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Kuwait Board Psychiatry study materials
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Kuwait Board Psychiatry practice questions

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Question 1Basic Neurosciences and Behavioural Sciences

Degeneration of dopaminergic neurons in the substantia nigra pars compacta is the core neurochemical lesion in which condition?

  1. Alzheimer disease
  2. Huntington disease
  3. Parkinson disease Correct answer.
  4. Amyotrophic lateral sclerosis

Explanation

Loss of nigrostriatal dopamine projections to the striatum produces the cardinal motor features of bradykinesia, rigidity and resting tremor, and dopamine replacement remains the mainstay of treatment. Alzheimer disease is characterised more by cortical cholinergic loss and amyloid-tau pathology rather than nigral dopamine loss.

Question 2Basic Neurosciences and Behavioural Sciences

Which brain structure is critically involved in the acquisition and expression of conditioned fear?

  1. Caudate nucleus
  2. Hippocampus
  3. Mammillary body
  4. Amygdala Correct answer.

Explanation

The basolateral amygdala integrates sensory cues with aversive outcomes, and lesions or inactivation of the amygdala impair both the acquisition and the expression of conditioned fear. The hippocampus contributes more to contextual and spatial aspects of memory rather than to fear learning itself.

Question 3Basic Neurosciences and Behavioural Sciences

In a healthy relaxed adult with the eyes closed, the dominant posterior EEG rhythm is:

  1. Delta rhythm (0.5-4 Hz)
  2. Theta rhythm (4-7 Hz)
  3. Alpha rhythm (8-13 Hz) Correct answer.
  4. Beta rhythm (14-30 Hz)

Explanation

The alpha rhythm is a posterior dominant 8-13 Hz oscillation seen in relaxed wakefulness with eyes closed, and it attenuates on eye opening or mental effort. Beta activity predominates in alert, active states, while delta characterises slow-wave sleep.

Question 4Basic Neurosciences and Behavioural Sciences

The therapeutic action of selective serotonin reuptake inhibitors is best explained by:

  1. Blockade of presynaptic serotonin autoreceptors
  2. Direct agonism at postsynaptic 5-HT2A receptors
  3. Inhibition of the serotonin transporter (SERT) Correct answer.
  4. Irreversible inhibition of monoamine oxidase type A

Explanation

Selective serotonin reuptake inhibitors bind the serotonin transporter and reduce serotonin reuptake into the presynaptic terminal, raising extracellular serotonin and producing adaptive downstream changes over weeks. Monoamine oxidase inhibitors and receptor agonists act through entirely different mechanisms.

Question 5Basic Neurosciences and Behavioural Sciences

Working memory in humans is most consistently linked to which cortical region?

  1. Primary visual cortex
  2. Medial prefrontal cortex
  3. Dorsolateral prefrontal cortex Correct answer.
  4. Orbitofrontal cortex

Explanation

The dorsolateral prefrontal cortex shows sustained delay-period activity during working memory tasks, and lesions there impair performance on n-back and delayed-response paradigms. Medial prefrontal and orbitofrontal regions are more concerned with emotional regulation and reward valuation.

Question 6Basic Neurosciences and Behavioural Sciences

A patient shows placidity, hyperorality and an inability to recognise familiar objects after bilateral temporal lobe damage. This presentation is most consistent with:

  1. Anton syndrome
  2. Balint syndrome
  3. Gerstmann syndrome
  4. Kluver-Bucy syndrome Correct answer.

Explanation

Kluver-Bucy syndrome follows bilateral damage to the amygdala and anterior temporal lobes and is characterised by psychic blindness, hyperorality, hypersexuality and reduced fear. The other named syndromes arise from parietal or occipital lesions and have distinct clinical signatures.

Question 7Basic Neurosciences and Behavioural Sciences

Antipsychotic-induced hyperprolactinaemia is principally caused by dopamine D2 receptor blockade in which pathway?

