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Egyptian Board Psychiatry study materials
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Egyptian Board Psychiatry practice questions

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Question 1Psychopathology and Psychiatric Assessment

A 24-year-old man is brought by his family because for 7 months he has shown no interest in work or friends, speaks in a flat monotone, and describes himself as 'empty inside'. He denies any period of elevated mood. Which term best describes the predominant symptom cluster?

  1. Negative symptoms Correct answer.
  2. Affective flattening only
  3. Positive symptoms
  4. Catatonic excitement

Explanation

Negative symptoms are deficits from normal function, including avolition, anhedonia, alogia, blunted affect and asociality. The patient's loss of motivation, monotone speech and social withdrawal are all negative features rather than added abnormal experiences.

Question 2Psychopathology and Psychiatric Assessment

In the mental status examination, which finding is documented under 'insight' rather than under 'judgement'?

  1. The patient's recognition that his beliefs are symptoms of an illness Correct answer.
  2. The patient's capacity to weigh the risks of refusing treatment
  3. The patient's plan to spend his savings on a new business
  4. The patient's ability to explain how he would handle a house fire

Explanation

Insight refers to the patient's awareness of having an illness and of the nature of his experiences, including whether he attributes them to a disorder. Judgement concerns practical decision-making and appraisal of real-life situations.

Question 3Psychopathology and Psychiatric Assessment

A patient repeatedly uses neologisms, jumps between loosely connected ideas, and cannot be understood. Which formal thought disorder is best described?

  1. Circumstantiality
  2. Clang association
  3. Perseveration
  4. Derailment Correct answer.

Explanation

Derailment (loosening of associations) is speech in which ideas slip from one topic to another with no logical connection, so the listener cannot follow the thread. Neologisms and incoherence commonly accompany it in schizophrenia.

Question 4Psychopathology and Psychiatric Assessment

Which feature most strongly distinguishes a delusion from an overvalued idea?

  1. The belief is held with unshakeable conviction despite contrary evidence Correct answer.
  2. The belief causes distress to the patient
  3. The belief concerns the patient's own body
  4. The belief is shared by the patient's family

Explanation

A delusion is a fixed, false belief held with extraordinary conviction that is not amenable to reason and is out of keeping with the person's cultural background. An overvalued idea is also strongly held but remains understandable and can be modified by argument or experience.

Question 5Psychopathology and Psychiatric Assessment

A 30-year-old woman reports hearing two voices discussing her in the third person for the past 4 months, with no mood disturbance. This symptom is classically regarded as:

  1. An illusion
  2. A hypnagogic hallucination
  3. A first-rank symptom of schizophrenia Correct answer.
  4. A pseudohallucination

Explanation

Third-person auditory hallucinations in the form of voices discussing the patient are among Schneider's first-rank symptoms, which strongly suggest schizophrenia. They are true hallucinations occurring in clear consciousness.

Question 6Psychopathology and Psychiatric Assessment

Which description is most consistent with a true hallucination?

  1. A vivid mental image that the patient recognises as imaginary
  2. A perception that occurs only when the patient is falling asleep
  3. A distorted perception of a real external object
  4. A perception experienced in the absence of an external stimulus but with the quality of a real perception Correct answer.

Explanation

A true hallucination is a perception without an object that has the full force and vividness of real perception and is experienced in external space. The patient generally acts on it as real.

Question 7Psychopathology and Psychiatric Assessment

A 19-year-old student shows odd speech and social withdrawal for 8 months but has never met full criteria for a psychotic disorder. Which diagnosis is most appropriate?

  1. Attenuated psychosis syndrome Correct answer.
  2. Schizophreniform disorder
  3. Brief psychotic disorder
  4. Delusional disorder

Explanation

Attenuated psychosis syndrome describes subthreshold psychotic symptoms that are below the threshold for a full psychotic disorder and have been present recently. It is a research category for early detection and does not require the duration or severity of a psychotic disorder.

Question 8Psychopathology and Psychiatric Assessment

Which finding best supports a diagnosis of delirium rather than dementia?

