Substance-induced mood disorders US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Substance-induced mood disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Substance-induced mood disorders US Medical PG Question 1: A 19-year-old woman is brought to the physician by her parents because of irritable mood that started 5 days ago. Since then, she has been staying up late at night working on a secret project. She is energetic despite sleeping less than 4 hours per day. Her parents report that she seems easily distracted. She is usually very responsible, but this week she spent her paycheck on supplies for her project. She has never had similar symptoms before. In the past, she has had episodes where she felt too fatigued to go to school and slept until 2 pm every day for 2 weeks at a time. During those times, her parents noticed that she cried excessively, was very indecisive, and expressed feelings of worthlessness. Two months ago, she had an asthma exacerbation and was treated with bronchodilators and steroids. She tried cocaine once in high school but has not used it since. Vital signs are within normal limits. On mental status examination, she is irritable but cooperative. Her speech is pressured and her thought process is linear. Which of the following is the most likely diagnosis?
- A. Major depressive disorder
- B. Bipolar I disorder
- C. Bipolar II disorder (Correct Answer)
- D. Schizoaffective disorder
- E. Substance abuse
Substance-induced mood disorders Explanation: ***Bipolar II disorder***
- This patient exhibits symptoms consistent with both **hypomania** (increased energy, decreased need for sleep, irritability, distractibility, spending sprees) and past episodes of **major depression** (fatigue, hypersomnia, crying, indecisiveness, worthlessness). The key distinction for Bipolar II is the presence of at least one hypomanic episode and one major depressive episode, without a full manic episode.
- The current symptoms of increased energy and decreased need for sleep for 5 days, along with a significant change in behavior (spending paycheck on a "secret project"), indicate a level of impairment consistent with hypomania, rather than a full-blown mania as the thought process is described as linear.
*Major depressive disorder*
- While the patient has a history of depressive episodes, the current presentation with **elevated mood, increased energy, and decreased need for sleep** is inconsistent with a unipolar depressive episode.
- Major depressive disorder does not involve periods of elevated or irritable mood or increased activity.
*Bipolar I disorder*
- Bipolar I disorder requires the occurrence of at least one **manic episode**. While the patient's current symptoms are suggestive of a mood elevation, they do not meet the criteria for full mania, which typically involves severe impairment, psychotic features, or hospitalization.
- The patient's speech is pressured but her thought process is described as **linear**, which is less typical for a full manic episode where **flight of ideas** or **tangential/disorganized thinking** might be present.
*Schizoaffective disorder*
- Schizoaffective disorder involves a period of uninterrupted illness during which there is a **major mood episode (depressive or manic) concurrent with symptoms of schizophrenia**, such as delusions or hallucinations.
- The patient's symptoms are primarily mood-related, and there is no mention of psychotic symptoms independent of the mood disturbance.
*Substance abuse*
- Although the patient used cocaine once in high school, there is no evidence of recent substance use that would explain the current symptoms. The symptoms are sustained over days and include a history of recurrent mood disturbances.
- While the patient received steroid treatment 2 months ago (which can precipitate mood episodes), the timing and clinical presentation are more consistent with a primary mood disorder rather than a substance/medication-induced disorder.
Substance-induced mood disorders US Medical PG Question 2: One hour after undergoing an uncomplicated laparoscopic appendectomy, a 22-year-old man develops agitation and restlessness. He also has tremors, diffuse sweating, headache, and nausea with dry heaves. One liter of lactated ringer's was administered during the surgery and he had a blood loss of approximately 100 mL. His urine output was 100 mL. His pain has been controlled with intravenous morphine. He was admitted to the hospital 3 days ago and has not eaten in 18 hours. He has no history of serious illness. He is a junior in college. His mother has Hashimoto's thyroiditis. He has experimented with intravenous illicit drugs. He drinks 3 beers and 2 glasses of whiskey daily during the week and more on the weekends with his fraternity. He appears anxious. His temperature is 37.4°C (99.3°F), pulse is 120/min, respirations are 19/min, and blood pressure is 142/90 mm Hg. He is alert and fully oriented but keeps asking if his father, who is not present, can leave the room. Mucous membranes are moist and the skin is warm. Cardiac examination shows tachycardia and regular rhythm. The lungs are clear to auscultation. His abdomen has three port sites with clean and dry bandages. His hands tremble when his arms are extended with fingers spread apart. Which of the following is the most appropriate next step in management?