  1. Tuberoinfundibular pathway Correct answer.
  2. Nigrostriatal pathway
  3. Mesolimbic pathway
  4. Mesocortical pathway

Explanation

Tuberoinfundibular dopamine neurons tonically inhibit prolactin release from the anterior pituitary, so D2 blockade here removes that inhibition and raises serum prolactin. Blockade of the other pathways accounts for antipsychotic efficacy and extrapyramidal or negative-symptom effects rather than prolactin elevation.

Question 8Basic Neurosciences and Behavioural Sciences

Which statement about REM sleep in healthy adults is correct?

  1. It is usually absent during the first sleep cycle of the night
  2. It occupies the largest proportion of total sleep time
  3. It is accompanied by skeletal muscle atonia and desynchronised EEG Correct answer.
  4. It is characterised by high-voltage slow EEG activity

Explanation

REM sleep combines low-voltage, mixed-frequency desynchronised EEG with rapid eye movements and brainstem-mediated skeletal muscle atonia. Stage N2 occupies the largest share of total sleep time, and REM periods lengthen towards the later part of the night.

Question 9Basic Neurosciences and Behavioural Sciences

Long-term potentiation at hippocampal CA1 synapses depends critically on:

  1. GABA-A receptor-mediated chloride influx
  2. Presynaptic voltage-gated calcium entry alone
  3. Activation of AMPA receptors alone without postsynaptic depolarisation
  4. Calcium influx through NMDA receptors after coincident glutamate release and postsynaptic depolarisation Correct answer.

Explanation

NMDA receptors are blocked by magnesium at resting potential, so they conduct calcium only when glutamate binding coincides with sufficient postsynaptic depolarisation. The resulting calcium rise activates CaMKII and drives insertion of AMPA receptors, the cellular basis of this Hebbian form of plasticity.

Question 10Basic Neurosciences and Behavioural Sciences

Monozygotic twins show substantially higher concordance for schizophrenia than dizygotic twins. This finding is best interpreted as evidence that:

  1. Shared family environment accounts for all of the variance
  2. Schizophrenia is caused by a single dominant gene
  3. Schizophrenia is not heritable
  4. Genetic factors contribute substantially to liability, with environmental factors also involved Correct answer.

Explanation

Concordance of roughly 40-50 percent in monozygotic versus 10-15 percent in dizygotic twins indicates a large heritable component, estimated at about 80 percent. Because monozygotic concordance is well below 100 percent, non-shared environmental influences must also contribute to liability.

Question 11Basic Neurosciences and Behavioural Sciences

Which neurotransmitter provides the principal fast inhibitory transmission in the adult mammalian central nervous system?

  1. Dopamine acting at D2 receptors
  2. Glutamate acting at AMPA receptors
  3. Gamma-aminobutyric acid Correct answer.
  4. Acetylcholine acting at nicotinic receptors

Explanation

Gamma-aminobutyric acid is the main fast inhibitory transmitter in the adult brain. It acts largely at GABA-A receptors, which are ligand-gated chloride channels that hyperpolarise the postsynaptic neuron and reduce firing probability.

Question 12Basic Neurosciences and Behavioural Sciences

Cell bodies of noradrenergic neurons that project diffusely to the cerebral cortex are located mainly in which structure?

  1. Raphe nuclei
  2. Substantia nigra pars compacta
  3. Basal nucleus of Meynert
  4. Locus coeruleus Correct answer.

Explanation

The locus coeruleus in the dorsal pons contains most noradrenergic cell bodies projecting to the forebrain. Its widespread projections regulate arousal, vigilance and attention.

Question 13Basic Neurosciences and Behavioural Sciences

Which feature is characteristic of stage N2 sleep on polysomnography?

  1. Delta waves occupying more than 20% of the epoch
  2. Alpha rhythm with eye closure
  3. Sawtooth waves with rapid eye movements
  4. Sleep spindles and K-complexes Correct answer.

Explanation

Stage N2 sleep is defined by sleep spindles and K-complexes against a mixed-frequency background. Alpha rhythm predominates in relaxed wakefulness with eyes closed, whereas slow delta waves define N3 sleep.