  1. Fluctuating level of consciousness with acute onset Correct answer.
  2. Insidious progression over several years
  3. Preserved attention throughout the day
  4. Stable cognitive deficits for six months

Explanation

Delirium is characterised by acute onset, fluctuating course and impaired attention and awareness, often with an identifiable medical cause. Dementia typically has an insidious, progressive course with relatively preserved consciousness early on.

Question 9Psychopathology and Psychiatric Assessment

A patient with major depressive disorder is described as having 'psychomotor retardation'. Which observation best matches this sign?

  1. Rapid pressured speech with flight of ideas
  2. Repetitive purposeless movements
  3. Slowed movements, prolonged speech latency and reduced gesture Correct answer.
  4. Increased appetite with weight gain

Explanation

Psychomotor retardation refers to objectively slowed motor activity and thinking, seen as slowed gait, reduced spontaneous movement, long pauses before answering and diminished gesturing. It is a recognised melancholic feature of depression.

Question 10Psychopathology and Psychiatric Assessment

Which manic feature is most characteristic of a 'mixed feature' specifier in a depressive episode?

  1. Rapid cycling over two years
  2. Presence of psychotic symptoms only
  3. A history of at least one manic episode
  4. Three or more manic symptoms during a major depressive episode Correct answer.

Explanation

A mixed features specifier applies when subsyndromal manic or hypomanic symptoms occur during a depressive episode. The presence of full manic criteria would instead indicate a manic or mixed episode, not a depressive episode with mixed features.

Question 11Psychopathology and Psychiatric Assessment

A patient describes feeling that his thoughts are being removed by an outside force and that his actions are controlled by others. These phenomena are best classified as:

  1. Passivity phenomena Correct answer.
  2. Ideas of reference
  3. Obsessions
  4. Depersonalisation

Explanation

Passivity phenomena, also called made phenomena, include thought insertion, thought withdrawal, thought broadcasting and made actions or feelings attributed to an external agency. They are first-rank symptoms suggesting schizophrenia.

Question 12Psychopathology and Psychiatric Assessment

Which instrument is specifically designed to rate the severity of depressive symptoms?

  1. Hamilton Depression Rating Scale Correct answer.
  2. PANSS
  3. Mini-Mental State Examination
  4. Young Mania Rating Scale

Explanation

The Hamilton Depression Rating Scale is a clinician-rated measure of depressive symptom severity. It is widely used in research and clinical follow-up of depression.

Question 13Psychopathology and Psychiatric Assessment

A 45-year-old man has a fixed belief that his spouse is unfaithful, based on trivial evidence, for 2 years, with no other psychotic symptoms and preserved functioning. Which diagnosis fits best?

  1. Schizoaffective disorder
  2. Delusional disorder Correct answer.
  3. Obsessive-compulsive disorder
  4. Schizophrenia

Explanation

Delusional disorder involves persistent non-bizarre delusions, such as infidelity, with functioning relatively preserved and no other prominent psychotic features. The absence of hallucinations and decline favours it over schizophrenia.

Question 14Psychopathology and Psychiatric Assessment

Which feature is most typical of a brief psychotic disorder?

  1. Duration of psychotic symptoms of at least 6 months
  2. Duration of psychotic symptoms between 1 day and 1 month with eventual full return to baseline Correct answer.
  3. Presence of delusions for at least 2 years
  4. Cognitive decline over 12 months

Explanation

Brief psychotic disorder is defined by psychotic symptoms lasting more than one day but less than one month, followed by full return to premorbid functioning. A longer duration would suggest schizophreniform or schizophrenia.

Question 15Psychopathology and Psychiatric Assessment

A patient's speech is described as 'flight of ideas'. Which additional feature would most support this finding?

  1. Rapid speech with shifting topics linked by puns or rhymes Correct answer.
  2. Repetition of the examiner's words
  3. Slow, halting speech with long pauses
  4. Use of invented words with fixed private meanings

Explanation

Flight of ideas is rapid, continuous speech in which ideas shift quickly, often with distractible links, punning and rhyming. It is classically associated with mania.

