Mood Disorders Practice Questions

Q: An 82-year-old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is consulted at the request of her daughters, who think their mother is depressed because she is tearful, often talks about her dead husband, and states that she has heard his voice several times. She blames herself for not having gone with him on his last visit to his sister and cries frequently. She has never seen a psychiatrist before and has been "strong" all her life. Which of the following is the most likely diagnosis?

Grief reaction. ### Explanation **1. Why Grief Reaction is Correct:** The patient is experiencing a **Normal Grief Reaction (Bereavement)**. Following the loss of a loved one, it is normal to experience sadness, tearfulness, and preoccupation with the deceased. Key features in this case that point toward grief rather than clinical depression include: * **Timeline:** Symptoms started 6 weeks ago (within the expected window of acute grief). * **Nature of Guilt:** Her guilt is specific to the deceased (not going on the last visit), rather than a generalized sense of worthlessness. * **Hallucinations:** Hearing the voice of the deceased (pseudohallucinations) is a common and normal finding in bereavement and does not signify psychosis. * **Functioning:** Despite her sadness, there is no mention of global functional impairment or pervasive suicidal ideation. **2. Why Other Options are Incorrect:** * **A. Depression secondary to GMC:** While she has cardiac issues, her symptoms are clearly linked to the psychological stressor of her husband’s death. * **B. Dysthymia (Persistent Depressive Disorder):** This requires a depressed mood for at least **2 years** (1 year in children). Her symptoms are acute (6 weeks). * **D. Major Depressive Disorder (MDD):** While grief can evolve into MDD, this patient lacks "SIGECAPS" severity. In MDD, guilt is usually pervasive/delusional, and hallucinations are typically not limited to the deceased. **3. Clinical Pearls for NEET-PG:** * **Normal Grief vs. MDD:** In grief, self-esteem is usually preserved. In MDD, feelings of worthlessness and self-loathing are prominent. * **Persistent Complex Bereavement Disorder:** Diagnosed if symptoms cause significant impairment and persist for at least **12 months** (DSM-5). * **Management:** Normal grief requires support and monitoring, not immediate antidepressants. * **Kubler-Ross Stages:** Denial, Anger, Bargaining, Depression, Acceptance (**DABDA**).

Q: What is dysthymia?

Chronic depression. **Explanation:** **Dysthymia**, now clinically referred to as **Persistent Depressive Disorder (PDD)** in DSM-5, is characterized as a **chronic, low-grade depression**. 1. **Why Option A is Correct:** The hallmark of Dysthymia is a depressed mood that lasts for most of the day, for more days than not, for at least **two years** (one year in children/adolescents). While the symptoms are less severe than Major Depressive Disorder (MDD), their chronic nature leads to significant functional impairment. Patients often describe it as "always being sad" or "part of their personality." 2. **Why Other Options are Incorrect:** * **B. Chronic Mania:** Mania is a state of elevated mood. Chronic mania is not a standard clinical diagnosis; persistent mood elevation is usually part of Bipolar Disorder or Cyclothymia. * **C. Bipolar Disorder:** This requires episodes of mania or hypomania alternating with depression. Dysthymia is a unipolar condition (depressive spectrum only). * **D. Personality Disorder:** While Dysthymia can coexist with personality disorders (like Borderline or Avoidant), it is classified as a **Mood (Affective) Disorder**. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of 2":** Symptoms must persist for **2 years**, and the patient is never without symptoms for more than **2 months** at a time. * **Double Depression:** This occurs when a patient with underlying Dysthymia experiences an episode of Major Depressive Disorder (MDD). * **Treatment:** A combination of Pharmacotherapy (SSRIs are first-line) and Psychotherapy (CBT or Interpersonal Therapy) is more effective than either alone. * **Cyclothymia vs. Dysthymia:** Cyclothymia involves periods of hypomanic symptoms and depressive symptoms for 2 years, whereas Dysthymia is purely depressive.

Q: Early morning awakening and reduced latency of REM sleep is suggestive of which of the following conditions?