Question 14Basic Neurosciences and Behavioural Sciences

Cocaine produces its main reinforcing effect by blocking which presynaptic transporter?

  1. Serotonin transporter
  2. Norepinephrine transporter
  3. Vesicular monoamine transporter 2
  4. Dopamine transporter Correct answer.

Explanation

Cocaine binds the dopamine transporter and reduces dopamine reuptake, increasing extracellular dopamine in reward-related circuits such as the nucleus accumbens. Although cocaine also affects serotonin and norepinephrine transporters, its principal reinforcing action is attributed to dopamine transporter blockade.

Question 15Basic Neurosciences and Behavioural Sciences

According to the Rescorla-Wagner model, the amount of conditioning supported by a conditioned stimulus on a given trial depends most directly on which factor?

  1. The total number of prior pairings, irrespective of outcome
  2. The physical intensity of the conditioned stimulus alone
  3. The discrepancy between expected and received reinforcement Correct answer.
  4. The intertrial interval, independent of reinforcement

Explanation

The Rescorla-Wagner model treats conditioning as driven by prediction error. Learning is greatest when the unconditioned stimulus is surprising, that is, when the reinforcement received differs from what the conditioned stimuli already predict.

Question 16Basic Neurosciences and Behavioural Sciences

A rat repeatedly explores a familiar maze. Hippocampal neurons that fire only when the animal is in one particular location are called which type of cell?

  1. Head-direction cells
  2. Grid cells
  3. Mirror neurons
  4. Place cells Correct answer.

Explanation

Place cells are hippocampal pyramidal neurons with location-specific firing fields, and they are thought to support spatial mapping and navigation. Grid cells, by contrast, are found mainly in the entorhinal cortex and fire in a periodic hexagonal pattern.

Question 17Basic Neurosciences and Behavioural Sciences

Light entrains the suprachiasmatic nucleus through which neural pathway?

  1. The retinohypothalamic tract Correct answer.
  2. The olfactory bulb projection tract
  3. The spinothalamic somatosensory tract
  4. The acoustic radiation to the midbrain

Explanation

Specialised retinal ganglion cells containing melanopsin send light information directly to the suprachiasmatic nucleus via the retinohypothalamic tract. This pathway allows the circadian clock to synchronise with the environmental light-dark cycle.

Question 18Basic Neurosciences and Behavioural Sciences

A 52-year-old man with chronic alcohol use develops confusion, ataxia and horizontal nystagmus. Neuropathology most typically involves which structure?

  1. Cerebellar tonsils
  2. Caudate nucleus
  3. Hippocampus
  4. Mammillary bodies Correct answer.

Explanation

The presentation suggests Wernicke encephalopathy due to thiamine deficiency. Typical lesions affect the mammillary bodies, medial thalamus and periaqueductal grey matter, producing confusion, ataxia and oculomotor signs.

Question 19Basic Neurosciences and Behavioural Sciences

Fragile X syndrome, a common inherited cause of intellectual disability and autism, most often results from which genetic abnormality?

  1. A paternal deletion of chromosome 15q11-q13
  2. A trinucleotide repeat expansion within the huntingtin gene
  3. A CGG repeat expansion in FMR1 Correct answer.
  4. A point mutation within the MECP2 gene

Explanation

Fragile X syndrome is usually caused by expansion of a CGG trinucleotide repeat in the FMR1 gene. When the expansion is large, the promoter becomes methylated and FMR1 is silenced, reducing production of fragile X mental retardation protein.

Question 20Basic Neurosciences and Behavioural Sciences

Which set of regions is most consistently described as core nodes of the default mode network?

  1. Amygdala and periaqueductal grey
  2. Medial prefrontal cortex and posterior cingulate cortex Correct answer.
  3. Lateral geniculate nucleus and primary visual cortex
  4. Primary motor cortex and primary somatosensory cortex

Explanation

The default mode network is a set of midline and lateral association regions that are more active during rest and internally directed thought. Its core nodes include the medial prefrontal cortex, posterior cingulate cortex and precuneus, with contributions from lateral parietal cortex.

