Psychopharmacology Practice Questions

Q: A 31-year-old female patient has been diagnosed with bipolar affective disorder. She is planned to be started on Lithium. Before starting the medication, which of the following laboratory tests should be performed?

Thyroid function tests, serum creatinine, pregnancy test. **Explanation:** Lithium is the gold-standard mood stabilizer for Bipolar Affective Disorder, but it has a narrow therapeutic index and significant systemic side effects, necessitating a thorough baseline workup. **Why Option A is Correct:** 1. **Serum Creatinine (Renal Function):** Lithium is almost exclusively excreted by the kidneys. Impaired renal function can lead to toxic accumulation. Baseline creatinine is essential to calculate the GFR and monitor for potential nephrogenic diabetes insipidus or chronic interstitial nephritis. 2. **Thyroid Function Tests (TFTs):** Lithium inhibits the release of thyroid hormones and can cause goiter or hypothyroidism (in up to 10-20% of patients). Baseline levels are needed to monitor for treatment-induced thyroid dysfunction. 3. **Pregnancy Test (hCG):** Lithium is teratogenic, specifically associated with **Ebstein’s Anomaly** (downward displacement of the tricuspid valve) if taken during the first trimester. **Why Other Options are Incorrect:** * **Options B & C:** While a CBC (specifically WBC count) may show benign leukocytosis under Lithium, it is not a mandatory pre-treatment screening test compared to pregnancy status. * **Options C & D:** Lithium is not metabolized by the liver; therefore, Liver Function Tests (ALT/LFTs) are not required. LFTs are instead mandatory for patients starting Valproate. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Range:** 0.6–1.2 mEq/L (Acute mania: 0.8–1.2; Maintenance: 0.6–0.8). * **Toxicity Level:** >1.5 mEq/L. Dialysis is indicated if levels exceed 4.0 mEq/L (acute) or 2.5 mEq/L (chronic with symptoms). * **ECG Changes:** Lithium can cause T-wave flattening or inversion (similar to hypokalemia). * **Drug Interactions:** **NSAIDs, Thiazides, and ACE inhibitors** increase Lithium levels by decreasing renal clearance. (Mnemonic: **N**o **S**alt **A**t **T**he **A**CE).

Q: Which of the following drugs is the first-line treatment for Tourette's syndrome?

Haloperidol. **Explanation:** **Tourette’s Syndrome (TS)** is a neurodevelopmental disorder characterized by multiple motor and vocal tics. The pathophysiology is primarily linked to **dopaminergic overactivity** in the basal ganglia. Therefore, dopamine (D2) receptor antagonists are the mainstay of pharmacological treatment. **Why Haloperidol is correct:** **Haloperidol**, a high-potency typical antipsychotic, is the traditional **first-line drug** and the first FDA-approved medication for Tourette’s syndrome. It works by potently blocking D2 receptors, effectively reducing the frequency and severity of tics. While newer agents are often used in clinical practice to avoid side effects, Haloperidol remains the classic textbook answer and the gold standard for competitive exams like NEET-PG. **Why other options are incorrect:** * **Chlorpromazine:** A low-potency typical antipsychotic. While it blocks D2 receptors, its significant sedative and anticholinergic side effects make it less suitable for the long-term management of tics compared to Haloperidol. * **Olanzapine & Risperidone:** These are atypical antipsychotics. While **Risperidone** is frequently used "off-label" and is often preferred in modern clinical practice due to a lower risk of Extrapyramidal Symptoms (EPS), Haloperidol remains the established first-line reference in standard pharmacological hierarchy for TS. **High-Yield Clinical Pearls for NEET-PG:** * **Pimozide:** Another high-potency typical antipsychotic specifically indicated for TS when Haloperidol fails or causes intolerable side effects. * **Alpha-2 Agonists:** Drugs like **Clonidine** and **Guanfacine** are often preferred as initial therapy if the patient has comorbid ADHD. * **Side Effects:** When using Haloperidol, monitor for **Extrapyramidal Symptoms (EPS)** such as dystonia, akathisia, and tardive dyskinesia.

Q: Which of the following psychiatric disorders, apart from depression, are selectively treated with serotonin reuptake inhibitors?

