Mood Disorders Practice Questions

Q: Which of the following is NOT a cause of depression?

Metronidazole. **Explanation:** In psychiatry, identifying **organic causes of depression** is a high-yield topic for NEET-PG. Many pharmacological agents can induce depressive symptoms by altering neurotransmitter levels (Serotonin, Norepinephrine, or Dopamine) or affecting the Hypothalamic-Pituitary-Adrenal (HPA) axis. **Why Metronidazole is the correct answer:** Metronidazole is a nitroimidazole antibiotic used for anaerobic infections and protozoa. While it is known for causing neurological side effects like peripheral neuropathy, seizures, or a **disulfiram-like reaction** with alcohol, it is **not** typically associated with causing clinical depression. **Analysis of Incorrect Options:** * **Clonazepam (Benzodiazepines):** Long-term use of benzodiazepines is a well-documented cause of "depressive pseudodementia" or worsening of depressive symptoms due to their CNS depressant effects and modulation of GABA receptors. * **Levodopa:** Used in Parkinson’s disease, Levodopa can cause a wide range of psychiatric side effects. While it more commonly causes psychosis/hallucinations, it is also associated with mood fluctuations, including depression and anxiety. * **Corticosteroids:** These are notorious for causing "Steroid-induced Mood Disorders." They can cause euphoria/mania acutely, but long-term use or withdrawal frequently leads to severe depression and even suicidal ideation. **High-Yield Clinical Pearls for NEET-PG:** * **Most common drug causing depression:** Reserpine (by depleting monoamine stores). * **Other common culprits:** Beta-blockers (Propranolol), Interferon-alpha, Isotretinoin (Acne treatment), and Oral Contraceptive Pills (OCPs). * **Rule of Thumb:** Always screen for hypothyroidism or Vitamin B12 deficiency in patients presenting with new-onset depression, as these are common organic mimics.

Q: Mania is best described as which of the following?

A mood disorder. **Explanation:** **Mania** is fundamentally defined as a **Mood Disorder** (Option A). In psychiatry, mood refers to a pervasive and sustained emotion that colors the person's perception of the world. Mania represents the pathological "high" pole of mood disturbances, characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood lasting at least one week. Under the ICD-11 and DSM-5 classifications, mania is a core component of Bipolar Affective Disorder (BPAD). **Why other options are incorrect:** * **B. Psychological disorder:** This is a broad, non-specific umbrella term encompassing all mental health conditions. While mania is a psychological disorder, "Mood Disorder" is the specific diagnostic category required for medical examinations. * **C. Obsessive disorder:** These are characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions), as seen in OCD. Mania involves pressured speech and flight of ideas, which are distinct from obsessionality. * **D. Neurotic disorder:** Historically, neuroses (like anxiety or mild depression) involved intact reality testing. Mania often includes psychotic features (delusions of grandeur) and a loss of insight, classifying it traditionally as a **Psychotic/Functional disorder** rather than a neurotic one. **Clinical Pearls for NEET-PG:** * **Core Symptoms (DIG FAST):** **D**istractibility, **I**ndiscretion (excessive pleasure-seeking), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep need decreased, **T**alkativeness (pressured speech). * **Key Distinction:** If the symptoms last at least 4 days without significant functional impairment or psychosis, it is **Hypomania**. * **Drug of Choice:** **Lithium** is the gold standard for long-term prophylaxis and acute mania (though valproate or antipsychotics are often used for rapid control).

Q: Which of the following is TRUE about manic-depressive psychosis?

Mood disorders often have seasonal patterns. ### Explanation **Correct Option: D. Mood disorders often have seasonal patterns** Seasonal Affective Disorder (SAD) is a recognized specifier for mood disorders (Bipolar and MDD). It most commonly presents as "Winter Depression," characterized by atypical symptoms like hypersomnia and hyperphagia, triggered by reduced sunlight. This is linked to disruptions in circadian rhythms and melatonin metabolism. **Analysis of Incorrect Options:** * **Option A:** While Cyclothymic disorder involves hypomanic symptoms and depressive symptoms, the DSM-5/ICD criteria specify that these symptoms **must not meet the full criteria** for a Major Depressive Episode or a Manic Episode. The option's phrasing "episodes of depression" is technically imprecise in a clinical examination context compared to the definitive seasonal pattern. * **Option B:** Psychosocial stressors (e.g., sleep deprivation, major life events) are significant triggers for the onset and relapse of manic episodes. The "Kindling Hypothesis" suggests that while early episodes may require a stressor, later episodes may occur spontaneously. * **Option C:** While thyroid dysfunction affects mood, **Hypothyroidism** (not hyperthyroidism) is more classically associated with rapid-cycling bipolar disorder and treatment-resistant depression. **High-Yield Clinical Pearls for NEET-PG:** * **Rapid Cycling:** Defined as $\geq$ 4 mood episodes (manic, hypomanic, or depressive) within 12 months. * **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode PLUS one Major Depressive episode. * **Treatment of Choice:** Lithium is the gold standard for maintenance; however, Valproate is preferred for rapid cycling and mixed episodes. * **Seasonal Pattern Treatment:** Phototherapy (bright light therapy, 10,000 lux) is the first-line treatment for SAD.

