Drug-induced psychiatric disorders: recognition and management MCQs With Answer

Introduction: This collection of MCQs on Drug-induced psychiatric disorders: recognition and management is designed for M.Pharm students preparing for Pharmacotherapeutics II (MPP 202T). The quiz emphasizes clinically relevant presentations, common culprit drugs, underlying mechanisms, risk factors, diagnostic clues, and evidence-based management strategies. Questions focus on distinguishing primary psychiatric illness from medication-related conditions, recognizing toxidromes such as serotonin syndrome and anticholinergic delirium, and applying pragmatic interventions (drug cessation, dose adjustment, symptomatic therapies, or use of mood stabilizers/antipsychotics). Use these MCQs to reinforce pharmacologic reasoning, improve patient safety, and prepare for examinations and clinical decision-making in psychopharmacology.

Q1. Which of the following drugs is most classically associated with causing treatment-emergent major depression during therapy?

• Interferon-alpha
• Metformin
• Amoxicillin
• Propranolol

Correct Answer: Interferon-alpha

Q2. Typical time course for onset of corticosteroid-induced mood and psychotic symptoms after initiation of high-dose systemic steroids is:

• Within hours of the first dose
• Within days to weeks of starting therapy
• Only after months of continuous use
• Only after abrupt withdrawal

Correct Answer: Within days to weeks of starting therapy

Q3. First-line management of severe steroid-induced psychosis in a patient who still requires corticosteroid therapy is:

• Abruptly stop the corticosteroid immediately
• Continue steroid and monitor without psychotropic treatment
• Taper the steroid if possible and add an antipsychotic (e.g., haloperidol)
• Switch corticosteroid to an opioid analgesic

Correct Answer: Taper the steroid if possible and add an antipsychotic (e.g., haloperidol)

Q4. Which classes of medications are most likely to precipitate mania or hypomania in susceptible individuals?

• Antidepressants (especially TCAs/SNRIs) and systemic corticosteroids
• First-generation antihistamines and proton pump inhibitors
• Topical antivirals and local anesthetics
• Loop diuretics and calcium channel blockers

Correct Answer: Antidepressants (especially TCAs/SNRIs) and systemic corticosteroids

Q5. Which clinical features best characterize anticholinergic delirium caused by medications such as TCAs or diphenhydramine?

• Fluctuating consciousness, visual hallucinations, dry skin, mydriasis, urinary retention
• Bradykinesia, hypersalivation, pinpoint pupils, hyporeflexia
• Intense tremor, diaphoresis, miosis, hyperactive bowel sounds
• Progressive memory loss without changes in attention or consciousness

Correct Answer: Fluctuating consciousness, visual hallucinations, dry skin, mydriasis, urinary retention

Q6. Psychotic symptoms such as hallucinations and paranoid ideation are commonly precipitated by increased dopaminergic activity from which medication?

• Levodopa (or dopamine agonists like pramipexole)
• Metformin
• Hydrochlorothiazide
• Atorvastatin

Correct Answer: Levodopa (or dopamine agonists like pramipexole)

Q7. The core clinical triad of serotonin syndrome includes:

• Neuromuscular hyperactivity, autonomic instability, altered mental status
• Quiet mutism, catalepsy, waxy flexibility
• Severe hypotension, bradycardia, hypothermia
• Painless jaundice, pruritus, cholestasis

Correct Answer: Neuromuscular hyperactivity, autonomic instability, altered mental status

Q8. Immediate management of moderate-to-severe serotonin syndrome should include:

• Continue serotonergic agents and observe
• Discontinue serotonergic drugs, provide supportive care, benzodiazepines, and consider cyproheptadine
• Immediate ECT (electroconvulsive therapy)
• High-dose intravenous haloperidol as monotherapy

Correct Answer: Discontinue serotonergic drugs, provide supportive care, benzodiazepines, and consider cyproheptadine

Q9. Which withdrawal syndrome is most associated with rebound anxiety, insomnia, tremor, and risk of seizures if stopped abruptly after long-term use?

