Mood Disorders — MCQs

A 30-year-old female, married for one year, presents with hyperactivity for two weeks. A diagnosis of mania is made. She has had three prior episodes of mania in the last five years, and each time her symptoms resolved after medication. Her urine pregnancy test is positive. Which is the preferred drug for the management of this patient?

Q107Medium

A 17-year-old girl presents with decreased sleep, irritability, and a 4-5 kg weight loss over the past two months, accompanied by a subjective feeling of increased energy. Physical examination reveals a thin build, normal BMI, nasal mucosal erythema, and mild facial acne. What is the most likely diagnosis?

Q108Medium

A female patient presented with depressed mood, loss of appetite, insomnia, and no interest in her surroundings for the past one year. The onset of depression was preceded by a history of business loss. Which of the following statements regarding the management of this patient is true?

Q109Easy

Which of the following is NOT considered a risk factor for suicide?

Q110Easy

What is the most common age group affected by depression?

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 101: Which of the following is NOT a risk factor for depression?

A. Middle-aged female
B. Hypothyroidism
C. Age above 70 years, either sex
D. 18-year-old teenager (Correct Answer)

Explanation: In psychiatry, understanding the epidemiology and risk factors of Major Depressive Disorder (MDD) is crucial for NEET-PG. **Explanation of the Correct Answer:** **Option D (18-year-old teenager)** is the correct answer because, statistically, the peak age of onset for depression is between **20 and 50 years**, with the mean age being approximately **40 years**. While adolescents can suffer from depression, being an 18-year-old is not considered a primary "risk factor" compared to the established demographic and medical vulnerabilities listed in the other options. **Analysis of Incorrect Options:** * **Option A (Middle-aged female):** Female gender is a significant risk factor; women are twice as likely to develop depression as men. The risk is highest during reproductive years and middle age due to hormonal fluctuations and psychosocial stressors. * **Option B (Hypothyroidism):** This is a classic organic cause of secondary depression. Endocrine disorders (including Cushing’s and Addison’s disease) are high-yield medical comorbidities that trigger depressive symptoms. * **Option C (Age above 70 years):** Geriatric populations are at high risk due to social isolation, bereavement, chronic physical illnesses, and neurological changes. In the elderly, depression often presents as "pseudodementia." **High-Yield Clinical Pearls for NEET-PG:** * **Gender Ratio:** Female:Male = 2:1. * **Marital Status:** Highest risk in those who are divorced or separated; lowest risk in married individuals. * **Genetics:** If one monozygotic twin has MDD, the other has a 50% chance of developing it. * **Biogenic Amine Hypothesis:** Depression is primarily linked to low levels of Serotonin (5-HT) and Norepinephrine in the synaptic cleft.

Question 102: What is the minimum duration of chronic mild depression to be considered dysthymia?

A. 3 to 6 months
B. 6 months to 1 year
C. 1 to 1.5 years
D. More than 2 years (Correct Answer)

Explanation: ### Explanation **Concept Overview:** Dysthymia, now referred to as **Persistent Depressive Disorder (PDD)** in DSM-5, is a chronic form of depression where the mood is low for most of the day, for more days than not, but the symptoms are typically less severe than those of Major Depressive Disorder (MDD). **Why Option D is Correct:** According to both ICD-10 and DSM-5 criteria, the hallmark of Dysthymia is its **chronicity**. For a diagnosis in adults, the depressive symptoms must persist for **at least 2 years**. During this period, the individual must not be symptom-free for more than 2 months at a time. This duration is essential to differentiate a chronic personality-like depressive state from an acute depressive episode. **Why Other Options are Incorrect:** * **Options A, B, and C:** These durations (3 months to 1.5 years) are insufficient for a diagnosis of Dysthymia. While a Major Depressive Episode only requires symptoms for **2 weeks**, and Adjustment Disorder typically lasts less than 6 months after a stressor, Dysthymia specifically requires the long-term 2-year threshold. **Clinical Pearls for NEET-PG:** * **Pediatric Exception:** In children and adolescents, the duration required for diagnosis is only **1 year**, and the mood may be **irritable** rather than depressed. * **"Double Depression":** This term is used when a patient with pre-existing Dysthymia experiences a superimposed Major Depressive Episode. * **Symptoms:** Look for the "Rule of 2": **2 years** duration + at least **2 symptoms** (e.g., poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, or hopelessness). * **Treatment:** A combination of Pharmacotherapy (SSRIs are first-line) and Psychotherapy (CBT or IPT) is more effective than either alone.

