Bipolar Disorder: Manic Episodes — MCQs
What is the core feature required for diagnosing a manic episode?
Management of a violent patient in psychiatry includes all except:
Which of the following is least characteristic of mania?
A patient with bipolar disorder shows poor response to lithium. Which feature best explains this?
A 40-year-old man presents with persistently elevated mood, increased energy, and decreased need for sleep for the past week. What is the most likely diagnosis?
Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:
Double depression is seen in:
Which of the following is false about bipolar disorder?
During a manic episode, a patient typically exhibits:
A 45-year-old lady presents with normal PT and increased aPTT. About 2 years ago, she underwent cholecystectomy and did not have any bleeding episode. What is the next investigation for clinical diagnosis?
Bipolar Disorder: Manic Episodes Indian Medical PG Practice Questions and MCQs
Question 1: What is the core feature required for diagnosing a manic episode?
- A. Decreased appetite
- B. Increased sleep
- C. Grandiosity
- D. Elevated mood (Correct Answer)
Explanation: ***Elevated mood*** - The **DSM-5 criteria** for a manic episode explicitly state that an abnormally and persistently **elevated, expansive, or irritable mood** must be present for at least one week. - This core mood disturbance is what differentiates mania from other psychiatric conditions and is a prerequisite for diagnosis. *Grandiosity* - While **grandiosity** (inflated self-esteem or sense of importance) is a common associated symptom of a manic episode, it is not the sole diagnostic requirement. - It is one of several symptom criteria that must be present in addition to the mood disturbance for a diagnosis of mania. *Decreased appetite* - **Decreased appetite** is generally not a feature of a manic episode; in fact, individuals in a manic state often have an **increased appetite** or engage in impulsive eating due to lack of inhibition. - A decreased appetite is more commonly associated with depressive episodes. *Increased sleep* - **Increased sleep** is contrary to the typical presentation of a manic episode, where individuals often experience a **decreased need for sleep** and can function on very little sleep, feeling energized. - A significant reduction in the need for sleep is a characteristic symptom of mania, not an increase.
Question 2: Management of a violent patient in psychiatry includes all except:
- A. CBT (Correct Answer)
- B. Haloperidol
- C. ECT
- D. BZD
Explanation: ***CBT*** - **Cognitive Behavioral Therapy (CBT)** is a long-term psychological intervention aimed at changing maladaptive thought patterns and behaviors. It is **not suitable for immediate management** of an acutely violent patient. - While CBT can be beneficial for aggression management in a stable patient, it requires patient cooperation, cognitive engagement, and time, which are not available during a **violent psychiatric emergency**. *Haloperidol* - **Haloperidol** is a potent typical antipsychotic frequently used in acute settings for rapid tranquilization of violent or severely agitated patients. - It is effective in reducing **psychosis-related agitation** and can be administered **intramuscularly** for quick onset of action. - Often used in combination with benzodiazepines for optimal control of acute violence. *ECT* - **Electroconvulsive Therapy (ECT)** may be considered in **severe, treatment-resistant cases** of violence associated with conditions like uncontrolled mania, catatonic excitement, or psychotic depression when pharmacological interventions have failed. - While not used for immediate acute management due to logistical requirements (consent, anesthesia, specialized setup), it can be an effective option for severe psychiatric conditions with persistent violence. - It works by inducing a brief controlled seizure, which can rapidly alleviate severe symptoms. *BZD* - **Benzodiazepines (BZDs)** like lorazepam or diazepam are **first-line agents** in the acute management of violent or agitated patients due to their rapid anxiolytic, sedative, and muscle relaxant properties. - They are particularly useful for **calming acute agitation** and are often combined with antipsychotics for rapid tranquilization. - Can be administered intramuscularly or intravenously for quick action in psychiatric emergencies.
Question 3: Which of the following is least characteristic of mania?
- A. Disorientation (Correct Answer)
- B. Pressure of speech
- C. Decreased need for sleep
- D. Grandiose delusions
Explanation: ***Disorientation*** - While psychotic features can occur in severe mania, **disorientation** (confusion about time, place, or person) is not a typical or primary symptom. - It suggests a more profound cognitive disturbance or an organic cause (such as delirium), which is less characteristic of an uncomplicated manic episode. - The presence of disorientation should prompt evaluation for medical causes. *Decreased need for sleep* - **Decreased need for sleep** is a hallmark symptom of a manic episode and one of the core diagnostic criteria. - Individuals with mania feel energetic and rested despite sleeping very little (often 2-3 hours or less). - This is distinct from insomnia—patients don't feel tired or have difficulty sleeping; rather, they simply don't need much sleep. *Pressure of speech* - **Pressure of speech**, characterized by rapid, loud, and difficult-to-interrupt speech, is a core diagnostic feature of mania. - It reflects the underlying racing thoughts (flight of ideas) and increased psychomotor activity typical of manic episodes. - Speech may be tangential, circumstantial, or filled with puns, jokes, and theatrical references. *Grandiose delusions* - **Grandiose delusions** (delusions of grandeur), such as believing one has special powers, extraordinary wealth, or a special relationship with famous figures, are common psychotic features in severe mania. - These delusions are mood-congruent and consistent with the elevated mood, inflated self-esteem, and impaired judgment seen in manic episodes.
