Mood and Anxiety Disorders — MCQs
What is considered the most effective treatment for Borderline Personality Disorder?
A young girl presents with a history of multiple episodes of loss of consciousness lasting for 20 minutes. These episodes occur only in front of family members and only during the daytime. There is no history of tongue biting or incontinence, and EEG and MRI studies are normal. What is the most appropriate management?
Cyclothymia is classified as which type of mood disorder?
A 15-year-old boy feels that dirt has stuck onto him whenever he passes through a dirty street. He knows that there is actually no dirt after he has cleaned once, but he is not satisfied and feels compelled to continue thinking about it. The most likely diagnosis is:
Best therapy suited to teach daily life skill to a mentally challenged child:
Which of the following antidepressant drugs is used in the treatment of nocturnal enuresis?
At what age does stranger anxiety typically develop in infants?
Best treatment for nocturnal enuresis is
A 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise. Which sleep disturbance is most consistent with this history?
A child guidance clinic is most helpful in all of the following conditions except:
Mood and Anxiety Disorders Indian Medical PG Practice Questions and MCQs
Question 1: What is considered the most effective treatment for Borderline Personality Disorder?
- A. Combination of DBT and pharmacotherapy
- B. Cognitive Behavioural Therapy (CBT)
- C. Pharmacotherapy alone
- D. Dialectical Behaviour Therapy (DBT) (Correct Answer)
Explanation: ***Dialectical Behaviour Therapy (DBT)*** - **DBT** is the **gold standard** and most evidence-based psychotherapy specifically developed for Borderline Personality Disorder - Developed by **Marsha Linehan** specifically to target the core symptoms of BPD including emotional dysregulation, impulsivity, and interpersonal difficulties - Combines **cognitive-behavioral techniques** with mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness skills - Has the **strongest research evidence** for reducing suicidal behavior, self-harm, and improving overall functioning in BPD patients - Multiple RCTs demonstrate DBT's superiority in treating BPD compared to standard care *Cognitive Behavioural Therapy (CBT)* - While **CBT** is effective for many mental health conditions and can help with certain BPD symptoms, it was not specifically designed for BPD - DBT is actually a specialized adaptation of CBT tailored for BPD, making it more targeted and effective for this specific condition - Generic CBT may help with co-occurring conditions like depression or anxiety but lacks the comprehensive approach needed for core BPD features *Combination of DBT and pharmacotherapy* - This combination is clinically useful, especially when treating **co-morbid conditions** like depression, anxiety, or severe mood instability - However, psychotherapy (particularly DBT) remains the **cornerstone** of BPD treatment, with medications serving an adjunctive role - The question asks for the single most effective treatment, which is DBT alone *Pharmacotherapy alone* - **No medication** is FDA-approved specifically for BPD - Pharmacotherapy may help manage specific symptoms (mood swings, impulsivity, brief psychotic episodes) but does not address the core **personality pathology** - Generally not recommended as monotherapy for BPD; should always be combined with psychotherapy
Question 2: A young girl presents with a history of multiple episodes of loss of consciousness lasting for 20 minutes. These episodes occur only in front of family members and only during the daytime. There is no history of tongue biting or incontinence, and EEG and MRI studies are normal. What is the most appropriate management?
- A. Treat with aversive therapy
- B. Insight-oriented psychotherapy (Correct Answer)
- C. Valproate
- D. Ketogenic diet
Explanation: ***Insight-oriented psychotherapy*** - The presentation strongly suggests **non-epileptic seizures (NES)**, also known as **psychogenic non-epileptic seizures (PNES)**, which are usually of psychological origin. - **Insight-oriented psychotherapy** is the most appropriate management, aiming to address underlying psychological conflicts or stress that manifest as these episodes. *Treat with aversive therapy* - **Aversive therapy** is typically used for behavioral modification in conditions like substance abuse or paraphilias, where a negative stimulus is paired with an undesirable behavior. - It is not indicated for **psychogenic non-epileptic seizures**, where the underlying cause is psychological distress rather than a learned undesirable behavior. *Valproate* - **Valproate** is an **antiepileptic drug** used to treat various types of seizures, including generalized tonic-clonic and absence seizures. - Since EEG and MRI are normal, and the clinical features (no tongue biting/incontinence, specific timing/audience) rule out epilepsy, antiepileptic medication like Valproate is **inappropriate**. *Ketogenic diet* - The **ketogenic diet** is a high-fat, low-carbohydrate diet used as a medical treatment for **drug-resistant epilepsy**, particularly in children. - Given that the episodes are **non-epileptic** and investigations are normal, a ketogenic diet would be ineffective and unnecessary.