Question 16Psychopathology and Psychiatric Assessment

Which of the following best defines 'insight' in psychiatric assessment?

  1. The patient's awareness of having a mental illness and of the nature of symptoms Correct answer.
  2. The patient's ability to recall three objects after five minutes
  3. The patient's capacity to consent to research
  4. The patient's intelligence quotient

Explanation

Insight is the patient's awareness of illness, its nature and the need for treatment. It is distinct from intelligence, memory and formal capacity assessments, although impaired insight often affects treatment adherence.

Question 17Psychopathology and Psychiatric Assessment

A patient reports that the television news is sending him personal messages. This symptom is best termed:

  1. Thought broadcasting
  2. Ideas of reference Correct answer.
  3. Erotomania
  4. Nihilistic delusion

Explanation

Ideas of reference are beliefs that neutral events, such as media broadcasts, have special personal significance for the patient. When held with delusional conviction they become delusions of reference.

Question 18Psychopathology and Psychiatric Assessment

Which pattern of cognitive impairment is most characteristic of early Alzheimer's disease?

  1. Fluctuating attention with visual hallucinations
  2. Prominent episodic memory impairment with relatively preserved language and visuospatial skills Correct answer.
  3. Prominent executive dysfunction with preserved memory
  4. Isolated visual hallucinations with intact memory

Explanation

Early Alzheimer's disease typically presents with prominent episodic memory impairment, especially encoding and recall of new information, while other domains are relatively preserved initially. This pattern reflects early medial temporal involvement.

Question 19Psychopathology and Psychiatric Assessment

Which statement about the Mini-Mental State Examination is most accurate?

  1. It assesses personality disorder traits
  2. It is a brief cognitive screening tool whose score is influenced by education and language Correct answer.
  3. It is a diagnostic test that confirms dementia
  4. It measures depressive symptom severity

Explanation

The MMSE is a brief screening instrument for cognitive impairment, and scores are affected by educational level, language and sensory deficits. It supports but does not confirm a diagnosis, which requires clinical assessment.

Question 20Psychopathology and Psychiatric Assessment

A patient with schizophrenia is asked to explain a proverb and responds with a concrete, literal interpretation. This finding is best described as:

  1. Concrete thinking Correct answer.
  2. Flight of ideas
  3. A delusion of persecution
  4. Impaired abstraction

Explanation

Concrete thinking is the loss of the ability to think abstractly, shown by literal interpretation of proverbs or similarities. It is a recognised feature of formal thought disorder in schizophrenia.

Question 21Psychopharmacology and Biological Treatments

A patient with schizophrenia develops a high fever, muscle rigidity, confusion, and a creatine kinase level of 4,000 U/L four days after starting an antipsychotic. Which medication class is most strongly implicated in this presentation?

  1. SSRIs such as fluoxetine
  2. High-potency typical antipsychotics such as haloperidol Correct answer.
  3. Mood stabilizers such as lithium
  4. Benzodiazepines such as lorazepam

Explanation

This is neuroleptic malignant syndrome, a life-threatening reaction characterized by hyperthermia, lead-pipe rigidity, autonomic instability, altered consciousness, and markedly elevated creatine kinase. It is classically associated with dopamine D2 antagonism, most often high-potency typical antipsychotics like haloperidol, though it can occur with any dopamine-blocking agent. Management involves stopping the offending drug and supportive care, with dantrolene or bromocriptine in severe cases.

Question 22Psychopharmacology and Biological Treatments

Which baseline investigation is most important before initiating lithium therapy in a patient with bipolar disorder?

  1. Serum amylase
  2. Renal function and thyroid function tests Correct answer.
  3. Serum calcium
  4. Liver function tests

Explanation

Lithium is excreted unchanged by the kidneys and can cause nephrogenic diabetes insipidus and chronic tubulointerstitial damage, so renal function must be documented before starting. Lithium also inhibits thyroid hormone release and can precipitate hypothyroidism, making thyroid function testing essential at baseline and during monitoring. Calcium, liver enzymes, and amylase are not the priority pre-lithium investigations.

