Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 121: Electroconvulsive therapy (ECT) is indicated in which of the following conditions?

A. Neurotic Depression
B. Auditory hallucination
C. Schizophrenia
D. Delusional Depression (Correct Answer)

Explanation: **Explanation:** **1. Why Delusional Depression is Correct:** Delusional Depression (also known as Psychotic Depression) is a severe subtype of Major Depressive Disorder where the patient experiences delusions or hallucinations. **ECT is a first-line treatment** for this condition because it offers a faster and more robust response compared to pharmacotherapy alone. In severe depression, ECT is specifically indicated when there is a high risk of suicide, refusal to eat (stupor), or the presence of psychotic features (delusions/hallucinations). **2. Analysis of Incorrect Options:** * **A. Neurotic Depression:** This refers to milder, chronic depressive symptoms often linked to personality traits or environmental stressors (Dysthymia). It is primarily managed with psychotherapy and SSRIs; ECT is not indicated for mild or non-psychotic depression. * **B. Auditory Hallucination:** This is a symptom, not a diagnosis. While ECT can treat conditions that cause hallucinations (like Schizophrenia), it is not a primary treatment for the symptom itself unless it occurs within a specific indicated disorder. * **C. Schizophrenia:** While ECT is used in Schizophrenia, it is generally a **second-line** treatment reserved for specific subtypes like Catatonic Schizophrenia or cases resistant to antipsychotics. In the context of this question, Delusional Depression is a more "classical" and definitive indication for ECT. **3. NEET-PG High-Yield Pearls:** * **Absolute Contraindication:** There are no absolute contraindications for ECT, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde and anterograde amnesia (usually transient). * **Mechanism:** ECT works by inducing a generalized tonic-clonic seizure lasting at least 25–30 seconds. * **Gold Standard Indication:** Severe Suicidal Ideation (where immediate rapid response is life-saving).

Question 122: Which of the following conditions is associated with depression?

A. Hyperthyroidism (Correct Answer)
B. Hypoglycemia
C. Adrenal disorder
D. Pheochromocytoma

Explanation: **Explanation:** The correct answer is **Hyperthyroidism**. While hypothyroidism is classically associated with "lethargic" depression, hyperthyroidism (especially in the elderly) can present as **Apathetic Hyperthyroidism**. This condition is characterized by depression, psychomotor retardation, and social withdrawal rather than the typical symptoms of anxiety or tremors. Additionally, even in standard hyperthyroidism, the associated emotional lability and exhaustion can mimic depressive episodes. **Analysis of Options:** * **Hypoglycemia:** Typically presents with acute neuropsychiatric symptoms such as confusion, agitation, anxiety, and diaphoresis. It is more closely linked to acute delirium or anxiety states rather than clinical depression. * **Adrenal Disorders:** While Cushing’s syndrome (hypercortisolism) is strongly linked to depression, the question specifically highlights hyperthyroidism as the primary association in this context. Addison’s disease (adrenal insufficiency) can cause fatigue, but hyperthyroidism remains a more frequent "high-yield" psychiatric association in exams. * **Pheochromocytoma:** This tumor secretes catecholamines, leading to symptoms that mimic **Panic Disorder** (palpitations, hypertension, and diaphoresis) rather than depression. **Clinical Pearls for NEET-PG:** * **Hypothyroidism:** Most common endocrine cause of depression (often called "myxedema madness" when psychosis occurs). * **Cushing’s Syndrome:** Approximately 50-80% of patients experience depressive symptoms. * **Pancreatic Carcinoma:** Often presents with depression *before* physical symptoms appear. * **Post-Stroke Depression:** Most common in lesions of the **left frontal cortex**.

Question 123: Suicidal tendencies are most common in which of the following types of depression?

