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TEP Psiquiatria study materials
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TEP Psiquiatria practice questions

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Question 1Psychopathology and clinical interview / diagnostic formulation

Which symptom is a first-rank (Schneiderian) symptom of schizophrenia?

  1. Generalized slowing of movement
  2. Thought broadcasting Correct answer.
  3. Persistent low mood
  4. Panic attacks in crowds

Explanation

Schneider's first-rank symptoms include experiences of thought alienation, such as thought broadcasting, thought insertion and thought withdrawal, along with audible thoughts, voices discussing the patient and delusional perception. They were proposed as highly suggestive of schizophrenia rather than as a complete diagnostic criterion.

Question 2Psychopathology and clinical interview / diagnostic formulation

A patient describes hearing a voice that comments on his actions throughout the day. This phenomenon is best termed:

  1. Running commentary hallucination Correct answer.
  2. Gedankenlautwerden
  3. Delusional perception
  4. Echolalia

Explanation

A running commentary hallucination consists of voices that describe or comment on the patient's ongoing activity in the third person, and it is counted among first-rank symptoms. It must be distinguished from hearing one's own thoughts spoken aloud and from simple repetition of speech.

Question 3Psychopathology and clinical interview / diagnostic formulation

According to the standard mental state examination, which function is assessed by asking the patient to explain proverbs and similarities?

  1. Insight
  2. Abstract thinking Correct answer.
  3. Attention
  4. Orientation

Explanation

Proverb interpretation and similarity questions probe abstract thinking, revealing whether the patient can move from concrete to conceptual meaning. Concrete or bizarre responses may suggest formal thought disorder or cognitive impairment, but performance is influenced by education and culture.

Question 4Psychopathology and clinical interview / diagnostic formulation

A patient's speech jumps between loosely connected topics, with ideas that seem linked only by sound. This is best described as:

  1. Circumstantiality
  2. Mutism
  3. Flight of ideas Correct answer.
  4. Perseveration

Explanation

Flight of ideas is accelerated, pressured speech in which successive ideas are connected by superficial associations such as rhyme, punning or clang association. It is classically seen in mania but can occur in other excited states.

Question 5Psychopathology and clinical interview / diagnostic formulation

A patient insists that a stranger on television is secretly sending him coded messages intended for him alone. This belief is best classified as:

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

Explanation

A delusion of reference is the false belief that neutral events, objects or the behaviour of others carry a special meaning directed at the patient. It is common in schizophrenia and must be distinguished from other delusional themes such as persecution or guilt.

Question 6Psychopathology and clinical interview / diagnostic formulation

Which feature most strongly suggests that a patient's reported experience is a true hallucination rather than a pseudohallucination?

  1. It can be dismissed at will
  2. It occurs only when falling asleep
  3. It is recognized as self-generated
  4. It is perceived as located in external objective space Correct answer.

Explanation

True hallucinations are perceived as real, external and beyond voluntary control, whereas pseudohallucinations are experienced in inner subjective space and recognized as not real. Hypnagogic experiences occur at sleep onset and are usually not pathological.

Question 7Psychopathology and clinical interview / diagnostic formulation

A patient reports low mood for two weeks, anhedonia, poor sleep and reduced concentration. Which single question best screens for the presence of suicidal ideation during the interview?

  1. Asking about the patient's appetite and weight
  2. Directly asking whether the patient has thoughts of ending their life Correct answer.
  3. Asking about the patient's early childhood
  4. Asking whether the family has noticed a change in behaviour

Explanation

Suicidal ideation is assessed by direct, non-judgemental questioning, which does not increase risk and improves disclosure. Collateral information and general history are useful but do not substitute for asking the patient directly about thoughts of self-harm.

Question 8Psychopathology and clinical interview / diagnostic formulation

A patient with schizophrenia is asked why he has been admitted and replies that he came for a holiday and has no illness. This finding is best recorded as:

  1. Absent insight Correct answer.
  2. Impaired attention
  3. Formal thought disorder
  4. Impaired orientation

Explanation

Insight refers to the patient's awareness of being ill and of the need for treatment; denying illness while in hospital indicates absent insight. This judgement is separate from orientation, cognition and the form of thought.

Question 9Psychopathology and clinical interview / diagnostic formulation

A patient's speech answers each question correctly but drifts through many irrelevant details before eventually reaching the point. This pattern is termed:

  1. Thought blocking
  2. Flight of ideas
  3. Circumstantiality Correct answer.
  4. Neologism

Explanation

Circumstantiality is over-inclusive, detail-laden speech that nevertheless reaches the original goal, in contrast to tangentiality, where the goal is never reached. It is often associated with obsessional traits or epilepsy rather than with acute psychosis.