Question 103: Which of the following drugs does NOT have abuse liability?

A. Buprenorphine
B. Alprazolam
C. Fluoxetine (Correct Answer)
D. Dextropropoxyphene

Explanation: **Explanation:** The correct answer is **Fluoxetine**. Abuse liability refers to a drug's potential to be used in a non-medical way, often due to its ability to produce euphoria, sedation, or a "high." **1. Why Fluoxetine is the correct answer:** Fluoxetine is a **Selective Serotonin Reuptake Inhibitor (SSRI)**. Unlike drugs with abuse potential, SSRIs do not cause immediate euphoria or rapid surges in dopamine within the brain's reward system (nucleus accumbens). Their therapeutic effects take weeks to manifest. While abrupt discontinuation can lead to "discontinuation syndrome," they do not cause craving or drug-seeking behavior. **2. Why the other options are incorrect:** * **Buprenorphine:** A partial opioid agonist used in opioid substitution therapy. While it has a "ceiling effect," it still possesses significant abuse liability, especially among opioid-naive individuals. * **Alprazolam:** A high-potency, short-acting **Benzodiazepine**. It is highly addictive due to its rapid onset of action and GABA-ergic sedative effects. It is one of the most commonly abused prescription drugs. * **Dextropropoxyphene:** An opioid analgesic. It was historically widely abused for its narcotic effects before being banned or restricted in many regions due to its toxicity and potential for dependence. **High-Yield Clinical Pearls for NEET-PG:** * **Antidepressants** (SSRIs, SNRIs, TCAs) generally have **zero abuse liability**. * **Zolpidem/Zopiclone (Z-drugs)**: Though marketed as safer, they *do* have abuse potential. * **Ketamine**: An NMDA antagonist used for treatment-resistant depression, it has **high abuse liability** (dissociative effects). * **Tianeptine**: An atypical antidepressant that acts on mu-opioid receptors; it is a notable exception with known abuse potential.

Question 104: Which of the following is true about Major Depressive Disorder?

A. Abnormally diminished activity in the prefrontal cortex.
B. Genetic predisposition is present.
C. Disturbances in the monoaminergic system.
D. All of the above. (Correct Answer)

Explanation: Major Depressive Disorder (MDD) is a complex psychiatric condition with a multifactorial etiology involving neuroanatomical, genetic, and biochemical components. **Explanation of Options:** * **A. Neuroanatomy:** Functional neuroimaging studies in MDD patients consistently show **hypofrontality** (diminished activity) in the **Prefrontal Cortex (PFC)**, particularly the dorsolateral PFC. This area is responsible for executive function and emotional regulation. Conversely, there is often increased activity in the amygdala (emotional processing). * **B. Genetics:** MDD has a strong hereditary component. First-degree relatives of patients with MDD are **2-3 times more likely** to develop the disorder. Twin studies show a concordance rate of approximately 40-50% for monozygotic twins. * **C. Neurochemistry:** The **Monoamine Hypothesis** is the leading biochemical theory. It suggests that depression results from a functional deficiency of neurotransmitters, primarily **Serotonin (5-HT), Norepinephrine (NE), and Dopamine (DA)**, in the synaptic cleft. Since all three statements accurately describe the pathophysiology of MDD, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** * **Most common finding on Sleep EEG:** Decreased REM latency (entering REM sleep faster), increased REM density, and decreased slow-wave (Stage 3 & 4) sleep. * **Neuroendocrine marker:** Non-suppression of cortisol in the **Dexamethasone Suppression Test (DST)**, indicating HPA axis hyperactivity. * **Brain Structure:** Chronic MDD is associated with a **reduction in Hippocampal volume** due to prolonged hypercortisolemia. * **First-line treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the gold standard for pharmacotherapy.

Question 105: The classical triad of symptoms of depression includes all the following except?

