INI-CET 2025 — Psychiatry

Q: Which of the following is not an ICD-10 diagnostic criterion for depression?

Persistent worry about everyday matters. ### Explanation The diagnosis of a **Depressive Episode** according to **ICD-10** is based on a specific cluster of symptoms. The criteria are divided into **Typical (Core)** symptoms and **Other common** symptoms. #### Why Option D is Correct **Persistent worry about everyday matters** is the hallmark feature of **Generalized Anxiety Disorder (GAD)**, not Depression. While anxiety often co-exists with depression (comorbidity), it is not a diagnostic criterion for a depressive episode under ICD-10. #### Why Other Options are Incorrect Options A, B, and C represent the **three core (typical) symptoms** of depression in ICD-10. For a diagnosis, at least two of these must be present for a minimum of **2 weeks**: * **Low mood (Depressed mood):** To a degree that is definitely abnormal for the individual, present for most of the day and almost every day. * **Loss of interest or pleasure (Anhedonia):** In activities that are normally enjoyable. * **Low energy (Fatigability):** Increased fatigability or marked decrease in activity. #### High-Yield Clinical Pearls for NEET-PG/INI-CET * **ICD-10 Classification:** Depression is coded under **F32** (Depressive episode) and **F33** (Recurrent depressive disorder). * **Somatic Syndrome:** ICD-10 allows for a "somatic" specifier if symptoms like early morning awakening (2 hours early), diurnal variation (worse in morning), and psychomotor retardation are present. * **Severity Grading:** * **Mild:** 2 core + 2 others. * **Moderate:** 2 core + 3–4 others. * **Severe:** 3 core + $\geq$ 4 others. * **DSM-5 Difference:** Unlike ICD-10, **DSM-5** requires 5 out of 9 symptoms (must include either depressed mood or anhedonia) and does not list "low energy" as a separate core category in the same way. [Practice more Psychiatry PYQs on OnCourse]

5 Previous Year Questions with Answers & Explanations

Questions

Which of the following is not an ICD-10 diagnostic criterion for depression?

All of the following statements are correct except:

A patient with schizophrenia says, "Lord Hanuman was celibate, I am celibate too, so I am Lord Hanuman." Which thought abnormality is present in this patient?

Which of the following drugs are used in the management of acute mania?

Which among the following psychoactive substances has antidepressant properties?

INI-CET 2025 - Psychiatry INI-CET Practice Questions and MCQs

Question 1: Which of the following is not an ICD-10 diagnostic criterion for depression?

A. Low energy levels
B. Low mood for most of the day
C. Loss of interest in pleasurable things
D. Persistent worry about everyday matters (Correct Answer)

Explanation: ### Explanation The diagnosis of a **Depressive Episode** according to **ICD-10** is based on a specific cluster of symptoms. The criteria are divided into **Typical (Core)** symptoms and **Other common** symptoms. #### Why Option D is Correct **Persistent worry about everyday matters** is the hallmark feature of **Generalized Anxiety Disorder (GAD)**, not Depression. While anxiety often co-exists with depression (comorbidity), it is not a diagnostic criterion for a depressive episode under ICD-10. #### Why Other Options are Incorrect Options A, B, and C represent the **three core (typical) symptoms** of depression in ICD-10. For a diagnosis, at least two of these must be present for a minimum of **2 weeks**: * **Low mood (Depressed mood):** To a degree that is definitely abnormal for the individual, present for most of the day and almost every day. * **Loss of interest or pleasure (Anhedonia):** In activities that are normally enjoyable. * **Low energy (Fatigability):** Increased fatigability or marked decrease in activity. #### High-Yield Clinical Pearls for NEET-PG/INI-CET * **ICD-10 Classification:** Depression is coded under **F32** (Depressive episode) and **F33** (Recurrent depressive disorder). * **Somatic Syndrome:** ICD-10 allows for a "somatic" specifier if symptoms like early morning awakening (2 hours early), diurnal variation (worse in morning), and psychomotor retardation are present. * **Severity Grading:** * **Mild:** 2 core + 2 others. * **Moderate:** 2 core + 3–4 others. * **Severe:** 3 core + $\geq$ 4 others. * **DSM-5 Difference:** Unlike ICD-10, **DSM-5** requires 5 out of 9 symptoms (must include either depressed mood or anhedonia) and does not list "low energy" as a separate core category in the same way.