Question 10Psychopathology and clinical interview / diagnostic formulation

During the interview a patient suddenly stops mid-sentence and reports that his thoughts were removed from his head. This experience is best described as:

  1. Thought insertion
  2. Thought withdrawal Correct answer.
  3. Thought broadcasting
  4. Obsessional doubt

Explanation

Thought withdrawal is the belief that thoughts have been taken away by an external agency and is one of the passivity phenomena. It is often accompanied by thought blocking and is regarded as a first-rank symptom.

Question 11Psychopathology and clinical interview / diagnostic formulation

A patient believes with conviction that his spouse has been replaced by an identical-looking impostor. This is:

  1. Fregoli syndrome
  2. Capgras syndrome Correct answer.
  3. Cotard syndrome
  4. De Clerambault syndrome

Explanation

Capgras syndrome is the delusion that a familiar person has been replaced by an impostor, often in the context of organic brain disease or schizophrenia. It is distinguished from its mirror-image, Fregoli syndrome, in which one person is believed to appear in many disguises.

Question 12Psychopathology and clinical interview / diagnostic formulation

Which feature best distinguishes obsessions from delusions?

  1. Obsessions are always accompanied by hallucinations
  2. Obsessions are held with fixed conviction despite evidence
  3. Obsessions are experienced as intrusive and resisted as unwanted Correct answer.
  4. Obsessions are confined to depressive episodes

Explanation

Obsessions are recurrent, intrusive thoughts recognized as the patient's own and usually resisted, whereas delusions are fixed beliefs held with conviction that are not amenable to reason. The key discriminator is the patient's appraisal of the thought rather than its content.

Question 13Psychopathology and clinical interview / diagnostic formulation

A patient describes feeling that his own movements are being controlled by an outside force, as though his limbs are operated by machinery. This is an example of:

  1. Somatic hallucination
  2. Conversion symptom
  3. Made-impulse phenomenon Correct answer.
  4. Depersonalization

Explanation

The made-impulse phenomenon is the experience that one's actions are driven by an external agency and belongs to the passivity phenomena. It differs from depersonalization, which is a sense of unreality of the self, and from conversion symptoms, which are motor or sensory deficits.

Question 14Psychopathology and clinical interview / diagnostic formulation

A patient shows disorientation to time and place, fluctuating attention and visual hallucinations that began acutely after a urinary infection. Which diagnosis should be considered first?

  1. Schizophrenia
  2. Obsessive-compulsive disorder
  3. Bipolar disorder
  4. Delirium Correct answer.

Explanation

Acute onset, fluctuating attention, disorientation and visual hallucinations in the setting of a physical illness strongly suggest delirium. Delirium is a medical emergency requiring identification of the underlying cause, and it must be distinguished from primary psychotic disorders.

Question 15Psychopathology and clinical interview / diagnostic formulation

Which finding is most characteristic of a manic episode rather than a depressive episode?

  1. Psychomotor retardation
  2. Early morning waking with fatigue
  3. Decreased need for sleep with increased energy Correct answer.
  4. Anhedonia with weight loss

Explanation

Mania is characterised by increased energy and activity alongside a reduced need for sleep, in contrast to the insomnia and fatigue of depression. Elevated mood, pressured speech and grandiosity commonly accompany these changes.

Question 16Psychopathology and clinical interview / diagnostic formulation

During the interview a patient describes his mood as euthymic but laughs loudly while describing the death of his child. This discrepancy is best recorded as:

  1. Blunted affect
  2. Incongruent affect Correct answer.
  3. Labile affect
  4. Flat affect

Explanation

Incongruent affect means the expressed emotion does not match the content of speech or the reported mood, and it is often noted in schizophrenia. It is distinguished from blunting and flatness, which concern the range and intensity of affect rather than its appropriateness.

Question 17Psychopathology and clinical interview / diagnostic formulation

A patient reports that his thoughts are being spoken aloud by a voice outside his head, audible to him as speech. This symptom is called:

  1. Echo de la pensee
  2. Gedankenlautwerden Correct answer.
  3. Verbigeration
  4. Palilalia

Explanation

Gedankenlautwerden is the hearing of one's own thoughts spoken aloud, an auditory pseudo-hallucination counted among first-rank symptoms. Echo de la pensee is the experience that one's thoughts are repeated aloud by another person.

