Mood Disorders

Mood Disorders US Medical PG Question 1: A researcher is investigating whether there is an association between the use of social media in teenagers and bipolar disorder. In order to study this potential relationship, she collects data from people who have bipolar disorder and matched controls without the disorder. She then asks how much on average these individuals used social media in the 3 years prior to their diagnosis. This continuous data is divided into 2 groups: those who used more than 2 hours per day and those who used less than 2 hours per day. She finds that out of 1000 subjects, 500 had bipolar disorder of which 300 used social media more than 2 hours per day. She also finds that 400 subjects who did not have the disorder also did not use social media more than 2 hours per day. Which of the following is the odds ratio for development of bipolar disorder after being exposed to more social media?

• A. 1.5
• B. 6 (Correct Answer)
• C. 0.17
• D. 0.67

Mood Disorders Explanation: ***6*** - To calculate the odds ratio, we first construct a 2x2 table [1]: - Bipolar Disorder (Cases): 500 - No Bipolar Disorder (Controls): 500 (1000 total subjects - 500 cases) - Cases exposed to more social media (>2 hrs/day): 300 - Cases not exposed to more social media (≤2 hrs/day): 200 (500 - 300) - Controls not exposed to more social media (≤2 hrs/day): 400 - Controls exposed to more social media (>2 hrs/day): 100 (500 - 400) - The odds ratio (OR) is calculated as (odds of exposure in cases) / (odds of exposure in controls) = (300/200) / (100/400) = 1.5 / 0.25 = **6** [1]. *1.5* - This value represents the **odds of exposure** (more than 2 hours of social media) in individuals with bipolar disorder (300 cases exposed / 200 cases unexposed = 1.5). - It is not the odds ratio, which compares these odds to the odds of exposure in the control group. *0.17* - This value is close to the reciprocal of 6 (1/6 ≈ 0.166), suggesting a potential miscalculation or an inverted odds ratio. - An odds ratio of 0.17 would imply a protective effect (lower odds of bipolar disorder with more social media), which is contrary to the calculation and typical interpretation in this context. *0.67* - This value is the reciprocal of 1.5 (1/1.5 ≈ 0.67) which represents the odds of *not* being exposed in cases (200/300). - It does not represent the correct odds ratio, which compares the odds of exposure in cases to the odds of exposure in controls.

Mood Disorders US Medical PG Question 2: A 35-year-old man is brought to the emergency department by his wife. She was called by his coworkers to come and pick him up from work after he barged into the company’s board meeting and was being very disruptive as he ranted on about all the great ideas he had for the company. When they tried to reason with him, he became hostile and insisted that he should be the CEO as he knew what was best for the future of the company. The patient’s wife also noted that her husband has been up all night for the past few days but assumed that he was handling a big project at work. The patient has no significant past medical or psychiatric history. Which of the following treatments is most likely to benefit this patient’s condition?

• A. Antidepressants
• B. Valproic acid (Correct Answer)
• C. Haloperidol
• D. Psychotherapy
• E. Clozapine