Question 23Psychopharmacology and Biological Treatments

A patient on fluoxetine reports that the medication stopped working after several months of good response. Which pharmacokinetic property of fluoxetine best explains a delayed onset of interaction with a newly added drug?

  1. Its long half-life and active metabolite norfluoxetine Correct answer.
  2. Its short half-life of about 4 hours
  3. Its lack of hepatic metabolism
  4. Its renal-only elimination

Explanation

Fluoxetine has a long elimination half-life of several days, and its active metabolite norfluoxetine persists even longer, so inhibitory effects on CYP2D6 and CYP2C19 can outlast discontinuation by weeks. This explains why interactions with newly added drugs can emerge slowly and persist after fluoxetine is stopped. The other options misstate its pharmacokinetics.

Question 24Psychopharmacology and Biological Treatments

Which adverse effect is most characteristic of clozapine and requires regular absolute neutrophil count monitoring?

  1. Nephrogenic diabetes insipidus
  2. Retroperitoneal fibrosis
  3. Agranulocytosis Correct answer.
  4. Pulmonary hypertension

Explanation

Clozapine carries a well-known risk of neutropenia and agranulocytosis, occurring in roughly 1 percent of patients, which mandates regular blood count monitoring according to a defined schedule. Other serious clozapine effects include myocarditis, seizures, and severe constipation. The remaining options are not clozapine-specific hematologic risks.

Question 25Psychopharmacology and Biological Treatments

A patient with bipolar disorder on lithium presents with coarse tremor, ataxia, vomiting, and confusion. Which factor most likely precipitated lithium toxicity?

  1. Starting a proton pump inhibitor
  2. Starting a beta-blocker
  3. Starting a thiazide diuretic Correct answer.
  4. Starting an inhaled corticosteroid

Explanation

Thiazide diuretics increase proximal tubular sodium reabsorption, which enhances lithium reabsorption and can raise serum levels into the toxic range. Other precipitants include dehydration, NSAIDs, ACE inhibitors, and renal impairment. Beta-blockers, inhaled steroids, and proton pump inhibitors do not meaningfully raise lithium levels.

Question 26Psychopharmacology and Biological Treatments

Which medication is the first-line pharmacological treatment for a patient with moderate-to-severe alcohol withdrawal in a general hospital setting?

  1. Naltrexone
  2. Disulfiram
  3. Chlordiazepoxide Correct answer.
  4. Haloperidol

Explanation

Benzodiazepines such as chlordiazepoxide are first-line for alcohol withdrawal because they reduce the risk of seizures and delirium tremens by enhancing GABA-A activity, countering the withdrawal-related GABA deficit. They are typically given in a symptom-triggered or fixed-tapering regimen. Haloperidol may control agitation but does not prevent seizures, and disulfiram and naltrexone are relapse-prevention agents used after detoxification.

Question 27Psychopharmacology and Biological Treatments

A patient with treatment-resistant depression is started on phenelzine. Which dietary instruction is essential?

  1. Avoid tyramine-rich foods such as aged cheese and cured meats Correct answer.
  2. Avoid leafy green vegetables
  3. Avoid all dairy products including fresh milk
  4. Avoid gluten-containing grains

Explanation

Phenelzine is a nonselective irreversible monoamine oxidase inhibitor, so tyramine-rich foods can trigger a hypertensive crisis through massive noradrenaline release. Patients must avoid aged cheeses, cured meats, fermented products, and certain tap beers. Fresh dairy, leafy greens, and gluten are not restricted for this reason.

Question 28Psychopharmacology and Biological Treatments

Which laboratory parameter must be monitored most closely when initiating and titrating valproate in a patient with bipolar disorder?

  1. Serum lithium level
  2. Serum calcium
  3. Serum creatinine only
  4. Liver function tests and platelet count Correct answer.

