Common Mental Disorders Practice Questions

Question 1

A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. Her BMI is 16 kg/m². She has bradycardia and hypotension. What is the most serious immediate risk?

Accepted Answer

Cardiac arrhythmias

Answer

Osteoporosis

Answer

Renal failure

Answer

Hypothermia

Answer

Electrolyte imbalance

Question 2

A 40-year-old woman presents with recurrent episodes of palpitations, sweating, and tremor lasting 10-15 minutes. These occur 2-3 times per week with no obvious trigger. Physical examination and ECG during an episode are normal. What is the most likely diagnosis?

Accepted Answer

Panic disorder

Answer

Hyperthyroidism

Answer

Cardiac arrhythmia

Answer

Pheochromocytoma

Answer

Caffeine excess

Question 3

A 43-year-old woman presents with episodes of severe anxiety, palpitations, and sweating. These occur unpredictably and last 10-15 minutes. Between episodes she feels well. What is the most likely diagnosis?

Accepted Answer

Panic disorder

Answer

Generalized anxiety disorder

Answer

Social anxiety disorder

Answer

Hyperthyroidism

Answer

Pheochromocytoma

Question 4

A 30-year-old woman presents with episodes of feeling detached from herself and her surroundings, as if watching herself from outside her body. These episodes last 10-15 minutes and cause significant distress. What is the most likely diagnosis?

Accepted Answer

Dissociative disorder

Answer

Panic disorder

Answer

Schizophrenia

Answer

Depression

Answer

Anxiety disorder

Question 5

A 27-year-old woman presents with amenorrhea, weight loss, and excessive exercise. She has fine lanugo hair and her BMI is 16 kg/m². She denies having an eating disorder. What is the most likely diagnosis?

Accepted Answer

Anorexia nervosa

Answer

Hyperthyroidism

Answer

Depression

Answer

Celiac disease

Answer

Addison's disease

Question 6

A 60-year-old woman with treatment-resistant depression has been referred for electroconvulsive therapy (ECT) after failing adequate trials of four different antidepressants including augmentation strategies. She has severe depression with psychomotor retardation, significant weight loss, and pervasive guilt. Her family is concerned about potential cognitive side effects of ECT. They ask about factors that might be modified to minimise cognitive adverse effects while maintaining treatment efficacy. Which modification would most effectively reduce cognitive side effects while preserving antidepressant efficacy?

Accepted Answer

Using unilateral electrode placement on the non-dominant hemisphere rather than bilateral placement

Answer

Reducing the electrical dose to just above seizure threshold regardless of electrode placement

Answer

Extending the interval between treatments from twice weekly to once weekly throughout the course

Answer

Using ultra-brief pulse width stimulation with bilateral electrode placement

Answer

Limiting the total number of ECT sessions to a maximum of 6 treatments

Question 7

A 38-year-old solicitor presents with a 10-week history of low mood, anhedonia, fatigue, and reduced concentration. She describes feeling guilty about her work performance despite no objective evidence of problems. She has prominent anxiety symptoms including worry, restlessness, and muscle tension present most days. Her PHQ-9 is 17 and GAD-7 is 14. She has no past psychiatric history. What is the most appropriate initial pharmacological treatment choice?

Accepted Answer

Commence sertraline as it effectively treats both depressive and anxiety symptoms

Answer

Commence mirtazapine for its combined antidepressant and anxiolytic effects with rapid onset

Answer

Commence pregabalin for the generalised anxiety disorder with review to add an antidepressant if depression persists

Answer

Commence a low-dose benzodiazepine for anxiety symptoms with an SSRI added after anxiety is controlled

Answer

Commence venlafaxine as an SNRI is more effective than SSRIs for mixed anxiety-depression

Question 8

A 35-year-old woman with panic disorder has been stable on escitalopram 20mg daily for 18 months, remaining panic-free for 12 months. She wishes to discontinue medication as she is planning pregnancy. She previously had severe panic disorder with 8-10 attacks weekly and significant agoraphobic avoidance requiring 6 months off work. She received CBT alongside medication. Which approach to discontinuation carries the optimal balance of minimising withdrawal symptoms while reducing recurrence risk?

Accepted Answer

Gradually taper over at least 4 weeks while reinstating CBT techniques and monitoring for early signs of recurrence

Answer

Discontinue escitalopram abruptly as SSRIs can be safely stopped without tapering due to long half-lives

Answer

Reduce by 50% every week for 2 weeks then stop, as escitalopram has relatively low discontinuation syndrome risk

Answer

Switch to fluoxetine for 2 weeks before discontinuation due to its longer half-life reducing withdrawal symptoms

Answer

Reduce dose by 25% every 2 weeks while commencing a tricyclic antidepressant which is safer in pregnancy

Question 9

A 52-year-old businessman presents with symptoms of both panic disorder and alcohol dependence. He reports drinking 60-80 units per week for the past 3 years. He experiences 3-4 panic attacks weekly, mostly in the morning, with palpitations, sweating, and tremor. He recognises he uses alcohol to manage his anxiety symptoms. He has no history of seizures or delirium tremens. He is motivated to address both problems. What is the most appropriate initial management strategy?

Accepted Answer

Manage alcohol withdrawal first using a benzodiazepine-assisted reduction regimen before addressing panic disorder

Answer

Commence an SSRI immediately for panic disorder while simultaneously initiating alcohol reduction strategies

Answer

Start propranolol for panic symptoms and naltrexone for alcohol dependence simultaneously

Answer

Refer to specialist dual diagnosis services before initiating any specific treatment

Answer

Commence CBT for panic disorder while the patient continues to drink at current levels to establish therapeutic alliance

Common Mental Disorders

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