A. Depressed mood
B. Slowed thinking
C. Distractibility (Correct Answer)
D. Psychomotor retardation

Explanation: ### Explanation The **Classical Triad of Depression**, historically described by Emil Kraepelin, consists of three core clinical features that characterize a depressive episode. These are: 1. **Depressed Mood:** A pervasive and persistent feeling of sadness or "low" mood. 2. **Slowed Thinking (Poverty of Thought):** Patients often experience a decrease in the flow of ideas, difficulty concentrating, and slowed cognitive processing. 3. **Psychomotor Retardation:** A visible slowing of physical movements, speech, and emotional reactions. **Why Distractibility is the Correct Answer:** Distractibility is **not** part of the classical triad of depression. In fact, distractibility is a hallmark symptom of **Mania** (as part of the DIGFAST mnemonic). While depressed patients may struggle with concentration, their cognitive state is characterized by "slowness" rather than the rapid shifting of attention seen in distractibility. **Analysis of Incorrect Options:** * **Depressed mood:** This is the primary emotional component of the triad. * **Slowed thinking:** This represents the cognitive component of the triad. * **Psychomotor retardation:** This represents the physical/behavioral component of the triad. **High-Yield Clinical Pearls for NEET-PG:** * **ICD-10 Core Criteria:** For a diagnosis of depression, ICD-10 requires at least two of the three core symptoms: Depressed mood, Loss of interest (Anhedonia), and Fatigability. * **Beck’s Cognitive Triad:** Do not confuse the classical triad with Beck’s Triad, which consists of negative views about the **Self, the World, and the Future**. * **Psychomotor Agitation:** While retardation is classical, some patients (especially in elderly or "Agitated Depression") may show increased purposeless activity. * **Melancholic Depression:** Characterized by a complete loss of pleasure, early morning awakening, and psychomotor retardation/agitation.

Question 106: A 30-year-old female, married for one year, presents with hyperactivity for two weeks. A diagnosis of mania is made. She has had three prior episodes of mania in the last five years, and each time her symptoms resolved after medication. Her urine pregnancy test is positive. Which is the preferred drug for the management of this patient?

A. Promethazine
B. Haloperidol (Correct Answer)
C. Clonazepam
D. Lithium

Explanation: **Explanation:** The patient is a 30-year-old pregnant female presenting with an acute episode of mania. The management of bipolar disorder during pregnancy requires balancing maternal stability with fetal safety. **1. Why Haloperidol is the correct answer:** In acute mania during pregnancy, **First-Generation Antipsychotics (FGAs)** like **Haloperidol** are considered the first-line treatment. Haloperidol has a long-standing safety record in pregnancy; it is not associated with significant teratogenic risks (unlike mood stabilizers) and effectively controls hyperactivity and psychotic symptoms. It is the preferred agent when rapid stabilization is required in a pregnant patient. **2. Why the other options are incorrect:** * **Lithium:** While highly effective for mania, Lithium is associated with **Ebstein’s anomaly** (a cardiac malformation) if used during the first trimester. It is generally avoided in the initial management of a newly diagnosed pregnancy unless other options fail. * **Clonazepam:** Benzodiazepines can be used as adjuncts for sedation, but they are not primary anti-manic agents. There are also concerns regarding "floppy infant syndrome" and cleft palate with high-dose use in pregnancy. * **Promethazine:** This is an antihistamine with sedative properties, often used for morning sickness or mild sedation, but it has no efficacy in treating the core symptoms of mania. **Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC) for Mania in Pregnancy:** Haloperidol. * **Teratogenicity:** Lithium (Ebstein’s Anomaly), Valproate (Neural Tube Defects - highest risk), Carbamazepine (Neural Tube Defects). * **Safe Mood Stabilizer:** If a mood stabilizer must be used later in pregnancy, Lithium is safer than Valproate. * **ECT in Pregnancy:** Electroconvulsive therapy is considered safe and highly effective for severe, refractory mania or depression during pregnancy.

Question 107: A 17-year-old girl presents with decreased sleep, irritability, and a 4-5 kg weight loss over the past two months, accompanied by a subjective feeling of increased energy. Physical examination reveals a thin build, normal BMI, nasal mucosal erythema, and mild facial acne. What is the most likely diagnosis?