Question 18Psychopathology and clinical interview / diagnostic formulation

Which combination of features best supports a diagnosis of catatonia in a patient who is mute and immobile?

  1. Confabulation and disorientation
  2. Tremor and rigidity
  3. Waxy flexibility and negativism Correct answer.
  4. Compulsions and tics

Explanation

Catatonia is a psychomotor syndrome whose signs include waxy flexibility, negativism, stupor, posturing and mutism. It can occur in schizophrenia, mood disorders and medical conditions, and it responds to benzodiazepines or electroconvulsive therapy.

Question 19Psychopathology and clinical interview / diagnostic formulation

A patient reports that he has no thoughts at all and that his mind is empty, yet he is fully alert and answers questions appropriately. This experience is best described as:

  1. Thought broadcasting
  2. Thought emptiness Correct answer.
  3. Derealization
  4. Obsessional rumination

Explanation

Thought emptiness, or the experience of a vacant mind, is a passivity-type phenomenon sometimes reported in schizophrenia and is often grouped with thought alienation. It differs from derealization, in which the external world feels unreal.

Question 20Psychopathology and clinical interview / diagnostic formulation

A 24-year-old presents with six months of social withdrawal, odd beliefs and occasional self-muttering, but no clear delusions or hallucinations. Which formulation is most appropriate?

  1. Established schizophrenia
  2. Attenuated psychosis syndrome requiring close follow-up Correct answer.
  3. Acute and transient psychotic disorder
  4. Malingering

Explanation

Subthreshold psychotic symptoms with preserved insight and no frank psychosis fit an attenuated or ultra-high-risk state, which warrants monitoring rather than an immediate diagnosis of schizophrenia. The duration and severity criteria for schizophrenia are not met.

Question 21Mood disorders (depressive and bipolar spectrum)

According to the ICD-11, what is the minimum duration of a depressive episode?

  1. Four weeks
  2. One week
  3. Six months
  4. Two weeks Correct answer.

Explanation

Both ICD-11 and DSM-5 require a core depressive syndrome to persist for at least two weeks before a depressive episode can be diagnosed. Shorter presentations are described as subthreshold or brief depressive states rather than a full episode.

Question 22Mood disorders (depressive and bipolar spectrum)

Which symptom is required for a diagnosis of a manic episode but is not required for a hypomanic episode?

  1. Elevated or irritable mood
  2. Marked impairment in social or occupational functioning Correct answer.
  3. Decreased need for sleep
  4. Increased goal-directed activity

Explanation

Mania is distinguished from hypomania chiefly by severity: mania causes marked impairment in functioning, may require hospitalisation, or includes psychotic features. Hypomania by definition does not cause marked functional impairment or psychosis.

Question 23Mood disorders (depressive and bipolar spectrum)

A patient reports low mood and anhedonia for three weeks, with no history of elevated mood, and no substance use. What is the most appropriate initial diagnostic formulation?

  1. Persistent depressive disorder
  2. Cyclothymic disorder
  3. Bipolar I disorder
  4. Major depressive episode Correct answer.

Explanation

A three-week illness with low mood and loss of interest, without any hypomanic or manic history, meets criteria for a major depressive episode. Bipolar disorder requires evidence of mania or hypomania, and persistent depressive disorder requires a chronic course of at least two years.

Question 24Mood disorders (depressive and bipolar spectrum)

Which feature most strongly suggests that a first depressive episode is actually part of a bipolar disorder?

  1. A prior hypomanic episode after antidepressant treatment Correct answer.
  2. Psychomotor retardation
  3. Family history of depression
  4. Early morning awakening

Explanation

A treatment-emergent hypomanic or manic switch indicates that the underlying illness is bipolar rather than unipolar. This history should prompt caution with antidepressant monotherapy and consideration of mood stabilisation.

Question 25Mood disorders (depressive and bipolar spectrum)

What is the typical minimum duration of a hypomanic episode?

  1. Two weeks
  2. Four consecutive days Correct answer.
  3. One month
  4. 24 hours

Explanation

Hypomania requires a distinct period of abnormally elevated or irritable mood lasting at least four consecutive days. Mania requires at least one week, or any duration if hospitalisation is needed.

Question 26Mood disorders (depressive and bipolar spectrum)

A 28-year-old presents with elevated mood, grandiosity, reduced need for sleep and psychotic delusions lasting ten days. What is the most likely diagnosis?