Explanation

Valproate carries risks of hepatotoxicity and thrombocytopenia, so baseline and periodic liver function tests and full blood counts are recommended. It can also cause hyperammonemic encephalopathy and pancreatitis. Lithium levels are irrelevant to valproate, and creatinine and calcium are not the primary parameters for valproate toxicity.

Question 29Psychopharmacology and Biological Treatments

A patient with schizophrenia on long-term haloperidol develops involuntary chewing movements and tongue protrusion. Which management step is most appropriate?

  1. Consider switching to clozapine after assessing the severity Correct answer.
  2. Reassure the patient that the movements will resolve spontaneously
  3. Increase the haloperidol dose to suppress the movements
  4. Add an anticholinergic such as benztropine as definitive treatment

Explanation

These are tardive dyskinesia movements, a late-onset complication of dopamine antagonist exposure that can be irreversible. Anticholinergics typically worsen tardive dyskinesia, and increasing the antipsychotic dose only masks symptoms temporarily before they return worse. Switching to a lower-risk agent such as clozapine, with careful risk-benefit assessment, is a recognized strategy.

Question 30Psychopharmacology and Biological Treatments

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

  1. They act as partial agonists at dopamine D2 receptors
  2. They inhibit monoamine oxidase enzymes
  3. They directly block postsynaptic serotonin receptors
  4. They inhibit the serotonin transporter, increasing synaptic serotonin over time Correct answer.

Explanation

SSRIs block the presynaptic serotonin transporter, reducing reuptake and raising extracellular serotonin, with downstream neuroadaptive changes that account for the delayed clinical response. They do not act primarily at postsynaptic receptors, do not inhibit MAO, and are not dopamine partial agonists.

Question 31Psychopharmacology and Biological Treatments

A young man with first-episode psychosis is started on risperidone and develops a sustained painful erection lasting several hours. What is the most appropriate immediate action?

  1. Reassure him that this is a common and benign effect
  2. Refer for urgent urological assessment for priapism Correct answer.
  3. Double the risperidone dose
  4. Start an SSRI to counteract the effect

Explanation

Priapism is a rare but serious adverse effect of antipsychotics, especially those with strong alpha-1 adrenergic blockade such as risperidone. It is a urological emergency that can lead to permanent erectile dysfunction if not treated promptly, so urgent urological assessment is required. Dose changes and adding an SSRI are inappropriate and potentially harmful.

Question 32Psychopharmacology and Biological Treatments

Which agent is most appropriate for maintenance treatment to reduce relapse in opioid use disorder?

  1. Methadone or buprenorphine as opioid agonist therapy Correct answer.
  2. Chlorpromazine
  3. Propranolol
  4. Diazepam

Explanation

Opioid agonist therapy with methadone or buprenorphine reduces craving and withdrawal, blocks euphoric effects at adequate doses, and is the best-evidenced maintenance treatment for opioid use disorder. It lowers mortality and illicit opioid use. Benzodiazepines, antipsychotics, and beta-blockers do not treat the underlying disorder.

Question 33Psychopharmacology and Biological Treatments

A patient with depression on sertraline is prescribed tramadol for pain. What is the main pharmacological concern?

  1. Increased risk of tardive dyskinesia
  2. Serotonin syndrome risk from combined serotonergic activity Correct answer.
  3. Loss of tramadol analgesic effect
  4. Reduced sertraline absorption

Explanation

Tramadol inhibits serotonin reuptake in addition to its opioid action, so combining it with an SSRI increases the risk of serotonin toxicity, manifesting as agitation, clonus, hyperreflexia, and hyperthermia. The combination also lowers the seizure threshold. The other options do not describe the main interaction.

Question 34Psychopharmacology and Biological Treatments

Which property distinguishes atypical antipsychotics from typical antipsychotics in terms of receptor profile?