A. Anorexia nervosa
B. Avoidant food intake disorder
C. Bulimia nervosa
D. Cocaine use disorder (Correct Answer)

Explanation: **Explanation:** The clinical presentation of decreased sleep, irritability, increased energy, and significant weight loss points toward a **sympathomimetic toxidrome** or a manic episode. However, the physical examination findings are the key to differentiating the diagnosis. **1. Why Cocaine Use Disorder is correct:** Cocaine is a potent CNS stimulant that inhibits the reuptake of dopamine, norepinephrine, and serotonin. Chronic or acute use leads to **decreased appetite (weight loss)**, **insomnia**, and **hyperactivity/irritability**. The pathognomonic finding in this case is **nasal mucosal erythema** (or septal perforation/epistaxis), which results from the vasoconstrictive effects of snorting cocaine (insufflation). The presence of **facial acne** (or "coke bumps") and a thin build further support stimulant abuse. **2. Why other options are incorrect:** * **Anorexia Nervosa:** While weight loss and thin build are present, it does not explain the nasal mucosal erythema or the subjective feeling of "increased energy" and irritability typical of a stimulant high. * **Avoidant Food Intake Disorder (ARFID):** This involves restricted food intake due to sensory issues or fear of consequences (e.g., choking) without body image distortion. It does not present with nasal irritation or manic-like symptoms. * **Bulimia Nervosa:** Patients usually maintain a **normal or slightly high BMI**. While they may have dental erosions or Parotid gland swelling (Sialadenosis), nasal mucosal erythema is not a feature. **3. High-Yield Clinical Pearls for NEET-PG:** * **Cocaine vs. Mania:** Always look for physical signs (dilated pupils, tachycardia, nasal changes) to rule out substance-induced mood disorders before diagnosing Bipolar Disorder. * **Nasal Findings:** Chronic snorting leads to ischemic necrosis of the nasal septum. * **Treatment:** For cocaine-induced agitation, **Benzodiazepines** are the first-line treatment. **Beta-blockers are contraindicated** due to the risk of unopposed alpha-adrenergic stimulation causing severe hypertension.

Question 108: A female patient presented with depressed mood, loss of appetite, insomnia, and no interest in her surroundings for the past one year. The onset of depression was preceded by a history of business loss. Which of the following statements regarding the management of this patient is true?

A. No treatment is necessary as the symptoms are due to business loss.
B. SSRI is the most efficacious of the available antidepressant drugs.
C. Start SSRI treatment based on the side effect profile. (Correct Answer)
D. Combination therapy of two antidepressant drugs is indicated.

Explanation: ### Explanation **1. Why Option C is Correct:** The patient presents with core symptoms of **Major Depressive Disorder (MDD)**—depressed mood, anhedonia (no interest), and somatic symptoms (insomnia, loss of appetite)—lasting for one year. Even though the depression was triggered by a psychosocial stressor (business loss), the severity and duration necessitate pharmacological intervention. **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line treatment for MDD. In clinical practice, all standard antidepressants (SSRIs, SNRIs, TCAs) have **comparable efficacy**. Therefore, the choice of a specific drug is not based on superior effectiveness, but on the **side effect profile**, patient comorbidities, cost, and previous response. **2. Why Other Options are Incorrect:** * **Option A:** A "reactive" cause (business loss) does not preclude the need for treatment. If symptoms meet the diagnostic criteria for MDD and persist, they require management to prevent morbidity. * **Option B:** While SSRIs are first-line due to safety and tolerability, they are **not more efficacious** than other classes like TCAs or SNRIs. * **Option D:** Combination therapy (using two antidepressants) is reserved for **treatment-resistant depression** and is never the initial step in management. **3. NEET-PG High-Yield Pearls:** * **Diagnostic Criteria (ICD-11/DSM-5):** Symptoms must be present for at least **2 weeks** for a diagnosis of MDD. * **Efficacy vs. Potency:** All antidepressants are equally effective; they differ primarily in their adverse effects (e.g., Fluoxetine causes insomnia/agitation; Paroxetine is more sedating). * **Lag Period:** Antidepressants typically take **2–4 weeks** to show clinical improvement. * **First-line for MDD with Psychosis:** Antidepressant + Antipsychotic OR ECT. * **Most common side effect of SSRIs:** Gastrointestinal upset (nausea/diarrhea) and sexual dysfunction.