Question 21Psychopathology, Assessment and Classification

In psychopathology, which description best defines a delusion?

  1. A fixed false belief held despite contrary evidence and not shared by the person's culture Correct answer.
  2. A misperception of a real external stimulus occurring in clear consciousness
  3. An intrusive unwanted thought recognised as arising from the person's own mind and resisted
  4. A culturally sanctioned belief that is shared by other members of the person's community and is not considered pathological

Explanation

A delusion is a fixed false belief held with strong conviction despite contrary evidence and not shared by the person's culture. It is distinguished from an obsession, which is intrusive and recognised as egodystonic, and from an illusion, which is a misperception of a real stimulus. Culturally sanctioned beliefs are not delusions merely because an examiner does not share them.

Question 22Psychopathology, Assessment and Classification

Which symptom is regarded as a Schneiderian first-rank symptom of schizophrenia?

  1. Thought insertion Correct answer.
  2. Depressed mood with diurnal variation
  3. Clang associations
  4. Flight of ideas

Explanation

Schneiderian first-rank symptoms include thought insertion, thought withdrawal, thought broadcasting, made feelings or impulses, somatic passivity, delusional perception, and certain auditory hallucinations. Thought insertion is the experience that thoughts are being placed into one's mind by an external agency. Mood, flight of ideas, and clang associations are not first-rank symptoms.

Question 23Psychopathology, Assessment and Classification

Which instrument is a 21-item self-report questionnaire designed to measure the severity of depressive symptoms?

  1. Positive and Negative Syndrome Scale (PANSS)
  2. Mini-Mental State Examination (MMSE)
  3. Young Mania Rating Scale (YMRS)
  4. Beck Depression Inventory-II (BDI-II) Correct answer.

Explanation

The Beck Depression Inventory-II is a 21-item self-report scale that quantifies depressive symptom severity over the preceding two weeks. The PANSS assesses psychosis, the YMRS assesses mania, and the MMSE screens cognition.

Question 24Psychopathology, Assessment and Classification

According to DSM-5, a diagnosis of schizophrenia requires continuous signs of disturbance for at least which minimum period, including at least one month of active-phase symptoms?

  1. One month
  2. Three months
  3. Six months Correct answer.
  4. Two weeks

Explanation

DSM-5 requires continuous signs of the disturbance for at least six months, with at least one month of active-phase symptoms; the remaining period may include prodromal or residual symptoms. Shorter durations are considered schizophreniform disorder or brief psychotic disorder depending on length.

Question 25Psychopathology, Assessment and Classification

Which pattern of mood episodes is required for a DSM-5 diagnosis of bipolar II disorder?

  1. One or more manic episodes plus one or more major depressive episodes, with or without psychosis
  2. One or more hypomanic episodes plus one or more major depressive episodes, without mania Correct answer.
  3. Two or more hypomanic episodes without any major depressive episode
  4. One or more mixed episodes with psychotic features and no hypomanic episode

Explanation

Bipolar II disorder requires at least one hypomanic episode and at least one major depressive episode, with no lifetime manic episode. A manic episode, even if depression also occurs, places the diagnosis in bipolar I disorder.

Question 26Psychopathology, Assessment and Classification

A patient states that his private thoughts are being transmitted to others without his control. This symptom is best classified as:

  1. Delusional perception
  2. Thought withdrawal
  3. Thought broadcasting Correct answer.
  4. Thought insertion

Explanation

Thought broadcasting is the belief that one's thoughts are being transmitted or made known to others without one's control. It is a passivity phenomenon often grouped with first-rank symptoms. Thought insertion and withdrawal concern thoughts being placed into or removed from the mind.

Question 27Psychopathology, Assessment and Classification

An 82-year-old man with a urinary tract infection develops acute confusion and inattention that fluctuate over the day. Which instrument is most appropriate for structured delirium screening?