Mood Disorders Explanation: ***Valproic acid*** - This patient presents with symptoms highly suggestive of a **manic episode**, including grandiosity (believing he should be CEO), decreased need for sleep (up all night for days), pressured speech (ranting), and impulsivity with poor judgment (disruptive behavior at a board meeting). - **Valproic acid** is a **first-line, guideline-recommended mood stabilizer** for acute mania. It is particularly effective for managing the core symptoms of mania including mood elevation, irritability, and impulsivity. - It has a relatively rapid onset of action and a favorable side effect profile compared to typical antipsychotics, making it an excellent choice for initial management of acute mania in the emergency setting. *Antidepressants* - Administering **antidepressants** during a manic or hypomanic episode can exacerbate symptoms, potentially leading to a rapid cycling pattern or worsening mania. - Antidepressants are primarily used for depressive episodes in bipolar disorder, typically in conjunction with a mood stabilizer, never as monotherapy in a patient presenting with mania. *Haloperidol* - **Haloperidol** is a typical antipsychotic that can be used for acute agitation in mania, but it does not address the underlying mood dysregulation. - While it may help with immediate behavioral control, mood stabilizers like valproic acid or lithium are preferred as primary treatments because they target the core pathophysiology of bipolar disorder. - Haloperidol also has a higher risk of extrapyramidal symptoms and does not prevent future mood episodes. *Psychotherapy* - **Psychotherapy** is a crucial component of long-term management for bipolar disorder but is not effective as a sole treatment for acute mania. - Patients in acute mania are often too agitated, impulsive, and lack sufficient insight to meaningfully engage in therapeutic interventions. - Psychotherapy should be initiated after mood stabilization with pharmacotherapy. *Clozapine* - **Clozapine** is an atypical antipsychotic reserved for treatment-resistant schizophrenia or treatment-resistant bipolar disorder, particularly with prominent psychotic features that have not responded to multiple other medications. - Given its significant side effect profile, including agranulocytosis requiring regular blood monitoring, it is not a first-line or even second-line treatment for an initial presentation of mania. - This patient has no psychiatric history and requires standard first-line treatment, not a medication reserved for refractory cases.

Mood Disorders US Medical PG Question 3: A 25-year-old woman is brought to the emergency department by EMS after being found naked in a busy downtown square. The patient stated that she is liberating people from material desires and was found destroying objects. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is deferred due to patient combativeness. The patient is given diphenhydramine and haloperidol and transferred to the psychiatric ward. On day 1 on the ward, the patient is no longer aggressive or agitated and has calmed down. She states that she feels severely depressed and wants to kill herself. The patient is started on a medication and monitored closely. On day 3 of the patient's stay in the hospital she is found in her room drawing up plans and states that she has major plans to revamp the current energy problems in the country. Which of the following is the most likely medication that was started in this patient?

• A. Quetiapine
• B. Olanzapine
• C. Lamotrigine
• D. Sertraline (Correct Answer)
• E. Lithium

Mood Disorders Explanation: ***Sertraline*** - This patient exhibits classic **bipolar I disorder** with rapid mood cycling from **mania** (naked in public, grandiose delusions, destroying objects) to **severe depression** (suicidal ideation on Day 1) and back to **mania** (grandiose plans on Day 3). - The key clinical clue is the **rapid return to mania by Day 3** after starting medication during the depressive phase. This suggests **antidepressant-induced mania/mood switch**, a well-known complication of using **SSRI antidepressants** (like sertraline) **without adequate mood stabilization** in bipolar disorder. - **Antidepressants can precipitate manic episodes** within days in bipolar patients, which is why they should be avoided or used only with concomitant mood stabilizers. This question tests recognition of this critical psychiatric principle. *Lithium* - Lithium is a first-line **mood stabilizer** for bipolar disorder and would be appropriate for long-term management. However, lithium **prevents manic episodes** rather than causing them. - Lithium takes **1-2 weeks to reach therapeutic levels**, so it would not explain the rapid mood switch to mania by Day 3. If lithium had been started, we would expect **stabilization or improvement**, not a return to mania. *Quetiapine* - Quetiapine is an **atypical antipsychotic** effective for both acute mania and bipolar depression. It can provide rapid mood stabilization. - If quetiapine was started on Day 1, we would expect **mood stabilization or sedation**, not a switch back to mania. Quetiapine does **not precipitate manic episodes**. *Olanzapine* - Olanzapine is another **atypical antipsychotic** used for acute mania and maintenance in bipolar disorder. - Like quetiapine, olanzapine would **stabilize mood** and reduce manic symptoms, not trigger them. It would not explain the return to mania on Day 3. *Lamotrigine* - Lamotrigine is a mood stabilizer particularly effective for **preventing depressive episodes** in bipolar disorder, though less effective for acute mania. - Lamotrigine **does not precipitate manic episodes** and takes weeks to titrate to therapeutic doses due to risk of Stevens-Johnson syndrome. It would not explain the rapid mood switch observed here.