  1. Cyclothymic disorder
  2. Hypomanic episode
  3. Manic episode with psychotic features Correct answer.
  4. Bipolar II disorder

Explanation

Elevated mood with grandiosity, reduced sleep and psychosis lasting more than a week fulfils criteria for mania with psychotic features. Bipolar II is excluded because psychotic symptoms and full mania are incompatible with hypomania.

Question 27Mood disorders (depressive and bipolar spectrum)

Which class of medication is first-line for maintenance treatment of bipolar I disorder to prevent relapse?

  1. Mood stabilisers such as lithium Correct answer.
  2. Selective serotonin reuptake inhibitors
  3. Benzodiazepines
  4. Antipsychotics used only during acute episodes

Explanation

Lithium and other mood stabilisers reduce the risk of both manic and depressive relapse in bipolar I disorder. Antidepressant monotherapy risks inducing a switch or rapid cycling and is not used for maintenance alone.

Question 28Mood disorders (depressive and bipolar spectrum)

Which finding is most characteristic of melancholic depression?

  1. Anhedonia with early morning waking and psychomotor disturbance Correct answer.
  2. Hypersomnia with leaden paralysis
  3. Mood reactivity to positive events
  4. Increased appetite with weight gain

Explanation

Melancholic features include loss of pleasure, non-reactive mood, early morning waking, psychomotor agitation or retardation, and excessive guilt. These contrast with atypical features such as mood reactivity and hypersomnia.

Question 29Mood disorders (depressive and bipolar spectrum)

A patient with depression reports mood reactivity, hyperphagia, hypersomnia and heavy limbs. Which specifier best fits?

  1. Melancholic features
  2. Atypical features Correct answer.
  3. Psychotic features
  4. Catatonic features

Explanation

Mood reactivity plus increased appetite, hypersomnia and leaden paralysis define the atypical features specifier. These patients may respond preferentially to MAO inhibitors rather than tricyclics.

Question 30Mood disorders (depressive and bipolar spectrum)

Which statement about the epidemiology of major depressive disorder is most accurate?

  1. It is equally common in all age groups with no sex difference
  2. It affects men twice as often as women
  3. Lifetime prevalence is approximately 15-20% with female preponderance Correct answer.
  4. Prevalence is highest in older adults over 65

Explanation

Major depression has a lifetime prevalence of roughly 15-20% and is about twice as common in women as in men. Onset peaks in young adulthood rather than old age.

Question 31Mood disorders (depressive and bipolar spectrum)

Which of the following best describes a mixed feature specifier in a depressive episode?

  1. Alternating episodes of mania and depression over years
  2. Presence of three or more manic symptoms during a depressive episode Correct answer.
  3. Depression with prominent anxiety symptoms
  4. Depression occurring only in winter months

Explanation

Mixed features are defined by the co-occurrence of at least three manic or hypomanic symptoms during a predominantly depressive episode. This pattern carries a higher risk of bipolarity and suicidality.

Question 32Mood disorders (depressive and bipolar spectrum)

What is the main mechanism of action of lithium in mood stabilisation?

  1. Dopamine D2 receptor blockade
  2. GABA-A receptor agonism
  3. Selective serotonin reuptake inhibition
  4. Inhibition of inositol monophosphatase and glycogen synthase kinase-3 Correct answer.

Explanation

Lithium is thought to act through inhibition of inositol monophosphatase and glycogen synthase kinase-3, modulating intracellular signalling. It also has narrow therapeutic monitoring requirements due to renal elimination.

Question 33Mood disorders (depressive and bipolar spectrum)

A patient on lithium develops tremor, vomiting and confusion, with a lithium level of 2.5 mmol/L. What is the most appropriate immediate action?

  1. Add a thiazide diuretic to lower the level
  2. Continue the same dose and recheck in a week
  3. Stop lithium, rehydrate and consider haemodialysis if severe Correct answer.
  4. Increase the dose to stabilise mood

Explanation

A level of 2.5 mmol/L with neurological and gastrointestinal signs indicates lithium toxicity. Management involves stopping the drug, correcting dehydration and considering haemodialysis in severe cases.

Question 34Mood disorders (depressive and bipolar spectrum)

Which factor is most associated with an increased risk of suicide in mood disorders?

  1. Recent discharge from psychiatric hospital Correct answer.
  2. Female sex
  3. Presence of a confidant
  4. Married status

Explanation

The period shortly after psychiatric discharge carries a markedly elevated suicide risk. Other high-risk features include male sex, living alone, previous attempts and hopelessness.