  1. Generalised Anxiety Disorder-7 (GAD-7)
  2. Confusion Assessment Method (CAM) Correct answer.
  3. Positive and Negative Syndrome Scale (PANSS)
  4. Mini-Mental State Examination (MMSE)

Explanation

The Confusion Assessment Method is a structured screening tool for delirium based on acute onset with fluctuating course, inattention, disorganised thinking, and altered level of consciousness. The MMSE screens cognition but does not establish delirium, while the GAD-7 and PANSS assess anxiety and psychosis respectively.

Question 28Psychopathology, Assessment and Classification

In the DSM-5 Cultural Formulation Interview, a patient's explanation that his distress is caused by the 'evil eye' is best documented as:

  1. Malingering to obtain secondary gain
  2. A cultural concept of distress Correct answer.
  3. A personality trait reflecting suggestibility
  4. A psychotic delusion requiring antipsychotic treatment

Explanation

DSM-5 cultural concepts of distress include cultural syndromes, idioms of distress, and causal explanations such as the evil eye. These are documented to understand the patient's explanatory model and should not automatically be pathologised as delusions. Cultural formulation improves diagnostic validity and engagement.

Question 29Psychopathology, Assessment and Classification

A patient with suspected behavioural variant frontotemporal dementia shows prominent apathy, disinhibition, and loss of empathy. Which neuropsychological profile is most consistent with this condition?

  1. Disproportionate executive and social cognition impairment with relatively preserved visuospatial skills Correct answer.
  2. Isolated visuospatial deficit with intact language and personality
  3. Global uniform decline affecting memory, language, and visuospatial function equally from onset
  4. Severe early amnesia with preserved executive function, language, and social conduct

Explanation

Behavioural variant frontotemporal dementia typically presents with early executive dysfunction, apathy, disinhibition, and impaired social cognition, while visuospatial skills are relatively spared early. Alzheimer's disease more often produces prominent episodic memory impairment, and Lewy body disease may produce early visuospatial deficits.

Question 30Psychopathology, Assessment and Classification

Which statement accurately distinguishes post-traumatic stress disorder from acute stress disorder in DSM-5?

  1. Acute stress disorder requires psychotic symptoms, whereas PTSD requires prominent dissociative symptoms
  2. PTSD requires symptoms persisting beyond one month; acute stress disorder covers three days to one month Correct answer.
  3. PTSD can be diagnosed immediately after trauma, whereas acute stress disorder requires a six-month delay
  4. Acute stress disorder requires symptoms lasting more than one month, whereas PTSD requires symptoms lasting less than one month

Explanation

DSM-5 distinguishes PTSD from acute stress disorder mainly by duration: PTSD requires symptoms persisting for more than one month, while acute stress disorder covers the period from three days to one month after trauma. Both require exposure to a traumatic event and characteristic symptom clusters.

Question 31Psychopathology, Assessment and Classification

Which rating scale is specifically designed to quantify the severity of manic symptoms in a patient with bipolar disorder?

  1. Young Mania Rating Scale (YMRS) Correct answer.
  2. Hamilton Depression Rating Scale (HAM-D)
  3. Columbia Suicide Severity Rating Scale (C-SSRS)
  4. Positive and Negative Syndrome Scale (PANSS)

Explanation

The Young Mania Rating Scale is an 11-item clinician-rated instrument that quantifies manic symptom severity and is widely used to track treatment response in bipolar disorder. The HAM-D measures depression, the PANSS measures positive and negative symptoms of schizophrenia, and the C-SSRS assesses suicidal ideation and behaviour.

Question 32Psychopathology, Assessment and Classification

A 32-year-old man is screened in primary care for unhealthy alcohol use. Which instrument is a 10-item interviewer-administered questionnaire developed by the World Health Organization for this purpose?

  1. Alcohol Use Disorders Identification Test (AUDIT)
  2. Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar)
  3. Drug Abuse Screening Test (DAST-10)
  4. CAGE questionnaire Correct answer.