Q: Type II bipolar disorder includes a combination of:

Hypomania and depression. **Explanation:** Bipolar II Disorder is characterized by a clinical course of one or more **Major Depressive Episodes** accompanied by at least one **Hypomanic Episode**. 1. **Why Option A is correct:** According to DSM-5 and ICD-11 criteria, the diagnosis of Bipolar II requires the presence (or history) of at least one major depressive episode and at least one hypomanic episode. Unlike Bipolar I, there is **never** a full manic episode. 2. **Why other options are incorrect:** * **Option B & C:** "Subsyndromal depression" refers to depressive symptoms that do not meet the full diagnostic criteria for a Major Depressive Episode. Bipolar II specifically requires a full-syndrome depressive episode. * **Option D:** Dysthymia (Persistent Depressive Disorder) is a chronic, milder form of depression. While it can coexist, the defining feature of Bipolar II is the presence of discrete Major Depressive Episodes. If a patient has hypomania and periods of low mood that do not meet full criteria for depression, the diagnosis is **Cyclothymic Disorder**. **High-Yield Clinical Pearls for NEET-PG:** * **Bipolar I:** At least one **Manic** episode. (Depression is common but not strictly required for diagnosis). * **Bipolar II:** **Hypomania + Major Depression**. * **Cyclothymia:** Hypomanic symptoms + Subsyndromal depression for at least **2 years**. * **Hypomania vs. Mania:** Hypomania lasts at least **4 days**, does not cause marked functional impairment, and lacks psychotic features. Mania lasts at least **1 week** (or requires hospitalization) and may include psychosis. * **Treatment:** Lithium is the gold standard mood stabilizer; however, in Bipolar II, treating the depressive phase is often the primary clinical challenge.

Q: According to DSM-IV, for a diagnosis of mania in Bipolar Disorder, how long must symptoms persist in an outpatient?

1 week. ### Explanation **1. Why Option A is Correct:** According to the **DSM-IV (and DSM-5)** criteria, a **Manic Episode** is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting **at least 1 week** (or any duration if hospitalization is necessary). The symptoms must be present most of the day, nearly every day, and must cause significant impairment in social or occupational functioning. **2. Why Other Options are Incorrect:** * **Option B (2 weeks):** This is the minimum duration required for a **Major Depressive Episode (MDE)** or Dysthymia (where symptoms persist for 2 years). * **Options C & D (3 and 4 weeks):** These timeframes do not correspond to the diagnostic criteria for acute mood episodes in Bipolar Disorder. While chronic conditions like Cyclothymia require a 2-year duration, the acute manic phase is defined by the 1-week threshold. **3. High-Yield Clinical Pearls for NEET-PG:** * **Hypomania vs. Mania:** Hypomania requires a minimum duration of **4 consecutive days**. Unlike mania, it does *not* cause marked impairment, does *not* require hospitalization, and *never* features psychotic symptoms. * **The "DIG FAST" Mnemonic for Mania:** **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit (decreased need for sleep), and **T**alkativeness (pressured speech). * **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode. Bipolar II requires at least one **Hypomanic** episode AND one **Major Depressive** episode. * **Mixed Features:** If symptoms of both mania and depression occur simultaneously for at least 1 week, it was termed a "Mixed Episode" in DSM-IV (now a "Mixed Features" specifier in DSM-5).

Q: Depression is a feature of which of the following conditions?

