Forensic Psychiatry and ECT MCQs

Psychiatry · 14 free questions with answers & explanations.

1. A 68-year-old woman with severe treatment-resistant major depressive disorder has failed four adequate antidepressant trials and remains in a life-threatening nutritional state due to refusal to eat. She is referred for electroconvulsive therapy (ECT). Which of the following is considered an absolute contraindication to ECT?
2. A 55-year-old woman with severe treatment-resistant MDD (failed 4 antidepressant trials) is referred for ECT. She has no prior seizure disorder. Her baseline ECG shows a QTc of 445 ms and she takes atenolol. What anesthetic consideration is critical for ECT?
3. Under the Mental Healthcare Act 2017 (India), a person with mental illness who refuses treatment but poses immediate danger to self or others can receive treatment without consent for up to:
4. During ECT, succinylcholine is administered as a muscle relaxant. A patient develops prolonged apnoea lasting 45 minutes after a standard dose. The most likely explanation is:
5. According to McNaughten rules, an accused is not criminally responsible for an act if, at the time of committing it, due to a mental disease, he did NOT know:
6. A 35-year-old man with schizophrenia commits a violent act during a florid psychotic episode, believing he was being attacked by demons. His attorney argues insanity defense. Under the McNaughton rules, what is the LEGAL standard for insanity?
7. A 55-year-old woman with treatment-resistant major depressive disorder with psychotic features undergoes ECT. Which of the following is the MOST common cognitive side effect of bilateral ECT versus right unilateral ECT?
8. ECT is administered to a 60-year-old woman with treatment-resistant depression. She develops prolonged seizure activity (>120 seconds). Which drug should be given immediately, and what is the maximum cumulative dose before switching to a barbiturate?
9. In Indian forensic psychiatry under the Mental Healthcare Act 2017, which provision specifically prohibits the use of seclusion and restraint as a treatment modality, and what is the permitted use of physical restraint?
10. A patient develops prolonged seizure during an ECT session (status epilepticus lasting > 3 minutes). The most appropriate immediate pharmacological intervention is:
11. The McNaughton (M'Naghten) Rules for the insanity defence require that at the time of the crime, the accused did not know the 'nature and quality of the act' OR did not know that the act was 'wrong'. Under Indian law, which section of the Bharatiya Nyaya Sanhita (BNS) 2023 codifies a similar test for unsoundness of mind?
12. A 55-year-old woman with severe, medication-refractory bipolar depression has failed 3 adequate antidepressant trials including augmentation. She has persistent suicidal ideation with a plan. Which is the MOST appropriate next step in treatment?
13. A 45-year-old woman with severe, treatment-resistant major depressive disorder with psychotic features fails multiple antidepressant and antipsychotic trials. She has expressed suicidal ideation. Which treatment has the HIGHEST response rate and most rapid onset of action for this presentation?
14. A 48-year-old woman with severe treatment-resistant major depressive disorder is being considered for ECT. Regarding ECT electrode placement, which statement is TRUE about right unilateral (RUL) vs bilateral (BL) ECT?