Explanation

The AUDIT is a 10-item WHO screening instrument covering consumption, dependence symptoms, and alcohol-related problems. The CAGE is a brief four-item screen, the DAST-10 targets drug use, and the CIWA-Ar measures alcohol withdrawal severity rather than hazardous drinking.

Question 33Psychopathology, Assessment and Classification

A psychiatrist is revising a service protocol to align with ICD-11. Which change from ICD-10 applies to the classification of schizophrenia?

  1. The classic clinical subtypes have been removed, and schizophrenia is recorded as a single category. Correct answer.
  2. The classic clinical subtypes, such as paranoid and hebephrenic schizophrenia, have been retained as separate diagnoses.
  3. Schizophrenia has been moved into the ICD-11 chapter for anxiety and fear-related disorders.
  4. A minimum duration of six months has replaced the previous one-month duration requirement.

Explanation

ICD-11 simplifies schizophrenia by removing the ICD-10 clinical subtypes, such as paranoid, hebephrenic, catatonic, undifferentiated, and residual schizophrenia, and describing a single schizophrenia category with symptomatic dimensions. ICD-11 keeps schizophrenia among mental, behavioural, and neurodevelopmental disorders and does not require a six-month minimum duration.

Question 34Psychopathology, Assessment and Classification

A 28-year-old woman has a three-year history of recurrent major depressive episodes. During the current episode she has mood-congruent delusions of guilt. Delusions occur only during her depressive episodes, and she has never had psychotic symptoms when euthymic. Which diagnosis is most appropriate?

  1. Major depressive disorder with psychotic features Correct answer.
  2. Schizophrenia
  3. Brief psychotic disorder
  4. Schizoaffective disorder, depressive type

Explanation

Psychotic symptoms that occur exclusively during major mood episodes are consistent with major depressive disorder with psychotic features. Schizoaffective disorder requires delusions or hallucinations for at least two weeks in the absence of a major mood episode at some point during the illness, which this patient has never experienced.

Question 35Psychopathology, Assessment and Classification

A patient started haloperidol and now reports an intense inner restlessness and an inability to sit still. Which instrument is most appropriate for quantifying this adverse effect?

  1. Barnes Akathisia Rating Scale (BARS) Correct answer.
  2. Calgary Depression Scale for Schizophrenia
  3. Abnormal Involuntary Movement Scale (AIMS)
  4. Simpson-Angus Scale

Explanation

The Barnes Akathisia Rating Scale rates objective akathisia, subjective awareness of restlessness, and associated distress, making it the specific tool for this extrapyramidal adverse effect. The AIMS rates tardive dyskinesia, the Simpson-Angus Scale rates parkinsonism, and the Calgary scale measures depression in schizophrenia.

Question 36Psychopathology, Assessment and Classification

Which statement reflects the DSM-5-TR requirement for confirming premenstrual dysphoric disorder before a definitive diagnosis?

  1. Prospective daily ratings are required across at least two symptomatic cycles. Correct answer.
  2. A day-21 serum oestradiol level is required to confirm the diagnosis.
  3. Symptoms must persist throughout the whole cycle for at least six months.
  4. One retrospective rating of the worst premenstrual week is sufficient to confirm the diagnosis.

Explanation

DSM-5-TR requires prospective daily symptom ratings over at least two symptomatic menstrual cycles to confirm the temporal pattern of premenstrual dysphoric disorder. Symptoms must be present in the final week before menses, begin to improve within days of onset, and be minimal or absent in the postmenstrual week, with clinically significant distress or impairment.

Question 37Schizophrenia Spectrum and Other Psychotic Disorders

According to DSM-5-TR, what is the minimum total duration of continuous signs required for a diagnosis of schizophrenia?

  1. At least six months Correct answer.
  2. At least two years
  3. At least one year
  4. At least one month

Explanation

DSM-5-TR requires continuous signs of schizophrenia for at least six months, including at least one month of active-phase symptoms. One month is only the active-phase minimum, while one or two years exceed the required total duration.

