100+ Free DMH(SA) Practice Questions

Explanation: A Major Depressive Episode requires at least 2 weeks of persistent depressed mood or loss of interest/pleasure (anhedonia) accompanied by at least 4 additional neurovegetative or cognitive symptoms. A 1-week duration is insufficient for major depression, whereas 1 month is required for schizophrenia or PTSD.

Explanation: Postpartum depression is characterized by depressive symptoms persisting beyond 2 weeks after childbirth, causing functional impairment and requiring active therapeutic intervention. Postpartum blues affects up to 80% of new mothers, peaks around day 3–5, and resolves spontaneously within 10–14 days. Postpartum psychosis involves overt delusions or hallucinations.

Explanation: A Manic Episode is defined by a distinct period of abnormally elevated, expansive, or irritable mood and abnormally increased activity/energy lasting at least 7 consecutive days, or any duration if hospitalization becomes necessary. Hypomania requires at least 4 consecutive days without severe functional disruption.

Explanation: Selective Serotonin Reuptake Inhibitors (SSRIs), such as Citalopram or Fluoxetine, are recommended as first-line agents for moderate-to-severe depression in South African primary care guidelines due to their favorable safety profile, lower overdose toxicity compared to TCAs, and better tolerability. TCAs are reserved as second-line or for specific pain/insomnia indications.

Explanation: SSRIs require 2 to 4 weeks (and up to 6–8 weeks for full effect) of continuous daily administration to induce neuroadaptive changes (such as 5-HT1A receptor desensitization) necessary for clinical antidepressant efficacy. Patients must be counseled not to discontinue therapy prematurely due to lack of immediate mood response.

Explanation: Sodium Valproate (or Carbamazepine) is the preferred mood stabilizer in patients with significant renal impairment because it undergoes hepatic metabolism and lacks nephrotoxicity. Lithium is excreted unchanged by the kidneys, carries a narrow therapeutic window, causes interstitial nephritis, and is relatively contraindicated in moderate-to-severe renal failure.

Explanation: The target 12-hour trough serum lithium level for maintenance therapy in Bipolar Disorder is 0.6 to 1.0 mmol/L (acute mania target is 0.8–1.2 mmol/L). Levels above 1.5 mmol/L carry significant toxicity risks (tremor, ataxia, confusion), and levels >2.0–2.5 mmol/L are life-threatening emergencies.

Explanation: Electroconvulsive Therapy (ECT) is the treatment of choice in emergency life-threatening catatonia or severe depressive psychosis with severe food/fluid refusal causing acute physical decline. ECT acts rapidly (within days) compared to oral psychotropics which take weeks.

Explanation: High immediate suicide risk is indicated by active suicidal intent coupled with a specific, high-lethality plan, availability of lethal means, preparations for death (arranging final affairs/writing notes), and recent severe psychosocial loss. Passive ideation without intent or plan represents lower immediate risk.

Explanation: Persistent Depressive Disorder (Dysthymia) is characterized by chronic depressed mood occurring for most of the day, for more days than not, for at least 2 years in adults (1 year in children/adolescents), without symptom-free intervals exceeding 2 months.