Question 2: All of the following statements are correct except:

A. Opioid withdrawal is rarely fatal
B. Buprenorphine can be used for the management of opioid withdrawal
C. Flumazenil is used for the management of long-term alcohol dependence syndrome (Correct Answer)
D. Cannabis withdrawal is associated with minimal physical symptoms

Explanation: ### **Explanation** The correct answer is **C**, as **Flumazenil** is a competitive **GABA-A receptor antagonist** used specifically for the reversal of **Benzodiazepine (BZD) overdose**, not for alcohol dependence. #### **Why Option C is Incorrect (The Concept):** * **Alcohol dependence** is managed using **Disulfiram** (aversion therapy), **Acamprosate** (anticraving), or **Naltrexone** (anticraving). * While both alcohol and BZDs act on GABA receptors, Flumazenil has no role in long-term alcohol sobriety. In fact, using Flumazenil in a patient with combined alcohol/BZD dependence can **precipitate seizures** by lowering the seizure threshold. #### **Analysis of Other Options:** * **Option A:** **Opioid withdrawal** is characterized by intense distress (lacrimation, rhinorrhea, piloerection, diarrhea) but is **rarely fatal** in healthy adults. This distinguishes it from Alcohol or BZD withdrawal, which can cause life-threatening seizures and delirium tremens. * **Option B:** **Buprenorphine** is a **partial mu-opioid agonist**. It is highly effective for detoxification (withdrawal management) and long-term maintenance therapy because of its long half-life and "ceiling effect" on respiratory depression. * **Option C:** **Cannabis withdrawal** is primarily psychological (irritability, insomnia, anxiety). While it includes mild tremors or sweating, it is noted for having **minimal physical symptoms** compared to sedative-hypnotics or opioids. --- ### **High-Yield Clinical Pearls for INI-CET:** * **Drug of Choice (DOC) for Alcohol Withdrawal:** Benzodiazepines (e.g., **Chlordiazepoxide** or **Lorazepam**). * **DOC for Opioid Overdose:** **Naloxone** (Pure opioid antagonist). * **Wernicke’s Encephalopathy Triad:** Confusion, Ataxia, and Ophthalmoplegia (due to Thiamine/B1 deficiency). * **Cannabis:** The most common physical sign of acute intoxication is **Conjunctival injection** (red eyes) and tachycardia.

Question 3: A patient with schizophrenia says, "Lord Hanuman was celibate, I am celibate too, so I am Lord Hanuman." Which thought abnormality is present in this patient?

A. Autistic thinking (Correct Answer)
B. Verbigeration
C. Neologism
D. Loosening of association

Explanation: ### Explanation The correct answer is **Autistic thinking**. **1. Why Autistic Thinking is Correct:** Autistic thinking (also known as **dereistic thinking**) is a hallmark of schizophrenia, first described by Eugen Bleuler as one of the **4 As**. It refers to a private, highly subjective internal world where the patient’s thoughts are governed by **personal logic** and fantasies rather than objective reality. * In this case, the patient uses **paralogical reasoning** (specifically **predicate logic** or Von Domarus principle): "A has property X, B has property X, therefore A is B." * Because both Hanuman and the patient share the predicate "celibacy," the patient concludes they are the same entity. This disregard for external reality in favor of internal symbolism is the essence of autistic thinking. **2. Why Other Options are Incorrect:** * **Verbigeration:** Also known as "word salad" or "palilalia," this involves the senseless repetition of specific words or phrases. The patient’s statement here is a structured (though illogical) sentence, not repetitive babbling. * **Neologism:** This refers to the creation of **new words** that have a private meaning to the patient but are meaningless to others. No new words were coined in the prompt. * **Loosening of Association:** This is a lack of logical connection between sequential sentences (Knight’s Move thinking). While the logic here is flawed, the sentence itself follows a specific internal "theme," making "Autistic thinking" the more specific psychopathological term for this type of identity-based logic. **3. High-Yield Clinical Pearls for INI-CET:** * **Bleuler’s 4 As of Schizophrenia:** **A**utistic thinking, **A**mbivalence, **A**ffective flattening, and **A**ssociative looseness. * **Von Domarus Principle:** The specific type of paralogical thinking where identity is assumed based on identical predicates (as seen in this question). * **Dereism vs. Autism:** While often used interchangeably, **dereism** emphasizes the detachment from reality, while **autism** emphasizes the preoccupation with the inner world.

Question 4: Which of the following drugs are used in the management of acute mania?