Hyperthyroidism. **Explanation:** In the context of psychiatric manifestations of endocrine disorders, **Hyperthyroidism** (Option B) is the correct answer. While hyperthyroidism is classically associated with anxiety, restlessness, and irritability, it can frequently present as **"Apathetic Hyperthyroidism,"** particularly in elderly patients. This condition mimics clinical depression, characterized by lethargy, psychomotor retardation, and withdrawal. Furthermore, chronic thyrotoxicosis can lead to emotional lability and secondary depressive states. **Analysis of Options:** * **Hypothyroidism (Option C):** While hypothyroidism is a very common cause of "organic depression" (pseudodementia), in the specific context of this question's source material or clinical focus on thyrotoxicosis-induced mood shifts, hyperthyroidism is highlighted. However, in general clinical practice, both are linked; if this were a "multiple-choice" multiple-response question, both would be relevant. * **Hypopituitarism (Option A):** Usually presents with generalized fatigue, apathy, and loss of libido due to secondary adrenal/gonadal failure, but is less specifically linked to a primary depressive syndrome compared to thyroid dysfunction. * **Hypoglycemia (Option D):** Typically presents with acute neuroglycopenic symptoms (confusion, sweating, tremors, seizures) rather than a sustained depressive mood. **High-Yield Clinical Pearls for NEET-PG:** * **Apathetic Hyperthyroidism:** Always suspect this in an elderly patient presenting with new-onset depression and weight loss. * **Postpartum Blues/Depression:** Always screen for thyroiditis, as thyroid dysfunction is common in the postpartum period. * **Steroid-Induced Mood Changes:** Corticosteroids can cause both mania (acute) and depression (chronic). * **Pancreatic Carcinoma:** Depression is often a "prodromal" symptom appearing before physical signs of the malignancy.

Q: A 50-year-old male presents with a 3-year history of irritability, low mood, lack of interest in surroundings, and general dissatisfaction with everything. There is no significant disruption in his sleep or appetite. What is the most likely diagnosis?

Dysthymia. ### Explanation The patient’s presentation is classic for **Dysthymia** (now referred to as **Persistent Depressive Disorder** in DSM-5). **1. Why Dysthymia is correct:** Dysthymia is characterized by a chronic, low-grade depressed mood that lasts for at least **2 years** in adults. Key features include irritability and a general lack of interest, but the symptoms are **not severe enough** to meet the full criteria for a Major Depressive Episode. Crucially, the patient remains functional despite their dissatisfaction, and there is often an absence of significant vegetative symptoms (like marked sleep or appetite disturbances), as seen in this case. **2. Why the other options are incorrect:** * **Major Depression:** Requires a minimum duration of only 2 weeks but must involve more severe symptoms (the "SIGECAPS" criteria) and significant functional impairment. The 3-year duration and lack of biological symptoms (sleep/appetite) point away from acute MDD. * **No psychiatric disorder:** The 3-year persistence of irritability and low mood indicates a pathological state that requires clinical attention; it is not a normal baseline. * **Chronic Fatigue Syndrome:** While it involves exhaustion, the primary feature is profound fatigue lasting >6 months that is not improved by rest, rather than a primary mood disturbance like irritability or low interest. **Clinical Pearls for NEET-PG:** * **Duration Criteria:** 2 years in adults; 1 year in children/adolescents (where mood can be irritable rather than depressed). * **Rule of Two:** Symptoms must not be absent for more than **2 months** at a time during the 2-year period. * **Double Depression:** A term used when a patient with underlying Dysthymia experiences a superimposed Major Depressive Episode. * **Treatment:** A combination of Pharmacotherapy (SSRIs are first-line) and Psychotherapy (CBT or Interpersonal Therapy) is most effective.

Q: ECT is most useful in:

Depression. **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry. While it has several indications, it is considered the **gold standard** and is most frequently used for **Major Depressive Disorder (MDD)**, particularly when it is severe, treatment-resistant, or accompanied by psychotic features or suicidal ideation. **Why Depression is the Correct Answer:** ECT has the highest efficacy rate (70-90%) for severe depression. It works by inducing a generalized seizure, which leads to a massive release of neurotransmitters (serotonin, dopamine, norepinephrine) and increases Brain-Derived Neurotrophic Factor (BDNF), promoting neuroplasticity. It is the treatment of choice when a rapid clinical response is required (e.g., patient refusing to eat or actively suicidal). **Analysis of Incorrect Options:** * **A. Mania:** ECT is effective for acute mania (especially delirious mania), but it is generally a second-line treatment after mood stabilizers and antipsychotics. * **C. OCD:** ECT is rarely used for OCD and is only considered in extreme, refractory cases with comorbid depression. It is not a primary indication. * **D. Schizophrenia:** ECT is used for Catatonic Schizophrenia or treatment-resistant cases, but it is not the first-line or "most useful" application compared to its role in depression. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde amnesia and post-ictal confusion. * **Electrode Placement:** Bilateral (Gold standard for efficacy) vs. Unilateral (Lower cognitive side effects). * **Drugs used:** Atropine (pre-medication), Propofol/Thiopentone (anesthesia), and **Succinylcholine** (muscle relaxant to prevent fractures).