Question 109: Which of the following is NOT considered a risk factor for suicide?

A. Social isolation
B. Male sex
C. Drug dependence
D. Somatization (Correct Answer)

Explanation: **Explanation:** The correct answer is **Somatization**. In psychiatric epidemiology, somatization (the expression of psychological distress through physical symptoms) is generally considered a "protective" factor or, at the very least, is not associated with an increased risk of completed suicide. Patients with somatization disorder often have a high frequency of medical consultations and a focus on physical health, which contrasts with the hopelessness and self-destructive intent seen in high-risk individuals. **Analysis of Options:** * **Male sex:** While females make more suicide *attempts*, males are more likely to *complete* suicide (a ratio of approximately 3:1). This is due to the use of more lethal methods (e.g., firearms, hanging). * **Social isolation:** Living alone, being widowed, or lacking a social support system are significant risk factors. "Social integration" is a known protective factor. * **Drug dependence:** Substance use disorders (especially alcohol and opioids) significantly increase impulsivity and worsen underlying depression, making it a major risk factor for suicide. **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Predictor:** A **previous suicide attempt** is the single strongest predictor of a future completed suicide. * **SAD PERSONS Scale:** A mnemonic used to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol use, Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness). * **Psychiatric Comorbidity:** Over 90% of individuals who commit suicide have a diagnosable psychiatric disorder, most commonly **Depression**. * **Age:** Risk increases with age; elderly males have the highest rates of completed suicide.

Question 110: What is the most common age group affected by depression?

A. Middle-aged men
B. Middle-aged women (Correct Answer)
C. Young girls
D. Children

Explanation: **Explanation:** The correct answer is **Middle-aged women**. Epidemiological studies consistently show that Major Depressive Disorder (MDD) is most prevalent among women, particularly those in the **35 to 45-year age group**. **1. Why Middle-aged Women?** The gender gap in depression begins at puberty and persists through adulthood, with women being roughly **twice as likely** to experience depression as men (2:1 ratio). This peak in middle age is attributed to a combination of biological factors (fluctuating estrogen/progesterone levels, perimenopause), psychological stressors (the "sandwich generation" burden of caring for both children and aging parents), and socio-cultural factors. **2. Analysis of Incorrect Options:** * **Middle-aged men:** While men do suffer from depression, the prevalence is significantly lower than in women. However, it is a high-yield fact that men have a higher rate of **completed suicide** despite lower rates of diagnosed depression. * **Young girls:** Before puberty, the incidence of depression is roughly equal between boys and girls. The divergence only occurs post-puberty. * **Children:** Depression is relatively rare in childhood compared to adulthood. When it does occur, it often presents atypically with **irritability** rather than low mood. **Clinical Pearls for NEET-PG:** * **Gender Ratio:** 2:1 (Female:Male) for Depression; 1:1 for Bipolar Disorder. * **Mean Age of Onset:** Approximately 40 years (though it can occur at any age). * **Most Common Symptom:** While "depressed mood" is core, **Anhedonia** (loss of interest) is a key diagnostic criterion. * **Genetic Risk:** If one parent has MDD, the risk to the child is 10-25%; if both parents are affected, the risk doubles.

Practice by Chapter

Major Depressive Disorder

Practice Questions

Bipolar Disorder: Manic Episodes

Practice Questions

Bipolar Disorder: Depressive and Mixed Episodes

Practice Questions

Persistent Depressive Disorder (Dysthymia)

Practice Questions

Cyclothymic Disorder

Practice Questions

Seasonal Affective Disorder

Practice Questions

Suicide and Suicidal Behavior

Practice Questions

Pharmacotherapy of Mood Disorders

Practice Questions

Psychotherapy for Mood Disorders

Practice Questions

Brain Stimulation Therapies

Practice Questions

Treatment-Resistant Depression

Practice Questions

Mood Disorders in Special Populations

Practice Questions

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