Major Depressive Disorder — MCQs
What is the definition of "double depression" in the context of mental health?
An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
Which of the following conditions is characterized by intense depression and misery?
A 30-year-old female with depressed mood, decreased appetite, and no interest for one year. What is the diagnosis?
A reduction in the CSF 5-HIAA (Hydroxyindoleacetic Acid) is associated with all the following, EXCEPT:
A 30-year-old male was brought for evaluation, with a history of his 3-year-old son's death, 5 months prior, following a car accident. At the time of the accident, the patient was a witness. Since then, he has experienced symptoms of sadness, crying spells, feelings of hopelessness, poor sleep, and poor appetite. He has had suicidal thoughts on two occasions, but has not acted on them. He has not been attending work for the past 5 months. What is the likely diagnosis?
Double depression is seen in:
Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:
What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?
Which of the following is the most prevalent psychiatric disorder in the general population?
Major Depressive Disorder Indian Medical PG Practice Questions and MCQs
Question 1: What is the definition of "double depression" in the context of mental health?
- A. Depression superimposed on dysthymia (Correct Answer)
- B. Recurrent major depressive episodes without chronic low mood
- C. Major depressive disorder occurring alongside cognitive decline
- D. Chronic low-grade depression without major depressive episodes
Explanation: ***Depression superimposed on dysthymia*** - **Double depression** refers to the co-occurrence of a major depressive episode in an individual who already suffers from **dysthymia** (persistent depressive disorder) - This means the person experiences periods of more severe depression on top of their chronic, milder low mood - This combination results in a more severe clinical presentation and worse prognosis *Recurrent major depressive episodes without chronic low mood* - This describes **recurrent major depressive disorder**, where distinct episodes of severe depression occur without a persistent background of mild depression - It does not involve the chronic, low-grade depressive state characteristic of dysthymia *Major depressive disorder occurring alongside cognitive decline* - While depression can be associated with cognitive symptoms, this is not the standard definition of "double depression" in psychiatric diagnostic criteria - This would represent a comorbidity rather than the specific term "double depression" *Chronic low-grade depression without major depressive episodes* - This describes **dysthymia** (persistent depressive disorder), characterized by chronic, low-grade depressed mood lasting at least two years - This definition specifically excludes major depressive episodes, which is the key component that differentiates "double depression"
Question 2: An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
- A. Olanzapine
- B. ECT (Correct Answer)
- C. Mirtazapine
- D. Clozapine
Explanation: ***ECT*** - **Electroconvulsive therapy (ECT)** is the **treatment of choice** for severe depression with **suicidal ideation** due to its rapid onset of action and high efficacy. - It is particularly indicated when there is an urgent need for symptom remission to prevent self-harm, as verbal therapies and medications take longer to exert their full effects. *Olanzapine* - **Olanzapine** is an **antipsychotic medication** with some antidepressant properties, but it is not the first-line treatment for severe depression with suicidal tendencies. - It is often used as an **adjunctive treatment** in treatment-resistant depression or in psychotic depression with delusions. *Mirtazapine* - **Mirtazapine** is an **antidepressant** that can be very effective in cases of major depressive disorder, especially when insomnia and appetite loss are prominent. - However, its onset of action is not as rapid as ECT, making it less suitable for situations requiring immediate intervention for **severe suicidal risk**. *Clozapine* - **Clozapine** is an **antipsychotic medication** primarily used for **treatment-resistant schizophrenia** and reducing suicidal behavior in schizophrenia. - It is highly effective but has significant side effects, including **agranulocytosis**, and is not a first-line treatment for major depressive disorder with suicidal tendencies.
Question 3: Which of the following conditions is characterized by intense depression and misery?