Mood Disorders US Medical PG Question 4: A 32-year-old woman is brought to the physician by her husband, who is concerned about her ability to care for herself. Three weeks ago, she quit her marketing job to start a clothing company. Since then, she has not slept more than 4 hours per night because she has been working on her business plans. She used a significant portion of their savings to fund business trips to Switzerland in order to buy “only the best quality fabrics in the world.” She has not showered and has eaten little during the past 3 days. She has had 2 similar episodes a few years back that required hospitalization and treatment in a psychiatry unit. She has also suffered from periods of depression. She is currently not taking any medications. She appears unkempt and agitated, pacing up and down the room. She speaks very fast without interruption about her business ideas. She has no suicidal ideation or ideas of self-harm. Toxicology screening is negative. Which of the following is the most appropriate pharmacotherapy for the management of this patient?

• A. Clonazepam therapy for one year
• B. Long-term lithium therapy (Correct Answer)
• C. Sertraline therapy for one year
• D. Long-term risperidone therapy
• E. Long-term clozapine therapy

Mood Disorders Explanation: ***Long-term lithium therapy*** - This patient presents with classic symptoms of **mania** (decreased need for sleep, grandiosity, compulsive spending, rapid speech) and a history of both manic and depressive episodes, consistent with **bipolar I disorder**. - **Lithium** is a first-line agent for the **long-term maintenance treatment** of **bipolar I disorder**, particularly effective in preventing both manic and depressive episodes. *Clonazepam therapy for one year* - **Clonazepam** is a **benzodiazepine** primarily used for short-term management of acute agitation or severe insomnia, not for long-term mood stabilization in bipolar disorder. - Long-term use of benzodiazepines carries risks of **tolerance** and **dependence**, making it inappropriate for chronic maintenance treatment. *Sertraline therapy for one year* - **Sertraline** is an **antidepressant** (SSRI) that, when used as monotherapy in bipolar disorder, can induce **mania** or **rapid cycling**. - While periods of depression are mentioned, the current presentation is manic, and mood stabilizers are the priority for long-term management. *Long-term risperidone therapy* - **Risperidone** is a **second-generation antipsychotic** effective in treating acute mania and can be used for maintenance in bipolar disorder, often as an adjunct or in patients who cannot tolerate lithium. - However, for long-term monotherapy in bipolar I disorder, **lithium** is generally considered more effective and is the preferred first-line agent, especially given the history of recurrent episodes. *Long-term clozapine therapy* - **Clozapine** is an **atypical antipsychotic** reserved for **treatment-resistant schizophrenia** and **refractory bipolar disorder**, often due to its significant side effect profile, including **agranulocytosis**. - While it can be effective for severe or refractory cases of bipolar disorder, it is not a first-line long-term treatment given its risks and the availability of safer alternatives.

Mood Disorders US Medical PG Question 5: A 19-year-old woman presents to an outpatient psychiatrist after 2 weeks of feeling “miserable.” She has been keeping to herself during this time with no desire to socialize with her friends or unable to enjoy her usual hobbies. She also endorses low energy, difficulty concentrating and falling asleep, and decreased appetite. You diagnose a major depressive episode but want to screen for bipolar disorder before starting her on an anti-depressant. Which of the following cluster of symptoms, if previously experienced by this patient, would be most consistent with bipolar I disorder?