A. Only 1 (Lithium)
B. 1, 2 & 3 (Lithium, Valproate & Haloperidol) (Correct Answer)
C. 1, 2 & 4 (Lithium, Valproate & Amitriptyline)
D. 2 & 4 (Valproate & Amitriptyline)

Explanation: ### **Explanation: Management of Acute Mania** The management of **acute mania** focuses on rapid stabilization of mood and control of psychomotor agitation. The treatment of choice involves **Mood Stabilizers** and/or **Antipsychotics**. #### **1. Why Option B is Correct (1, 2 & 3)** * **Lithium (1):** The "Gold Standard" mood stabilizer. It is highly effective for acute mania, though it has a slow onset of action (5–7 days). * **Valproate (2):** An anticonvulsant mood stabilizer often preferred over Lithium in **Rapid Cycling** or **Mixed Episodes** due to its faster onset and better tolerability in certain patients. * **Haloperidol (3):** A high-potency typical antipsychotic. In acute mania, antipsychotics (both typical like Haloperidol and atypical like Olanzapine/Risperidone) are used for rapid control of agitation, aggression, and psychotic symptoms. #### **2. Why Other Options are Incorrect** * **Amitriptyline (4):** This is a **Tricyclic Antidepressant (TCA)**. Antidepressants are **contraindicated** in acute mania as they can worsen the manic state or trigger a "switch" from depression into mania. Therefore, any option containing Amitriptyline (C and D) is incorrect. * **Option A** is incomplete because while Lithium is used, it is not the *only* drug; Valproate and Haloperidol are equally standard first-line interventions. --- ### **High-Yield Clinical Pearls for NEET-PG / INI-CET** * **Drug of Choice (DOC):** For classic acute mania, **Lithium** is the DOC. For rapid cycling Bipolar Disorder, **Valproate** is the DOC. * **Therapeutic Index:** Lithium has a narrow therapeutic index. For acute mania, target serum levels are **0.8–1.2 mEq/L**. * **Pregnancy:** Avoid Lithium in the first trimester (risk of **Ebstein’s Anomaly**). Avoid Valproate (risk of **Neural Tube Defects**). * **Combination Therapy:** In severe mania, a combination of a mood stabilizer (Lithium/Valproate) plus an antipsychotic is more effective than monotherapy.

Question 5: Which among the following psychoactive substances has antidepressant properties?

A. Cannabidiol
B. Mephedrone
C. Bupropion
D. Ketamine (Correct Answer)

Explanation: ### **Explanation** **Correct Answer: D. Ketamine** **Ketamine** is a non-competitive **NMDA receptor antagonist** that has revolutionized the management of **Treatment-Resistant Depression (TRD)**. Unlike traditional antidepressants that take weeks to work, Ketamine exerts a rapid-onset antidepressant effect (within hours) by increasing **synaptic plasticity** and stimulating the release of **Brain-Derived Neurotrophic Factor (BDNF)**. * **Esketamine** (the S-enantiomer) is now FDA-approved as a nasal spray for TRD and major depression with acute suicidal ideation. --- ### **Analysis of Incorrect Options** * **A. Cannabidiol (CBD):** While CBD is a non-psychoactive component of cannabis used for epilepsy (Lennox-Gastaut syndrome), it is primarily studied for its **anxiolytic** and antipsychotic potential, rather than being a primary antidepressant. * **B. Mephedrone:** Also known as "Meow Meow," this is a synthetic stimulant (cathinone). It causes euphoria and alertness but is a **drug of abuse** with significant neurotoxic risks; it is not used therapeutically for depression. * **C. Bupropion:** While Bupropion is indeed an antidepressant (NDRI), the question asks which "psychoactive substance" (often implying drugs with anesthetic or dissociative properties in this context) has these properties. However, in the specific context of recent **INI-CET/NEET-PG trends**, Ketamine is the "hot topic" high-yield answer for its novel rapid-acting mechanism. *Note: If this were a multi-select, Bupropion would be correct, but Ketamine is the preferred answer for its unique rapid-acting profile.* --- ### **High-Yield Clinical Pearls for INI-CET** * **Mechanism of Ketamine:** Blocks NMDA receptors on GABAergic interneurons $\rightarrow$ Disinhibition of Glutamate $\rightarrow$ **AMPA receptor activation** $\rightarrow$ Increased BDNF. * **Dissociative Anesthesia:** Ketamine causes "eyes open" unconsciousness, nystagmus, and profound analgesia. * **Side Effects:** Emergence delirium (prevented by **Benzodiazepines**), hypertension, and tachycardia. * **Drug of Choice:** Ketamine is the induction agent of choice for patients with **bronchial asthma** (bronchodilator) and **hypovolemic shock** (sympathomimetic).