Mood Disorders Practice Questions

Q: A 29-year-old female has persistently low mood, doesn’t feel like doing anything, sleeps 15 hours a day, limbs feel heavy, eats a lot for 2 months. She feels happy when she hears her mother is coming to visit her in 2 weeks. Likely diagnosis?

MDD -Atypical features. ***MDD -Atypical features*** - This patient presents with the hallmark symptoms of **atypical depression**, which include **hypersomnia**, **hyperphagia** (increased appetite/weight gain), and **leaden paralysis** (heavy feeling in arms and legs). - A defining feature is **mood reactivity**, where the patient's mood brightens in response to positive external events (like her mother's visit), distinguishing it from melancholic depression. *Mania* - Characterized by a distinct period of **elevated or irritable mood** and **increased energy**, directly opposing the lethargy and low mood seen here. - Patients with mania typically show a **decreased need for sleep**, whereas this patient is sleeping excessively (15 hours). *Adjustment disorder* - This diagnosis requires symptoms to occur in response to an **identifiable stressor** within 3 months of the event; the vignette describes a persistent 2-month period without a specific trigger. - It is a milder condition and usually does not manifest with the specific complex of vegetative symptoms (hypersomnia/hyperphagia) seen in this case. *Anxiety disorder* - While often comorbid with depression, generalized anxiety focuses on **excessive worry** rather than the pervasive low mood and anhedonia (lack of interest) described. - The specific somatic symptoms of leaden paralysis and hyperphagia are more characteristic of depressive disorders with atypical features than primary anxiety states.

Q: An 18-year-old student complains of a lack of interest in studies for the last 6 months. He has frequent quarrels with his parents and experiences frequent headaches. What is the most appropriate clinical approach?

Rule out depression.. **Explanation:** The correct answer is **Rule out depression (Option B)**. In adolescents, depression often presents atypically compared to adults. While adults typically manifest "low mood" or sadness, adolescents frequently present with **irritable mood**, behavioral issues (quarrels with parents), and **somatic complaints** (frequent headaches). The patient’s "lack of interest in studies" for 6 months signifies **anhedonia** or a decline in socio-occupational functioning, which are core diagnostic criteria for Depressive Disorder under DSM-5 and ICD-11. **Why other options are incorrect:** * **Option A:** Attributing a 6-month decline in functioning and persistent somatic symptoms to "normal adolescent behavior" is a common clinical error. Any significant change in baseline behavior warrants a pathological workup. * **Option C:** While he has headaches, the presence of behavioral changes and academic decline suggests the headache is likely a somatic manifestation of an underlying psychiatric condition rather than a primary neurological disorder like migraine. * **Option D:** Oppositional Defiant Disorder (ODD) involves a pattern of angry/irritable mood and vindictiveness, but it does not typically explain the "lack of interest in studies" or the somatic symptoms as effectively as depression does. **Clinical Pearls for NEET-PG:** * **Atypical Presentation:** Irritability and somatic symptoms (headache, stomach ache) are the hallmarks of pediatric and adolescent depression. * **Duration:** For a diagnosis of Major Depressive Disorder, symptoms must persist for at least **2 weeks**. This patient has been symptomatic for 6 months. * **Pseudodementia:** In elderly patients, depression often mimics dementia; in adolescents, it often mimics "laziness" or "rebellion." Always screen for mood symptoms in cases of sudden academic decline.

Q: All of the following are features of mania except?