• A. Insomnia, anxiety, nightmares, and flashbacks for 6 months
• B. Elevated mood, insomnia, distractibility, and flight of ideas for 5 days
• C. Impulsivity, rapid mood swings, intense anger, self-harming behavior, and splitting for 10 years
• D. Auditory hallucinations, paranoia, and disorganized speech for 2 weeks
• E. Impulsivity, insomnia, increased energy, irritability, and auditory hallucinations for 2 weeks (Correct Answer)

Mood Disorders Explanation: ***Impulsivity, insomnia, increased energy, irritability, and auditory hallucinations for 2 weeks*** - This cluster of symptoms indicates a past **manic episode** with **psychotic features**, characteristic of **Bipolar I disorder**. The duration of 2 weeks meets the diagnostic criteria for a manic episode. - The presence of **auditory hallucinations** during a manic episode signifies **psychosis**, which is a key differentiator in Bipolar I as opposed to Bipolar II. *Elevated mood, insomnia, distractibility, and flight of ideas for 5 days* - While these symptoms suggest a **hypomanic episode**, the duration of 5 days is insufficient to meet the criteria for a manic episode (which requires a minimum of 7 days or hospitalization). - A hypomanic episode, without psychotic features, indicates **Bipolar II disorder**, not Bipolar I. *Insomnia, anxiety, nightmares, and flashbacks for 6 months* - This symptom cluster is highly suggestive of **Post-Traumatic Stress Disorder (PTSD)** due to the presence of nightmares and flashbacks over an extended period. - These symptoms are not indicative of a manic or hypomanic episode, and thus do not point to bipolar disorder. *Auditory hallucinations, paranoia, and disorganized speech for 2 weeks* - This constellation of symptoms suggests a **psychotic disorder** such as **schizophrenia** or **schizophreniform disorder**, especially with auditory hallucinations and disorganized speech dominating the clinical picture. - While psychosis can occur in bipolar disorder, the question specifically asks for symptoms *consistent with bipolar I*, and these symptoms alone do not describe the characteristic mood disturbance (mania) of bipolar disorder. *Impulsivity, rapid mood swings, intense anger, self-harming behavior, and splitting for 10 years* - This pattern of symptoms, particularly the chronic impulsivity, rapid mood swings, intense anger, and splitting, is highly suggestive of **Borderline Personality Disorder (BPD)**. - The chronic nature and specific interpersonal and behavioral challenges are hallmarks of BPD, not primarily a manic or hypomanic episode of bipolar disorder.

Mood Disorders US Medical PG Question 6: A 37-year-old African American man is brought to the emergency department by police. The patient refused to leave a petting zoo after closing. He states that he has unique ideas to revolutionize the petting zoo experience. The patient has a past medical history of multiple suicide attempts. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 100/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient's cardiac and pulmonary exams are within normal limits. He denies any nausea, vomiting, shortness of breath, or systemic symptoms. The patient struggles to answer questions, as he is constantly changing the subject and speaking at a very rapid rate. The patient is kept in the emergency department overnight and is observed to not sleep and is very talkative with the nurses. Which of the following is the best long-term therapy for this patient?

• A. Haloperidol
• B. Lithium (Correct Answer)
• C. Diphenhydramine
• D. Valproic acid
• E. Risperidone

Mood Disorders Explanation: ***Lithium*** - The patient exhibits classic symptoms of **mania**, including grandiosity, decreased need for sleep, pressured speech, and flight of ideas, suggesting **bipolar I disorder**. - **Lithium** is considered a first-line agent and the best long-term maintenance therapy for **bipolar I disorder**, effective in reducing both manic and depressive episodes and decreasing suicide risk. *Haloperidol* - **Haloperidol** is a potent typical antipsychotic primarily used for acute management of severe agitation, psychosis, or manic episodes due to its rapid tranquilizing effects. - While it could be used for immediate symptom control, it is not the **best long-term therapy** for mood stabilization in bipolar disorder and carries a high risk of **extrapyramidal side effects**. *Diphenhydramine* - **Diphenhydramine** is an antihistamine with sedative properties, sometimes used for mild insomnia or allergic reactions, but it has no role in the treatment of acute mania or the long-term management of bipolar disorder. - It would not address the underlying mood dysregulation and behavioral symptoms seen in this patient's presentation. *Valproic acid* - **Valproic acid** (divalproex) is an effective mood stabilizer used for bipolar disorder, particularly in patients who cannot tolerate lithium or have rapid cycling. - However, for long-term therapy and overall efficacy, especially considering lithium's proven benefits in reducing suicidality, **lithium** is generally considered the preferred first-line agent, although valproic acid is a strong alternative. *Risperidone* - **Risperidone** is an atypical antipsychotic, primarily used for acute mania or as an adjunct in bipolar depression, and in schizophrenia. - While useful for acute symptom management of psychosis and agitation in bipolar disorder, it is not typically the sole **best long-term maintenance monotherapy** compared to mood stabilizers like lithium, which directly target the mood swings.