Q: Which of the following is NOT considered a differential diagnosis of premenstrual tension?

Chronic fatigue syndrome. **Explanation:** Premenstrual Dysphoric Disorder (PMDD) or Premenstrual Tension (PMT) is characterized by significant emotional and physical symptoms that occur during the **luteal phase** of the menstrual cycle and remit shortly after the onset of menses. **Why Chronic Fatigue Syndrome (CFS) is the correct answer:** Chronic Fatigue Syndrome is characterized by persistent, unexplained exhaustion lasting at least six months that is not relieved by rest. Unlike PMT, CFS symptoms are **chronic and continuous**, lacking the cyclical, hormone-dependent pattern essential for a PMT diagnosis. While fatigue is a symptom of PMT, the lack of periodicity in CFS makes it an unlikely differential diagnosis compared to mood and anxiety disorders that can "mimic" or be exacerbated by the menstrual cycle (premenstrual magnification). **Analysis of Incorrect Options:** * **A. Psychiatric Depressive Disorder:** Major Depressive Disorder (MDD) is a primary differential. Clinicians must distinguish whether the patient has PMT or a continuous depression that worsens premenstrually. * **B. Panic Disorder:** Many women experience increased autonomic arousal and panic attacks specifically during the luteal phase, making it a common differential. * **C. Generalized Anxiety Disorder (GAD):** GAD involves persistent worry. Because PMT often presents with high levels of irritability and anxiety, GAD must be ruled out by tracking symptoms on a daily prospective calendar. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Prospective daily charting of symptoms for at least **two consecutive menstrual cycles**. * **First-line Treatment:** SSRIs (e.g., Fluoxetine, Sertraline). Unlike in MDD, SSRIs for PMT can be effective even when taken only during the luteal phase (intermittent dosing). * **Key Symptom:** Irritability is often the most prominent emotional symptom in PMT/PMDD.

Question 1

Which of the following is NOT a cause of depression?

Accepted Answer

Metronidazole

Answer

Clonazepam

Answer

Levodopa

Answer

Corticosteroids

Question 2

Mania is best described as which of the following?

Accepted Answer

A mood disorder

Answer

A psychological disorder

Answer

An obsessive disorder

Answer

A neurotic disorder

Question 3

Which of the following is TRUE about manic-depressive psychosis?

Accepted Answer

Mood disorders often have seasonal patterns

Answer

Cyclothymic disorder consists of hypomanic and less severe episodes of depression

Answer

Psychosocial stressors have no influence on manic episodes

Answer

Hyperthyroidism causes rapid-cycling bipolar disorder in females

Question 4

Type II bipolar disorder includes a combination of:

Accepted Answer

Hypomania and depression

Answer

Hypomania and subsyndromal depression

Answer

Mania and subsyndromal depression

Answer

Hypomania and dysthymia

Question 5

According to DSM-IV, for a diagnosis of mania in Bipolar Disorder, how long must symptoms persist in an outpatient?

Accepted Answer

1 week

Answer

2 weeks

Answer

3 weeks

Answer

4 weeks

Question 6

Which of the following statements regarding rapid cycling bipolar disorder is true?

Accepted Answer

Alcohol, stimulants, and caffeine use are risk factors.

Answer

Defined as at least four episodes per year.

Answer

Hospitalization is common.

Answer

More common in women than men.

Question 7

Depression is a feature of which of the following conditions?

Accepted Answer

Hyperthyroidism

Answer

Hypopituitarism

Answer

Hypothyroidism

Answer

Hypoglycemia

Question 8

A 50-year-old male presents with a 3-year history of irritability, low mood, lack of interest in surroundings, and general dissatisfaction with everything. There is no significant disruption in his sleep or appetite. What is the most likely diagnosis?

Accepted Answer

Dysthymia

Answer

Major depression

Answer

No psychiatric disorder

Answer

Chronic fatigue syndrome

Question 9

ECT is most useful in:

Accepted Answer

Depression

Answer

Mania

Answer

OCD

Answer

Schizophrenia

Question 10

Which of the following is NOT considered a differential diagnosis of premenstrual tension?

Accepted Answer

Chronic fatigue syndrome

Answer

Psychiatric depressive disorder

Answer

Panic disorder

Answer

Generalized anxiety disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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