Question 4: A patient with bipolar disorder shows poor response to lithium. Which feature best explains this?
- A. Early age of onset
- B. Classical mania
- C. Family history of bipolar
- D. Mixed episodes (Correct Answer)
Explanation: ***Mixed episodes*** - The presence of **mixed episodes** (simultaneous manic and depressive symptoms) in bipolar disorder predicts a poorer response to **lithium** monotherapy. - Patients experiencing mixed features often require **antipsychotics** or **mood stabilizers** like valproate or carbamazepine in addition to or instead of lithium. *Early age of onset* - While an early age of onset can indicate a more severe course of bipolar disorder, it doesn't specifically predict **poor response to lithium**. - In fact, lithium can be effective in reducing the frequency of episodes for many patients with early-onset bipolar disorder. *Classical mania* - **Classical mania** (euphoric, agitated, pressured speech) is generally associated with a **good response to lithium**. - Lithium is considered a first-line treatment for classic euphoric mania. *Family history of bipolar* - A **family history of bipolar disorder** suggests a genetic predisposition but does not inherently predict a poor response to lithium. - Genetic factors can influence treatment response, but a positive family history alone is not a contraindication or predictor of lithium failure.
Question 5: A 40-year-old man presents with persistently elevated mood, increased energy, and decreased need for sleep for the past week. What is the most likely diagnosis?
- A. Schizophrenia
- B. Mania (Correct Answer)
- C. Hypomania
- D. Depression
Explanation: ***Mania*** - **Elevated mood**, **increased energy**, and **decreased need for sleep** are classic symptoms of a manic episode. - This presentation, lasting for **at least a week**, meets the **diagnostic criteria for mania** (DSM-5 requires ≥7 days or any duration if hospitalization needed). - The distinct period of persistently elevated, expansive, or irritable mood with increased goal-directed activity distinguishes this from other conditions. *Schizophrenia* - Characterized primarily by **psychotic symptoms** such as hallucinations, delusions, and disorganized thought/speech, which are not described here. - While agitation can occur, the core symptoms of elevated mood and increased energy are not typical of an acute schizophrenic episode. *Hypomania* - Hypomania presents with similar symptoms (elevated mood, increased energy, decreased sleep) but is **less severe** and of **shorter duration** (requires only 4 consecutive days). - Hypomanic episodes do **not cause marked impairment** in social or occupational functioning and do not require hospitalization. - The question states symptoms have lasted "for the past week" which, if causing significant functional impairment, would suggest mania rather than hypomania. *Depression* - Depression is characterized by a **depressed mood**, **loss of interest or pleasure (anhedonia)**, **low energy**, and often **increased need for sleep** or insomnia with early morning awakening. - The patient's symptoms of elevated mood and increased energy are the opposite of what is seen in depression.
Question 6: Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:
- A. Chlorpromazine
- B. Haloperidol
- C. Diazepam
- D. Lithium carbonate (Correct Answer)
Explanation: **Lithium carbonate** - **Lithium** is a well-established and highly effective **mood stabilizer**, considered a first-line treatment for managing both **manic** and **depressive episodes** in bipolar disorder. - It helps prevent recurrent episodes and reduces the severity of mood swings, acting as a prophylactic agent. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** that is primarily used to treat **schizophrenia** and other psychotic disorders. - While it can be used acutely to manage severe manic agitation, it is not a first-line agent for the long-term mood stabilization characteristic of bipolar disorder. *Haloperidol* - **Haloperidol** is another **first-generation antipsychotic** often used for acute treatment of **psychotic symptoms** or severe agitation, including in mania. - It is not a primary long-term mood stabilizer for bipolar disorder due to its side effect profile and lack of efficacy in preventing future mood episodes compared to lithium. *Diazepam* - **Diazepam** is a **benzodiazepine** primarily used for treating **anxiety**, muscle spasms, and acute seizures. - While it can help manage acute agitation and insomnia during a manic episode, it does not have mood-stabilizing properties and is not a long-term treatment for bipolar disorder.
Question 7: Double depression is seen in:
- A. Depression with dysthymia (Correct Answer)
- B. Depression with anxiety attack
- C. Major depression with OCD
- D. Major depressive disorder from 2 years
Explanation: ***Depression with dysthymia*** - **Double depression** is a specific mood disorder characterized by the co-occurrence of a **major depressive episode** on top of a pre-existing **dysthymic disorder** (persistent depressive disorder). - This means an individual experiences the chronic, milder symptoms of dysthymia, which are then worsened by the more severe symptoms of a major depressive episode. *Depression with anxiety attack* - While depression and anxiety attacks can co-occur, this specific combination is not referred to as **double depression**. - **Anxiety attacks** are acute episodes of intense fear and discomfort, often associated with panic disorder, and are distinct from chronic low-grade depressive symptoms. *Major depression with OCD* - **Obsessive-compulsive disorder (OCD)** is a distinct anxiety disorder characterized by obsessions and compulsions, which can co-occur with major depression. - However, the term **double depression** specifically refers to the combination of major depression and dysthymia, not other psychiatric comorbidities. *Major depressive disorder from 2 years* - Experiencing **major depressive disorder for 2 years** implies a chronic course of major depression. - If the symptoms meet the criteria for major depressive disorder continuously for at least two years, it might be termed **chronic major depressive disorder**, but not double depression, unless there was an underlying dysthymia.