Question 35Mood disorders (depressive and bipolar spectrum)

Which treatment is considered first-line for moderate to severe major depressive disorder?

  1. Electroconvulsive therapy alone
  2. Long-term benzodiazepines
  3. Antidepressant medication or structured psychotherapy Correct answer.
  4. Antipsychotic monotherapy

Explanation

For moderate to severe depression, either an antidepressant or an evidence-based psychotherapy such as CBT is first-line, often combined. ECT is reserved for severe, psychotic or treatment-resistant cases.

Question 36Mood disorders (depressive and bipolar spectrum)

A patient with bipolar depression is started on an SSRI without a mood stabiliser and develops rapid cycling. What is the best explanation?

  1. Lithium toxicity
  2. Serotonin syndrome
  3. Antidepressant-induced mood destabilisation Correct answer.
  4. Neuroleptic malignant syndrome

Explanation

Antidepressant monotherapy in bipolar disorder can precipitate switching, mixed states and rapid cycling. Guidelines therefore recommend avoiding antidepressant monotherapy and using mood stabilisers as the backbone of treatment.

Question 37Mood disorders (depressive and bipolar spectrum)

Which of the following is the most appropriate definition of rapid cycling in bipolar disorder?

  1. Four or more mood episodes within twelve months Correct answer.
  2. Two episodes within five years
  3. Continuous cycling within a single week
  4. One episode per decade

Explanation

Rapid cycling is defined as at least four mood episodes in the preceding twelve months. It is more common in women and is associated with antidepressant use and thyroid dysfunction.

Question 38Mood disorders (depressive and bipolar spectrum)

What is the approximate therapeutic serum range for lithium in maintenance treatment?

  1. 0.01-0.1 mmol/L
  2. 0.4-1.0 mmol/L Correct answer.
  3. 1.5-2.5 mmol/L
  4. 3.0-4.0 mmol/L

Explanation

Maintenance lithium levels are typically kept between 0.4 and 1.0 mmol/L, with higher levels sometimes used acutely. Levels above 1.5 mmol/L increase the risk of toxicity.

Question 39Mood disorders (depressive and bipolar spectrum)

A patient with recurrent depression has had three episodes in five years. What is the recommended approach?

  1. Switch to antipsychotic monotherapy
  2. Consider long-term maintenance antidepressant treatment Correct answer.
  3. Stop antidepressants after remission of the current episode
  4. Use benzodiazepines as maintenance

Explanation

Recurrent depression, particularly with three or more episodes, warrants maintenance antidepressant treatment to reduce relapse risk. Maintenance is typically continued for at least two years or longer depending on risk.

Question 40Mood disorders (depressive and bipolar spectrum)

Which feature best distinguishes persistent depressive disorder from major depressive disorder?

  1. Chronic course lasting at least two years Correct answer.
  2. Seasonal onset
  3. Presence of psychotic symptoms
  4. Rapid response to antidepressants

Explanation

Persistent depressive disorder requires a chronic depressed mood for at least two years in adults, though symptom severity may be lower than in major depression. Major depressive episodes may occur on top of it.

Question 41Mood disorders (depressive and bipolar spectrum)

Which of the following is a recognised risk factor for postpartum depression?

  1. Male infant
  2. High socioeconomic status
  3. Absence of any life stressors
  4. Previous history of depression Correct answer.

Explanation

A prior history of depression or anxiety is among the strongest predictors of postpartum depression. Other risk factors include poor social support, obstetric complications and recent stressful life events.

Question 42Mood disorders (depressive and bipolar spectrum)

A patient with bipolar I disorder has had multiple manic episodes despite lithium. Which agent is an appropriate alternative for maintenance?

  1. An SSRI alone
  2. A benzodiazepine alone
  3. A tricyclic antidepressant alone
  4. Valproate or an atypical antipsychotic such as quetiapine Correct answer.

Explanation

When lithium fails or is poorly tolerated, valproate or atypical antipsychotics such as quetiapine are evidence-based maintenance options. Antidepressant monotherapy is avoided because of switch risk.

Question 43Anxiety, obsessive-compulsive and trauma-related disorders

A 28-year-old man reports sudden episodes of intense fear lasting about 10 minutes, with palpitations, sweating and a feeling of impending doom, occurring several times a week in different situations. Between episodes he worries constantly about having another attack. Which diagnosis best fits this picture?

  1. Generalized anxiety disorder
  2. Social anxiety disorder
  3. Specific phobia
  4. Panic disorder Correct answer.

Explanation

Recurrent unexpected panic attacks followed by persistent concern about further attacks or their consequences define panic disorder. The anticipatory worry here is about the attacks themselves, not about multiple life domains or social scrutiny.

