Saudi Board Psychiatry Final Written Exam (SCFHS)

A 28-year-old male presents with a 4-month history of a fixed belief that his liver is putrefying and emitting a foul odor. Despite normal liver function tests and abdominal imaging, he insists this is true. He is highly distressed but does not try to resist the thought. He has no other psychotic symptoms. What is the most appropriate psychopathological categorization of this symptom?

• ASomatic delusion
• BObsession
• COvervalued idea
• DSensory hallucination

A 45-year-old female presents with depression. She claims that she has no internal organs, that her blood has dried up, and that she is actually dead. Which delusion is this candidate demonstrating?

• ACotard's delusion
• BCapgras delusion
• CFregoli delusion
• DDe Clerambault's delusion

During a mental state examination, a patient with mania speaks rapidly and shifts from one topic to another. The connections between the topics are based on sounds (clanging) and distractibility by environmental stimuli, but a logical connection can still be traced if the listener pays close attention. What form of thought disorder is this?

• AFlight of ideas
• BDerailment (loose associations)
• CCircumstantiality
• DTangentiality

Which of the following represents a key diagnostic difference for Schizophrenia between the DSM-5-TR and the ICD-11 criteria?

• AICD-11 requires a minimum duration of symptoms of 1 month, whereas DSM-5-TR requires 6 mo…
• BDSM-5-TR requires first-rank symptoms, while ICD-11 does not mention them.
• CICD-11 requires cognitive impairment as a core diagnostic criterion, whereas DSM-5-TR doe…
• DDSM-5-TR requires a minimum duration of symptoms of 1 month, whereas ICD-11 requires 6 mo…

A 23-year-old male patient reports that his thoughts are being broadcast out loud so that everyone around him can hear them as they occur. He describes this as a physical sensation of his thoughts leaving his head. Which of Schneider's first-rank symptoms is described here?

• AThought broadcasting
• BThought insertion
• CThought withdrawal
• DAuditory hallucinations of the third person

A 35-year-old female presents with a history of mood swings. She describes episodes lasting 4 to 5 days where she feels highly energetic, needs less sleep, is very productive, and has a mildly elevated mood. These episodes do not cause significant social or occupational impairment, and there are no psychotic features. However, she also has episodes of deep depression lasting 3 weeks that cause significant distress and impairment. What is the most likely diagnosis?

• ABipolar II disorder
• BBipolar I disorder
• CCyclothymic disorder
• DMajor depressive disorder with anxious distress

A patient with borderline personality disorder unconsciously attributes her own unacceptable feelings of anger to her therapist. She then acts in a hostile manner that provokes the therapist to react with anger, thereby confirming the patient's belief that the therapist is indeed angry with her. Which defense mechanism is this?

• AProjective identification
• BProjection
• CSplitting
• DReaction formation

To meet the DSM-5-TR diagnostic criteria for Schizoaffective Disorder, what is the required relationship between the psychotic symptoms and the mood episodes?

• ADelusions or hallucinations must be present for at least 2 weeks in the absence of a majo…
• BPsychotic symptoms must occur exclusively during periods of major mood disturbance.
• CThe mood episode must occupy at least 90% of the total duration of the illness.
• DPsychotic symptoms and mood symptoms must begin and end at the exact same time.

A 78-year-old male is admitted with a 3-day history of acute confusion, fluctuating levels of alertness, and visual hallucinations of insects on the wall. He has a history of mild cognitive impairment but was functioning well at home. His physical examination reveals a urinary tract infection. What is the most likely diagnosis?

• ADelirium
• BDementia with Lewy Bodies
• CAlzheimer's dementia
• DLate-onset schizophrenia

During an examination of a patient with schizophrenia, the therapist places the patient's arm in an awkward, raised position. The patient maintains this posture for over 30 minutes without moving, despite being told they can relax. Which catatonic feature is demonstrated?

• AWaxy flexibility
• BCatalepsy
• CPosturing
• DNegativism

A 22-year-old college student reports hearing a voice calling his name just as he is falling asleep. He sits up, turns on the light, and realizes no one is there. He has no other psychiatric symptoms. What is the most likely description of this phenomenon?

• AHypnagogic hallucination
• BHypnopompic hallucination
• CExtracampine hallucination
• DPseudohallucination

A 50-year-old man has a 2-year history of believing that his wife is cheating on him. He has hired private investigators and installed secret cameras, but has found no evidence. Despite this, his belief remains unshakeable. He has no other symptoms, his occupational functioning is intact, and his behavior is normal apart from actions related to this belief. What is the most likely diagnosis?

• ADelusional disorder, jealous type
• BSchizophrenia
• CParanoid personality disorder
• DObsessive-compulsive disorder

Which clinical feature is most useful for distinguishing Obsessive-Compulsive Disorder (OCD) from Obsessive-Compulsive Personality Disorder (OCPD)?

