DHA DHA Mental Health & Psychiatry 2 — Questions and Answers
Question 1: A patient with bipolar disorder type I is in an acute manic episode. The MOST appropriate initial pharmacological intervention is:
- Start an antidepressant immediately
- Administer a mood stabiliser such as lithium or valproate (Correct answer)
- Provide psychotherapy alone
- Prescribe a stimulant to regulate sleep
Correct answer: Administer a mood stabiliser such as lithium or valproate
Mood stabilisers (lithium, valproate, or atypical antipsychotics) are first-line treatment for acute mania in bipolar type I disorder.
Question 2: Lithium toxicity is MOST likely to develop when a patient:
- Increases daily fluid intake
- Eats a sodium-rich diet
- Becomes dehydrated or sodium-depleted (Correct answer)
- Takes acetaminophen concurrently
Correct answer: Becomes dehydrated or sodium-depleted
Lithium and sodium compete for renal reabsorption; dehydration or low sodium intake causes increased lithium reabsorption and toxicity.
Question 3: Which feature is a hallmark characteristic of borderline personality disorder (BPD)?
- Grandiosity and pervasive lack of empathy
- Intense fear of abandonment and unstable interpersonal relationships (Correct answer)
- Odd beliefs and social isolation
- Perfectionism and inflexibility
Correct answer: Intense fear of abandonment and unstable interpersonal relationships
BPD is characterised by an intense fear of abandonment, unstable relationships, emotional dysregulation, and impulsivity.
Question 4: Which psychotherapy has the strongest evidence base as a treatment for borderline personality disorder?
- Cognitive Behavioural Therapy (CBT)
- Dialectical Behaviour Therapy (DBT) (Correct answer)
- Brief psychodynamic therapy
- Electroconvulsive therapy (ECT)
Correct answer: Dialectical Behaviour Therapy (DBT)
DBT, developed specifically for BPD, is the gold-standard evidence-based treatment, focusing on distress tolerance and emotion regulation skills.
Question 5: Which antipsychotic medication is associated with the HIGHEST risk of metabolic syndrome?
- Haloperidol
- Risperidone
- Clozapine (Correct answer)
- Aripiprazole
Correct answer: Clozapine
Clozapine carries the highest risk of metabolic syndrome — including significant weight gain, hyperglycaemia, and dyslipidaemia — requiring regular metabolic monitoring.
Question 6: A patient discloses command hallucinations to harm a specific named individual. The clinician's MOST appropriate response is:
- Discharge with outpatient psychiatric follow-up
- Assess duty-to-warn obligations and consider inpatient admission (Correct answer)
- Initiate outpatient therapy without hospitalisation
- Advise the patient to ignore the voices
Correct answer: Assess duty-to-warn obligations and consider inpatient admission
Command hallucinations to harm an identifiable third party require risk assessment, potential Tarasoff duty-to-warn notification, and serious consideration of inpatient admission.
DHA DHA Mental Health & Psychiatry 2
A patient with bipolar disorder type I is in an acute manic episode.
The MOST appropriate initial pharmacological intervention is: