Free NEET PG & INI-CET Psychiatry MCQs

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A major depressive episode requires depressed mood or loss of interest, plus associated symptoms, for at least 2 weeks. Core features include anhedonia, sleep and appetite change, low energy, guilt, poor concentration, and suicidal thoughts.

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Biological symptoms of depression include early morning awakening, diurnal variation with mood worse in the morning, loss of appetite and weight, and reduced libido. Grandiosity and flight of ideas are features of mania, not depression.

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A manic episode features elevated or irritable mood, grandiosity, decreased need for sleep, pressured speech, flight of ideas, distractibility, and risky behaviour, lasting at least a week or needing hospitalisation.

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Bipolar I disorder requires at least one manic episode; depressive episodes usually occur but are not required. Bipolar II involves hypomanic and depressive episodes without a full manic episode.

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A prior attempt is one of the strongest predictors of completed suicide, along with a clear plan, access to means, hopelessness, and certain psychiatric diagnoses. Risk assessment guides the level of support and monitoring needed. This is a sensitive topic; anyone in personal distress should be encouraged to seek professional help.

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Postpartum psychosis is a psychiatric emergency, usually within the first two weeks, with delusions, hallucinations, disorganisation, and risk to mother and baby, needing urgent treatment. It is far more severe than the transient, self-limiting 'baby blues'.

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Persistent depressive disorder (dysthymia) is chronic depressive symptoms lasting at least 2 years, generally milder than a major depressive episode but longer-lasting. Cyclothymia, by contrast, involves chronic fluctuating hypomanic and depressive symptoms.

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DSM-5 requires at least 6 months of continuous disturbance, including at least 1 month of active-phase symptoms, for schizophrenia. Schizophreniform disorder describes the same picture lasting 1 to 6 months.

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Positive symptoms, meaning added experiences, include hallucinations, delusions, and disorganised speech or behaviour. Negative symptoms, meaning deficits, include blunted affect, alogia, avolition, and social withdrawal.

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Schneider's first-rank symptoms include thought insertion, withdrawal, and broadcasting, delusional perception, passivity phenomena such as made acts and feelings, and third-person auditory hallucinations. They are suggestive of, though not exclusive to, schizophrenia.

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A delusion of infidelity, or Othello syndrome, is a fixed false belief that a partner is unfaithful. Other types include grandiose, persecutory, nihilistic, and delusions of reference, where neutral events are believed to refer specifically to oneself.

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Brief psychotic disorder features sudden-onset psychotic symptoms lasting from a day to under a month, with full return to premorbid functioning. It is often triggered by a marked stressor.

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Delusional disorder involves one or more non-bizarre delusions for at least a month, without the other features of schizophrenia and with relatively preserved functioning apart from the delusion's impact.

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Good prognostic features in schizophrenia include acute onset, a precipitating stressor, later onset, prominent mood symptoms, good premorbid functioning, and a family history of mood disorder. Insidious onset and prominent negative symptoms suggest a poorer outcome.

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Panic disorder features recurrent unexpected panic attacks — abrupt surges of intense fear peaking within minutes with somatic symptoms such as palpitations, sweating, and chest tightness — plus persistent worry about further attacks. SSRIs and CBT are effective.

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Generalised anxiety disorder is persistent, excessive, hard-to-control worry about many things for at least 6 months, with restlessness, fatigue, poor concentration, irritability, muscle tension, and sleep disturbance.

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OCD involves recurrent, intrusive, unwanted thoughts (obsessions) causing anxiety, and repetitive behaviours or mental acts (compulsions) performed to reduce that anxiety. The person usually recognises them as excessive. SSRIs and CBT with exposure and response prevention are first-line.

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Exposure and response prevention, a form of CBT, is the psychological treatment of choice for OCD, gradually exposing the person to triggers while preventing the compulsion. SSRIs, often at higher doses, are the first-line medication.

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PTSD follows exposure to a traumatic event and features re-experiencing through intrusive memories, flashbacks, and nightmares, avoidance of reminders, negative alterations in mood and cognition, and hyperarousal, persisting beyond a month. Trauma-focused CBT and EMDR are effective.

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A specific phobia is a marked, out-of-proportion fear of a particular object or situation such as heights, needles, or animals, leading to avoidance. Graded exposure therapy is the treatment of choice.

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Conversion disorder presents with neurological symptoms not explained by organic disease, typically following psychological stress, and is not consciously produced, unlike malingering or factitious disorder, which are intentional. Reassurance and physiotherapy help.

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Delirium tremens is the most severe alcohol withdrawal syndrome, occurring around 48 to 72 hours after the last drink, with confusion, agitation, hallucinations, tremor, and autonomic instability. It can be fatal and is treated with benzodiazepines and supportive care.

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Wernicke encephalopathy, from thiamine (B1) deficiency, presents with the triad of confusion, ophthalmoplegia, and ataxia. It is a medical emergency treated with urgent thiamine; untreated, it can progress to irreversible Korsakoff psychosis.

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Benzodiazepines such as chlordiazepoxide or diazepam are first-line for alcohol withdrawal, preventing seizures and delirium tremens through cross-tolerance with alcohol at the GABA receptor. Thiamine is given to prevent Wernicke encephalopathy.

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Naloxone is an opioid antagonist used to reverse opioid overdose, with its respiratory depression, pinpoint pupils, and reduced consciousness. Flumazenil, by contrast, reverses benzodiazepine overdose. Naltrexone is used in longer-term relapse prevention.

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Opioid withdrawal causes dilated pupils, yawning, lacrimation, rhinorrhoea, sweating, piloerection, abdominal cramps, and diarrhoea — distressing but rarely life-threatening. Overdose, in contrast, causes pinpoint pupils and respiratory depression.