  1. Greater dopamine D2 blockade with no serotonin activity
  2. Selective serotonin reuptake inhibition
  3. Combined serotonin 5-HT2A and dopamine D2 antagonism Correct answer.
  4. Pure dopamine D1 agonism

Explanation

Atypical antipsychotics characteristically combine 5-HT2A antagonism with weaker or more loosely bound D2 antagonism, which is thought to underlie their lower extrapyramidal symptom burden. Typical agents rely mainly on strong D2 blockade. They are not selective serotonin reuptake inhibitors or D1 agonists.

Question 35Psychopharmacology and Biological Treatments

A pregnant woman with bipolar disorder maintained on lithium is considering continuing treatment. Which statement is most accurate for counselling?

  1. Lithium is absolutely contraindicated in all pregnancies
  2. Lithium exposure in early pregnancy is associated with a small increased risk of cardiac anomalies, notably Ebstein anomaly Correct answer.
  3. Lithium causes neural tube defects comparable to valproate
  4. Lithium has no teratogenic risk at any trimester

Explanation

Lithium exposure in the first trimester is associated with a modestly increased risk of congenital cardiac malformations, classically Ebstein anomaly, though the absolute risk is lower than once believed. The decision should weigh relapse risk against this small teratogenic risk, with fetal echocardiography offered. Absolute contraindication and equivalence to valproate's neural tube defect risk are incorrect.

Question 36Psychopharmacology and Biological Treatments

Which clinical finding best distinguishes serotonin syndrome from neuroleptic malignant syndrome?

  1. Hyperreflexia and clonus Correct answer.
  2. Lead-pipe rigidity
  3. Autonomic instability
  4. Markedly elevated creatine kinase

Explanation

Serotonin syndrome typically produces neuromuscular hyperactivity with hyperreflexia, clonus, and tremor, whereas neuroleptic malignant syndrome produces lead-pipe rigidity with bradyreflexia. Both can cause hyperthermia, autonomic instability, and raised creatine kinase, so these do not discriminate well. Recognizing the neuromuscular pattern guides urgent management.

Question 37Psychopharmacology and Biological Treatments

A patient with schizophrenia on olanzapine develops excessive thirst, polyuria, and hyperglycaemia. Which explanation is most likely?

  1. Olanzapine-induced hypothyroidism
  2. Olanzapine-induced nephrogenic diabetes insipidus
  3. Olanzapine-induced diabetes mellitus and possible diabetic ketoacidosis Correct answer.
  4. Olanzapine-induced hypercalcaemia

Explanation

Atypical antipsychotics, particularly olanzapine and clozapine, are associated with weight gain, insulin resistance, and new-onset diabetes, sometimes presenting as ketoacidosis. The combination of polyuria, polydipsia, and hyperglycaemia fits osmotic diuresis from hyperglycaemia. Nephrogenic diabetes insipidus is a lithium effect, and hypercalcaemia or hypothyroidism do not explain hyperglycaemia.

Question 38Psychopharmacology and Biological Treatments

Which medication is used as a first-line agent for obsessive-compulsive disorder and typically requires higher doses than for depression?

  1. Diazepam
  2. Lithium
  3. Fluoxetine Correct answer.
  4. Haloperidol

Explanation

SSRIs such as fluoxetine are first-line pharmacotherapy for OCD, but response often requires doses at the upper end of the licensed range and a longer trial of 8 to 12 weeks. Clomipramine is an alternative. Lithium, haloperidol, and diazepam are not first-line for OCD.

Question 39Psychopharmacology and Biological Treatments

A patient taking lithium reports a fine tremor that interferes with writing. Which management approach is most appropriate if the level is within the therapeutic range?

  1. Stop lithium immediately and start an antipsychotic
  2. Add a second mood stabilizer without changing lithium
  3. Consider dose reduction and, if needed, a beta-blocker such as propranolol Correct answer.
  4. Ignore the tremor as it is not treatment-related

Explanation

Fine tremor is a common dose-related lithium effect that can be managed by reducing the dose if the clinical situation allows, and propranolol is often effective for persistent tremor. Abrupt discontinuation risks relapse, and adding another mood stabilizer does not address the tremor. Recognizing this benign effect prevents unnecessary treatment changes.

