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RANZCP MCQ Exam study materials
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RANZCP MCQ Exam practice questions

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Question 1General adult psychiatry

A 28-year-old man has had a persistent low mood for two years, with poor appetite, insomnia and low energy, but has never met criteria for a major depressive episode. Which diagnosis best fits his presentation?

  1. Bipolar II disorder
  2. Major depressive disorder, single episode
  3. Cyclothymic disorder
  4. Persistent depressive disorder Correct answer.

Explanation

Persistent depressive disorder requires a depressed mood present for most of the day, on most days, for at least two years in adults, without ever meeting full criteria for a major depressive episode during that period. The chronic, subthreshold course distinguishes it from episodic major depression.

Question 2General adult psychiatry

Which symptom is required for a diagnosis of a manic episode?

  1. Rapid speech
  2. Elevated, expansive or irritable mood Correct answer.
  3. Sleep disturbance
  4. Psychotic features

Explanation

A manic episode is defined by a distinct period of abnormally and persistently elevated, expansive or irritable mood lasting at least one week, accompanied by increased energy or activity. Sleep disturbance and rapid speech are possible associated symptoms but are not required.

Question 3General adult psychiatry

Which class of medication is first-line pharmacotherapy for generalised anxiety disorder in most guidelines?

  1. Selective serotonin reuptake inhibitors Correct answer.
  2. Beta blockers
  3. Benzodiazepines
  4. Antipsychotics

Explanation

SSRIs are recommended as first-line pharmacological treatment for generalised anxiety disorder because of their efficacy and favourable long-term tolerability. They are preferred over benzodiazepines, which carry dependence risk and are generally reserved for short-term use.

Question 4General adult psychiatry

A 24-year-old woman describes hearing voices discussing her in the third person for six months, with no mood disturbance. Which diagnosis is most appropriate?

  1. Schizoaffective disorder
  2. Delusional disorder
  3. Brief psychotic disorder
  4. Schizophrenia Correct answer.

Explanation

Third-person auditory hallucinations commenting on the patient, lasting more than one month in the absence of prominent mood disturbance, support a diagnosis of schizophrenia. The duration rules out brief psychotic disorder, and the absence of mood episodes argues against schizoaffective disorder.

Question 5General adult psychiatry

Which feature is characteristic of delirium rather than dementia?

  1. Preserved level of consciousness
  2. Insidious progressive decline
  3. Prominent focal neurological signs
  4. Acute onset with fluctuating attention Correct answer.

Explanation

Delirium is distinguished by an acute onset, fluctuating course and impaired attention and awareness. Dementia typically has an insidious, progressive course with relatively preserved consciousness until late stages.

Question 6General adult psychiatry

Which laboratory test is essential before starting lithium therapy?

  1. Thyroid stimulating hormone only
  2. Serum calcium
  3. Liver function tests
  4. Renal function tests Correct answer.

Explanation

Lithium is renally excreted and can cause nephrogenic diabetes insipidus and renal impairment, so baseline renal function is essential before initiation. Thyroid function should also be checked, but renal function is the key prerequisite for safe dosing.

Question 7General adult psychiatry

A 35-year-old man with schizophrenia has been stable on risperidone for two years. He develops involuntary tongue movements and lip smacking. What is the most likely diagnosis?

  1. Tardive dyskinesia Correct answer.
  2. Acute dystonia
  3. Parkinsonism
  4. Akathisia

Explanation

Tardive dyskinesia is a late-onset movement disorder characterised by involuntary choreoathetoid movements, especially of the tongue, lips and face, after prolonged antipsychotic exposure. Its delayed onset distinguishes it from acute extrapyramidal reactions.

Question 8General adult psychiatry

Which finding most strongly predicts a high risk of suicide in a patient with depression?

  1. Older age at first onset
  2. Female sex
  3. Married status
  4. Previous suicide attempt Correct answer.

Explanation

A previous suicide attempt is one of the strongest known predictors of completed suicide and should prompt a thorough risk assessment and safety planning. Other demographic factors modify risk but carry less predictive weight.