• AOCD symptoms are ego-dystonic, whereas OCPD traits are ego-syntonic.
• BOCD involves perfectionism, while OCPD does not.
• COCD is characterized by hoarding behavior, whereas OCPD is not.
• DOCD presents only in childhood, while OCPD presents only in late adulthood.

A 40-year-old woman lost her mother 3 months ago. She feels deep sadness, cries frequently, and has vivid dreams of her mother. However, she is still able to feel warm feelings toward her children, her self-esteem remains intact, and her sadness comes in waves that are triggered by reminders of her mother. What is the most appropriate clinical interpretation?

• ANormal grief (bereavement)
• BMajor depressive episode
• CAdjustment disorder with depressed mood
• DPersistent depressive disorder (dysthymia)

A 30-year-old female presents with sudden onset of complete blindness in her left eye. Extensive ophthalmological and neurological evaluations find no organic pathology or anatomical abnormalities that explain her blindness. The onset of symptoms occurred immediately after she witnessed a traumatic motor vehicle accident. The patient seems surprisingly unconcerned about her blindness ('la belle indifference'). What is the most likely diagnosis?

• AConversion disorder (Functional Neurological Symptom Disorder)
• BSomatic symptom disorder
• CIllness anxiety disorder
• DFactitious disorder

A 25-year-old female patient reports recurrent episodes where she feels detached from her own body, as if she is an outside observer of her own mental processes and physical self. She states: 'I feel like a robot, and my hands don't feel like they belong to me.' During these episodes, she is fully aware that this is only a feeling and her reality testing remains intact. What phenomenon is this?

• ADepersonalization
• BDerealization
• CAutoscopy
• DDelusional alienation

A 29-year-old female patient reports severe mood swings, irritability, anxiety, and depression that occur regularly during the week before her menses and resolve within a few days after her menses starts. These symptoms cause significant distress and interfere with her work. What is a mandatory requirement to confirm a diagnosis of Premenstrual Dysphoric Disorder (PMDD)?

• AProspective daily ratings of symptoms for at least two symptomatic cycles
• BA positive response to a trial of a selective serotonin reuptake inhibitor (SSRI)
• CA blood test confirming abnormal estrogen-to-progesterone ratios
• DThe presence of psychotic features during the luteal phase

A 34-year-old male describes sudden, unexpected episodes of intense fear accompanied by palpitations, sweating, shortness of breath, and a fear of dying. These episodes peak within 10 minutes. Between episodes, he experiences persistent worry about having another attack and has changed his behavior to avoid public places. What is the key diagnostic element for Panic Disorder in this vignette?

• AThe attacks must be unexpected and followed by at least 1 month of persistent concern or…
• BThe attacks must be triggered by a specific social situation.
• CThe physical symptoms must be explained by a general medical condition.
• DThe patient must experience at least one episode of psychosis during the attack.

A 9-year-old boy is brought to the clinic due to severe, recurrent temper outbursts that are grossly out of proportion to the situation. These outbursts occur 4 times a week, and his mood between outbursts is persistently irritable and angry. This pattern has been present for 18 months in multiple settings. What is the most appropriate diagnosis?

• ADisruptive Mood Dysregulation Disorder (DMDD)
• BBipolar I disorder
• COppositional Defiant Disorder (ODD)
• DAttention-Deficit/Hyperactivity Disorder (ADHD)

A 38-year-old man is found in a city 200 kilometers from his home. He is working under a new name and has no memory of his past life or identity. He has no history of head trauma or substance use, and physical exams are normal. Which dissociative phenomenon is this patient demonstrating?

• ADissociative fugue
• BDissociative amnesia without fugue
• CDissociative identity disorder
• DDepersonalization disorder

A 29-year-old male schizophrenia patient treated with high-dose haloperidol presents to the emergency department with severe 'lead-pipe' muscle rigidity, a temperature of 40.2 C, altered mental status, tachycardia, and diaphoresis. His serum creatine kinase (CK) is significantly elevated. Which of the following is the most likely diagnosis?

• ANeuroleptic Malignant Syndrome (NMS)
• BSerotonin Syndrome (SS)
• CAnticholinergic toxicity
• DMalignant hyperthermia

A 34-year-old female patient is being started on Clozapine for treatment-resistant schizophrenia. Which of the following laboratory parameters must be monitored, and what is the absolute neutrophil count (ANC) threshold below which Clozapine must be immediately discontinued in a non-benign ethnic neutropenia (BEN) patient?