- A. Administer intravenous lorazepam (Correct Answer)
- B. Administer 5% dextrose in 1/2 normal saline
- C. Administer intravenous naloxone
- D. Administer intravenous propranolol
- E. Administer intravenous dexamethasone
Substance-induced mood disorders Explanation: ***Administer intravenous lorazepam***
- The patient's symptoms (agitation, restlessness, tremors, sweating, tachycardia, hypertension, and anxiety) occurring post-surgery in a patient with a history of heavy alcohol use are highly suggestive of alcohol withdrawal syndrome.
- Benzodiazepines like lorazepam are the first-line treatment for alcohol withdrawal due to their sedative, anxiolytic, and anticonvulsant properties, which can prevent progression to more severe complications like seizures or delirium tremens.
*Administer 5% dextrose in 1/2 normal saline*
- This solution is primarily used to address dehydration and provide some caloric support, but it does not directly manage the neuroexcitatory symptoms of alcohol withdrawal.
- While supportive care including fluids is important, addressing the underlying alcohol withdrawal is the immediate priority.
*Administer intravenous naloxone*
- Naloxone is an opioid antagonist used to reverse opioid overdose.
- The patient's symptoms are inconsistent with opioid overdose; in fact, he is experiencing agitation and autonomic hyperactivity, which are the opposite of opioid effects.
*Administer intravenous propranolol*
- Propranolol is a beta-blocker that can help control some autonomic symptoms like tachycardia and hypertension, but it does not address the underlying neuroexcitability or prevent seizures associated with alcohol withdrawal.
- It should not be used as monotherapy for alcohol withdrawal and should be given cautiously, often after benzodiazepines, especially in patients with respiratory concerns.
*Administer intravenous dexamethasone*
- Dexamethasone is a potent corticosteroid used for anti-inflammatory or immunosuppressive effects and in conditions like cerebral edema or adrenal insufficiency.
- It has no role in the management of alcohol withdrawal syndrome.
Substance-induced mood disorders US Medical PG Question 3: A mental health volunteer is interviewing locals as part of a community outreach program. A 46-year-old man discloses that he has felt sad for as long as he can remember. He feels as though his life is cursed and if something terrible can happen to him, it usually will. He has difficulty making decisions and feels hopeless. He also feels that he has had worsening suicidal ideations, guilt from past problems, decreased energy, and poor concentration over the past 2 weeks. He is otherwise getting enough sleep and able to hold a job. Which of the following statement best describes this patient's condition?
- A. The patient may have symptoms of mania or psychosis.
- B. The patient is likely to show anhedonia.
- C. The patient likely has paranoid personality disorder.
- D. The patient has double depression. (Correct Answer)
- E. The patient should be started on an SSRI.
Substance-induced mood disorders Explanation: ***The patient has double depression.***
- The patient describes **chronic low-grade depressive symptoms** ("felt sad for as long as he can remember," "life is cursed," "difficulty making decisions," "hopeless") consistent with **persistent depressive disorder (dysthymia)**, which requires at least 2 years of symptoms.
- The recent worsening of symptoms over the past two weeks, including "worsening suicidal ideations, guilt from past problems, decreased energy, and poor concentration," indicates an additional **major depressive episode (MDE) superimposed on dysthymia**, a condition known as **double depression**.
- This patient currently meets criteria for both conditions simultaneously, not just at risk for developing them.
*The patient may have symptoms of mania or psychosis.*
- There are no symptoms mentioned that suggest **mania**, such as elevated mood, increased energy, decreased need for sleep, grandiosity, or racing thoughts.
- While suicidal ideation is present, there is no evidence of **psychotic features** like hallucinations or delusions.
*The patient is likely to show anhedonia.*
- **Anhedonia** (inability to feel pleasure) is a common symptom of depression and may well be present in this patient.
- However, the patient's presentation specifically highlights the pattern of **chronic dysthymia with a superimposed major depressive episode**, making **double depression** a more precise, comprehensive, and diagnostically specific description of his current condition.