Question 9General adult psychiatry

A 42-year-old woman has intrusive, unwanted thoughts of harming her child and performs repetitive checking rituals. She finds the thoughts distressing and ego-dystonic. What is the most likely diagnosis?

  1. Obsessive-compulsive disorder Correct answer.
  2. Generalised anxiety disorder
  3. Psychotic disorder
  4. Post-traumatic stress disorder

Explanation

Obsessive-compulsive disorder is characterised by recurrent, intrusive and unwanted thoughts that are ego-dystonic, together with repetitive behaviours performed to reduce distress. Insight into the senselessness of the symptoms supports this diagnosis.

Question 10General adult psychiatry

Which feature distinguishes anorexia nervosa from bulimia nervosa?

  1. Presence of binge eating
  2. Significantly low body weight Correct answer.
  3. Fear of weight gain
  4. Body image disturbance

Explanation

Anorexia nervosa is distinguished by significantly low body weight relative to expectations, whereas bulimia nervosa typically occurs at normal or near-normal weight. Both conditions share fear of weight gain and body image disturbance.

Question 11General adult psychiatry

A 30-year-old man presents with euphoria, grandiosity, decreased need for sleep and increased goal-directed activity for five days, following a period of normal mood. What is the most likely diagnosis?

  1. Substance-induced mood disorder
  2. Cyclothymic disorder
  3. Hypomanic episode Correct answer.
  4. Manic episode

Explanation

Hypomania requires a distinct period of elevated or irritable mood lasting at least four consecutive days with associated symptoms, without marked impairment or psychosis. The five-day duration with no functional impairment fits hypomania rather than mania.

Question 12General adult psychiatry

Which statement about the mechanism of action of selective serotonin reuptake inhibitors is correct?

  1. They block dopamine D2 receptors
  2. They block presynaptic serotonin reuptake transporters Correct answer.
  3. They directly stimulate serotonin receptors
  4. They inhibit monoamine oxidase

Explanation

SSRIs work by inhibiting the serotonin transporter, reducing presynaptic reuptake and increasing synaptic serotonin availability. This differs from monoamine oxidase inhibitors and antipsychotics, which act through other mechanisms.

Question 13General adult psychiatry

A patient on clozapine develops fever, sore throat and a neutrophil count of 1.2 x 10^9/L. What is the most appropriate immediate action?

  1. Add a mood stabiliser
  2. Increase the clozapine dose
  3. Continue clozapine and repeat the blood test in one week
  4. Stop clozapine and seek urgent medical assessment Correct answer.

Explanation

Clozapine can cause neutropenia and agranulocytosis, and a falling neutrophil count with infective symptoms requires immediate cessation and urgent medical review. Continued dosing risks severe infection and sepsis.

Question 14General adult psychiatry

Which factor most increases the risk of alcohol withdrawal seizures?

  1. Female sex
  2. Social drinking pattern
  3. Use of cannabis
  4. A history of previous withdrawal seizures Correct answer.

Explanation

A history of previous withdrawal seizures is a strong predictor of further seizures during subsequent withdrawals and warrants close monitoring and prophylaxis. Other factors such as heavy chronic use and concurrent illness also contribute but are less specific.

Question 15General adult psychiatry

Which cognitive domain is typically affected earliest in Alzheimer's disease?

  1. Executive function
  2. Language fluency
  3. Episodic memory Correct answer.
  4. Visuospatial ability

Explanation

Alzheimer's disease typically begins with impairment in episodic memory, reflecting early involvement of the medial temporal lobes and hippocampus. Other domains such as language and executive function are affected later in the course.

Question 16General adult psychiatry

A 55-year-old man with no prior psychiatric history develops paranoid delusions that his neighbours are poisoning him, without hallucinations or mood disturbance. What is the most likely diagnosis?