Question 38Schizophrenia Spectrum and Other Psychotic Disorders

A patient develops sudden delusions and disorganized speech that resolve completely after 3 weeks. What is the most likely diagnosis?

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

Explanation

Brief psychotic disorder lasts at least one day but less than one month, with eventual full return to premorbid functioning. Schizophreniform disorder requires one to six months, schizophrenia requires at least six months, and delusional disorder requires at least one month of delusions.

Question 39Schizophrenia Spectrum and Other Psychotic Disorders

A patient has a 2-year history of a fixed, nonbizarre belief of being followed by neighbors, with no hallucinations and no marked functional decline. What is the most likely diagnosis?

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

Explanation

Delusional disorder is characterized by at least one month of nonbizarre delusions without prominent hallucinations, disorganized behavior, negative symptoms, or marked functional decline. The two-year course with preserved functioning and no hallucinations fits delusional disorder better than the other psychotic disorders.

Question 40Schizophrenia Spectrum and Other Psychotic Disorders

Which symptom is considered a Schneiderian first-rank symptom of schizophrenia?

  1. Grandiose delusions of being a prophet
  2. Avolition and social withdrawal
  3. Third-person auditory hallucinations Correct answer.
  4. Visual hallucinations of deceased relatives

Explanation

Schneiderian first-rank symptoms include third-person auditory hallucinations, thought insertion or broadcasting, made feelings or impulses, and delusional perception. Visual hallucinations, grandiose delusions, and negative symptoms are not first-rank Schneiderian symptoms.

Question 41Schizophrenia Spectrum and Other Psychotic Disorders

A patient with schizophrenia has persistent positive symptoms after trials of two different antipsychotics at adequate doses for 6 weeks each, with good adherence. What is the next evidence-based step?

  1. Increase the current antipsychotic dose
  2. Add a second antipsychotic
  3. Start clozapine Correct answer.
  4. Switch to a long-acting injectable

Explanation

Treatment-resistant schizophrenia is generally defined as persistent symptoms after two adequate antipsychotic trials, each with good adherence and adequate dose and duration. Clozapine is the only antipsychotic with established superiority in this situation and should be offered rather than simply adding or increasing medication.

Question 42Schizophrenia Spectrum and Other Psychotic Disorders

A patient started on haloperidol 3 days ago develops fever of 39.5°C, lead-pipe rigidity, confusion, and creatine kinase of 4,000 U/L. Which management is most appropriate?

  1. Continue haloperidol and add benztropine
  2. Stop antipsychotic; supportive care plus dantrolene Correct answer.
  3. Start clozapine immediately
  4. Increase haloperidol and add a benzodiazepine

Explanation

The presentation suggests neuroleptic malignant syndrome, a life-threatening reaction to dopamine antagonists. Management is to stop the offending antipsychotic, provide supportive care, and use dantrolene or bromocriptine in severe cases.

Question 43Schizophrenia Spectrum and Other Psychotic Disorders

A patient with schizophrenia is mute, holds unusual postures, and has waxy flexibility. After a lorazepam challenge, symptoms improve. What is the most appropriate next step?

  1. Lorazepam, then ECT if refractory Correct answer.
  2. Observe without specific treatment
  3. Add an SSRI antidepressant to current
  4. Start high-dose haloperidol and monitor

Explanation

Catatonia responds first-line to benzodiazepines such as lorazepam, and a positive challenge supports this. ECT is indicated if catatonia is refractory or malignant, while antipsychotics may worsen catatonia.

Question 44Schizophrenia Spectrum and Other Psychotic Disorders

A woman 10 days postpartum has insomnia, fluctuating confusion, delusions, and hallucinations. She is at highest risk for which outcome?

  1. Tardive dyskinesia
  2. Hypothyroidism
  3. Suicide and infanticide Correct answer.
  4. Neuroleptic malignant syndrome

Explanation

Postpartum psychosis usually emerges within the first two weeks after delivery and is a psychiatric emergency. The greatest immediate dangers are suicide and infanticide, so urgent hospitalization and treatment are required.