Mood Disorders US Medical PG Question 7: A 28-year-old male presents to his primary care physician with complaints of intermittent abdominal pain and alternating bouts of constipation and diarrhea. His medical chart is not significant for any past medical problems or prior surgeries. He is not prescribed any current medications. Which of the following questions would be the most useful next question in eliciting further history from this patient?

• A. "Does the diarrhea typically precede the constipation, or vice-versa?"
• B. "Is the diarrhea foul-smelling?"
• C. "Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life"
• D. "Are the symptoms worse in the morning or at night?"
• E. "Can you tell me more about the symptoms you have been experiencing?" (Correct Answer)

Mood Disorders Explanation: ***Can you tell me more about the symptoms you have been experiencing?*** - This **open-ended question** encourages the patient to provide a **comprehensive narrative** of their symptoms, including details about onset, frequency, duration, alleviating/aggravating factors, and associated symptoms, which is crucial for diagnosis. - In a patient presenting with vague, intermittent symptoms like alternating constipation and diarrhea, allowing them to elaborate freely can reveal important clues that might not be captured by more targeted questions. *Does the diarrhea typically precede the constipation, or vice-versa?* - While knowing the sequence of symptoms can be helpful in understanding the **pattern of bowel dysfunction**, it is a very specific question that might overlook other important aspects of the patient's experience. - It prematurely narrows the focus without first obtaining a broad understanding of the patient's overall symptomatic picture. *Is the diarrhea foul-smelling?* - Foul-smelling diarrhea can indicate **malabsorption** or **bacterial overgrowth**, which are important to consider in some gastrointestinal conditions. - However, this is a **specific symptom inquiry** that should follow a more general exploration of the patient's symptoms, as it may not be relevant if other crucial details are missed. *Please rate your abdominal pain on a scale of 1-10, with 10 being the worst pain of your life* - Quantifying pain intensity is useful for assessing the **severity of discomfort** and monitoring changes over time. - However, for a patient with intermittent rather than acute, severe pain, understanding the **character, location, and triggers** of the pain is often more diagnostically valuable than just a numerical rating initially. *Are the symptoms worse in the morning or at night?* - Diurnal variation can be relevant in certain conditions, such as inflammatory bowel diseases where nocturnal symptoms might be more concerning, or functional disorders whose symptoms might be stress-related. - This is another **specific question** that should come after gathering a more complete initial picture of the patient's symptoms to ensure no key information is overlooked.

Mood Disorders US Medical PG Question 8: A 55-year-old man presents to his primary care physician with complaints of fluctuating mood for the past 2 years. He feels great and full of energy for some months when he is very creative with tons of ideas just racing through his mind. He is noted to be very talkative and distracted by his different ideas. During these times, he is very productive and able to accomplish much at work and home. However, these periods are frequently followed by a prolonged depressed mood. During this time, he has low energy, poor concentration, and low self-esteem. The accompanying feeling of hopelessness from these cycling “ups” and “downs” have him eating and sleeping more during the “downs.” He does not remember a period within the last 2 years where he felt “normal.” What is the most likely diagnosis?