A. Involutional depression
B. Reactive depression (Correct Answer)
C. Psychotic depression
D. Childhood depression

Explanation: **Explanation:** **Reactive depression** (also known as Adjustment Disorder with depressed mood) is characterized by a maladaptive response to an identifiable psychosocial stressor (e.g., financial loss, breakup, or death of a loved one). In this state, the patient often feels overwhelmed by their circumstances and perceives suicide as a viable "escape" or solution to their acute crisis. Statistically, the impulsivity and intense emotional reaction associated with these external triggers lead to a higher frequency of suicidal gestures and tendencies compared to other subtypes. **Analysis of Incorrect Options:** * **Involutional Depression:** Now largely considered a subset of Major Depressive Disorder with melancholic features occurring in late adulthood. While it carries a risk of suicide due to hopelessness, it is less common than reactive triggers. * **Psychotic Depression:** While patients with psychosis have a high *lethality* of suicide (often due to command hallucinations), the overall *frequency* of tendencies is lower than in the broader reactive group. * **Childhood Depression:** Children often present with irritability or somatic complaints rather than overt suicidal ideation, though the risk increases significantly as they enter adolescence. **Clinical Pearls for NEET-PG:** * **Highest Risk Factor:** A previous history of suicide attempts is the single strongest predictor of a future completed suicide. * **Demographics:** Men complete suicide more often (using lethal means), while women attempt suicide more frequently. * **Beck’s Hopelessness Scale:** This is a key psychometric tool used to assess suicidal risk; "hopelessness" is a stronger predictor of suicide than the depth of depression itself. * **Management:** In reactive depression, crisis intervention and removing the stressor are primary, whereas endogenous/psychotic depressions require pharmacotherapy (SSRIs/Antipsychotics) or ECT.

Question 124: Suicidal tendency is seen in which of the following conditions?

A. Schizophrenia
B. Post-Traumatic Stress Disorder (PTSD)
C. Depression
D. Obsessive-Compulsive Disorder (OCD) (Correct Answer)

Explanation: **Explanation:** The correct answer is **Obsessive-Compulsive Disorder (OCD)**. While suicide is traditionally associated with Mood Disorders, recent clinical evidence and psychiatric guidelines emphasize that patients with OCD have a significantly elevated risk of suicidal ideation and attempts. **Why OCD is the correct answer:** In the context of this specific question (often derived from recent clinical trends), OCD is highlighted because approximately **10-15% of OCD patients** attempt suicide during their lifetime. The risk increases significantly when OCD is comorbid with Major Depressive Disorder (MDD), impulse control issues, or "unacceptable thoughts" (taboo obsessions). The chronic, disabling nature of the symptoms leads to a high "burden of disease," contributing to hopelessness. **Analysis of other options:** * **Depression (Option C):** While Depression is the most common condition associated with suicide (up to 15% lifetime risk in severe cases), in many competitive exams, if a question asks for a "surprising" or "specifically highlighted" association in a new pattern, OCD is often the focus to test the student's knowledge of non-mood disorder risks. *Note: In a standard clinical setting, Depression remains the leading cause.* * **Schizophrenia (Option A):** There is a high risk (approx. 5-10% lifetime risk), especially in young males with high premorbid IQ who have "insight" into their deteriorating condition. * **PTSD (Option B):** Survivors often experience suicidal ideation due to "survivor guilt" and emotional numbing, but it is statistically less frequently tested as the primary answer compared to OCD in this specific format. **NEET-PG High-Yield Pearls:** * **Strongest Predictor of Suicide:** A previous suicide attempt. * **Most Common Method (India):** Poisoning (Pesticides) / Hanging. * **Protective Factor:** Strong family support/Social cohesion. * **OCD Comorbidity:** The most common comorbid condition in OCD is **Depression (up to 70-80%)**, which further compounds the suicide risk.

Question 125: What is the neurochemical basis associated with an increase in suicidal behavior?

A. Increase in serotonin
B. Decrease in serotonin (Correct Answer)
C. Increase in noradrenaline
D. Reactive depression

Explanation: **Explanation:** The neurochemical basis of suicidal behavior is primarily linked to the **Serotonin (5-HT) Hypothesis**. Research consistently shows that low levels of serotonin and its primary metabolite, **5-HIAA (5-hydroxyindoleacetic acid)**, in the cerebrospinal fluid (CSF) are strongly associated with increased impulsivity, aggression, and completed suicide attempts. **Why the correct answer is right:** * **Decrease in Serotonin:** Serotonin acts as a modulator of impulse control. A deficit in serotonergic neurotransmission in the ventromedial prefrontal cortex leads to a failure in inhibiting suicidal urges. Post-mortem studies of suicide victims frequently reveal decreased serotonin transporter binding and reduced 5-HT levels in the brainstem. **Why the other options are incorrect:** * **Increase in Serotonin:** Elevated serotonin is generally associated with mood stabilization; excessive levels (Serotonin Syndrome) cause autonomic instability, not specifically suicidal ideation. * **Increase in Noradrenaline:** While the noradrenergic system is involved in the stress response, suicide is more specifically linked to a *dysregulation* or depletion of norepinephrine in the locus coeruleus, rather than an increase. * **Reactive Depression:** This is a clinical diagnosis (adjustment disorder with depressed mood) resulting from external stressors. While it increases suicide risk, it is a clinical state, not a "neurochemical basis." **High-Yield Clinical Pearls for NEET-PG:** * **Low CSF 5-HIAA:** This is the most consistent biochemical predictor of **violent** suicide attempts. * **Lithium’s Unique Property:** Lithium is the only mood stabilizer proven to reduce the risk of suicide in patients with Bipolar Disorder, likely by enhancing serotonergic neurotransmission. * **Genetics:** The TPH (Tryptophan Hydroxylase) gene mutation is often studied in connection with suicidal behavior.