• AAbsolute Neutrophil Count (ANC); discontinue if ANC < 1500 /uL
• BWhite Blood Cell (WBC) count; discontinue if WBC < 4000 /uL
• CAbsolute Neutrophil Count (ANC); discontinue if ANC < 1000 /uL
• DPlatelet count; discontinue if platelets < 100,000 /uL

A 45-year-old bipolar patient on Lithium therapy presents with progressive polyuria, polydipsia, and a low urine osmolarity that does not increase after desmopressin administration. What is the mechanism of this side effect?

• ADownregulation of aquaporin-2 channels in the collecting duct
• BAntagonism of vasopressin receptors in the anterior pituitary
• CDestruction of the loop of Henle
• DInhibition of aldosterone synthesis in the adrenal cortex

A patient with depression abruptly stops taking their antidepressant. Within 3 days, they develop dizziness, electric-shock-like sensations (brain zaps), headache, anxiety, and nausea. Which of the following antidepressants is MOST likely to cause this discontinuation syndrome?

• AParoxetine
• BFluoxetine
• CAgomelatine
• DBupropion

A 56-year-old male with a history of alcohol use disorder is admitted for acute agitation. The team wishes to administer an antipsychotic. Which of the following antipsychotics carries the HIGHEST risk of QTc prolongation and Torsades de Pointes, particularly when administered intravenously?

• AHaloperidol
• BAripiprazole
• COlanzapine
• DLurasidone

A 24-year-old female patient treated with risperidone develops galactorrhea and amenorrhea. A blood test reveals elevated prolactin levels. Which dopaminergic pathway is responsible for this side effect?

• ATuberoinfundibular pathway
• BMesolimbic pathway
• CNigrostriatal pathway
• DMesocortical pathway

A 28-year-old female bipolar patient is treated with Valproate 1000 mg daily. The clinician decides to add Lamotrigine for depressive symptoms. How does Valproate affect Lamotrigine metabolism, and what modification is required for Lamotrigine titration?

• AValproate inhibits lamotrigine glucuronidation; the lamotrigine starting dose must be hal…
• BValproate induces lamotrigine metabolism; the lamotrigine starting dose must be doubled.
• CValproate has no effect on lamotrigine metabolism; use standard titration.
• DValproate increases renal clearance of lamotrigine; monitor urinary lamotrigine.

Which of the following is considered an absolute contraindication to Electroconvulsive Therapy (ECT)?

• AThere are no absolute contraindications to ECT.
• BRecent myocardial infarction (within 3 months)
• CIncreased intracranial pressure with a space-occupying lesion
• DFirst trimester of pregnancy

A patient with treatment-resistant depression is being switched from Fluoxetine to Phenelzine (an MAOI). What is the minimum required washout period after stopping Fluoxetine before starting Phenelzine to prevent Serotonin Syndrome?

• A5 weeks
• B2 weeks
• C1 week
• DNo washout period is required.

A 26-year-old female bipolar patient is prescribed Valproic Acid. What is the primary teratogenic risk associated with Valproic Acid when taken during the first trimester of pregnancy?

• ANeural tube defects (e.g., spina bifida)
• BEbstein's anomaly
• CCleft lip and palate
• DNeonatal persistent pulmonary hypertension

A 40-year-old male schizophrenia patient has been taking haloperidol for 10 years. During a clinic visit, the psychiatrist observes involuntary, repetitive movements of the patient's tongue (tongue protrusion) and grimacing. The patient is unaware of these movements. What is the most likely diagnosis and its underlying pathophysiology?

• ATardive dyskinesia; dopamine receptor supersensitivity in the nigrostriatal pathway
• BAcute dystonia; dopamine receptor blockade in the mesolimbic pathway
• CAkathisia; norepinephrine pathway hyperactivity
• DPseudoparkinsonism; acetylcholine deficiency in the basal ganglia

Which of the following atypical antipsychotic drugs carries the LOWEST risk of causing weight gain and metabolic syndrome?

• AAripiprazole
• BOlanzapine
• CClozapine
• DQuetiapine

A 32-year-old male bipolar patient treated with Carbamazepine develops lethargy, confusion, and muscle cramps. A basic metabolic panel reveals a serum sodium level of 121 mEq/L (hyponatremia). What is the mechanism of this side effect?

• ASyndrome of Inappropriate Antidiuretic Hormone (SIADH)
• BRenal tubular acidosis
• CAdrenal insufficiency
• DDirect nephrotoxicity causing sodium wasting

A 45-year-old patient who has been taking Alprazolam 2 mg three times daily for 5 years runs out of their prescription. Two days later, they are brought to the emergency department after experiencing a generalized tonic-clonic seizure. What is the pharmacological basis for this presentation?