• A. Dysthymic disorder
• B. Bipolar II disorder
• C. Persistent depressive disorder
• D. Bipolar I disorder
• E. Cyclothymic disorder (Correct Answer)

Mood Disorders Explanation: ***Cyclothymic disorder*** - The patient experiences chronic **fluctuating moods**, with numerous periods of **hypomanic symptoms** (elevated energy, racing thoughts, increased productivity) and numerous periods of **depressive symptoms** (low energy, poor concentration, hopelessness) over at least 2 years. - The symptoms are not severe enough to meet full criteria for a **manic episode**, **hypomanic episode**, or **major depressive episode**, and there has been no period longer than 2 months without symptoms. *Dysthymic disorder* - This is the **DSM-IV term** for what is now called **persistent depressive disorder** in DSM-5, involving a **chronic depressed mood** that lasts for at least 2 years. - It does not include periods of significant elevated mood or hypomania. - The patient's presentation includes distinct periods of **elevated mood and energy**, which are not characteristic of dysthymic disorder. *Bipolar II disorder* - Bipolar II disorder requires at least one **major depressive episode** and at least one **hypomanic episode**. - While the patient exhibits hypomanic and depressive symptoms, the periods of depression do not meet the full criteria for a **major depressive episode** (e.g., duration, number of symptoms) and the hypomanic symptoms are subsyndromal. *Persistent depressive disorder* - This is the **DSM-5 term** for chronic low-grade depression (formerly called dysthymic disorder), characterized by depressed mood for at least 2 years without manic or hypomanic symptoms. - The patient's history of elevated mood and energy precludes this diagnosis. *Bipolar I disorder* - Bipolar I disorder requires at least one **manic episode**, which is characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least 1 week and causing significant impairment. - The patient's "ups" are described as productive and not causing significant impairment or involving psychotic features, indicating **hypomanic symptoms** rather than full mania.

Mood Disorders US Medical PG Question 9: A 24-year-old woman presents to her primary care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, difficulty with concentration, and trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 years. She has had moments where she felt better, but it lasted a few weeks out of the year. She currently lives alone and does not pursue romantic relationships because she feels she is not attractive. She has a past medical history of asthma. Her mother is alive and healthy. Her father committed suicide and suffered from major depressive disorder. On physical exam, the patient has a gloomy demeanor and appears restless and anxious. Which of the following is the most likely diagnosis?

• A. Major depressive disorder
• B. Cyclothymia
• C. Persistent depressive disorder (Correct Answer)
• D. Seasonal affective disorder
• E. Disruptive mood dysregulation disorder

Mood Disorders Explanation: ***Persistent depressive disorder*** - The patient exhibits chronic symptoms of depression (poor appetite, poor self-esteem, difficulty with concentration, trouble with sleep, hopelessness) lasting for at least **2 years**, with symptom-free periods lasting no more than **2 months**. - Her long-standing symptoms (3 years) and the intermittent improvement, but never full resolution for extended periods, are characteristic of **persistent depressive disorder** (formerly dysthymia). *Major depressive disorder* - While the patient has many symptoms of depression, **major depressive disorder** is characterized by distinct episodes of at least 2 weeks, with significant functional impairment. The chronic, fluctuating course over 3 years is less typical. - The presence of depressive symptoms for 3 years, with only brief periods of improvement, points away from episodic major depressive disorder alone and more towards a chronic form. *Cyclothymia* - **Cyclothymia** involves numerous periods of hypomanic symptoms and numerous periods of depressive symptoms for at least 2 years, with periods of stability lasting no more than 2 months. The patient describes only depressive symptoms, not hypomanic episodes. - There is no mention of elevated mood, increased energy, or decreased need for sleep, which are characteristic of **hypomanic episodes** in cyclothymia. *Seasonal affective disorder* - **Seasonal affective disorder** is a type of depressive disorder that occurs during a specific season (most commonly winter) and resolves during other seasons; the patient's symptoms are year-round and chronic. - The patient's symptoms are not described as tied to a particular season, making this diagnosis less likely. *Disruptive mood dysregulation disorder* - Predominantly diagnosed in **children and adolescents**, this disorder is characterized by severe recurrent temper outbursts and persistently irritable or angry mood between outbursts. - The patient's age (24 years old) and the absence of temper outbursts make this diagnosis inappropriate.

