INICET Psychiatry Previous Year Questions (2018–2026)

The correct answer is Avoid tea or coffee just before and 15 minutes after the gum.

Nicotine from gum and lozenges is absorbed through the buccal (oral) mucosa, which needs an alkaline pH. The gum contains a buffer, but acidic drinks such as coffee, tea, juice and soft drinks lower the oral pH and sharply reduce nicotine absorption. Patients are therefore told not to eat or drink for about 15 minutes before and while using the gum, and to use the chew and park technique - chew until a peppery tingle appears, then park the gum against the cheek to absorb, over about 30 minutes (continuous chewing causes nausea and hiccups). So statement B is correct.

The other statements are false. Nicotine gums and lozenges have comparable efficacy (A is wrong). Varenicline is not an NRT - it is a partial nicotinic-receptor agonist, and its boxed warning was for neuropsychiatric effects (later removed), not cardiovascular ones (C is wrong). Swallowed nicotine is poorly absorbed and undergoes first-pass metabolism, so NRT does not work by the gastrointestinal route (D is wrong).

Incorrect Options:

• Nicotine gums are better than lozenges: gums and lozenges have similar efficacy, and neither is clearly superior.
• Varenicline carries a CVS black box warning: varenicline is not NRT, and its boxed warning was neuropsychiatric (now removed).
• Nicotine is delivered by the gastrointestinal route: NRT nicotine is absorbed buccally, and swallowed nicotine is largely inactivated by first-pass metabolism.

High-Yield Facts:

• Avoid acidic drinks (coffee, tea, juice) 15 minutes before and during nicotine gum use.
• Nicotine gum and lozenge are absorbed via the buccal mucosa, needing an alkaline pH.
• Varenicline is a partial nicotinic agonist, NOT an NRT.
• Use the chew and park technique for nicotine gum.

Figure 1: A nicotine patch - a transdermal form of NRT.

Figure 2: A nicotine lozenge/pastille - like the gum, it is absorbed through the buccal mucosa.

The correct answer is Vilazodone.

Vilazodone is a novel antidepressant approved in 2011. It is a serotonin partial agonist and reuptake inhibitor (SPARI) - it both blocks the serotonin transporter (like an SSRI) and is a partial agonist at the 5-HT1A receptor (like buspirone). This dual action raises synaptic serotonin and may give a faster onset with less sexual dysfunction. It is used for major depressive disorder, so it is the novel antidepressant here.

The other options do not fit. Trazodone is an OLDER atypical antidepressant (a serotonin antagonist and reuptake inhibitor, SARI), not novel. Blonanserin is an atypical antipsychotic (a dopamine D2 and 5-HT2A antagonist), not an antidepressant. Etizolam is a thienodiazepine - a benzodiazepine-like anxiolytic and hypnotic - not an antidepressant.

Incorrect Options:

• Trazodone: an older atypical antidepressant (SARI), also used for insomnia, but not a novel agent.
• Blonanserin: an atypical antipsychotic (D2 and 5-HT2A antagonist), not an antidepressant.
• Etizolam: a thienodiazepine (benzodiazepine-like) anxiolytic and hypnotic, not an antidepressant.

High-Yield Facts:

• Vilazodone is a novel antidepressant (SPARI: SSRI plus 5-HT1A partial agonist).
• Vortioxetine is another novel serotonin-modulator antidepressant.
• Trazodone is an OLDER atypical antidepressant (SARI), often used for insomnia.
• Blonanserin is an antipsychotic, and etizolam is a benzodiazepine-like anxiolytic.

Figure 1: Vilazodone - a novel serotonin partial agonist and reuptake inhibitor (SPARI) antidepressant.

Figure 2: Vilazodone acts at the serotonin synapse - inhibiting the serotonin transporter and partially agonising the 5-HT1A receptor.

The correct answer is Hospitalisation and safety precautions.

This patient carries multiple high-risk factors for suicide - male, middle-aged, recently divorced (a major loss), depression and alcohol dependence - and is now voicing active suicidal ideation (what is the point in living?). With active suicidal thoughts in a high-risk patient who may not be able to keep himself safe, the safest next step is psychiatric hospitalisation with suicide precautions (close observation, removal of means, a safe environment) while the depression and alcohol use are treated. Safety always comes first.

Outpatient options are unsafe here. Reassuring him that it is transient dismisses a real risk, and CBT or an antidepressant with only weekly OPD follow-up leaves a high-risk patient unprotected between visits. Antidepressants and psychotherapy are important, but they are started alongside or after ensuring immediate safety, not instead of it.

Incorrect Options:

• Reassurance and tell that it is a transient phenomenon: false reassurance dismisses a serious risk and can be dangerous.
• CBT and weekly OPD visit: outpatient therapy leaves an actively suicidal high-risk patient unsafe between visits.
• Antidepressant and weekly OPD: medication is needed but does not ensure immediate safety, and antidepressants take weeks to act.

High-Yield Facts:

• Active suicidal ideation with high risk means admit for safety (hospitalisation plus suicide precautions).
• High-risk factors: male, older age, depression, alcohol or substance use, recent loss, prior attempts.
• Ensure safety FIRST, then treat the depression and substance use.
• Never give false reassurance to a suicidal patient.