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Disulfiram inhibits aldehyde dehydrogenase, so drinking alcohol causes acetaldehyde accumulation and an unpleasant reaction with flushing, nausea, and palpitations, acting as a deterrent. It is used as an adjunct in motivated patients under supervision.

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ADHD is characterised by persistent inattention and/or hyperactivity-impulsivity present before age 12, across more than one setting, and causing functional impairment. Management includes behavioural strategies and, where indicated, stimulant medication such as methylphenidate.

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Autism spectrum disorder involves persistent deficits in social communication and interaction, together with restricted, repetitive patterns of behaviour, interests, or activities, with onset in early development. Presentations range widely in severity.

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Stimulants such as methylphenidate are first-line pharmacotherapy for ADHD, improving attention and reducing hyperactivity. Atomoxetine is a non-stimulant alternative. Medication is combined with behavioural and educational support.

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Conduct disorder is a persistent pattern of behaviour violating others' basic rights or major societal norms — aggression to people or animals, property destruction, deceitfulness, and serious rule-breaking. It may precede antisocial personality disorder in adulthood.

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For primary nocturnal enuresis, after excluding organic causes, first-line management is behavioural measures and an enuresis alarm, which has the best long-term outcome. Desmopressin is an option for short-term needs such as sleepovers.

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Delirium is an acute, fluctuating disturbance of consciousness and attention with disorientation, usually from an underlying medical cause such as infection, drugs, or metabolic upset. It is reversible with treatment of the cause, unlike the chronic, gradual course of dementia.

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Delirium has an acute onset, a fluctuating course, clouded consciousness, and impaired attention, and is often reversible. Dementia has an insidious onset, a chronic progressive course, and clear consciousness until late.

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Alzheimer disease is the most common cause of dementia, with insidious, progressive memory loss and cognitive decline, associated with amyloid plaques and neurofibrillary tangles. Cholinesterase inhibitors such as donepezil provide symptomatic benefit.

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Dementia with Lewy bodies features fluctuating cognition, recurrent detailed visual hallucinations, and spontaneous parkinsonism, with dangerous sensitivity to antipsychotics. Recognising it matters because antipsychotics can cause severe reactions.

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The Mini-Mental State Examination is a widely used bedside screen for cognitive impairment, assessing orientation, memory, attention, language, and visuospatial skills. It screens for and tracks dementia but is not diagnostic on its own.

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Borderline personality disorder features pervasive instability of relationships, self-image, and affect, with impulsivity, fear of abandonment, and recurrent self-harm. Dialectical behaviour therapy is an evidence-based treatment, and anyone affected should be supported towards professional care.

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Antisocial personality disorder involves a pervasive disregard for others' rights, deceitfulness, impulsivity, aggression, and lack of remorse, with onset by adulthood and evidence of conduct disorder before age 15. It is a Cluster B personality disorder.

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Cluster A, the odd or eccentric group, comprises paranoid, schizoid, and schizotypal personality disorders. Cluster B, dramatic or erratic, includes antisocial, borderline, histrionic, and narcissistic; Cluster C, anxious or fearful, includes avoidant, dependent, and obsessive-compulsive.

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Anorexia nervosa features restriction of energy intake leading to significantly low body weight, an intense fear of gaining weight, and a distorted body image. It carries serious medical risks; this is a sensitive topic, and anyone affected should be encouraged to seek professional support.

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Bulimia nervosa features recurrent binge eating with compensatory behaviours such as vomiting, laxatives, or excessive exercise, usually with a normal or near-normal weight. Signs can include dental erosion and knuckle calluses (Russell's sign). It is a sensitive topic warranting professional care.

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SSRIs such as fluoxetine and sertraline are first-line antidepressants, preferred for their favourable side-effect profile and relative safety in overdose compared with tricyclics and MAOIs. They are also first-line for several anxiety disorders and OCD.

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Lithium has a narrow therapeutic index; toxicity causes a coarse tremor, ataxia, nausea and vomiting, diarrhoea, confusion, and, if severe, seizures and renal failure. Levels and renal and thyroid function must be monitored, and dehydration or NSAIDs can precipitate toxicity.

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Neuroleptic malignant syndrome is a rare, life-threatening reaction to antipsychotics through dopamine blockade, with hyperthermia, 'lead-pipe' rigidity, altered consciousness, autonomic instability, and raised creatine kinase. Treatment is stopping the drug and supportive care, with dantrolene or bromocriptine in severe cases.

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Typical antipsychotics block dopamine D2 receptors and commonly cause extrapyramidal symptoms — acute dystonia, drug-induced parkinsonism, akathisia, and, with long-term use, tardive dyskinesia. Atypical antipsychotics cause fewer such effects but more metabolic side effects.

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Clozapine is reserved for treatment-resistant schizophrenia and mandates regular blood count monitoring because of the risk of agranulocytosis. Other notable adverse effects include myocarditis, seizures, weight gain, and constipation.

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Serotonin syndrome results from excess serotonergic activity, often from combining serotonergic drugs, and features neuromuscular hyperactivity with clonus, hyperreflexia, and tremor, autonomic instability, and altered mental state. Rapid onset with hyperreflexia and clonus helps distinguish it from the rigidity of neuroleptic malignant syndrome.

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ECT is indicated in severe or treatment-resistant depression, particularly with life-threatening features such as poor oral intake or high suicide risk, or with psychotic or catatonic features, and in some cases of mania and catatonia. It is given under anaesthesia; memory disturbance is the main side effect.

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Benzodiazepines are effective for short-term relief of anxiety and insomnia but cause tolerance and dependence with continued use, and abrupt withdrawal can cause seizures. They are therefore used for short periods and tapered gradually.