Question 40Psychopharmacology and Biological Treatments

Which statement about electroconvulsive therapy in severe treatment-resistant depression is most accurate?

  1. It has no effect on suicidality
  2. It is contraindicated in all patients over 65
  3. It is ineffective in psychotic depression
  4. It requires informed consent and is delivered under general anaesthesia with muscle relaxation Correct answer.

Explanation

Modern ECT is given under general anaesthesia with a muscle relaxant and requires informed consent, with strict legal frameworks for incapacitated patients. It is particularly effective in severe, psychotic, or life-threatening depression, including in older adults, and rapidly reduces suicidal ideation. The other statements misrepresent its indications and safety.

Question 41Psychopharmacology and Biological Treatments

A patient with schizophrenia on clozapine presents with fever, tachycardia, and troponin elevation two weeks after initiation. Which diagnosis should be suspected?

  1. Clozapine-induced nephrogenic diabetes insipidus
  2. Clozapine-induced tardive dyskinesia
  3. Clozapine-induced myocarditis Correct answer.
  4. Clozapine-induced agranulocytosis

Explanation

Clozapine-induced myocarditis typically presents in the first 8 weeks of treatment with fever, tachycardia, chest discomfort, and raised troponin or inflammatory markers. It requires immediate clozapine cessation and urgent cardiology assessment. Agranulocytosis presents with infection and low neutrophils, while the other options are unrelated to this acute febrile cardiac picture.

Question 42Psychopharmacology and Biological Treatments

Which drug is a recognized first-line treatment for generalized anxiety disorder with a favourable dependence profile compared with benzodiazepines?

  1. Escitalopram Correct answer.
  2. Alprazolam
  3. Zolpidem
  4. Chlordiazepoxide

Explanation

SSRIs such as escitalopram are first-line pharmacotherapy for generalized anxiety disorder because they treat the core symptoms with a favourable long-term safety profile and low dependence risk. Benzodiazepines like alprazolam and chlordiazepoxide provide rapid relief but carry dependence and withdrawal risks and are reserved for short-term use. Zolpidem is a hypnotic, not an anxiolytic maintenance treatment.

Question 43Psychopharmacology and Biological Treatments

A patient with bipolar depression is started on lamotrigine. Which titration strategy minimizes the risk of a serious rash?

  1. Start at a high dose and reduce if rash appears
  2. Start with a loading dose followed by alternate-day dosing
  3. Start low and increase slowly over several weeks Correct answer.
  4. Combine with valproate to speed titration

Explanation

Lamotrigine must be started at a low dose and titrated slowly over several weeks to reduce the risk of Stevens-Johnson syndrome and toxic epidermal necrolysis. Valproate inhibits lamotrigine metabolism and raises its levels, so the starting dose must be halved and titrated even more cautiously when combined. Rapid or high-dose initiation increases rash risk.

Question 44Psychopharmacology and Biological Treatments

Which statement best reflects the evidence on antidepressant efficacy in mild depression?

  1. Antidepressants are highly effective in all severities of depression
  2. Antidepressants are contraindicated in moderate depression
  3. Placebo is more effective than antidepressants in severe depression
  4. Benefits over placebo are small in mild depression and increase with symptom severity Correct answer.

Explanation

Meta-analytic evidence indicates that the advantage of antidepressants over placebo is modest in mild depression and becomes clinically meaningful in moderate to severe illness. For mild depression, psychological therapies and watchful waiting are often preferred first. Antidepressants remain effective and indicated in moderate to severe depression.

Question 45Psychotherapy and Psychosocial Interventions

A 28-year-old woman with panic disorder is started on cognitive behavioral therapy. In the cognitive model of panic, which intervention targets the core maintaining mechanism most directly?