Question 45Schizophrenia Spectrum and Other Psychotic Disorders

A patient with schizophrenia has prominent avolition and flat affect while taking risperidone, and also has parkinsonism and depressed mood. Which approach best clarifies whether the negative symptoms are primary?

  1. Treat secondary causes, then reassess Correct answer.
  2. Add an antidepressant immediately
  3. Increase risperidone dose
  4. Diagnose deficit syndrome without further assessment

Explanation

Negative symptoms can be primary to schizophrenia or secondary to parkinsonism, depression, positive symptoms, or environmental deprivation. Treating identifiable secondary causes first is necessary before concluding that avolition and flat affect are primary negative symptoms.

Question 46Schizophrenia Spectrum and Other Psychotic Disorders

A patient on clozapine develops fever and sore throat; the absolute neutrophil count is 0.8 × 10^9/L. Which action is correct?

  1. Continue clozapine and repeat CBC in one week
  2. Stop clozapine and treat neutropenic sepsis urgently Correct answer.
  3. Add lithium to stimulate neutrophils
  4. Reduce clozapine dose by half

Explanation

Clozapine can cause severe neutropenia and agranulocytosis, and an absolute neutrophil count below 1.0 × 10^9/L requires stopping the drug. Fever and sore throat suggest infection, so urgent septic screen and medical treatment are needed.

Question 47Schizophrenia Spectrum and Other Psychotic Disorders

Which of the following is classified as a negative symptom of schizophrenia?

  1. Delusions of persecution
  2. Auditory hallucinations
  3. Avolition Correct answer.
  4. Disorganized speech

Explanation

Negative symptoms reflect a loss or diminution of normal functions and include avolition, alogia, anhedonia, blunted affect, and asociality. Hallucinations and delusions are positive symptoms, while disorganized speech belongs to the disorganization domain. Recognizing the symptom domain guides prognosis and treatment planning.

Question 48Schizophrenia Spectrum and Other Psychotic Disorders

Increased dopaminergic activity in which pathway is most closely associated with the positive symptoms of schizophrenia?

  1. Mesolimbic pathway Correct answer.
  2. Tuberoinfundibular pathway
  3. Mesocortical pathway
  4. Nigrostriatal pathway

Explanation

The mesolimbic dopamine pathway is implicated in positive symptoms such as hallucinations and delusions, and D2 blockade in this pathway is thought to reduce them. The mesocortical pathway is more often linked to negative and cognitive symptoms, while nigrostriatal and tuberoinfundibular effects explain extrapyramidal and prolactin adverse effects.

Question 49Schizophrenia Spectrum and Other Psychotic Disorders

A patient has schizophrenia-like symptoms and recurrent major depressive episodes. Which feature is required to diagnose schizoaffective disorder rather than major depressive disorder with psychotic features?

  1. Psychotic symptoms occur only during mood episodes
  2. Negative symptoms are absent throughout the illness
  3. Two weeks of psychosis without mood symptoms Correct answer.
  4. Total duration of illness is less than one month

Explanation

Schizoaffective disorder requires that delusions or hallucinations be present for at least 2 weeks in the absence of a major mood episode at some point during the illness. If psychosis occurs exclusively during mood episodes, the presentation is better classified as a mood disorder with psychotic features. The 2-week criterion helps separate schizoaffective disorder from psychotic mood disorders.

Question 50Schizophrenia Spectrum and Other Psychotic Disorders

A patient with schizophrenia started on aripiprazole 5 days ago reports an intense inner restlessness and an inability to sit still, with pacing and shifting weight. He denies anxious ruminations. Which adverse effect is most likely?

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

Explanation

Akathisia is a subjective sense of inner restlessness with observable pacing or shifting, often arising within days of starting or increasing an antipsychotic. It can be mistaken for anxiety or agitation, but the urge to move rather than anxious worry is characteristic. Acute dystonia involves sustained muscle contractions, parkinsonism involves tremor and rigidity, and tardive dyskinesia is typically later onset.