- While anhedonia might be present, it is a symptom rather than a diagnostic formulation.
*The patient likely has paranoid personality disorder.*
- **Paranoid personality disorder** is characterized by pervasive distrust and suspicion of others, interpreting their motives as malevolent, without sufficient basis.
- The patient's feelings of being "cursed" and that "something terrible can happen" reflect **depressive pessimism and negative cognitive distortions**, not paranoid ideation about others' intentions.
- This is consistent with the hopelessness seen in depression.
*The patient should be started on an SSRI.*
- While an **SSRI (selective serotonin reuptake inhibitor)** combined with psychotherapy would likely be appropriate treatment for double depression, making a specific treatment recommendation is premature without comprehensive clinical assessment.
- The question asks for the **best statement describing the patient's condition** (diagnosis), not for treatment recommendations.
Substance-induced mood disorders US Medical PG Question 4: A 27-year-old homeless man presents to the emergency department with abdominal pain and vomiting. He has a known history of intravenous drug use and has been admitted to the hospital several times before. On physical examination his temperature is 99°F (37.2°C), blood pressure is 130/85 mmHg, pulse is 90/min, respirations are 19/min, and pulse oximetry is 99% on room air. The patient is in obvious discomfort. There is increased salivation and lacrimation. Pupils are reactive to light and 5 mm bilaterally. Cardiopulmonary exam is unremarkable. There is diffuse abdominal tenderness to palpation with no rebound or guarding. Which of the following interventions would have prevented this patient’s current condition?
- A. Naltrexone
- B. Buprenorphine (Correct Answer)
- C. Lorazepam
- D. Naloxone
- E. Bupropion
Substance-induced mood disorders Explanation: ***Buprenorphine***
- This patient is presenting with symptoms consistent with **opioid withdrawal** (abdominal pain, vomiting, increased salivation, lacrimation). **Buprenorphine** is used for **opioid dependence treatment** as it's a **partial opioid agonist** that helps manage withdrawal symptoms and cravings, thus preventing acute withdrawal episodes.
- By stabilizing opioid receptors, buprenorphine, often combined with naloxone (Suboxone), reduces the risk of relapse and prevents the cycle of **intravenous drug use** that leads to withdrawal.
*Naltrexone*
- **Naltrexone** is an **opioid antagonist** used to prevent relapse in individuals who have achieved abstinence from opioids. It blocks the effects of opioids.
- However, administering naltrexone to someone actively using opioids or in withdrawal would precipitate or worsen withdrawal symptoms, making it unsuitable for preventing this acute presentation.
*Lorazepam*
- **Lorazepam** is a **benzodiazepine** primarily used to treat **anxiety**, **insomnia**, and **seizures**, and it is often used in **alcohol withdrawal**.
- While it can help manage some anxiety associated with opioid withdrawal, it does not address the underlying opioid dependence or prevent the physical symptoms of withdrawal itself, nor does it prevent the underlying cause of withdrawal which is abstinence from opioids.
*Naloxone*
- **Naloxone** is a potent, short-acting **opioid antagonist** used to **reverse opioid overdose** by rapidly displacing opioids from receptors.
- It would not prevent withdrawal; in fact, administering naloxone to an opioid-dependent individual would acutely precipitate severe withdrawal.
*Bupropion*
- **Bupropion** is an **antidepressant** that also aids in **smoking cessation**. It works by inhibiting the reuptake of norepinephrine and dopamine.
- It has no role in the prevention or treatment of opioid withdrawal and would not have altered this patient's current condition.
Substance-induced mood disorders US Medical PG Question 5: A 30-year-old man is brought to the emergency department by the police after starting a fight at a local bar. He has several minor bruises and he appears agitated. He talks incessantly about his future plans. He reports that he has no history of disease and that he is "super healthy" and "never felt better". His temperature is 38.0°C (100.4°F), pulse is 110/min, respirations are 16/min, and blood pressure is 155/80 mm Hg. On physical examination reveals a euphoric and diaphoretic man with slightly dilated pupils. An electrocardiogram is obtained and shows tachycardia with normal sinus rhythm. A urine toxicology screen is positive for cocaine. The patient is held in the ED for observation. Which of the following symptoms can the patient expect to experience as he begins to withdraw from cocaine?