All of the above. Selective Serotonin Reuptake Inhibitors (SSRIs) are the first-line pharmacological treatment for a wide spectrum of psychiatric conditions beyond Major Depressive Disorder. Their primary mechanism involves inhibiting the presynaptic reuptake of serotonin (5-HT), thereby increasing its availability in the synaptic cleft and modulating downstream neural circuits involved in anxiety and impulse control. **Explanation of Options:** * **Obsessive-Compulsive Disorder (OCD):** SSRIs (e.g., Fluoxetine, Fluvoxamine, Sertraline) are the gold standard treatment. They typically require higher doses and a longer duration (10–12 weeks) to show efficacy compared to depression. * **Phobias:** SSRIs are highly effective for **Social Anxiety Disorder (Social Phobia)** and Panic Disorder with or without agoraphobia. They help desensitize the "fear circuitry" in the amygdala. * **Post-Traumatic Stress Disorder (PTSD):** SSRIs (specifically Sertraline and Paroxetine) are FDA-approved first-line agents that help manage the core symptoms of re-experiencing, avoidance, and hyperarousal. Since SSRIs are the treatment of choice for all three conditions, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **DOC (Drug of Choice):** SSRIs are the DOC for OCD, PTSD, Panic Disorder, Social Phobia, GAD, and Premenstrual Dysphoric Disorder (PMDD). * **OCD Exception:** While SSRIs are first-line, **Clomipramine** (a TCA) is the most potent drug for OCD but is reserved for second-line due to its side-effect profile. * **Side Effects:** Remember the "S" mnemonic: **S**exual dysfunction (most common long-term side effect), **S**leep disturbances, and **S**tomach upset (nausea/diarrhea). * **Fluoxetine** has the longest half-life, making it least likely to cause withdrawal symptoms.

Q: A patient in the emergency department exhibits psychosis. Pharmacological intervention to decrease psychosis would most likely involve which of the following mechanisms?

Blockade of dopaminergic neurotransmission. ### Explanation **1. Why Option A is Correct:** The primary pharmacological management of psychosis is based on the **Dopamine Hypothesis of Schizophrenia**. This hypothesis suggests that psychosis results from overactivity of dopaminergic neurons in the **mesolimbic pathway** of the brain. Antipsychotic drugs (Neuroleptics) work by blocking postsynaptic **D2 receptors**, thereby reducing dopaminergic neurotransmission. Both typical (e.g., Haloperidol) and atypical antipsychotics (e.g., Risperidone) share this fundamental mechanism of D2 receptor antagonism to alleviate positive symptoms like hallucinations and delusions. **2. Why Other Options are Incorrect:** * **Option B:** Stimulating dopaminergic neurotransmission (e.g., using Levodopa or Amphetamines) actually **induces or worsens** psychosis. This is a common side effect seen in Parkinson’s patients treated with dopamine agonists. * **Options C & D:** Nitrergic neurotransmission involves Nitric Oxide (NO). While research is ongoing regarding the role of NO in NMDA receptor signaling and its potential link to schizophrenia, it is **not** the established target for standard emergency pharmacological intervention in psychosis. **3. NEET-PG High-Yield Pearls:** * **Mesolimbic Pathway:** Blockade here leads to the **therapeutic effect** (reduction of positive symptoms). * **Nigrostriatal Pathway:** Blockade here leads to **Extrapyramidal Side Effects (EPS)** like dystonia and parkinsonism. * **Tuberoinfundibular Pathway:** Blockade here leads to **Hyperprolactinemia** (galactorrhea, gynecomastia). * **Mesocortical Pathway:** Low dopamine here is linked to **negative symptoms** (apathy, withdrawal); traditional blockers may worsen these. * **Atypical Antipsychotics:** These also block **5-HT2A receptors**, which helps reduce EPS and improve negative symptoms.

Q: A 23-year-old male with schizophrenia, currently maintained on risperidone for 2 months, has no family history of the disease. For how long should the medication be continued?

2 years. **Explanation:** The duration of maintenance therapy in schizophrenia is primarily determined by the number of psychotic episodes and the risk of relapse. 1. **Why Option C (2 years) is correct:** According to standard psychiatric guidelines (APA and Maudsley), for a patient experiencing their **first episode of schizophrenia** who has achieved clinical remission, maintenance treatment with antipsychotics should be continued for **1 to 2 years**. This period is crucial to prevent relapse and ensure neuronal stabilization. Since the patient is 23 years old and there is no mention of prior episodes, this is treated as a first-episode case, making 2 years the most appropriate choice among the options. 2. **Why other options are incorrect:** * **Option B (6 months):** This duration is typically reserved for a "Brief Psychotic Disorder" or the initial stabilization phase, but it is insufficient for Schizophrenia, where the risk of relapse is high. * **Option D (12 months):** While some guidelines suggest 1 year, most competitive exams and clinical standards prefer the 2-year mark for a first episode to ensure long-term stability. * **Option A (5 years):** This duration is indicated for patients who have had **multiple episodes** (recurrent schizophrenia) or those with a history of violent behavior or severe relapses. **High-Yield Clinical Pearls for NEET-PG:** * **First Episode:** 1–2 years of maintenance. * **Second/Multiple Episodes:** At least 5 years of maintenance. * **Chronic/Severe Relapses:** May require lifelong treatment. * **Risk of Relapse:** Approximately 80% of patients relapse within 5 years if medication is discontinued prematurely. * **Risperidone:** An atypical antipsychotic; monitor for hyperprolactinemia and extrapyramidal symptoms (EPS) at higher doses.