• Benzodiazepine withdrawal
• SSRI withdrawal
• Beta-blocker withdrawal
• Statin withdrawal

Correct Answer: Benzodiazepine withdrawal

Q10. Which antipsychotic is most classically associated with a high risk of acute akathisia and extrapyramidal symptoms?

• Haloperidol
• Clozapine
• Quetiapine
• Olanzapine

Correct Answer: Haloperidol

Q11. First-line symptomatic treatment for antipsychotic-induced akathisia is usually:

• Propranolol (beta-blocker)
• High-dose fluoxetine
• Intravenous haloperidol
• Immediate ECT

Correct Answer: Propranolol (beta-blocker)

Q12. Which patient factors increase the risk of developing drug-induced psychiatric adverse effects?

• Advanced age, polypharmacy, renal/hepatic impairment, pre-existing CNS disease
• Young age, single-drug therapy, excellent renal function
• High BMI alone with no other comorbidities
• Regular exercise and balanced diet

Correct Answer: Advanced age, polypharmacy, renal/hepatic impairment, pre-existing CNS disease

Q13. Which antibiotic class is well recognized for causing neuropsychiatric effects including agitation, confusion, and psychosis, especially in the elderly?

• Fluoroquinolones (e.g., ciprofloxacin)
• Penicillins (e.g., amoxicillin)
• Macrolides (e.g., azithromycin)
• Tetracyclines (e.g., doxycycline)

Correct Answer: Fluoroquinolones (e.g., ciprofloxacin)

Q14. Which antiretroviral is particularly associated with vivid dreams, insomnia, and other neuropsychiatric effects?

• Efavirenz
• Zidovudine
• Lamivudine
• Tenofovir

Correct Answer: Efavirenz

Q15. When an essential medication (e.g., high-dose corticosteroid) precipitates mania and cannot be stopped, the recommended pharmacologic approach is:

• Add a mood stabilizer (e.g., valproate or lithium) and/or an antipsychotic while attempting to minimize steroid dose
• Stop all psychotropic treatment and continue the causative agent at full dose
• Immediate long-term benzodiazepine monotherapy
• Switch the steroid to a nonsteroidal analgesic regardless of indication

Correct Answer: Add a mood stabilizer (e.g., valproate or lithium) and/or an antipsychotic while attempting to minimize steroid dose

Q16. Which class of psychotropic medication is most commonly implicated in causing sexual dysfunction (decreased libido, anorgasmia, erectile dysfunction)?

• Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine
• Benzodiazepines such as lorazepam
• Typical antipsychotics such as haloperidol
• Stimulants such as methylphenidate

Correct Answer: Selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine

Q17. The principal mechanism underlying anticholinergic delirium from drugs is:

• Central muscarinic receptor antagonism leading to decreased cholinergic neurotransmission
• Excessive GABAergic activity in the cortex
• Serotonin 5-HT2A receptor antagonism
• NMDA receptor activation

Correct Answer: Central muscarinic receptor antagonism leading to decreased cholinergic neurotransmission

Q18. Concomitant use of St. John’s wort with serotonergic antidepressants primarily raises concern for which adverse interaction?

• Serotonin syndrome due to additive serotonergic effects
• Severe QT prolongation due to potassium channel blockade
• Profound hypoglycemia
• Immediate agranulocytosis

Correct Answer: Serotonin syndrome due to additive serotonergic effects

Q19. To minimize neuropsychiatric toxicity when treating a patient with lithium, monitoring should always include:

• Serum lithium levels, renal function, and thyroid function tests
• Only baseline ECG with no subsequent tests
• Weekly liver enzymes only
• No laboratory monitoring is required

Correct Answer: Serum lithium levels, renal function, and thyroid function tests

Q20. Which clinical feature most strongly supports a diagnosis of drug-induced psychosis rather than a primary psychotic disorder?

• Clear temporal relationship to initiation/dose change of a medication and symptom resolution after withdrawal
• Onset in late adolescence with gradual progression over years
• A strong family history of schizophrenia with chronic baseline symptoms
• Psychosis occurring without any recent medication changes or exposures

Correct Answer: Clear temporal relationship to initiation/dose change of a medication and symptom resolution after withdrawal

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