  1. Brief psychotic disorder
  2. Schizophrenia
  3. Schizoaffective disorder
  4. Delusional disorder Correct answer.

Explanation

Delusional disorder is characterised by persistent delusions, often non-bizarre, with relatively preserved functioning and no prominent hallucinations or mood disturbance. The absence of other psychotic features and the late onset support this diagnosis.

Question 17General adult psychiatry

Which of the following is a recognised risk factor for tardive dyskinesia?

  1. Young age at onset
  2. Long duration of antipsychotic treatment Correct answer.
  3. Female sex only
  4. Short-term antipsychotic use

Explanation

The risk of tardive dyskinesia increases with the duration of antipsychotic exposure and cumulative dose. Older age and female sex also increase risk, but duration of treatment is a well-established major factor.

Question 18General adult psychiatry

A patient with bipolar disorder on lithium develops polyuria and polydipsia. Which mechanism best explains this?

  1. Lithium-induced hyperthyroidism
  2. Lithium-induced hypercalcaemia
  3. Lithium-induced nephrogenic diabetes insipidus Correct answer.
  4. Lithium-induced renal artery stenosis

Explanation

Lithium impairs the renal concentrating ability by reducing responsiveness of the collecting duct to antidiuretic hormone, producing nephrogenic diabetes insipidus. This presents with polyuria and polydipsia and requires monitoring of renal function and electrolytes.

Question 19General adult psychiatry

Which feature best distinguishes a major depressive episode with psychotic features from schizoaffective disorder?

  1. There is a history of mania
  2. Psychotic symptoms occur only during mood episodes Correct answer.
  3. Psychotic symptoms precede mood symptoms by two weeks
  4. There is a family history of schizophrenia

Explanation

In psychotic depression, delusions or hallucinations occur exclusively during major depressive episodes. In schizoaffective disorder, psychotic symptoms persist for at least two weeks in the absence of mood symptoms.

Question 20General adult psychiatry

Which formulation of a patient's risk assessment is most consistent with good psychiatric practice?

  1. A single score on a risk assessment tool
  2. A judgement based only on the clinician's intuition
  3. A prediction based solely on diagnosis
  4. A structured assessment combining static and dynamic factors with a management plan Correct answer.

Explanation

Good risk assessment integrates static historical factors with modifiable dynamic factors and links findings to an explicit management plan. Reliance on a single score or diagnosis alone is insufficient and can be misleading.

Question 21Psychopathology and assessment

A patient describes hearing voices commenting on their actions, which they experience as coming from outside their head. This phenomenon is best classified as which type of hallucination?

  1. Gustatory
  2. Tactile
  3. Visual
  4. Auditory Correct answer.

Explanation

Third-person auditory hallucinations, including commentary voices, are a characteristic auditory phenomenon and are classically associated with psychotic illness. The described experience is sound-based and perceived as external, which defines an auditory hallucination.

Question 22Psychopathology and assessment

Which formal thought disorder is characterised by a listener being unable to follow the logical connection between successive sentences, though each sentence is grammatically intact?

  1. Derailment Correct answer.
  2. Clanging
  3. Echolalia
  4. Perseveration

Explanation

Derailment, or loosening of associations, describes speech in which ideas slip from one topic to another with lost logical connections between sentences. Individual sentences remain well formed, but the overall thread is disrupted.

Question 23Psychopathology and assessment

A patient reports a persistent, unrealistic fear of a specific object, avoids it, and recognises the fear as excessive. Which diagnosis best fits this presentation?

  1. Panic disorder
  2. Specific phobia Correct answer.
  3. Generalised anxiety disorder
  4. Obsessive-compulsive disorder

Explanation

A circumscribed, persistent, excessive fear of a defined object or situation with avoidance and insight is the core pattern of specific phobia. Generalised anxiety is diffuse, panic disorder centres on unexpected attacks, and OCD involves obsessions and compulsions.

Question 24Psychopathology and assessment

In a mental state examination, a patient's mood is best distinguished from affect by which feature?