  1. Scheduling a fixed daily routine of relaxation exercises without any cognitive work
  2. Prescribing a benzodiazepine to be taken whenever she feels anxious
  3. Interoceptive exposure combined with testing catastrophic misinterpretations of bodily sensations Correct answer.
  4. Encouraging her to avoid situations that previously triggered panic attacks

Explanation

The cognitive model of panic holds that attacks are maintained by catastrophic misinterpretation of benign bodily sensations, such as reading palpitations as a heart attack. Treatment therefore combines interoceptive exposure with behavioral experiments that disconfirm these predictions. Relaxation alone, PRN benzodiazepines and avoidance do not correct the misinterpretation and may reinforce it.

Question 46Psychotherapy and Psychosocial Interventions

In psychodynamic psychotherapy, which patient behavior is classically described as transference?

  1. The patient consciously agrees with the therapist's interpretations to please the therapist
  2. The patient experiences feelings toward the therapist that repeat patterns from earlier important relationships Correct answer.
  3. The patient reports dreams that symbolically represent the therapist
  4. The therapist's own unresolved conflicts distort the therapist's understanding of the patient

Explanation

Transference is the displacement onto the therapist of feelings, wishes and expectations originally attached to significant figures from the patient's past. It is distinguished from countertransference, which refers to the therapist's own evoked reactions. Dream symbolism and conscious compliance are different phenomena.

Question 47Psychotherapy and Psychosocial Interventions

A patient in the contemplation stage of the transtheoretical model of change is best engaged by which approach?

  1. Discharging the patient until motivation appears spontaneously
  2. Reassuring the patient that no change is needed at present
  3. Immediately prescribing a structured abstinence plan with fixed deadlines
  4. Exploring ambivalence and highlighting discrepancies between values and current behavior Correct answer.

Explanation

In the contemplation stage the patient recognizes a problem but is ambivalent about acting. Motivational work that explores ambivalence and develops discrepancy builds intrinsic motivation without provoking resistance. Premature action planning, reassurance or discharge does not match the stage.

Question 48Psychotherapy and Psychosocial Interventions

Which statement correctly describes the technique of exposure and response prevention in obsessive-compulsive disorder?

  1. The patient is helped to suppress intrusive thoughts through thought stopping
  2. The patient is taught to avoid all situations that provoke obsessions
  3. The patient performs the compulsion more slowly until it loses its meaning
  4. The patient is exposed to anxiety-provoking stimuli while refraining from the ritual that usually reduces anxiety Correct answer.

Explanation

Exposure and response prevention requires the patient to confront obsessional triggers while voluntarily blocking the compulsive ritual. Over repeated trials this allows anxiety to habituate and disconfirms the belief that the ritual prevents harm. Suppression, ritual rehearsal and avoidance all maintain the disorder.

Question 49Psychotherapy and Psychosocial Interventions

A 45-year-old man with alcohol dependence has relapsed three times. In relapse prevention based on Marlatt's model, which is the most appropriate focus of therapy?

  1. Restricting all social contact to family members only
  2. Replacing alcohol with a different substance to avoid withdrawal
  3. Establishing that any lapse proves the patient is incapable of change
  4. Identifying high-risk situations and rehearsing coping responses for them Correct answer.

Explanation

Marlatt's relapse prevention model emphasizes identifying high-risk situations, developing coping skills and managing the abstinence violation effect after a lapse. A lapse is reframed as a learning opportunity rather than proof of failure. Social restriction and substance substitution are not components of this model.

Question 50Psychotherapy and Psychosocial Interventions

In supportive psychotherapy, which therapist activity is most characteristic?

  1. Active reinforcement of the patient's adaptive defenses and coping resources Correct answer.
  2. Structured exposure homework with a fear hierarchy
  3. Systematic interpretation of unconscious conflict from childhood
  4. Socratic questioning to identify cognitive distortions

Explanation

Supportive psychotherapy aims to strengthen the patient's existing defenses, coping skills and self-esteem within a supportive relationship. It is distinguished from interpretive psychodynamic work, exposure-based behavioral therapy and cognitive restructuring. The therapist is relatively active and may offer advice and praise.