- A. Schizophrenia
- B. Major depressive disorder (Correct Answer)
- C. Mania
- D. Melancholia
Explanation: ***Major depressive disorder*** - This condition is primarily defined by a period of at least two weeks of **depressed mood** or **loss of interest or pleasure** (anhedonia). - Patients often experience profound **feelings of sadness, hopelessness, and misery**, along with other symptoms like changes in sleep, appetite, energy, and concentration. - **MDD is the primary diagnostic category** for conditions characterized by intense depression and misery. *Schizophrenia* - Schizophrenia is characterized by **psychotic symptoms** such as hallucinations, delusions, disorganized thought, and negative symptoms. - While people with schizophrenia might experience periods of low mood, the primary defining features are not intense depression and misery, but rather a **break from reality**. *Mania* - Mania is characterized by an **elevated or irritable mood**, increased energy, and hyperactivity, which are the opposite of depression. - Symptoms include **racing thoughts, decreased need for sleep, grandiosity, and impulsive behavior**, not intense depression. *Melancholia* - Melancholia is a **specifier for major depressive disorder**, not a standalone condition in DSM-5/ICD-11. - While melancholia describes a **particularly severe form** of depression with profound despondency, it is a **subtype or qualifier** applied to MDD, not a separate diagnostic entity. - **The question asks for a "condition"** - MDD is the primary condition, while melancholic features describe characteristics within that condition.
Question 4: A 30-year-old female with depressed mood, decreased appetite, and no interest for one year. What is the diagnosis?
- A. None of the options
- B. Dysthymia
- C. Anxiety
- D. Major Depressive Disorder (Correct Answer)
Explanation: ***Major Depressive Disorder*** - The patient presents with classic symptoms of **depressed mood**, **decreased appetite**, and **anhedonia** (no interest) which are core criteria for **Major Depressive Disorder**. - The duration of one year indicates a chronic and significant impact on daily functioning, consistent with a major depressive episode. *Dysthymia* - While dysthymia also involves chronic depressed mood, it typically presents with **less severe** symptoms than major depressive disorder. - The patient's symptoms of significant anhedonia and appetite changes are more indicative of the severity seen in a major depressive episode. *Anxiety* - Anxiety disorders are characterized primarily by **excessive worry, fear, or apprehension**, often accompanied by physical symptoms like palpitations or shortness of breath. - Although anxiety can co-occur with depression, the primary symptoms described (depressed mood, anhedonia, appetite changes) are classic for a depressive diagnosis. *None of the options* - The patient's symptoms clearly align with **Major Depressive Disorder**, meeting the diagnostic criteria based on severity and duration. - There is a suitable diagnosis among the given options; therefore, this option is incorrect.
Question 5: A reduction in the CSF 5-HIAA (Hydroxyindoleacetic Acid) is associated with all the following, EXCEPT:
- A. OCD (Correct Answer)
- B. Depression
- C. Suicide
- D. Violence
Explanation: ***OCD*** - **Obsessive-Compulsive Disorder (OCD)** has been linked to *increased* serotonin activity or hypersensitivity, rather than reduced 5-HIAA. - A *reduction* in CSF 5-HIAA is typically associated with conditions linked to *decreased* serotonin function. *Depression* - **Reduced CSF 5-HIAA** is consistently observed in many forms of **depression**, consistent with the serotonin hypothesis of mood disorders. - Decreased serotonin metabolites suggest lower serotonin turnover or activity in the central nervous system. *Suicide* - Low CSF 5-HIAA levels are a well-established biological marker associated with an **increased risk of suicide** and suicidal behavior, regardless of diagnosis. - This finding points to impaired serotonin function contributing to impulsivity and aggression often seen in suicide attempts. *Violence* - **Aggressive and violent behaviors**, particularly impulsive aggression, have been correlated with **reduced CSF 5-HIAA** levels. - This suggests a role for dysfunctional serotonin pathways in regulating inhibitions and behavioral control.
Question 6: A 30-year-old male was brought for evaluation, with a history of his 3-year-old son's death, 5 months prior, following a car accident. At the time of the accident, the patient was a witness. Since then, he has experienced symptoms of sadness, crying spells, feelings of hopelessness, poor sleep, and poor appetite. He has had suicidal thoughts on two occasions, but has not acted on them. He has not been attending work for the past 5 months. What is the likely diagnosis?