Mood Disorders US Medical PG Question 10: A 29-year-old man comes to the physician with his wife because she has noticed a change in his behavior over the past 2 weeks. His wife reports that he is very distracted and irritable. His colleagues have voiced concerns that he has not been turning up for work regularly and behaves erratically when he does. Previously, her husband had been a reliable and reasonable person. The patient says that he feels “fantastic”; he only needs 4 hours of sleep each night and wakes up cheerful and full of energy each morning. He thinks that his wife is overreacting. The patient has been healthy except for a major depressive episode 5 years ago that was treated with paroxetine. He currently takes no medications. His pulse is 98/min, respirations are 12/min, and blood pressure is 128/62 mm Hg. Mental status examination shows frenzied speech and a flight of ideas. Which of the following is the strongest predisposing factor for this patient's condition?

• A. Advanced paternal age
• B. Genetic predisposition (Correct Answer)
• C. Higher socioeconomic class
• D. Maternal obstetric complications
• E. Being married

Mood Disorders Explanation: ***Genetic predisposition*** - A strong **genetic predisposition** is a primary predisposing factor for bipolar disorder, as evidenced by a significantly higher concordance rate in monozygotic twins compared to dizygotic twins or the general population. - The patient's presentation with **manic symptoms** (decreased need for sleep, euphoria, irritability, frenzied speech, flight of ideas, erratic behavior) following a history of a **major depressive episode** is highly suggestive of **bipolar I disorder**. *Advanced paternal age* - While advanced paternal age has been associated with an increased risk of some neurodevelopmental disorders like **schizophrenia** and **autism spectrum disorder**, its link to bipolar disorder is less robust and not considered the strongest predisposing factor. - The primary risk factor for bipolar disorder involves heritability rather than specific parental age. *Higher socioeconomic class* - There is **no consistent evidence** to suggest that higher socioeconomic class is a predisposing factor for bipolar disorder. - Bipolar disorder affects individuals across all socioeconomic levels. *Maternal obstetric complications* - Maternal obstetric complications, such as **prenatal infections** or **hypoxia**, have been implicated in the development of certain psychiatric disorders, particularly **schizophrenia**. - However, for bipolar disorder, genetic factors play a far more significant and direct role than obstetric complications. *Being married* - **Marital status** does not serve as a predisposing factor for the development of bipolar disorder. - While relationship challenges can be a consequence or stressor for individuals with bipolar disorder, marriage itself is not a cause.

Mood Disorders Flashcard 1 of 10

Question: Neuro/Psych _____ is a potentially lethal adverse effect associated with any drug that increases 5-HT

Answer: Serotonin syndrome

Mood Disorders Flashcard 2 of 10

Question: Treatment for disruptive mood dysregulation disorder includes psychostimulants, antipsychotics, and _____

Answer: CBT

Mood Disorders Flashcard 3 of 10

Question: Treatment for binge eating disorder is _____ +/- SSRIs or lisdexamfetamine

Answer: CBT

Mood Disorders Flashcard 4 of 10

Question: Anorexia nervosa commonly coexists with _____

Answer: depression

Mood Disorders Flashcard 5 of 10

Question: Neuro/Psych Patients must wait _____ after stopping MAO inhibitors before starting serotonergic drugs and/or stopping dietary restrictions

Answer: 2 weeks

Mood Disorders Flashcard 6 of 10

Question: Which personality disorder is characterized by unstable mood and relationships and a sense of emptiness? _____

Answer: Borderline (cluster B)

Mood Disorders Flashcard 7 of 10

Question: sex drive

Answer: limbic system

Mood Disorders Flashcard 8 of 10

Question: emotion

Answer: limbic system

Mood Disorders Flashcard 9 of 10

Question: What is the timecourse of normal grief and bereavement?

Answer: up to one year

Mood Disorders Flashcard 10 of 10

Question: How does sexual interest change in the elderly?

Answer: It usually doesnt!