• ADownregulation of GABA-A receptors and abrupt loss of inhibitory tone
• BUpregulation of glutamate receptors leading to excitotoxicity
• CAcute block of voltage-gated sodium channels
• DAccumulation of toxic alprazolam metabolites

A 40-year-old male with treatment-resistant major depressive disorder is referred for repetitive Transcranial Magnetic Stimulation (rTMS). Which of the following represents a contraindication to rTMS?

• AMetallic implant in the head or neck (e.g., cochlear implant)
• BConcomitant treatment with an SSRI
• CHistory of asthma
• DAge over 35 years

Deep Brain Stimulation (DBS) is being investigated for treatment-resistant depression. What is the primary neuroanatomical target structure that is stimulated in most clinical trials for this indication?

• ASubcallosal cingulate gyrus (Brodmann Area 25)
• BNucleus accumbens
• CLocus coeruleus
• DSubthalamic nucleus

Mirtazapine is an atypical antidepressant with a unique mechanism of action. Which of the following describes its primary receptor pharmacology?

• AAntagonist at central alpha-2 adrenergic auto- and hetero-receptors, and antagonist at 5-…
• BSelective blocker of the serotonin reuptake transporter (SERT) and norepinephrine transpo…
• CAgonist at central dopamine D2 receptors and antagonist at 5-HT1A receptors
• DIrreversible inhibitor of monoamine oxidase A (MAO-A)

A patient with breast cancer is taking Tamoxifen. She is diagnosed with major depressive disorder. Which of the following antidepressants should be AVOIDED due to cytochrome P450 interactions?

• AParoxetine
• BVenlafaxine
• CEscitalopram
• DMirtazapine

A 23-year-old female presents with depression. The psychiatrist reviews her medical history and notes she has a history of Bulimia Nervosa. Which antidepressant is strictly CONTRAINDICATED in this patient?

• ABupropion
• BSertraline
• CFluoxetine
• DDuloxetine

A 10-year-old child with ADHD and a family history of substance abuse requires treatment. The parents are concerned about the abuse potential of stimulant medications. The clinician decides to prescribe Atomoxetine. What is the mechanism of action of Atomoxetine?

• ASelective inhibition of the presynaptic norepinephrine transporter (NET)
• BBlockade of postsynaptic dopamine D2 receptors
• CStimulation of GABA-A chloride channels
• DInhibition of vesicular monoamine transporter 2 (VMAT2)

In Dialectical Behavior Therapy (DBT), which of the following represents the core dialectical tension that the therapist must balance?

• AAcceptance of the patient as they are vs. pushing for change
• BSupportive therapy vs. expressive psychoanalysis
• CFree association vs. systematic desensitization
• DCognitive restructuring vs. physiological biofeedback

A depressed patient states: 'Because I made a minor spelling mistake on my report, the entire project is a complete failure, and my boss must think I am incompetent.' Which cognitive distortions are demonstrated?

• AAll-or-nothing thinking and overgeneralization
• BPersonalization and emotional reasoning
• CMind reading and catastrophizing
• DMental filtering and minimization

During psychodynamic psychotherapy, a patient reacts to the therapist with intense anger and accusations of being critical and rejecting, mirroring the relationship the patient had with their cold, demanding father. What psychodynamic concept does this represent?

• ATransference
• BCountertransference
• CResistance
• DActing out

Interpersonal Psychotherapy (IPT) is a structured, time-limited therapy developed for depression. What are the four primary interpersonal problem areas that IPT focuses on?

• AGrief, role disputes, role transitions, and interpersonal deficits
• BCore beliefs, intermediate beliefs, automatic thoughts, and schemas
• CMindfulness, distress tolerance, emotional regulation, and interpersonal effectiveness
• DTransference, resistance, dreams, and defense mechanisms

When conducting Cognitive Behavioral Therapy for Schizophrenia (CBTp) to address auditory hallucinations, which of the following represents the most appropriate therapeutic approach?

• ACollaborative empiricism and scaling of beliefs to explore alternative explanations for t…
• BDirectly confronting the delusion or hallucination and telling the patient it is not real
• CEncouraging the patient to completely ignore the voices and avoid talking about them
• DUsing hypnosis to recover the childhood trauma that caused the voices

A patient with alcohol dependence is in the contemplation stage of change according to the transtheoretical model. What is the primary task of the clinician when using Motivational Interviewing with this patient?

• AHelp the patient resolve ambivalence and weigh the pros and cons of changing their behavi…
• BProvide the patient with immediate referral to a 12-step rehabilitation program.
• CHelp the patient develop a concrete action plan and schedule a quit date.
• DGently point out that the patient is in denial and describe the medical complications of…

Which family therapy model, developed by Salvador Minuchin, focuses on boundaries, coalitions, subsystems, and the restructuring of family patterns during the session?

• AStructural Family Therapy
• BStrategic Family Therapy
• CSystemic Family Therapy (Milan model)
• DBowen Family Systems Therapy