- A. Psychosis
- B. Seizures
- C. Lacrimation
- D. Increased appetite (Correct Answer)
- E. Increased sympathetic stimulation
Substance-induced mood disorders Explanation: ***Increased appetite***
- **Cocaine withdrawal** is characterized by a "crash" phase, which includes severe fatigue, **dysphoria**, and increased appetite, often leading to binge eating as the body attempts to replenish depleted neurotransmitters.
- This symptom, combined with **hypersomnia** and a reduction in pleasure, represents a rebound effect from the intense stimulation caused by cocaine use.
*Psychosis*
- While acute cocaine intoxication can induce **psychotic symptoms** like paranoia and hallucinations, psychosis is not a typical feature of the *withdrawal* phase.
- Instead, the withdrawal period is often marked by a decrease in stimulation, leading to symptoms like depression and anhedonia rather than further agitation or psychosis.
*Seizures*
- **Seizures** are a potential complication of acute cocaine intoxication due to its stimulant effects on the central nervous system, but they are generally not a primary symptom of uncomplicated **cocaine withdrawal**.
- Withdrawal is more commonly associated with a state of brain hyperexcitability that manifests as cravings and dysphoria, not typically grand mal seizures.
*Lacrimation*
- **Lacrimation** (tearing) is a common symptom of **opioid withdrawal**, often accompanied by rhinorrhea, muscle aches, and piloerection.
- These **cholinergic rebound** symptoms are not characteristic of cocaine withdrawal, which primarily involves dopaminergic and noradrenergic system dysregulation.
*Increased sympathetic stimulation*
- Acute cocaine use directly causes increased sympathetic stimulation, resulting in **tachycardia**, **hypertension**, and dilated pupils, as seen in this patient.
- **Cocaine withdrawal**, conversely, leads to a *decrease* in sympathetic tone, often accompanied by fatigue, bradycardia, and a general depressive state, as the body rebounds from overstimulation.
Substance-induced mood disorders US Medical PG Question 6: A 24-year-old woman comes to the physician because she feels sad and has had frequent, brief episodes of crying for the last month. During this period, she sleeps in every morning and spends most of her time in bed playing video games or reading. She has not been spending time with friends but still attends a weekly book club and continues to plan her annual family reunion. She stopped going to the gym, eats more, and has gained 4 kg (8.8 lb) over the past 4 weeks. Three weeks ago, she also started to smoke marijuana a few times a week. She drinks one glass of wine daily and does not smoke cigarettes. She is currently unemployed; she lost her job as a physical therapist 3 months ago. Her vital signs are within normal limits. On mental status examination, she is calm, alert, and oriented to person, place, and time. Her mood is depressed; her speech is organized, logical, and coherent. She denies suicidal thoughts. Which of the following is the most likely diagnosis?
- A. Bipolar disorder
- B. Substance use disorder
- C. Major depressive disorder
- D. Adjustment disorder (Correct Answer)
- E. Persistent Depressive Disorder (Dysthymia)
Substance-induced mood disorders Explanation: ***Adjustment disorder***
- This diagnosis is characterized by the development of emotional or behavioral symptoms in response to an identifiable stressor (such as losing a job) occurring within **3 months** of the onset of the stressor.
- The patient exhibits depressive symptoms (sadness, crying, increased sleep, anhedonia, weight gain) that do not meet the full criteria for a major depressive episode and do not significantly impair social/occupational functioning, as evidenced by her continued participation in a book club and planning her family reunion.
*Bipolar disorder*
- This disorder typically involves episodes of **mania or hypomania** along with depressive episodes, neither of which are described in the patient's presentation.
- Her symptoms are consistently depressive in nature and linked to a specific stressor, without periods of elevated mood, increased energy, or decreased need for sleep.
*Substance use disorder*
- While the patient has recently started smoking marijuana and drinks alcohol, these behaviors developed *after* the onset of her depressive symptoms and a known stressor.
- Her marijuana use is still relatively recent ("a few times a week") and not yet described as causing significant impairment or dependence that would typically define a substance use disorder as the primary diagnosis.
*Major depressive disorder*
- This diagnosis requires a severe and pervasive depressive episode that lasts for at least **2 weeks** and significantly impairs functioning in multiple areas of life.