Question 44Anxiety, obsessive-compulsive and trauma-related disorders

According to current diagnostic frameworks, which core feature distinguishes obsessive-compulsive disorder from the anxiety disorders?

  1. Presence of recurrent intrusive thoughts
  2. Presence of physiological hyperarousal
  3. Presence of obsessions and/or compulsions that are time-consuming or cause impairment Correct answer.
  4. Presence of repetitive behaviors that reduce distress

Explanation

Obsessive-compulsive disorder is defined by obsessions and/or compulsions that are time-consuming or cause clinically significant impairment. Intrusive thoughts and reassurance-seeking rituals occur in anxiety disorders too, so the defining element is the functional impact of the obsessions and compulsions.

Question 45Anxiety, obsessive-compulsive and trauma-related disorders

A 34-year-old woman develops intrusive images of harming her infant and responds by hiding all knives and repeatedly praying to neutralize the thoughts. She finds the thoughts ego-dystonic and distressing. Which feature most supports obsessive-compulsive disorder over a psychotic disorder?

  1. The patient acts on the intrusive images
  2. The patient has no insight into the symptoms
  3. The thoughts are attributed to an external agency
  4. The thoughts are experienced as unwanted and recognized as excessive Correct answer.

Explanation

Obsessions in OCD are experienced as intrusive, unwanted and ego-dystonic, and are usually recognized as excessive or unreasonable. This preserved recognition and the neutralizing rituals distinguish them from delusional or passivity phenomena.

Question 46Anxiety, obsessive-compulsive and trauma-related disorders

Which medication class is first-line pharmacotherapy for post-traumatic stress disorder in adults according to major guidelines?

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

Explanation

Selective serotonin reuptake inhibitors are recommended as first-line pharmacotherapy for PTSD, with sertraline and paroxetine having the strongest evidence. They reduce core symptom clusters and are preferred over agents without established efficacy.

Question 47Anxiety, obsessive-compulsive and trauma-related disorders

Which symptom cluster is required for a diagnosis of acute stress disorder but not for post-traumatic stress disorder?

  1. Dissociative symptoms Correct answer.
  2. Re-experiencing symptoms
  3. Avoidance symptoms
  4. Hyperarousal symptoms

Explanation

Acute stress disorder requires the presence of dissociative symptoms among its criteria, in addition to intrusion, avoidance and arousal symptoms. PTSD does not require dissociation, though a dissociative subtype exists.

Question 48Anxiety, obsessive-compulsive and trauma-related disorders

A patient describes a persistent fear of speaking in meetings, present for years, with avoidance of work presentations and marked distress about possible embarrassment. Which diagnosis is most likely?

  1. Body dysmorphic disorder
  2. Panic disorder
  3. Agoraphobia
  4. Social anxiety disorder Correct answer.

Explanation

Marked fear of social or performance situations due to concern about negative evaluation, with avoidance and distress, characterizes social anxiety disorder. The fear is tied to scrutiny by others rather than to open spaces or unexpected attacks.

Question 49Anxiety, obsessive-compulsive and trauma-related disorders

A 41-year-old man with OCD has failed adequate trials of two SSRIs and remains moderately impaired. Which augmentation strategy has the strongest evidence in treatment-resistant OCD?

  1. Adding an MAOI
  2. Adding a stimulant
  3. Adding a low-potency antipsychotic such as quetiapine Correct answer.
  4. Adding a benzodiazepine

Explanation

Antipsychotic augmentation, particularly with low-dose atypical agents such as risperidone or aripiprazole, has the best evidence for SSRI-refractory OCD. Quetiapine is among the agents used, though evidence is somewhat weaker than for risperidone.

Question 50Anxiety, obsessive-compulsive and trauma-related disorders

A 30-year-old woman has severe PTSD with prominent nightmares and hyperarousal. She asks about the role of trauma-focused psychotherapy versus medication. Which statement is most accurate?

  1. Psychotherapy is only indicated after medication failure
  2. Medication should always precede psychotherapy
  3. Combining treatments is contraindicated
  4. Trauma-focused psychotherapy is recommended as first-line treatment and can be used alone or with medication Correct answer.

Explanation

Trauma-focused psychotherapies such as prolonged exposure and cognitive processing therapy are first-line for PTSD and may be used alone or combined with SSRIs. Medication is an alternative first-line option, not a mandatory prerequisite.