Free DHA Psychiatry mock test

Psychiatry sample questions with answers

10 more original exam-style Psychiatry questions, worked in full. They are not real or recalled exam questions, and none of them is in the diagnostic above, so sit that first if you have not.

1. Question 1 · Psychopharmacology & Somatic Therapies (ECT and Neuromodulation)

   A 38-year-old woman with refractory depression has failed fluoxetine 60 mg daily and is to be switched to phenelzine. Fluoxetine was stopped today. What is the minimum recommended interval before phenelzine can be started safely?

   1. A24 hours
   2. B1 week
   3. C2 weeks
   4. D5 weeks
   Show answer and explanation

   Correct answer: D. 5 weeks

   Fluoxetine's active metabolite norfluoxetine has a half-life of one to two weeks, so a washout of at least five weeks is required before starting an MAOI to avoid fatal serotonin syndrome. Two weeks is the standard washout for most other SSRIs and SNRIs, and 24 hours or one week is grossly inadequate for fluoxetine.

   Reference: Fluoxetine and phenelzine Summaries of Product Characteristics (EMA/MHRA); Maudsley Prescribing Guidelines in Psychiatry, 14th edition, 2021

2. Question 2 · Consultation-Liaison (Psychosomatic) Psychiatry, Somatic Symptom & Neurocognitive Disorders

   A 44-year-old man on thrice-weekly haemodialysis repeatedly leaves sessions early and exceeds fluid limits, presenting recurrently with pulmonary oedema. He says he feels trapped and hopeless and can see no future. Which is the most appropriate initial response from the liaison psychiatrist?

   1. AAssess for and treat depression, and explore the meaning of non-adherence with a collaborative behavioural plan agreed with the renal team
   2. BRecommend that the renal team declare him non-compliant and withdraw dialysis
   3. CAssess capacity and, if capacitous, take no further action
   4. DStart lithium to stabilise his mood and reduce impulsivity
   Show answer and explanation

   Correct answer: A. Assess for and treat depression, and explore the meaning of non-adherence with a collaborative behavioural plan agreed with the renal team

   Depression is highly prevalent in end-stage renal disease and is an independent predictor of dialysis non-adherence, hospitalisation and mortality, so identifying and treating it while addressing the behaviour collaboratively is the correct first step. Withdrawing dialysis in response to non-adherence is neither clinically nor ethically justified at this stage. A capacity assessment alone abandons a treatable disorder, and lithium is hazardous and complex to dose in dialysis and is not indicated here.

   Reference: Kimmel et al., Kidney International (2000); KDIGO and Renal Association guidance on psychosocial care in end-stage kidney disease

3. Question 3 · Depressive, Bipolar & Related Disorders

   A 25-year-old man with bipolar I disorder relapses repeatedly after discharge. He lives with parents who are highly critical and over-involved, frequently arguing about his medication. He is adherent to lithium at therapeutic levels. Which psychosocial intervention has the strongest evidence for reducing relapse in this specific situation?

   1. AFamily-focused therapy
   2. BLong-term individual psychoanalytic psychotherapy
   3. CNon-directive supportive counselling for the patient alone
   4. DInterpersonal and social rhythm therapy for the parents
   Show answer and explanation

   Correct answer: A. Family-focused therapy

   Family-focused therapy combines psychoeducation, communication enhancement training and problem-solving skills with the patient and relatives, and randomised trials show it reduces relapse and hospitalisation in bipolar disorder, especially in households with high expressed emotion (criticism, hostility and emotional over-involvement). Long-term psychoanalytic therapy and non-directive individual counselling lack comparable relapse-prevention evidence in bipolar disorder. Interpersonal and social rhythm therapy is an evidence-based bipolar treatment but is delivered to the patient to stabilise daily routines, not to the parents.

   Reference: Miklowitz DJ et al., Family-focused treatment for bipolar disorder, Archives of General Psychiatry / JAMA Psychiatry meta-analysis 2021; CANMAT/ISBD Guidelines, 2018

4. Question 4 · Schizophrenia Spectrum & Other Psychotic Disorders

   A 33-year-old woman admitted in catatonic stupor has been receiving lorazepam 6 mg daily for 48 hours with minimal benefit. She now has a temperature of 39.2°C, pulse 132/min, labile blood pressure, profuse diaphoresis, rigidity and creatine kinase of 4,200 U/L. She has received no antipsychotic. Which is the most appropriate definitive management?