Question 3: Cyclothymia is classified as which type of mood disorder?
- A. Major depression
- B. Dysthymia
- C. Persistent mood disorder
- D. Bipolar mood disorder (Correct Answer)
Explanation: ***Bipolar mood disorder*** - **Cyclothymia (Cyclothymic Disorder)** is classified under **Bipolar and Related Disorders** in both DSM-5 and ICD-11, making it part of the bipolar spectrum. - It is characterized by **chronic, fluctuating mood disturbances** lasting at least 2 years (1 year in children/adolescents) with numerous periods of hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes. - The alternating, less severe mood swings share the fundamental **bipolar pattern** of mood elevation and depression, hence its classification under bipolar mood disorders. *Major depression* - **Major depressive disorder** is a unipolar mood disorder involving persistent feelings of sadness, loss of interest, and other depressive symptoms that significantly impair daily functioning, **without any episodes of mania or hypomania**. - Cyclothymia involves **mood instability with both elevated and depressed periods**, which distinguishes it from unipolar major depression. *Dysthymia* - **Dysthymia** (now termed **Persistent Depressive Disorder** in DSM-5) is characterized by chronic, low-grade depressive symptoms lasting at least 2 years, **without manic or hypomanic episodes**. - While both involve sub-threshold symptoms, cyclothymia includes periods of **hypomanic symptoms** (elevated mood, increased energy), which are absent in dysthymia. *Persistent mood disorder* - This is a broad, non-specific descriptive term rather than a formal diagnostic category in DSM-5 or ICD-11. - While cyclothymia is indeed a persistent condition, it is **specifically categorized under Bipolar and Related Disorders** due to the presence of both elevated (hypomanic) and depressed mood states.
Question 4: A 15-year-old boy feels that dirt has stuck onto him whenever he passes through a dirty street. He knows that there is actually no dirt after he has cleaned once, but he is not satisfied and feels compelled to continue thinking about it. The most likely diagnosis is:
- A. OCD (Correct Answer)
- B. Conduct disorder
- C. Adjustment disorder
- D. Agoraphobia
Explanation: ***OCD (Obsessive-Compulsive Disorder)*** - The patient experiences **recurrent, persistent thoughts** (obsessions) about contamination with dirt, which he **recognizes as irrational** after cleaning. - Despite knowing logically that he is clean, he feels **compelled to continue thinking about contamination** and remains unsatisfied, demonstrating the **inability to suppress obsessive thoughts**. - This represents classic **contamination obsessions** with preserved insight, a hallmark of OCD. - The pattern of cleaning followed by continued distress suggests the obsessive-compulsive cycle. *Conduct disorder* - Characterized by repetitive and persistent pattern of behavior violating **basic rights of others** or major societal norms. - Symptoms include **aggression, destruction of property, deceitfulness, theft**, and serious rule violations. - None of these antisocial behaviors are described in this case. *Adjustment disorder* - Involves emotional or behavioral symptoms developing **in response to an identifiable stressor** within 3 months. - The patient's symptoms are not linked to a specific recent stressor. - The pattern of **obsessive thoughts with insight** is characteristic of OCD, not adjustment disorder. *Agoraphobia* - Marked fear or anxiety about situations such as **public transportation, open spaces, enclosed places, crowds**, or being outside home alone. - The patient's concern is specifically about **contamination and dirt**, not fear of being in specific situations. - No anxiety about being trapped or unable to escape is described.