  1. Mood is the sustained subjective emotional state reported by the patient Correct answer.
  2. Affect is the patient's self-reported emotion over weeks
  3. Mood is the observed facial expression during the interview
  4. Affect is always congruent with delusional content

Explanation

Mood refers to the patient's sustained, internally experienced emotional state, usually elicited by asking how they have felt. Affect is the observable, moment-to-moment emotional expression assessed by the clinician.

Question 25Psychopathology and assessment

Which feature most strongly suggests that a patient's low mood is a depressive episode rather than ordinary sadness?

  1. Preferring solitude during a stressful week
  2. Feeling sad for a few hours after disappointing news
  3. Crying at a funeral
  4. Pervasive anhedonia with functional impairment lasting at least two weeks Correct answer.

Explanation

A depressive episode requires persistent low mood or anhedonia with associated symptoms and impairment lasting at least two weeks. Ordinary sadness is time-limited, proportionate, and does not cause sustained functional decline.

Question 26Psychopathology and assessment

A patient insists that strangers on television are sending them personal messages. This belief is best described as which type of delusion?

  1. Nihilistic delusion
  2. Delusion of reference Correct answer.
  3. Delusion of guilt
  4. Delusion of grandeur

Explanation

A delusion of reference is the false belief that neutral events, such as broadcasts, are directed personally at the individual. It is distinct from grandiose, guilt, and nihilistic themes.

Question 27Psychopathology and assessment

A 28-year-old describes episodes of elevated mood, decreased need for sleep, and increased goal-directed activity lasting four days, without psychotic features or marked impairment. What is the most likely classification?

  1. Mixed episode
  2. Cyclothymic disorder
  3. Hypomanic episode Correct answer.
  4. Manic episode

Explanation

Hypomania requires elevated or irritable mood with increased energy lasting at least four consecutive days, without psychosis or marked functional impairment. Mania lasts at least a week or causes marked impairment or psychosis.

Question 28Psychopathology and assessment

Which cognitive assessment finding is most consistent with delirium rather than dementia?

  1. Progressive memory loss over several years with preserved alertness
  2. Gradual decline in executive function over two years
  3. Fluctuating attention and altered level of consciousness with acute onset Correct answer.
  4. Stable aphasia following a stroke six months ago

Explanation

Delirium is characterised by acute onset, fluctuating course, impaired attention, and altered consciousness. Dementia typically shows insidious, progressive cognitive decline with relatively preserved consciousness until late stages.

Question 29Psychopathology and assessment

A patient reports recurrent intrusive thoughts of contamination and washes hands for hours to reduce distress. Which feature confirms the thoughts are obsessions rather than delusions?

  1. The thoughts are attributed to an external agency
  2. The thoughts are experienced as intrusive and unwanted, with some insight Correct answer.
  3. The thoughts are always accompanied by hallucinations
  4. The thoughts are held with fixed conviction despite evidence

Explanation

Obsessions are intrusive, unwanted, ego-dystonic thoughts that the person usually recognises as excessive. Delusions are held with fixed, often ego-syntonic conviction and are not resisted.

Question 30Psychopathology and assessment

Which finding on the Mini-Mental State Examination most directly reflects executive dysfunction rather than memory impairment?

  1. Misnaming a common object
  2. Difficulty performing serial sevens with preserved recall Correct answer.
  3. Inability to recall three words after five minutes
  4. Disorientation to the current year

Explanation

Serial sevens place demands on working memory and attention, which are components of executive function, whereas delayed recall specifically probes memory. Naming and orientation test other domains.

Question 31Psychopathology and assessment

A patient with schizophrenia reports that their thoughts are being removed and replaced by thoughts inserted by others. Which two phenomena are described?

  1. Thought broadcasting and thought echo
  2. Delusional perception and referential delusion
  3. Thought withdrawal and thought insertion Correct answer.
  4. Made feelings and made impulses

Explanation

Thought withdrawal is the experience that thoughts have been removed from the mind, and thought insertion is the experience that alien thoughts have been placed there. Both are passivity phenomena of thought.