Q: What is the most accurate treatment for erectile dysfunction?

Sildenafil. **Explanation:** **Erectile Dysfunction (ED)** is defined as the persistent inability to attain or maintain a penile erection sufficient for satisfactory sexual performance. **Why Sildenafil is correct:** Sildenafil is a selective **Phosphodiesterase-5 (PDE-5) inhibitor**. It works by inhibiting the enzyme PDE-5, which normally breaks down cyclic Guanosine Monophosphate (cGMP) in the corpus cavernosum. By preventing cGMP degradation, it enhances nitric oxide-mediated smooth muscle relaxation and increases blood flow to the penis. It is currently the **first-line pharmacological treatment** for ED due to its high efficacy and oral route of administration. **Analysis of Incorrect Options:** * **Master and Johnson technique:** This refers to behavioral therapy (e.g., "sensate focus" exercises). While useful for psychogenic sexual dysfunction or premature ejaculation, it is not the primary or most accurate treatment for organic ED. * **Beta-blockers:** These are actually a **cause** of erectile dysfunction (a known side effect), not a treatment. * **Papaverine:** This is a vasodilator that can be used via intracavernosal injection. While effective, it is considered a second-line treatment due to the risk of priapism and the invasive nature of administration compared to oral PDE-5 inhibitors. **High-Yield Clinical Pearls for NEET-PG:** * **Contraindication:** Sildenafil must **never** be co-administered with **Nitrates** (e.g., Nitroglycerin), as it can lead to life-threatening hypotension. * **Side Effects:** Common side effects include headache, flushing, and **cyanopsia** (blue-tinted vision) due to cross-reactivity with PDE-6 in the retina. * **Tadalafil vs. Sildenafil:** Tadalafil has a much longer half-life (approx. 17.5 hours) compared to Sildenafil (4 hours), earning it the nickname "the weekend pill."

Question 1

A 31-year-old female patient has been diagnosed with bipolar affective disorder. She is planned to be started on Lithium. Before starting the medication, which of the following laboratory tests should be performed?

Accepted Answer

Thyroid function tests, serum creatinine, pregnancy test

Answer

Thyroid function tests, serum creatinine, complete blood count

Answer

Thyroid function tests, serum creatinine, ALT

Answer

Thyroid function tests, liver function tests, pregnancy test

Question 2

A 25-year-old male with a life-threatening depressive illness that has not responded adequately to medication is scheduled for electroconvulsive shock therapy (ECT). He is currently taking tranylcypramine. What is the recommended course of action?

Accepted Answer

Proceed with the ECT with caution, using the usual anesthetic drugs.

Answer

Cancel the procedure, cease the tranylcypramine, and perform the ECT in 2 weeks.

Answer

Proceed with the ECT, but induce with midazolam and remifentanil.

Answer

Proceed with the ECT, but pre-treat with esmolol.

Question 3

Which of the following are features of serotonin syndrome associated with SSRIs and MAOIs?

Accepted Answer

Tremors, Agitation, Cardiovascular collapse

Answer

Agitation, Cardiovascular collapse

Answer

Tremors, Cardiovascular collapse, Hypothermia

Answer

Agitation, Cardiovascular collapse, Hypothermia

Question 4

Which of the following drugs is the first-line treatment for Tourette's syndrome?

Accepted Answer

Haloperidol

Answer

Chlorpromazine

Answer

Olanzapine

Answer

Risperidone

Question 5

Which of the following is the treatment of choice for patients with schizophrenia who refuse to take treatment?

Accepted Answer

Fluphenazine

Answer

Clozapine

Answer

Thioridazine

Answer

Olanzapine

Question 6

Which of the following drugs is both effective and safe to use in a pregnant patient suffering from bipolar disorder?

Accepted Answer

Olanzapine

Answer

Carbamazepine

Answer

Lithium

Answer

Valproic acid

Question 7

Which of the following psychiatric disorders, apart from depression, are selectively treated with serotonin reuptake inhibitors?

Accepted Answer

All of the above

Answer

Phobias

Answer

Obsessive compulsive disorder

Answer

Post-traumatic stress disorder

Question 8

A patient in the emergency department exhibits psychosis. Pharmacological intervention to decrease psychosis would most likely involve which of the following mechanisms?

Accepted Answer

Blockade of dopaminergic neurotransmission

Answer

Stimulation of dopaminergic neurotransmission

Answer

Blockade of nitrergic neurotransmission

Answer

Stimulation of nitrergic neurotransmission

Question 9

A 23-year-old male with schizophrenia, currently maintained on risperidone for 2 months, has no family history of the disease. For how long should the medication be continued?

Accepted Answer

2 years

Answer

5 years

Answer

6 months

Answer

12 months

Question 10

What is the most accurate treatment for erectile dysfunction?

Accepted Answer

Sildenafil

Answer

Master and Johnson technique

Answer

Beta blockers

Answer

Papaverine

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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