Depression. **Explanation:** The correct answer is **Depression**. Sleep disturbances are a hallmark of Major Depressive Disorder (MDD), occurring in approximately 90% of patients. **Why Depression is correct:** In clinical psychiatry, "Early Morning Awakening" (terminal insomnia) is considered a classic biological marker for melancholic depression. Furthermore, polysomnography in depressed patients characteristically shows specific changes in the architecture of REM (Rapid Eye Movement) sleep: 1. **Reduced REM Latency:** The time from sleep onset to the first REM period is shortened (usually <60 minutes). 2. **Increased REM Density:** An increase in the frequency of rapid eye movements during REM sleep. 3. **Increased REM Duration:** The first REM period lasts longer than usual. 4. **Reduced Slow-Wave Sleep (N3):** A decrease in deep, restorative sleep. **Why other options are incorrect:** * **Delirium:** Characterized by a reversal of the sleep-wake cycle and fragmented sleep, but not specific REM latency changes. * **Schizophrenia:** While sleep disturbances occur, they are non-specific (usually increased sleep latency or fragmentation). * **Anxiety:** Typically presents with "initial insomnia" (difficulty falling asleep) rather than early morning awakening. **High-Yield Clinical Pearls for NEET-PG:** * **Biological Markers of Depression:** Hypercortisolemia (failure to suppress on the Dexamethasone Suppression Test) and reduced REM latency are the most frequently tested markers. * **Sleep Patterns:** Initial insomnia = Anxiety; Terminal insomnia = Depression. * **Narcolepsy:** Also features reduced REM latency (Sleep-Onset REM periods or SOREMPs), but is distinguished by daytime cataplexy and sleep attacks.

Q: Electroconvulsive therapy (ECT) is most effective in which of the following conditions?

Severe depression. **Explanation:** **Electroconvulsive therapy (ECT)** is a biological treatment involving the induction of a generalized seizure through the application of electrical current to the brain. **Why Option B is correct:** Severe depression, particularly **Major Depressive Disorder (MDD) with psychotic features or suicidal ideation**, is the primary and most effective indication for ECT. It is considered the "gold standard" for rapid symptom relief when a patient is at high risk of self-harm, refuses to eat, or is resistant to pharmacological treatments. The response rate for ECT in severe depression is approximately 80-90%, which is higher than any antidepressant medication. **Why the other options are incorrect:** * **Options A & D (Conversion and Dissociative Disorders):** These are neurotic, stress-related disorders primarily managed with psychotherapy (like CBT) and stress management. ECT has no proven efficacy in treating the core symptoms of dissociation or conversion. * **Option C (Mania):** While ECT is effective in treating acute mania (especially delirious mania or lithium-resistant cases), it is generally considered a **second-line** treatment after mood stabilizers and antipsychotics. Severe depression remains the most common and effective indication. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves within 6 months). * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Mortality rate:** Approximately 0.01% (similar to general anesthesia). * **Electrode placement:** Bilateral ECT is more effective but carries a higher risk of cognitive side effects compared to Unilateral (d'Elia) placement. * **Drug of choice for anesthesia:** Methohexital (Barbiturate); Succinylcholine is used as a muscle relaxant to prevent fractures.

Q: Which of the following is not a feature of atypical depression?

TCAs are better than MAO and SSRI for treatment. **Explanation:** Atypical depression is a subtype of Major Depressive Disorder characterized by specific "reversed" vegetative symptoms. **Why Option A is the correct answer (The False Statement):** Historically, atypical depression shows a **poor response to Tricyclic Antidepressants (TCAs)**. The first-line pharmacological treatment is **SSRIs** (due to their safety profile). However, **MAO Inhibitors (MAOIs)** are considered the most effective (gold standard) for treatment-resistant atypical depression. Therefore, stating TCAs are better than MAOIs/SSRIs is clinically incorrect. **Analysis of Incorrect Options (Features of Atypical Depression):** * **Option B (Mood Reactivity):** This is the hallmark feature. Unlike melancholic depression, patients with atypical depression experience a brightening of mood in response to actual or potential positive events. * **Option C (Reversed Vegetative Symptoms):** While typical depression involves insomnia and anorexia, atypical depression is characterized by **hyperphagia** (increased appetite/weight gain) and **hypersomnia** (increased sleep). * **Option D (Leaden Paralysis):** This refers to a pathological clinical sensation where the patient feels a heavy, weighted-down feeling in the arms or legs, often described as "leaden." **High-Yield Clinical Pearls for NEET-PG:** * **Interpersonal Rejection Sensitivity:** A long-standing trait in these patients where they are overly sensitive to perceived slights or rejection, leading to significant social/occupational impairment. * **DSM-5 Criteria:** Requires Mood Reactivity **PLUS** two or more of: Weight gain/increased appetite, Hypersomnia, Leaden paralysis, or Rejection sensitivity. * **Demographics:** More common in younger patients and females compared to melancholic depression.

Q: Which of the following is NOT true about Major Depressive Disorder?