Question 32Psychopathology and assessment

A 45-year-old presents with two weeks of low mood, insomnia, and poor appetite following job loss, but retains interest in hobbies and denies suicidal ideation. Which diagnosis is most appropriate?

  1. Bipolar II disorder
  2. Major depressive disorder
  3. Persistent depressive disorder
  4. Adjustment disorder with depressed mood Correct answer.

Explanation

Adjustment disorder involves emotional symptoms in response to an identifiable stressor, arising within three months and not meeting full criteria for another disorder. Preserved interest and the clear stressor favour this over major depression.

Question 33Psychopathology and assessment

Which feature best distinguishes a panic attack from generalised anxiety disorder?

  1. Panic attacks are always triggered by a specific social situation
  2. Generalised anxiety is characterised by fear of contamination
  3. Generalised anxiety involves sudden episodes peaking within minutes
  4. Panic attacks are discrete episodes with abrupt onset and peak within minutes Correct answer.

Explanation

Panic attacks are abrupt surges of fear with rapid crescendo, usually peaking within minutes, whereas generalised anxiety is a sustained, diffuse worry pattern. The episodic nature is the key discriminator.

Question 34Psychopathology and assessment

A patient displays reduced spontaneous movement, mutism, and waxy flexibility. This presentation is most consistent with which syndrome?

  1. Catatonia Correct answer.
  2. Neuroleptic malignant syndrome
  3. Tardive dyskinesia
  4. Akathisia

Explanation

Catatonia is a psychomotor syndrome marked by features such as stupor, mutism, posturing, and waxy flexibility. It can occur in psychotic, mood, and medical conditions.

Question 35Psychopathology and assessment

A patient with anorexia nervosa has a body mass index of 15 and reports feeling overweight. Which psychopathological feature does this most clearly illustrate?

  1. Distorted body image with overvaluation of shape and weight Correct answer.
  2. Generalised anxiety about multiple domains
  3. Impaired reality testing of delusional intensity
  4. Anhedonia secondary to malnutrition

Explanation

Anorexia nervosa is characterised by disturbed body image and overvaluation of shape and weight, which persist despite low weight. This is a disorder-specific body image disturbance rather than a delusion or general anxiety.

Question 36Psychopathology and assessment

Which symptom pattern is most characteristic of post-traumatic stress disorder rather than acute stress disorder?

  1. Symptoms persisting beyond one month after the trauma Correct answer.
  2. Symptoms consisting only of panic attacks
  3. Symptoms limited to the first four weeks after the trauma
  4. Symptoms beginning within three days of the trauma

Explanation

PTSD requires symptoms lasting more than one month after exposure to trauma, whereas acute stress disorder describes symptoms within the first month. The duration criterion is the principal distinction.

Question 37Psychopathology and assessment

A patient reports that their thoughts are being broadcast so others can hear them, and that their actions are controlled by an external force. These experiences are best understood as which type of phenomenon?

  1. Dissociative identity states
  2. Mood-congruent delusions
  3. Passivity phenomena indicating loss of ego boundaries Correct answer.
  4. Obsessive-compulsive symptoms

Explanation

Thought broadcasting and made actions are passivity phenomena in which the self feels controlled or permeable to external influence, reflecting disturbed ego boundaries. They are first-rank psychotic experiences rather than obsessions or dissociation.

Question 38Psychopathology and assessment

A patient with known schizophrenia develops fever, severe rigidity, autonomic instability, and raised creatine kinase after starting an antipsychotic. Which diagnosis should be considered first?

  1. Serotonin syndrome
  2. Neuroleptic malignant syndrome Correct answer.
  3. Acute dystonia
  4. Malignant catatonia

Explanation

The combination of fever, lead-pipe rigidity, autonomic instability, and elevated creatine kinase after dopamine antagonist exposure is the classic picture of neuroleptic malignant syndrome. Prompt recognition and drug withdrawal are critical.

Question 39Psychopathology and assessment

A patient's speech jumps between loosely connected ideas, but they also repeat the interviewer's words and rhyme spontaneously. Which combination of phenomena is present?