Question 8: Which of the following is false about bipolar disorder?
- A. Unipolar mania is more common than bipolar disorder (Correct Answer)
- B. Genetic factors play important role
- C. Rapid cycling is more common in females
- D. Age of onset is earlier than unipolar depression
Explanation: ***Unipolar mania is more common than bipolar disorder*** - This statement is **false** because **unipolar mania is extremely rare**, while **bipolar disorder (which includes both manic and depressive episodes)** is significantly more common. - **Unipolar mania** refers to recurrent manic episodes without any depressive episodes, a presentation that is seldom observed clinically. *Genetic factors play important role* - This statement is **true**, as **bipolar disorder has a strong genetic component**, with **heritability estimated between 60-80%**. - **First-degree relatives** of individuals with bipolar disorder are at a significantly higher risk of developing the condition. *Rapid cycling is more common in females* - This statement is **true**; **rapid cycling (4 or more mood episodes per year)** occurs more frequently in females with bipolar disorder. - **Women with bipolar disorder** are also more likely to experience **mixed features** and **more depressive episodes** compared to males. *Age of onset is earlier than unipolar depression* - This statement is **true** because the **typical age of onset for bipolar disorder is in early adulthood (late teens to early 20s)**, whereas **unipolar depression often has a later average onset**, though both can occur at any age. - An earlier age of onset in bipolar disorder is linked to poorer prognosis and more severe illness course.
Question 9: During a manic episode, a patient typically exhibits:
- A. Grandiosity (Correct Answer)
- B. Delusion of persecution
- C. Crying spells
- D. Low self-esteem
Explanation: ***Grandiosity*** - **Grandiosity**, characterized by an inflated sense of self-esteem, importance, or power, is a **hallmark symptom** of a manic episode. - Patients often believe they have special talents, abilities, or connections that are not based in reality. - This is one of the **core diagnostic criteria** for mania per DSM-5. *Delusion of persecution* - **Delusions of persecution**, where an individual believes they are being harmed or conspired against, are more characteristic of **schizophrenia** or **paranoid disorders**. - While psychotic features can occur in severe mania, **persecutory delusions** are less common than grandiose delusions during a manic episode. *Crying spells* - **Crying spells** are typically associated with **depressive episodes**, emotional lability, or conditions like **pseudobulbar affect**. - Manic episodes are marked by an **elevated or irritable mood**, and while irritability can lead to emotional outbursts, sustained crying spells are not typical. *Low self-esteem* - **Low self-esteem** is a core feature of **depressive episodes**, where individuals feel worthless, guilty, or inadequate. - In stark contrast, a manic episode is characterized by **inflated self-esteem** and grandiosity, not low self-esteem.
Question 10: A 45-year-old lady presents with normal PT and increased aPTT. About 2 years ago, she underwent cholecystectomy and did not have any bleeding episode. What is the next investigation for clinical diagnosis?
- A. Platelet aggregation test
- B. Ristocetin cofactor assay
- C. Factor VIII assay
- D. Dilute Russell viper venom assay (Correct Answer)
Explanation: ***Dilute Russell viper venom assay*** - A normal PT and an increased aPTT, along with a history of no bleeding during surgery, are highly suggestive of **antiphospholipid syndrome** (APS). [1] - The dilute Russell viper venom time (DRVVT) is a specific and sensitive test for detecting **lupus anticoagulant**, a key feature of APS. [1] *Platelet aggregation test* - This test evaluates platelet function and is used for diagnosing primary **platelet disorders** like von Willebrand disease or Bernard-Soulier syndrome. - It would not be the primary next step for an isolated prolonged aPTT with no bleeding history, as this pattern points to a **coagulation factor issue** or an anticoagulant. [1] *Ristocetin cofactor assay* - This assay is primarily used to diagnose **von Willebrand disease** by measuring the activity of von Willebrand factor (vWF). [2] - While von Willebrand disease can cause a prolonged aPTT, the absence of bleeding during a major surgery (cholecystectomy) makes a severe vWD diagnosis less likely, and APS is a more probable cause in this context. [3] *Factor VIII assay* - A Factor VIII deficiency (Hemophilia A) can cause a prolonged aPTT, but severe deficiencies typically lead to **significant bleeding episodes**, especially after surgery. [3] - The lack of bleeding during cholecystectomy makes a clinically significant Factor VIII deficiency less likely, and it wouldn't explain the normal PT. [1]
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free