- Although she has several depressive symptoms, her continued ability to engage in some social activities (book club) and plan events (family reunion) suggests that the impairment is not as severe or pervasive as typically seen in MDD. Additionally, her symptoms are clearly linked to a recent life stressor, which points away from MDD as the primary diagnosis.
*Persistent Depressive Disorder (Dysthymia)*
- This disorder is characterized by a chronically depressed mood that lasts for at least **2 years** (or 1 year in children/adolescents), with symptoms that are generally milder than major depression but more persistent.
- The patient's symptoms have only been present for one month, which is far too short a duration to meet the diagnostic criteria for persistent depressive disorder.
Substance-induced mood disorders US Medical PG Question 7: A 67-year-old man comes to the physician for a routine examination. He does not take any medications. He drinks 6 to 7 bottles of beer every night, and says he often has a shot of whiskey in the morning “for my headache.” He was recently fired from his job for arriving late. He says there is nothing wrong with his drinking but expresses frustration at his best friend no longer returning his calls. Which of the following is the most appropriate initial response by the physician?
- A. I'm sorry that your friend no longer returns your calls. What do you think your friend is worried about? (Correct Answer)
- B. I'm sorry to hear you lost your job. I am concerned about the amount of alcohol you are drinking.
- C. I'm sorry to hear you lost your job. Drinking the amount of alcohol that you do can have very negative effects on your health.
- D. I'm sorry that your friend no longer returns your calls. It seems like your drinking is affecting your close relationships.
- E. I'm sorry that your friend no longer returns your calls. Do you feel that your drinking has affected your relationship with your friend?
Substance-induced mood disorders Explanation: ***"I'm sorry that your friend no longer returns your calls. What do you think your friend is worried about?"***
- This response acknowledges the patient's expressed **frustration** about his friend, which is a point of **distress** he has brought up.
- By asking what the friend is worried about, the physician invites the patient to reflect on the potential impact of his drinking from an external perspective, fostering **insight** without being confrontational.
*"I'm sorry to hear you lost your job. I am concerned about the amount of alcohol you are drinking."*
- While addressing the job loss is empathetic, immediately stating concern about his drinking can be confrontational and may lead the patient to become **defensive**, especially since he denies a problem.
- This approach might **shut down** further discussion rather than encourage it, as the patient has already stated "there is nothing wrong with his drinking."
*"I'm sorry to hear you lost your job. Drinking the amount of alcohol that you do can have very negative effects on your health."*
- This response is **judgmental** and directly highlights the negative consequences of his drinking, which the patient has already dismissed.
- Presenting medical facts about health effects at this stage, before establishing rapport and insight, is likely to be met with **resistance** and make the patient less receptive to further conversation.
*"I'm sorry that your friend no longer returns your calls. It seems like your drinking is affecting your close relationships."*
- This statement is a direct accusation, implying the physician knows the cause of the friend's actions and directly links it to the patient's drinking.
- Such a direct link is likely to be perceived as **judgmental** and can make the patient feel attacked, leading to defensiveness and a breakdown in communication.
*"I'm sorry that your friend no longer returns your calls. Do you feel that your drinking has affected your relationship with your friend?"*
- While this question is good, asking directly if his drinking has affected the relationship may elicit a **denial**, as the patient has already shown **lack of insight** regarding his drinking problem.
- A more open-ended question about what the friend is "worried about" is less threatening and more likely to encourage the patient to consider the connection himself.
Substance-induced mood disorders US Medical PG Question 8: A 23-year-old woman is brought to the physician by her father because of irritability, mood swings, and difficulty sleeping over the past 10 days. A few days ago, she quit her job and spent all of her savings on supplies for a “genius business plan.” She has been energetic despite sleeping only 1–2 hours each night. She was diagnosed with major depressive disorder 2 years ago. Mental status examination shows pressured speech, a labile affect, and flight of ideas. Throughout the examination, she repeatedly states “I feel great, I don't need to be here.” Urine toxicology screening is negative. Which of the following is the most likely diagnosis?