Question 5: Best therapy suited to teach daily life skill to a mentally challenged child:
- A. Contingency management (Correct Answer)
- B. Cognitive reconstruction
- C. Self instruction
- D. CBT (Cognitive behavior therapy)
Explanation: ***Contingency management*** - This therapy involves consistently **rewarding desired behaviors** and withholding rewards for undesirable ones, which is highly effective for teaching new skills to individuals with intellectual disabilities. - It uses principles of **operant conditioning** to shape behavior through positive reinforcement, making it suitable for acquiring daily living skills. *Cognitive reconstruction* - This technique focuses on identifying and changing **maladaptive thought patterns**, which typically requires a higher level of cognitive function. - It is generally not the primary or most effective approach for teaching concrete daily life skills to individuals with significant **cognitive limitations**. *Self instruction* - This involves teaching individuals to guide their own behavior using **internal verbal cues** or self-talk. - While beneficial for some, it often requires a certain degree of **abstract thinking** and memory, making it less suitable as a standalone method for those with profound cognitive challenges in acquiring basic skills. *CBT (Cognitive behavior therapy)* - CBT integrates cognitive and behavioral strategies to address emotional and behavioral problems by modifying **thoughts, feelings, and behaviors**. - While beneficial for a range of psychological issues, its emphasis on **cognitive restructuring** makes it less directly applicable or the most effective first-line therapy for teaching concrete, functional daily living skills to mentally challenged children.
Question 6: Which of the following antidepressant drugs is used in the treatment of nocturnal enuresis?
- A. Imipramine (Correct Answer)
- B. Fluoxetine
- C. Trazodone
- D. Sertraline
Explanation: ***Imipramine*** - **Imipramine**, a **tricyclic antidepressant (TCA)**, is effective in treating nocturnal enuresis, particularly in children. - Its mechanism of action in this context is thought to involve anticholinergic effects, leading to **increased bladder capacity**, and alpha-adrenergic effects, causing **contraction of the internal urethral sphincter**. *Fluoxetine* - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** primarily used to treat depression, anxiety disorders, and obsessive-compulsive disorder. - It does not have a primary indication or established efficacy for the treatment of nocturnal enuresis. *Trazodone* - **Trazodone** is an **antidepressant** with sedative properties, often used for insomnia and depression. - While it modulates serotonin, it is not a first-line or established treatment for nocturnal enuresis. *Sertraline* - **Sertraline** is another **selective serotonin reuptake inhibitor (SSRI)** commonly prescribed for depression, anxiety, and panic disorder. - Like other SSRIs, it is not indicated for and has no significant role in the management of nocturnal enuresis.
Question 7: At what age does stranger anxiety typically develop in infants?
- A. 3 months
- B. 4 months
- C. 7 months (Correct Answer)
- D. 11 months
Explanation: ***7 months*** - **Stranger anxiety** typically emerges around **6-8 months** of age, peaking around 9-12 months. - This developmental stage reflects the infant's growing ability to distinguish between familiar and unfamiliar faces and their developing **attachment to primary caregivers**. *3 months* - At 3 months, infants are typically in an earlier stage of social development, primarily focusing on **recognizing primary caregivers** and showing social smiles. - They generally do not exhibit stranger anxiety, as their cognitive and emotional development has not yet reached that milestone. *4 months* - While 4-month-olds are becoming more socially aware and responsive, their **object permanence** and ability to differentiate strangers from familiar faces is still developing. - Therefore, definitive stranger anxiety is typically not observed at this age. *11 months* - By 11 months, stranger anxiety has already developed and is usually **at its peak**, as infants at this age have a well-established sense of who their primary caregivers are. - While stranger anxiety is very prominent at this age, it is not when it typically **develops** (initial emergence), but rather when it is most pronounced.
Question 8: Best treatment for nocturnal enuresis is
- A. Positive reinforcement
- B. Punishment
- C. Bed alarm (Correct Answer)
- D. Desmopressin
Explanation: ***Bed alarm*** - **Bed alarms** are considered the most effective long-term treatment for nocturnal enuresis by conditioning the child to wake up to a full bladder. - This method has a high success rate and a lower relapse rate compared to pharmacological treatments. *Positive reinforcement* - While helpful for building confidence and encouraging adherence to treatment, **positive reinforcement** alone is generally not sufficient to cure nocturnal enuresis. - It works best as an adjunct to other established treatments, like bed alarms, to motivate the child. *Punishment* - **Punishment** is not an effective or appropriate treatment for nocturnal enuresis and can be psychologically harmful to the child. - Enuresis is an involuntary condition, and punishment can lead to increased stress, anxiety, and shame, potentially worsening the problem. *Desmopressin* - **Desmopressin** (DDAVP) is a synthetic analog of antidiuretic hormone and can reduce urine production at night, offering a short-term solution. - It is effective in reducing the frequency of wet nights but has a higher relapse rate once discontinued, and it does not cure the underlying problem like a bed alarm does.