  1. Neologisms with thought blocking
  2. Derailment with echolalia and clanging Correct answer.
  3. Circumstantiality with palilalia
  4. Flight of ideas with perseveration

Explanation

Loosened associations between ideas indicate derailment, repetition of the interviewer's words is echolalia, and rhyming reflects clanging. These are separate formal thought disorder signs that can co-occur.

Question 40Psychopathology and assessment

A patient with bipolar disorder has delusions of guilt and worthlessness during a period of elevated mood and increased energy. How is this best classified?

  1. Major depression with psychotic features
  2. Mixed features with mood-incongruent psychotic symptoms Correct answer.
  3. Schizoaffective disorder, depressive type
  4. Pure mania with mood-congruent delusions

Explanation

The coexistence of elevated mood and energy with depressive delusional content indicates mixed features, and guilt-themed delusions during elevated mood are mood-incongruent. Pure mania would show mood-congruent grandiose themes, and schizoaffective disorder requires psychosis independent of mood episodes.

Question 41Biological treatments and psychopharmacology

A patient on long-term lithium therapy presents with coarse tremor, ataxia, vomiting and confusion. Serum lithium is 2.8 mmol/L, creatinine has risen, and the patient is dehydrated. Which is the single most appropriate immediate management?

  1. Withhold lithium, rehydrate and arrange urgent haemodialysis assessment Correct answer.
  2. Continue lithium at the same dose and add a beta-blocker for tremor
  3. Reduce the lithium dose by half and review in one week
  4. Add a thiazide diuretic to promote lithium excretion

Explanation

Levels above roughly 2.0 mmol/L with neurological toxicity and renal impairment constitute severe poisoning, and management centres on stopping the drug, restoring volume status and arranging extracorporeal removal. Haemodialysis is indicated for severe toxicity, especially with renal failure or deteriorating conscious state. Supportive care alone may be insufficient once significant neurotoxicity is present.

Question 42Biological treatments and psychopharmacology

Which class of antidepressant carries the most clearly established risk of hypertensive crisis when combined with tyramine-rich foods?

  1. Noradrenergic and specific serotonergic antidepressants
  2. Selective serotonin reuptake inhibitors
  3. Irreversible monoamine oxidase inhibitors Correct answer.
  4. Agomelatine

Explanation

Irreversible monoamine oxidase inhibitors block gut and hepatic MAO-A, so dietary tyramine escapes first-pass metabolism and can provoke a hypertensive crisis. This is why patients on these agents require strict dietary restriction of aged cheese, cured meats and fermented products. Reversible and selective agents carry much less or no clinically significant risk.

Question 43Biological treatments and psychopharmacology

Which baseline investigation is most important before starting clozapine?

  1. Thyroid function tests
  2. Serum lithium level
  3. Serum calcium
  4. Full blood count with absolute neutrophil count Correct answer.

Explanation

Clozapine carries a well-defined risk of neutropenia and agranulocytosis, so a baseline full blood count with absolute neutrophil count is mandatory and must meet the threshold before initiation. Regular monitoring then continues weekly for the first eighteen weeks and at reducing frequency thereafter. Other tests may be useful generally but are not the specific gate for starting clozapine.

Question 44Biological treatments and psychopharmacology

A patient develops a temperature of 39 degrees Celsius, muscular rigidity, fluctuating blood pressure and raised creatine kinase three days after starting an antipsychotic. Which diagnosis best fits this presentation?

  1. Neuroleptic malignant syndrome Correct answer.
  2. Malignant hyperthermia
  3. Serotonin syndrome
  4. Acute dystonic reaction

Explanation

The combination of hyperthermia, lead-pipe rigidity, autonomic instability, altered consciousness and markedly elevated creatine kinase after dopamine antagonist exposure is characteristic of neuroleptic malignant syndrome. Management involves stopping the antipsychotic, supportive care and possibly dantrolene or bromocriptine. Timing and drug history help separate it from the alternatives.