- A. Post-traumatic stress disorder (PTSD)
- B. Normal grief reaction
- C. Adjustment disorder with depressed mood
- D. Major depressive disorder (Correct Answer)
Explanation: ***Major depressive disorder*** - The duration of symptoms (5 months) and severity, including **suicidal ideation** and significant occupational impairment, exceed what is typically expected for **normal grief** or **adjustment disorder**. - Symptoms like **sadness**, crying spells, feelings of hopelessness, **poor sleep**, and poor appetite are classic for **major depressive disorder**, especially when persistent and functionally debilitating. *Post-traumatic stress disorder (PTSD)* - While experiencing a traumatic event (witnessing his son's death) is a prerequisite for PTSD, the patient's primary symptoms are **depressive** rather than the characteristic re-experiencing, avoidance, negative alterations in cognitions and mood, or hyperarousal associated with PTSD. - There is no mention of **flashbacks**, nightmares, or significant **avoidance behaviors** directly linked to the trauma beyond general withdrawal. *Normal grief reaction* - While grief is expected after the death of a child, the severity (suicidal ideation) and significant functional impairment (not attending work for 5 months) suggest a reaction beyond **normal grief**. - **Normal grief** typically doesn't involve persistent, severe functional impairment or recurrent suicidal thoughts over such a prolonged period without additional significant depressive symptoms. *Adjustment disorder with depressed mood* - **Adjustment disorder** usually resolves within 6 months of the stressor or its consequences ceasing, and symptoms are generally less severe than those seen in major depression. - The presence of **suicidal ideation** and profound, persistent functional impairment for 5 months makes **major depressive disorder** a more fitting diagnosis.
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 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 9: What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?
- A. Pyridoxine
- B. Cobalamin
- C. Ascorbate
- D. Folate (Correct Answer)
Explanation: ***Folate*** - **Folate (vitamin B9) deficiency** is strongly linked to depression and is a well-established cause of relapse in patients treated with antidepressants. - Folate plays a crucial role in the **one-carbon metabolism pathway**, which is essential for the synthesis of monoamine neurotransmitters including **serotonin, norepinephrine, and dopamine**. - Studies show that **low folate levels** are associated with poor response to SSRIs and TCAs, and folate supplementation can improve antidepressant efficacy. - Approximately **30% of depressed patients** have folate deficiency, making it a clinically significant factor in treatment resistance and relapse. *Cobalamin* - **Cobalamin (vitamin B12)** deficiency can cause neuropsychiatric symptoms including depression and cognitive impairment. - While B12 is important for myelin formation and neurotransmitter synthesis, it is less specifically implicated in antidepressant relapse compared to folate. - B12 deficiency more commonly presents with **cognitive and neurological symptoms** rather than pure mood symptoms. *Pyridoxine* - **Pyridoxine (vitamin B6)** is a cofactor in neurotransmitter synthesis, including serotonin and dopamine. - While B6 deficiency can contribute to mood disturbances, it is not commonly implicated as a primary cause of relapse in antidepressant-treated depression. *Ascorbate* - **Ascorbate (vitamin C)** is an antioxidant with some role in neurotransmitter metabolism. - Severe vitamin C deficiency (scurvy) can have psychiatric manifestations, but it is not typically associated with relapse in patients treated with SSRIs or TCAs.
Question 10: Which of the following is the most prevalent psychiatric disorder in the general population?
- A. Schizophrenia
- B. Mania
- C. Anxiety disorder (Correct Answer)
- D. Depression
Explanation: ***Anxiety disorder*** - **Anxiety disorders** are collectively the most prevalent psychiatric disorders in the general population, affecting approximately **10-30% of individuals** during their lifetime. - This category includes **specific phobias, social anxiety disorder, panic disorder, generalized anxiety disorder, and others**, which together have the highest prevalence among all psychiatric conditions. - Epidemiological studies consistently show that **anxiety disorders surpass depression** in terms of overall prevalence in community samples. *Depression* - **Major depressive disorder** is highly prevalent (lifetime prevalence approximately 10-15%) and is the **leading cause of disability worldwide**. - While extremely common and clinically significant, it is slightly less prevalent than anxiety disorders when considering community-based epidemiological data. - Depression often occurs **co-morbidly with anxiety disorders**, further emphasizing the importance of both conditions. *Schizophrenia* - **Schizophrenia** is a severe chronic mental illness with a much lower prevalence, affecting approximately **0.3-0.7%** of the general population. - Despite its significant impact on affected individuals and families, its overall prevalence is relatively low compared to mood and anxiety disorders. *Mania* - **Mania** is a mood state characteristic of **bipolar disorder**, which has a prevalence of approximately **1-2%** of the population. - This is considerably lower than the prevalence of both anxiety disorders and major depressive disorder.
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