousal. **Why other options are incorrect:** * **Benzodiazepines:** These are GABA-A agonists used for anxiety and insomnia. They have no specific effect on sexual drive and may actually cause disinhibition, potentially worsening paraphilic behaviors. * **Opioids:** These are analgesics. While chronic opioid use can lower testosterone, they are not a standard or indicated treatment for paraphilias due to high addiction potential. * **Barbiturates:** These are CNS depressants used for anesthesia or epilepsy. They do not target the neurobiology of sexual deviance. **High-Yield Clinical Pearls for NEET-PG:** * **Anti-androgens:** For severe or "high-risk" paraphilias, hormonal therapy is used. **Medroxyprogesterone acetate** and **Cyproterone acetate** reduce testosterone levels. * **GnRH Agonists:** Drugs like **Leuprolide** are the most potent hormonal treatments (chemical castration) used for refractory cases. * **Comorbidity:** Paraphilias often co-occur with OCD or Depression; SSRIs are particularly useful in these dual-diagnosis cases. * **Psychotherapy:** Pharmacotherapy is most effective when combined with **Cognitive Behavioral Therapy (CBT)**.

Q: A 40-year-old male presents with poor adherence to Haloperidol 10mg BD. He complains of unpleasant motor symptoms and reports having an 'urge to move' constantly. His wife reports that he is restless all the time. Which of the following explains the symptoms?

Akathisia. ### Explanation **Correct Answer: C. Akathisia** **Why it is correct:** Akathisia is a common **Extrapyramidal Side Effect (EPS)** caused by high-potency first-generation antipsychotics like Haloperidol. It is characterized by a subjective feeling of inner restlessness and an objective compulsion to move. The patient’s description of an "urge to move" and the wife’s observation of constant restlessness are classic clinical presentations. Pathophysiologically, it results from **dopamine (D2) receptor blockade** in the nigrostriatal pathway. **Why the other options are incorrect:** * **A. Tourette’s Syndrome:** This is a neurodevelopmental disorder characterized by multiple motor and at least one vocal tic lasting >1 year. It typically starts in childhood, not as a side effect of medication in a 40-year-old. * **B. Hyperkinetic Disorder (ADHD):** This involves a persistent pattern of inattention and/or hyperactivity-impulsivity. While it involves restlessness, it is a chronic developmental condition, not an acute drug-induced state. * **C. Psychotic Agitation:** While psychosis can cause agitation, it is usually driven by delusions or hallucinations. In this case, the symptoms are specifically described as "motor symptoms" following Haloperidol use, pointing toward a side effect rather than the primary illness. **NEET-PG High-Yield Pearls:** * **Management:** The first-line treatment for Akathisia is **Propranolol** (Beta-blocker). Benzodiazepines or anticholinergics (like Benztropine) can be used as second-line. * **Timeline:** Akathisia typically develops within days to weeks of starting or increasing the dose of an antipsychotic. * **Clinical Sign:** Patients are often seen pacing, shifting weight from foot to foot, or inability to sit still ("Mal de la marche"). * **Risk:** Akathisia is a major cause of **non-adherence** to treatment and is associated with an increased risk of suicide due to the extreme distress it causes.

Question 1

For therapeutic effect in manic depressive illness, what steady-state serum lithium concentration should be maintained?

Accepted Answer

0.5-0.8 mEq/L

Answer

0.2-0.4 mEq/L

Answer

1.0-1.3 mEq/L

Answer

1.5-2.5 mEq/L

Question 2

A patient with schizophrenia, who started haloperidol two days ago, presents with complaints of torticollis and orofaciolingual movements. What is the most likely diagnosis?

Accepted Answer

Acute dystonia

Answer

Tardive dyskinesia

Answer

Parkinsonism

Answer

Akathisia

Question 3

All of the following are true about antipsychotics except?

Accepted Answer

The most common extrapyramidal symptom is acute dystonia.

Answer

Haloperidol is a typical antipsychotic.

Answer

Asenapine can be administered sublingually.

Answer

Clozapine can lead to agranulocytosis.

Question 4

Elderly persons taking antipsychotics are especially susceptible to all of the following side effects except?

Accepted Answer

Paresthesias

Answer

Tardive dyskinesia

Answer

Dry mouth

Answer

Akathisia

Question 5

In Direct Electroconvulsive Therapy (ECT), what is the effect on intraocular tension?

Accepted Answer

Decreased

Answer

Increased

Answer

No change

Answer

Variable

Question 6

When compared to traditional antipsychotic medication, atypical antipsychotic medication is more likely to be helpful for which of the following symptoms?

Accepted Answer

Social withdrawal

Answer

Hallucinations

Answer

Delusions

Answer

Agitation

Question 7

Which of the following statements is NOT true regarding tricyclic antidepressants?

Accepted Answer

They are safe in bipolar depression as they do not cause a switch to mania.

Answer

They cause sedation.

Answer

They cause weight gain.

Answer

They cause giddiness.

Question 8

Which medication class is used in the medical treatment of paraphilias?

Accepted Answer

Selective Serotonin Reuptake Inhibitors (SSRIs)

Answer

Benzodiazepines

Answer

Opioids

Answer

Barbiturates

Question 9

A 34-year-old housewife reports a three-month history of feeling low, lack of interest in activities, lethargy, multiple body aches, feelings of worthlessness, decreased appetite, and disturbed sleep with early morning awakening. She is likely to benefit from:

Accepted Answer

Anti-depressants

Answer

Anti-psychotics

Answer

Anxiolytics

Answer

Hypno-sedatives

Question 10

A 40-year-old male presents with poor adherence to Haloperidol 10mg BD. He complains of unpleasant motor symptoms and reports having an 'urge to move' constantly. His wife reports that he is restless all the time. Which of the following explains the symptoms?

Accepted Answer

Akathisia

Answer

Tourette's Syndrome

Answer

Hyperkinetic Disorder

Answer

Psychotic Agitation

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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