It is two times more common in men than women.. **Explanation:** **1. Why Option A is the Correct Answer (The False Statement):** In Major Depressive Disorder (MDD), the prevalence is significantly higher in females than in males. Epidemiological studies consistently show that **MDD is twice as common in women as in men** (a 2:1 ratio). This disparity is attributed to hormonal differences (estrogen/progesterone fluctuations), higher rates of psychosocial stressors, and differences in coping mechanisms. Therefore, the statement that it is more common in men is incorrect. **2. Analysis of Other Options:** * **Option B (Incidence increases with age):** While the peak age of onset is often cited between 20-40 years, the overall cumulative incidence and prevalence of depressive symptoms tend to increase with advancing age due to factors like chronic medical illnesses, social isolation, and bereavement. * **Option C (Onset in adulthood):** The mean age of onset for MDD is approximately 40 years. While it can occur in childhood, the majority of clinical presentations in females occur during their reproductive and adult years. * **Option D (Genetic origin):** MDD has a strong genetic component. First-degree relatives of patients with MDD are 2 to 3 times more likely to develop the disorder. Heritability is estimated at approximately 30-40%. **High-Yield Clinical Pearls for NEET-PG:** * **Most common psychiatric disorder:** MDD is often cited as the most common mood disorder in the general population. * **Neurotransmitters:** Primarily involves decreased levels of **Serotonin (5-HT)** and **Norepinephrine**. * **Sleep Changes:** Classic MDD features **Reduced REM latency** (entering REM sleep faster) and increased REM density. * **Treatment:** SSRIs are the first-line pharmacological treatment. For treatment-resistant or severe depression with suicidal ideation, **ECT (Electroconvulsive Therapy)** remains the most effective intervention.

Q: Which of the following is most characteristic of sleep in a 45-year-old woman with major depressive disorder?

Waking up too early in the morning. **Explanation:** Sleep disturbances are a hallmark of Major Depressive Disorder (MDD), affecting approximately 90% of patients. The most characteristic finding in "melancholic" or typical depression is **Terminal Insomnia**, also known as **Early Morning Awakening (EMA)**. **1. Why Option C is Correct:** In MDD, there is a significant disruption of the circadian rhythm. Patients typically wake up 2 to 3 hours before their usual time and are unable to fall back asleep. This is often associated with "diurnal variation," where depressive symptoms (low mood, hopelessness) are most severe in the morning and slightly improve as the day progresses. Polysomnography (PSG) in these patients typically shows decreased REM latency (entering REM sleep faster), increased REM density, and a reduction in deep sleep (Stage N3/Slow Wave Sleep). **2. Analysis of Incorrect Options:** * **Option A (Hypersomnia):** While "sleeping too much" occurs in **Atypical Depression**, it is less common than insomnia in the classic 45-year-old MDD presentation. * **Option B (Sudden sleep onset):** This describes **Narcolepsy** (sleep attacks), not depression. * **Option D (Sleep Drunkenness):** This refers to **Confusional Arousal**, often seen in sleep apnea, idiopathic hypersomnia, or certain sedative uses, but it is not a diagnostic feature of MDD. **Clinical Pearls for NEET-PG:** * **Most common sleep disturbance in MDD:** Middle insomnia (waking up during the night). * **Most characteristic/specific sleep disturbance in MDD:** Terminal insomnia (Early morning awakening). * **Gold Standard PSG finding:** **Shortened REM Latency** (REM sleep starts <60 minutes after sleep onset). This is a high-yield biological marker for depression.

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

Metformin. **Explanation:** The correct answer is **Metformin**. This question tests your knowledge of **Secondary Depression**, which refers to depressive symptoms caused by underlying medical conditions or pharmacological agents. **Why Metformin is the correct answer:** Metformin is a biguanide used as the first-line treatment for Type 2 Diabetes Mellitus. It is **not** associated with causing depression. In fact, emerging research suggests that by improving insulin sensitivity and reducing systemic inflammation, Metformin may have potential neuroprotective and antidepressant-like effects. **Analysis of incorrect options (Drugs that DO cause depression):** * **Clonazepam (Benzodiazepines):** Long-term use of benzodiazepines is a well-known cause of "depressant" effects on the CNS, often leading to lethargy, emotional blunting, and clinical depression. * **Methyldopa:** This centrally acting alpha-2 agonist (used in pregnancy-induced hypertension) depletes central biogenic amines (dopamine, norepinephrine, and serotonin), which is a classic pharmacological trigger for depressive episodes. * **Corticosteroids:** Steroid-induced mood disorders are common. While they can cause euphoria or psychosis acutely, chronic use or withdrawal frequently leads to severe depression. **High-Yield Clinical Pearls for NEET-PG:** * **Other common drugs causing depression:** Reserpine (classic example), Interferon-alpha, Isotretinoin (Accutane), Propranolol (Beta-blockers), and Oral Contraceptive Pills (OCPs). * **Medical causes of depression:** Hypothyroidism (most common endocrine cause), Cushing’s syndrome, Vitamin B12 deficiency, and Pancreatic carcinoma. * **Mnemonic for Methyldopa/Reserpine:** These drugs "deplete the tank" of neurotransmitters, leading to the "Biogenic Amine Hypothesis" of depression.