   1. AUrgent electroconvulsive therapy alongside intensive supportive care and continued benzodiazepine
   2. BStart haloperidol to control the underlying psychosis
   3. CStart dantrolene and bromocriptine and discharge to the psychiatric ward
   4. DSwitch lorazepam to clonazepam and reassess in 72 hours
   Show answer and explanation

   Correct answer: A. Urgent electroconvulsive therapy alongside intensive supportive care and continued benzodiazepine

   Fever, autonomic instability, rigidity and raised creatine kinase in a catatonic patient indicate malignant catatonia, a life-threatening emergency; when benzodiazepines fail, urgent bilateral ECT is the definitive treatment and should not be delayed. Antipsychotics, particularly high-potency agents such as haloperidol, can precipitate or worsen malignant catatonia and neuroleptic malignant syndrome. Dantrolene and bromocriptine target neuroleptic malignant syndrome and are adjunctive at best here, and simply changing benzodiazepine wastes critical time in a condition with high mortality if untreated.

   Reference: Sienaert et al., Frontiers in Psychiatry (2014), clinical review of the treatment of catatonia; APA Practice Guideline for the Treatment of Patients with Schizophrenia, 3rd edition (2020)

5. Question 5 · Psychotherapy & Psychosocial Interventions

   A community mental health service is deciding which patients to allocate to its assertive community treatment team. Which patient is most likely to benefit from this model?

   1. AA woman with a first episode of moderate depression who has attended every clinic appointment
   2. BA man with panic disorder who wishes to reduce his benzodiazepine use
   3. CA woman with generalised anxiety disorder awaiting CBT
   4. DA man with schizophrenia and cannabis use who has had five admissions in two years, disengages from clinic follow-up and is repeatedly homeless
   Show answer and explanation

   Correct answer: D. A man with schizophrenia and cannabis use who has had five admissions in two years, disengages from clinic follow-up and is repeatedly homeless

   Assertive community treatment, with its small shared caseloads, assertive outreach and in-vivo delivery, shows benefit mainly for patients with severe mental illness who have high service use and poor engagement, reducing admissions and improving housing stability and retention in care. Patients with common mental disorders who attend appointments reliably gain nothing from this resource-intensive model and are better served by standard outpatient or stepped care.

   Reference: Marshall M, Lockwood A, Cochrane Database of Systematic Reviews (assertive community treatment for severe mental disorders), 2011; NICE CG178, 2014

6. Question 6 · Emergency Psychiatry, Risk Assessment & Crisis Management

   A 52-year-old man with decompensated alcoholic cirrhosis, jaundice and a prolonged INR is admitted in alcohol withdrawal with tremor, sweating and a rising CIWA-Ar score. Which benzodiazepine regimen is most appropriate?

   1. AChlordiazepoxide in a high fixed-dose schedule
   2. BLong-acting diazepam at high dose to prevent seizures
   3. CLorazepam or oxazepam, cautiously titrated to symptoms
   4. DAvoid benzodiazepines entirely and use haloperidol as the primary agent
   Show answer and explanation

   Correct answer: C. Lorazepam or oxazepam, cautiously titrated to symptoms

   Lorazepam and oxazepam undergo glucuronidation without hepatic oxidative metabolism and have no active metabolites, so they do not accumulate in significant liver impairment. Chlordiazepoxide and diazepam are long-acting oxidatively metabolised drugs that accumulate and can precipitate hepatic encephalopathy. Benzodiazepines remain the treatment of choice for withdrawal because they prevent seizures and delirium tremens; haloperidol lowers the seizure threshold and is only an adjunct for persistent hallucinations or agitation.

   Reference: NICE CG100 (2010); American Society of Addiction Medicine Clinical Practice Guideline on Alcohol Withdrawal Management (2020)

7. Question 7 · Foundations: Neuroscience, Basic Psychology, Psychiatric Assessment & Classification

   Which statement best characterises the Research Domain Criteria (RDoC) framework?

   1. AIt is a research framework organising study of psychopathology across functional domains and units of analysis, independent of DSM/ICD categories
   2. BIt is a replacement diagnostic manual intended for routine clinical coding and billing
   3. CIt defines new categorical disorders based on genome-wide association findings
   4. DIt abolishes dimensional measurement in favour of strictly categorical constructs
   Show answer and explanation

   Correct answer: A. It is a research framework organising study of psychopathology across functional domains and units of analysis, independent of DSM/ICD categories

   RDoC, launched by the US National Institute of Mental Health, is explicitly a research framework that organises investigation around functional domains such as negative valence, positive valence, cognitive, social processes, arousal/regulatory and sensorimotor systems, each studied across units of analysis from genes and circuits to behaviour and self-report. It is deliberately not a clinical diagnostic system and is not used for coding or billing, does not define new categorical disorders, and is dimensional rather than categorical in its approach.