Question 9: A 5-year-old child refuses to sleep in his bed, claiming there are monsters in his closet and that he has bad dreams. The parents allow him to sleep with them in their bed to avoid the otherwise inevitable screaming fit. The parents note that the child sleeps soundly, waking only at sunrise. Which sleep disturbance is most consistent with this history?
- A. Night terrors
- B. Nightmares
- C. Learned behavior (Correct Answer)
- D. Obstructive sleep apnea
Explanation: **Explanation:** The correct answer is **Learned behavior** (specifically, a conditioned sleep-onset association). **1. Why Learned Behavior is Correct:** The child’s refusal to sleep in his own bed and the subsequent "screaming fits" are forms of **limit-setting sleep disorder**. By allowing the child to sleep in their bed to avoid a tantrum, the parents are providing **positive reinforcement** for the behavior. The child has "learned" that protesting leads to the desired outcome (sleeping with parents). A key diagnostic clue here is that the child **sleeps soundly** once the condition (sleeping with parents) is met, which distinguishes this from primary sleep disorders. **2. Why Other Options are Incorrect:** * **Night Terrors (Sleep Terrors):** These occur during NREM (Stage N3) sleep. The child typically appears terrified, screams, and is inconsolable, but remains asleep and has **no memory** of the event. This child is awake and making "claims" about monsters to stay with parents. * **Nightmares:** While the child mentions "bad dreams," nightmares occur during REM sleep and typically cause the child to wake up *during* the night in a state of fear. This child’s primary issue is the **struggle at bedtime** (sleep onset), and he sleeps soundly once in the parents' bed. * **Obstructive Sleep Apnea (OSA):** OSA presents with snoring, gasping, restless sleep, and daytime hyperactivity. It does not manifest as behavioral resistance to sleeping alone. **Clinical Pearls for NEET-PG:** * **Night Terrors vs. Nightmares:** Night terrors occur in the first third of the night (NREM), with no recall. Nightmares occur in the later part of the night (REM), with vivid recall. * **Management of Learned Behavior:** The treatment of choice is **behavioral modification** (e.g., "graduated extinction" or "controlled crying") and establishing a consistent bedtime routine. * **Developmental Milestone:** Fears of "monsters" or the dark are developmentally normal for a 5-year-old, but the *persistence* and the parental *reaction* turn it into a behavioral sleep disturbance.
Question 10: A child guidance clinic is most helpful in all of the following conditions except:
- A. Bed wetting
- B. Cerebral palsy
- C. Squint (Correct Answer)
- D. School adjustment problems
Explanation: ### Explanation **Correct Option: C (Squint)** **Why Squint is the Correct Answer:** A **Child Guidance Clinic (CGC)** is a specialized multi-disciplinary facility designed to manage emotional, behavioral, and psychological disorders in children. **Squint (Strabismus)** is a purely physical/anatomical ophthalmological condition involving the misalignment of the eyes. It requires surgical or optical correction by an ophthalmologist, not psychological intervention. Therefore, it falls outside the scope of a CGC. **Analysis of Incorrect Options:** * **Bed wetting (Enuresis):** This is a common behavioral/developmental disorder. While it can have organic causes, it is frequently associated with emotional stress or developmental delays, making it a classic case for CGC management (behavioral therapy, counseling). * **Cerebral Palsy (CP):** Although CP is a motor disorder, children with CP often suffer from associated cognitive impairments, learning disabilities, and emotional/behavioral challenges. A CGC provides the necessary psychological support and rehabilitation guidance for these comorbid conditions. * **School adjustment problems:** These include school phobia, learning disabilities (Dyslexia), and ADHD. These are core areas of focus for a CGC, involving psychologists and social workers to improve the child’s social and academic functioning. **High-Yield Clinical Pearls for NEET-PG:** * **CGC Team:** Typically consists of a **Child Psychiatrist** (Leader), Clinical Psychologist, Educational Psychologist, and Psychiatric Social Worker. * **Primary Goal:** Early detection and treatment of maladjustment and personality disorders to prevent adult mental illness. * **Common Indications:** Habit disorders (thumb sucking, nail-biting), conduct disorders (lying, stealing), and emotional disorders (anxiety, temper tantrums).
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