- A. Schizoaffective disorder
- B. Bipolar disorder type II
- C. Bipolar disorder type I (Correct Answer)
- D. Delusional disorder
- E. Attention-deficit hyperactivity disorder
Substance-induced mood disorders Explanation: ***Bipolar disorder type I***
- The patient's presentation of lasting **elevated mood**, decreased need for sleep, increased energy, pressured speech, flight of ideas, and impulsive behavior (quitting job, spending savings) are hallmark symptoms of a **manic episode**.
- A diagnosis of **Bipolar I Disorder** requires the occurrence of at least one manic episode, which is clearly evident here and distinguishes it from other mood disorders, especially given her prior history of major depressive disorder.
*Schizoaffective disorder*
- This disorder involves a period of illness during which there is an uninterrupted period of major mood episode (depressive or manic) concurrent with symptoms of **schizophrenia**, such as delusions or hallucinations, for at least 2 weeks in the absence of a major mood episode.
- The patient's symptoms are primarily mood-driven and do not include the characteristic psychotic features that persist independently of mood disturbances.
*Bipolar disorder type II*
- Bipolar II Disorder is characterized by at least one major depressive episode and at least one **hypomanic episode**.
- The patient's current symptoms, including significant impairment in social/occupational functioning, are indicative of a **manic episode**, not a hypomanic episode, which by definition does not cause marked impairment or require hospitalization.
*Delusional disorder*
- This disorder is characterized by the presence of **non-bizarre delusions** that last for at least one month, without other prominent psychotic symptoms or significant impairment in functioning.
- While the patient's "genius business plan" might seem delusional, her pervasive mood disturbance, flight of ideas, and significant functional impairment are not consistent with the primary features of delusional disorder.
*Attention-deficit hyperactivity disorder*
- ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, often presenting in childhood.
- While there is some overlap in symptoms like impulsivity and difficulty sleeping, the episodic nature, the extent of **mood disturbance**, grandiosity, and **pressured speech** are more characteristic of a manic episode than ADHD.
Substance-induced mood disorders US Medical PG Question 9: A 26-year-old female college student is brought back into the university clinic for acting uncharacteristically. The patient presented to the same clinic 6 weeks ago with complaints of depressed mood, insomnia, and weightloss. She had been feeling guilty for wasting her parent’s money by doing so poorly at the university. She felt drained for at least 2 weeks before presenting to the clinic for the first time. She was placed on an antidepressant and was improving but now presents with elevated mood. She is more talkative with a flight of ideas and is easily distractible. Which of the following statements is most likely true regarding this patient’s condition?
- A. The patient may have psychotic features.
- B. Her diagnosis of unipolar depression is incorrect. (Correct Answer)
- C. The patient may have a history of mania.
- D. Antidepressants are inappropriate.
- E. Her new symptoms need to last at least 7 days.
Substance-induced mood disorders Explanation: ***Correct: Her diagnosis of unipolar depression is incorrect.***
The patient initially presented with symptoms consistent with a **depressive episode**, but the subsequent emergence of **elevated mood, increased talkativeness, flight of ideas, and distractibility after antidepressant use** strongly suggests a shift to a **manic or hypomanic episode**. This antidepressant-induced mood switch is a hallmark feature revealing **bipolar disorder** that was initially misdiagnosed as unipolar depression. This statement most directly addresses **what is true about this patient's condition** - that the fundamental diagnosis is incorrect. Once we establish the correct diagnosis of bipolar disorder, all treatment and management decisions follow from this.
*Incorrect: The patient may have psychotic features.*
While patients with severe **mania** can develop **psychotic features** (e.g., delusions, hallucinations), the provided symptoms (elevated mood, increased talkativeness, flight of ideas, distractibility) do not describe psychotic symptoms. There is no information suggesting the presence of **delusions or hallucinations**, which are necessary to diagnose psychotic features. The word "may" makes this theoretically possible but not supported by the clinical presentation described.
*Incorrect: The patient may have a history of mania.*
While patients with bipolar disorder often have previous undiagnosed episodes, this statement is speculative about her **past history** rather than addressing what is most directly evident from the **current presentation**. The vignette focuses on the antidepressant-induced mood switch, which immediately reveals that the current diagnosis of unipolar depression is incorrect. Whether or not she had previous manic episodes is less relevant than recognizing the misdiagnosis now.