   Reference: Insel et al., Research Domain Criteria (RDoC), Am J Psychiatry (2010); NIMH RDoC framework documentation

8. Question 8 · Substance-Related & Addictive Disorders

   In the three-stage model of addiction (binge/intoxication, withdrawal/negative affect, preoccupation/anticipation), which neural substrate is most responsible for the dysphoria, anxiety and irritability that dominate the withdrawal/negative affect stage?

   1. ANigrostriatal dopaminergic projections to the putamen
   2. BIncreased glutamatergic drive from the dorsolateral prefrontal cortex to the hippocampus
   3. CCholinergic projections from the nucleus basalis of Meynert to the neocortex
   4. DRecruitment of corticotropin-releasing factor and dynorphin systems in the extended amygdala
   Show answer and explanation

   Correct answer: D. Recruitment of corticotropin-releasing factor and dynorphin systems in the extended amygdala

   Koob and Volkow attribute the withdrawal/negative affect stage to 'anti-reward' recruitment of stress systems in the extended amygdala, principally corticotropin-releasing factor and dynorphin acting at kappa-opioid receptors, together with reduced accumbens dopamine. The preoccupation/anticipation stage is the prefrontal-cortical (executive/craving) stage, while nigrostriatal and basal-forebrain cholinergic systems mediate motor and attentional/memory functions rather than withdrawal dysphoria.

   Reference: Koob GF, Volkow ND, Neurobiology of Addiction: A Neurocircuitry Analysis, Lancet Psychiatry, 2016

9. Question 9 · Child & Adolescent Psychiatry and Neurodevelopmental Disorders

   A 4-year-old boy has had 12 hospital admissions for recurrent, unexplained hypoglycaemia and seizures. Investigations are always normal, episodes only ever occur when his mother is present, and she is unusually knowledgeable and comfortable on the ward. A nurse finds insulin in her handbag. Which is the most appropriate formulation and immediate action?

   1. ASomatic symptom disorder in the child; reassure and discharge
   2. BFactitious disorder imposed on another; ensure the child's immediate safety, involve child protection and separate the child from the suspected perpetrator pending investigation
   3. CMaternal generalised anxiety disorder; refer her for CBT and continue joint admissions
   4. DMalingering by the mother for financial gain; confront her in the ward round
   Show answer and explanation

   Correct answer: B. Factitious disorder imposed on another; ensure the child's immediate safety, involve child protection and separate the child from the suspected perpetrator pending investigation

   Recurrent unexplained illness occurring only in a caregiver's presence, with normal investigations and physical evidence of induction, is factitious disorder imposed on another (medical child abuse) - a form of child abuse that carries substantial mortality. The priority is the child's immediate safety through child protection referral and separation pending multi-agency investigation, not immediate confrontation, which risks flight or escalation. Somatic symptom disorder and maternal anxiety do not explain injected insulin, and malingering requires an external incentive that is not the defining feature here.

   Reference: American Psychiatric Association, DSM-5-TR (2022); Royal College of Paediatrics and Child Health, Perplexing Presentations and Fabricated or Induced Illness guidance (2021)

10. Question 10 · Anxiety, Obsessive-Compulsive & Related, Trauma- and Stressor-Related & Dissociative Disorders

    The same 8-year-old boy has a positive throat culture for group A streptococcus and severe, functionally impairing obsessive-compulsive symptoms. What is the most appropriate initial management?

    1. AIntravenous immunoglobulin as first-line therapy for all such cases
    2. BIndefinite prophylactic penicillin for every child with abrupt-onset OCD, regardless of streptococcal status
    3. CTherapeutic plasma exchange before any psychiatric treatment
    4. DAntibiotic eradication of the confirmed streptococcal infection together with standard OCD treatment (CBT with exposure and response prevention, plus a low, slowly titrated SSRI if needed)
    Show answer and explanation

    Correct answer: D. Antibiotic eradication of the confirmed streptococcal infection together with standard OCD treatment (CBT with exposure and response prevention, plus a low, slowly titrated SSRI if needed)

    Consensus treatment guidance is to treat the confirmed active streptococcal infection with an appropriate antibiotic while simultaneously delivering standard, evidence-based OCD care, namely CBT with exposure and response prevention and, for moderate-to-severe symptoms, an SSRI started at a low dose and titrated slowly because these children are prone to behavioural activation. Immunomodulatory treatments such as IVIG and plasma exchange are reserved for severe, refractory, clearly immune-mediated cases in specialist settings, not for routine first-line use. Long-term antibiotic prophylaxis is not recommended indiscriminately and lacks supporting evidence in the absence of documented recurrent streptococcal infection.

    Reference: Thienemann et al., PANS/PANDAS Consensus Treatment Guidelines Part I-III, J Child Adolesc Psychopharmacol (2017); NICE CG31 (2005, reviewed)