Question 45Biological treatments and psychopharmacology

Which medication is the first-line pharmacological treatment for moderate to severe alcohol withdrawal in a medically supervised inpatient setting?

  1. Acamprosate
  2. An antipsychotic such as haloperidol
  3. A benzodiazepine such as diazepam Correct answer.
  4. An SSRI such as sertraline

Explanation

Benzodiazepines are first-line for alcohol withdrawal because they restore GABA-A activity and reduce the risk of seizures and delirium tremens. They are usually given using a symptom-triggered or fixed-dose regimen with thiamine supplementation. The other agents address different problems or are adjuncts rather than withdrawal treatment.

Question 46Biological treatments and psychopharmacology

Which adverse effect is most characteristic of long-term lithium therapy?

  1. Hyperthyroidism
  2. Hypothyroidism Correct answer.
  3. Adrenal insufficiency
  4. Diabetes insipidus with hypernatraemia

Explanation

Lithium accumulates in the thyroid and inhibits hormone synthesis and release, producing goitre and hypothyroidism in a substantial minority of long-term users. Thyroid function should therefore be checked periodically. Nephrogenic diabetes insipidus also occurs but typically causes dilute polyuria rather than hypernatraemia, and the other endocrine options are not typical.

Question 47Biological treatments and psychopharmacology

A patient with treatment-resistant schizophrenia has been stable on clozapine. They develop a fever and sore throat and the absolute neutrophil count is 1.2 x 10^9/L. What is the most appropriate action?

  1. Add lithium to stimulate neutrophil production
  2. Continue clozapine and repeat the count in one week
  3. Increase the clozapine dose to improve the immune response
  4. Stop clozapine immediately and seek urgent haematological advice Correct answer.

Explanation

An absolute neutrophil count below 1.5 x 10^9/L is the defined threshold for interrupting clozapine, and with fever and sore throat the concern is agranulocytosis or serious infection. Clozapine should be stopped at once, a full blood count repeated urgently and haematology involved. Rechallenge is generally contraindicated after confirmed agranulocytosis.

Question 48Biological treatments and psychopharmacology

Which statement best describes the mechanism of action of selective serotonin reuptake inhibitors?

  1. They directly activate postsynaptic serotonin receptors
  2. They block presynaptic serotonin reuptake transporters, increasing synaptic serotonin Correct answer.
  3. They block postsynaptic dopamine D2 receptors
  4. They irreversibly inhibit monoamine oxidase

Explanation

SSRIs bind the serotonin transporter and reduce reuptake of serotonin into the presynaptic neuron, raising extracellular serotonin over time. Clinical benefit lags behind the pharmacological change, consistent with downstream adaptive processes. They do not act as direct receptor agonists or as monoamine oxidase inhibitors.

Question 49Biological treatments and psychopharmacology

Which agent is most appropriate for managing acute akathisia that develops after starting haloperidol?

  1. Olanzapine at a higher dose
  2. Propranolol Correct answer.
  3. Fluoxetine
  4. Carbamazepine

Explanation

Akathisia is best managed by reducing the offending antipsychotic dose where possible and adding a beta-blocker such as propranolol, which has the strongest evidence among pharmacological options. Anticholinergics are less effective for akathisia than for dystonia or parkinsonism. The other choices do not treat this extrapyramidal syndrome.

Question 50Biological treatments and psychopharmacology

A woman of childbearing potential with bipolar disorder is planning pregnancy. Which mood stabiliser is generally considered the safest option for continuing prophylaxis during pregnancy?

  1. Sodium valproate
  2. Lamotrigine Correct answer.
  3. Lithium
  4. Carbamazepine

Explanation

Lamotrigine has the most favourable pregnancy profile among common mood stabilisers, with no established pattern of major structural teratogenicity, though levels fall substantially in pregnancy and require monitoring. It is particularly useful for bipolar depression and maintenance. Valproate and carbamazepine carry clear teratogenic risks, and lithium carries cardiac and neonatal concerns requiring specialist planning.