Q: Which of the following is not an indicator of a good prognosis for major depressive disorder?

A history of more than one previous depressive episode. **Explanation:** In Major Depressive Disorder (MDD), prognosis is determined by clinical history, social support, and the nature of the episodes. **Why Option C is the correct answer:** A history of **recurrent episodes** is one of the strongest indicators of a **poor prognosis**. Statistically, the risk of recurrence increases with each subsequent episode: after one episode, the risk of a second is 50%; after two, it is 70%; and after three, it rises to 90%. Frequent episodes often lead to a more chronic course, shorter periods of remission, and increased treatment resistance. **Analysis of Incorrect Options (Good Prognostic Factors):** * **Option A (Stable family functioning):** Strong social support and a stable home environment are significant protective factors that correlate with better treatment adherence and faster recovery. * **Option B (No more than one previous hospitalization):** Fewer hospitalizations suggest a less severe illness trajectory and better community-based management. * **Option D (Advanced age of onset):** While late-life depression has its own challenges (like vascular causes), a **late age of onset** in adulthood is generally considered a good prognostic factor compared to early-onset MDD (childhood/adolescence), which is often associated with higher genetic loading and personality pathology. **High-Yield Clinical Pearls for NEET-PG:** * **Good Prognostic Factors:** Acute onset, absence of psychotic symptoms, short duration of the index episode, and solid friendships/social support. * **Poor Prognostic Factors:** Co-morbid anxiety or personality disorders, male gender, substance abuse, and a history of more than two previous episodes. * **Most common age of onset:** Approximately 40 years (though it can occur at any age). * **Gender ratio:** Twice as common in females (2:1).

Question 1

An 82-year-old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is consulted at the request of her daughters, who think their mother is depressed because she is tearful, often talks about her dead husband, and states that she has heard his voice several times. She blames herself for not having gone with him on his last visit to his sister and cries frequently. She has never seen a psychiatrist before and has been "strong" all her life. Which of the following is the most likely diagnosis?

Accepted Answer

Grief reaction

Answer

Depression secondary to general medical condition

Answer

Dysthymia

Answer

Major depressive disorder

Question 2

What is dysthymia?

Accepted Answer

Chronic depression

Answer

Chronic mania

Answer

Bipolar disorder

Answer

Personality disorder

Question 3

Early morning awakening and reduced latency of REM sleep is suggestive of which of the following conditions?

Accepted Answer

Depression

Answer

Delirium

Answer

Schizophrenia

Answer

Anxiety

Question 4

An elderly lady is becoming increasingly irritable. She displays unusual anger at the noise made by her children and sometimes harms them. What kind of psychiatric disorder does this lady have?

Accepted Answer

Severe depression

Answer

Schizophrenia

Answer

Paranoia

Answer

Phobia

Question 5

Electroconvulsive therapy (ECT) is most effective in which of the following conditions?

Accepted Answer

Severe depression

Answer

Conversion disorder

Answer

Mania

Answer

Dissociative disorder

Question 6

Which of the following is not a feature of atypical depression?

Accepted Answer

TCAs are better than MAO and SSRI for treatment

Answer

Variable mood responding to positive stimuli in surroundings

Answer

Increased sleep and weight gain

Answer

Marked fatigue and heaviness in the body

Question 7

Which of the following is NOT true about Major Depressive Disorder?

Accepted Answer

It is two times more common in men than women.

Answer

Its incidence increases with increasing age.

Answer

In affected females, the onset is typically in adulthood.

Answer

It has a genetic origin.

Question 8

Which of the following is most characteristic of sleep in a 45-year-old woman with major depressive disorder?

Accepted Answer

Waking up too early in the morning

Answer

Sleeping too many hours at night

Answer

Falling asleep suddenly during the daytime

Answer

Having difficulty coming fully awake after sleep

Question 9

Which of the following is NOT a cause of depression?

Accepted Answer

Metformin

Answer

Clonazepam

Answer

Methyldopa

Answer

Corticosteroid

Question 10

Which of the following is not an indicator of a good prognosis for major depressive disorder?

Accepted Answer

A history of more than one previous depressive episode

Answer

Stable family functioning

Answer

No more than one previous hospitalization

Answer

Advanced age of onset

Mood Disorders — MCQs

Mood Disorders — MCQs

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