*Incorrect: Antidepressants are inappropriate.*
This statement is clinically **true in principle** - antidepressants as monotherapy are generally inappropriate for bipolar disorder due to the risk of inducing mania or hypomania. However, this option addresses **treatment implications** rather than directly stating what is true about **the patient's condition itself**. The more fundamental and direct truth is that **her diagnosis is wrong** (bipolar, not unipolar depression). Once the correct diagnosis is established, then the inappropriateness of antidepressant monotherapy follows. Additionally, at the time of initial presentation with pure depressive symptoms, the antidepressant prescription was reasonable based on the information available - the inappropriateness only became clear retrospectively after the mood switch occurred.
*Incorrect: Her new symptoms need to last at least 7 days.*
For a diagnosis of **mania**, symptoms must last at least **one week** (or any duration if hospitalization is required). However, for **hypomania**, symptoms need to last only **4 consecutive days**. The vignette does not specify whether this is mania or hypomania, nor does it clearly state the duration of the current symptoms beyond "now presents." Therefore, we cannot definitively say a 7-day duration is required - it could be hypomania requiring only 4 days. This statement is not necessarily true.
Substance-induced mood disorders US Medical PG Question 10: Ten days after the vaginal delivery of a healthy infant girl, a 27-year-old woman is brought to the physician by her husband because of frequent mood changes. She has been tearful and anxious since she went home from the hospital 2 days after delivery. She says that she feels overwhelmed with her new responsibilities and has difficulties taking care of her newborn because she feels constantly tired. She only sleeps for 2 to 3 hours nightly because the baby “is keeping her awake.” Sometimes, the patient checks on her daughter because she thinks she heard her cry but finds her sleeping quietly. Her husband says that she is afraid that something could happen to the baby. She often gets angry at him and has yelled at him when he picks up the baby without using a hand sanitizer beforehand. She breastfeeds the baby without any problems. The patient's mother has bipolar disorder with psychotic features. The patient's vital signs are within normal limits. Physical examination shows an involuting uterus consistent in size with her postpartum date. Mental status examination shows a labile affect with no evidence of homicidal or suicidal ideation. Laboratory studies show a hemoglobin concentration of 13 g/dL and a thyroid-stimulating hormone level of 3.1 μU/mL. Which of the following is the most appropriate next step in management?
- A. Risperidone therapy
- B. Bupropion therapy
- C. Cognitive behavioral therapy
- D. Reassurance (Correct Answer)
- E. Sertraline therapy
Substance-induced mood disorders Explanation: ***Reassurance***
- The patient exhibits symptoms of **"baby blues"**, including tearfulness, anxiety, mood swings, and feeling overwhelmed, which are common within the first two weeks postpartum and typically resolve spontaneously.
- Given the transient nature of **baby blues** and the absence of more severe symptoms like psychosis or significant functional impairment, **reassurance** and supportive care are the most appropriate initial steps.
*Risperidone therapy*
- **Risperidone** is an **antipsychotic** medication used for conditions like psychosis or severe mood disorders, which are not present in this patient's mild, transient symptoms of baby blues.
- Initiating antipsychotic therapy for **self-limiting baby blues** is unnecessary and could lead to unwanted side effects.
*Bupropion therapy*
- **Bupropion** is an **antidepressant** primarily used for major depressive disorder and seasonal affective disorder, and is not indicated for the mild, transient symptoms of **baby blues**.
- Its mechanism of action involves dopamine and norepinephrine reuptake inhibition, differing from typical SSRIs often considered for postpartum depression.
*Cognitive behavioral therapy*
- While **CBT** is an effective treatment for **postpartum depression** and anxiety disorders, the patient's symptoms are consistent with **baby blues**, which are self-limiting and resolve with supportive care in most cases.
- CBT would be more appropriate if the symptoms were severe, persistent beyond two weeks, or indicative of a more significant mood disorder.
*Sertraline therapy*
- **Sertraline** is an **SSRI antidepressant** commonly used for **postpartum depression** and anxiety, but it is not indicated for the transient and mild symptoms of **baby blues**.
- Antidepressants are typically reserved for more severe and persistent symptoms characteristic of postpartum depression, which usually lasts longer than two weeks.
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