Psychiatry and Behavioral Science

Original practice questions written to the published framework for this section. No expert has reviewed them, and they are not taken from any official exam. Try each one before you open the answer.

1. Question 1Foundational

   What minimum duration of depressed mood or loss of interest, along with the associated symptoms, is required to diagnose a major depressive episode?

   1. AOne week
   2. BTwo weeks
   3. COne month
   4. DSix months

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   Answer: B. Two weeks

   A major depressive episode requires at least two weeks of depressed mood or anhedonia plus a total of five or more characteristic symptoms that represent a change from baseline. Six months is the tempting distractor because it is the duration criterion for generalized anxiety disorder, not for depression.

   Key insight: Two weeks for a major depressive episode, six months for generalized anxiety disorder.

2. Question 2Foundational

   What total duration of continuous signs of disturbance is required for a diagnosis of schizophrenia rather than schizophreniform disorder?

   1. AOne month
   2. BThree months
   3. CSix months
   4. DTwelve months

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   Answer: C. Six months

   Schizophrenia requires at least six months of continuous disturbance, including at least one month of active-phase symptoms such as delusions, hallucinations, or disorganized speech, with the remainder made up of prodromal or residual symptoms. One month is the tempting distractor because it is the minimum active-phase requirement and the cutoff that separates brief psychotic disorder from schizophreniform disorder.

   Key insight: Under one month is brief psychotic disorder, one to six months is schizophreniform, six months or more is schizophrenia.

3. Question 3Intermediate

   Which antipsychotic medication requires scheduled absolute neutrophil count monitoring because of its risk of agranulocytosis?

   1. AHaloperidol
   2. BRisperidone
   3. CClozapine
   4. DOlanzapine

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   Answer: C. Clozapine

   Clozapine is uniquely effective in treatment-resistant schizophrenia but can cause severe neutropenia, so it is dispensed only with a program of regular absolute neutrophil count monitoring. Olanzapine is the tempting distractor because it shares clozapine's metabolic burden of weight gain and dyslipidemia, but it does not carry the agranulocytosis monitoring requirement.

   Key insight: Clozapine buys efficacy in resistant illness at the cost of mandatory blood count surveillance.

4. Question 4Intermediate

   Which medication class is considered first-line pharmacotherapy for generalized anxiety disorder?

   1. ASelective serotonin reuptake inhibitors
   2. BBenzodiazepines
   3. CBeta blockers
   4. DFirst-generation antipsychotics

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   Answer: A. Selective serotonin reuptake inhibitors

   Selective serotonin reuptake inhibitors provide durable benefit in generalized anxiety disorder without the dependence and cognitive effects of sedatives, which is why they are started first alongside cognitive behavioral therapy. Benzodiazepines are the tempting distractor because they relieve acute anxiety within minutes, but tolerance, falls, and withdrawal make them a short-term bridge rather than maintenance therapy.

   Key insight: Fast relief and good long-term therapy are not the same drug in anxiety disorders.

5. Question 5Advanced

   Which life-threatening syndrome presents days after starting an antipsychotic with high fever, lead-pipe muscle rigidity, autonomic instability, altered mental status, and a markedly elevated creatine kinase?

   1. ASerotonin syndrome
   2. BNeuroleptic malignant syndrome
   3. CMalignant hyperthermia
   4. DAnticholinergic toxicity

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   Answer: B. Neuroleptic malignant syndrome

   Dopamine blockade produces neuroleptic malignant syndrome, whose signature is generalized lead-pipe rigidity with hyperthermia, autonomic instability, and rhabdomyolysis evolving over days. Serotonin syndrome is the tempting distractor and also causes fever and rigidity, but it follows serotonergic drugs, begins within hours, and features hyperreflexia and clonus that are most pronounced in the legs.

   Key insight: Lead-pipe rigidity after a dopamine blocker is neuroleptic malignant syndrome; clonus and hyperreflexia after a serotonergic drug is serotonin syndrome.