Decreased motor activity. **Explanation:** The correct answer is **D. Decreased motor activity**. Mania is a clinical syndrome characterized by a distinct period of abnormally elevated, expansive, or irritable mood and increased energy. **Why D is correct:** In mania, there is a characteristic **increase in psychomotor activity**. Patients are often restless, over-energetic, and may engage in excessive goal-directed activities (e.g., social, professional, or sexual). "Decreased motor activity" (psychomotor retardation) is instead a hallmark feature of **Depressive episodes**, not mania. **Why other options are incorrect:** * **A. Decreased need for sleep:** This is a classic diagnostic criterion. Unlike insomnia (where the person wants to sleep but can’t), a manic patient feels refreshed and energetic after only 2–3 hours of sleep or none at all. * **B. Elated mood:** Elation (a feeling of "being on top of the world") is the core emotional feature of mania. It can progress from euphoria to exaltation and ecstasy. * **C. Delusion of grandeur:** This is a common psychotic feature in mania where the patient believes they possess special powers, wealth, or a relationship with a famous person/deity. **High-Yield Clinical Pearls for NEET-PG:** * **DIG FAST Mnemonic** for Mania: **D**istractibility, **I**ndiscretion (excessive pleasure seeking), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressure of speech). * **Duration:** Symptoms must last at least **1 week** for Mania (DSM-5) and **4 days** for Hypomania. * **Drug of Choice:** **Lithium** is the gold standard for prophylaxis and acute mania, though atypical antipsychotics are often used for rapid control of agitation.

Q: A 40-year-old woman is being evaluated and is noted to have a decreased latency of REM sleep. Which disorder is she most likely suffering from?

Major depression. ### Explanation The correct answer is **Major Depressive Disorder (MDD)**. **Understanding REM Latency** REM latency is the interval between falling asleep and the first episode of REM (Rapid Eye Movement) sleep. In a healthy adult, this typically takes about 90 minutes. **Decreased REM latency** (entering REM sleep sooner than normal) is a hallmark polysomnographic finding in Major Depression. **Why Major Depression is Correct:** In patients with MDD, the architecture of sleep is significantly altered. Key findings include: * **Decreased REM Latency:** The most characteristic finding. * **Increased REM Duration:** The first REM period is longer. * **Increased REM Density:** More frequent eye movements during REM. * **Reduced Slow-Wave Sleep (N3):** Deep sleep is diminished. * **Early Morning Awakening:** Terminal insomnia. **Analysis of Incorrect Options:** * **Schizophrenia:** While sleep disturbances (like insomnia) occur, decreased REM latency is not a diagnostic or characteristic feature. * **PTSD:** Patients often experience nightmares and fragmented sleep, but the specific finding of shortened REM latency is not the primary physiological marker. * **Obsessive-Compulsive Disorder (OCD):** Sleep patterns in OCD are generally non-specific and do not consistently show the shortened REM latency seen in mood disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Biological Markers of MDD:** Along with decreased REM latency, look for **increased cortisol levels** (due to HPA axis hyperactivity) and a **positive Dexamethasone Suppression Test** (failure to suppress cortisol). * **Antidepressant Effect:** Most antidepressants (especially SSRIs and TCAs) **increase REM latency** and decrease total REM sleep, which is thought to contribute to their therapeutic effect. * **Cholinergic-Aminergic Balance:** Depression is associated with an overactive cholinergic system, which triggers REM sleep earlier.

Question 1

A 29-year-old female has persistently low mood, doesn’t feel like doing anything, sleeps 15 hours a day, limbs feel heavy, eats a lot for 2 months. She feels happy when she hears her mother is coming to visit her in 2 weeks. Likely diagnosis?

Accepted Answer

MDD -Atypical features

Answer

Mania

Answer

Adjustment disorder

Answer

Anxiety disorder

Question 2

An 18-year-old student complains of a lack of interest in studies for the last 6 months. He has frequent quarrels with his parents and experiences frequent headaches. What is the most appropriate clinical approach?

Accepted Answer

Rule out depression.

Answer

Consider it a normal adolescent problem.

Answer

Rule out migraine.

Answer

Rule out oppositional defiant disorder.

Question 3

All of the following are features of mania except?

Accepted Answer

Decreased motor activity

Answer

Decreased need for sleep

Answer

Elated mood

Answer

Delusion of grandeur

Question 4

A 40-year-old woman is being evaluated and is noted to have a decreased latency of REM sleep. Which disorder is she most likely suffering from?

Accepted Answer

Major depression

Answer

Schizophrenia

Answer

PTSD

Answer

Obsessive-compulsive disorder

Question 5

The period of normalcy is seen between two psychotic episodes. What is the diagnosis?

Accepted Answer

Manic depressive psychosis (Bipolar disorder)

Answer

Schizophrenia

Answer

Alcoholism

Answer

Depression

Mood Disorders — MCQs

Mood Disorders — MCQs

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