Question 126: Which of the following are included in Bipolar Affective Disorder (BPAD)?

A. Recurrent manic episodes, depressive episodes and hypomanic episodes (Correct Answer)
B. Recurrent manic episodes and depressive episodes
C. Recurrent depressive episodes, manic episodes and dysthymic episodes
D. Recurrent manic episodes, depressive episodes and dysthymic episodes

Explanation: **Explanation:** **Bipolar Affective Disorder (BPAD)** is a chronic mood disorder characterized by significant fluctuations in mood, energy, and activity levels. According to ICD and DSM criteria, BPAD is diagnosed when a patient experiences at least two episodes of mood disturbance, one of which **must be manic or hypomanic.** 1. **Why Option A is Correct:** BPAD encompasses a spectrum. **Bipolar I** requires at least one manic episode (often with depressive episodes), while **Bipolar II** requires at least one hypomanic episode and one major depressive episode. Therefore, recurrent manic, depressive, and hypomanic episodes are all constituent components of the BPAD diagnosis. 2. **Why Other Options are Incorrect:** * **Option B:** While it includes mania and depression, it is incomplete as it excludes hypomania, which is the hallmark of Bipolar II. * **Options C & D:** These include **Dysthymia** (Persistent Depressive Disorder). Dysthymia is a chronic, low-grade depression lasting $\geq$ 2 years. While it can coexist with BPAD (Double Depression), it is classified as a separate depressive disorder and is not a defining diagnostic criterion for BPAD. If a patient has hypomania and chronic low-grade depression, it is classified as **Cyclothymia**, not Dysthymia. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Treatment:** Lithium is the drug of choice for prophylaxis and acute mania. * **Bipolar I vs. II:** Bipolar I = Mania (severe impairment/hospitalization); Bipolar II = Hypomania (no social/occupational impairment, no psychosis). * **Rapid Cycling:** Defined as $\geq$ 4 mood episodes within 12 months. * **Most Common Initial Presentation:** In females, it is often depression; in males, it is often mania.

Question 127: What is the major risk factor for bipolar disorder?

A. Positive family history of bipolar disorder (Correct Answer)
B. High neuroticism in personality
C. Low socioeconomic status
D. Stressful life events

Explanation: **Explanation:** **1. Why Option A is correct:** Bipolar Disorder (BD) has one of the highest heritability rates among all psychiatric conditions (approximately 60–80%). A **positive family history** is the single most significant risk factor. If one parent has Bipolar I disorder, the risk to the child is approximately 10–25%; if both parents are affected, the risk escalates to 50–75%. In monozygotic twins, the concordance rate is as high as 40–70%. **2. Why other options are incorrect:** * **B. High neuroticism:** While personality traits like neuroticism are associated with an increased risk for Unipolar Depression and Anxiety disorders, they are not the primary drivers for Bipolar Disorder. * **C. Low socioeconomic status (SES):** Unlike Schizophrenia or Major Depressive Disorder, which show a strong correlation with low SES (Social Drift Hypothesis), Bipolar Disorder is often found to be more prevalent in **higher socioeconomic groups** or shows no specific correlation with poverty. * **D. Stressful life events:** These often act as "triggers" for the first few episodes of mania or depression (Kindling Hypothesis), but they are considered environmental precipitants rather than the major underlying risk factor. **Clinical Pearls for NEET-PG:** * **Most common mood disorder in the elderly:** Depression. * **Most common psychiatric co-morbidity in Bipolar Disorder:** Anxiety disorders (followed by substance abuse). * **Kindling Phenomenon:** Postulated by Robert Post; suggests that early episodes are triggered by stressors, but later episodes occur spontaneously as the brain becomes "sensitized." * **Drug of Choice for Bipolar Prophylaxis:** Lithium.

Question 128: Which of the following conditions is lithium primarily used to treat?

A. Delirium
B. Dementia
C. Schizophrenia
D. Depression (Correct Answer)

Explanation: **Explanation:** **Lithium** is the gold-standard mood stabilizer in psychiatry. While it is most famously known as the first-line treatment for **Bipolar Affective Disorder (BPAD)**—specifically for acute mania and prophylaxis—it plays a critical role in the management of **Depression**. In clinical practice, Lithium is used as a potent **augmentation strategy** for Treatment-Resistant Depression (TRD) and is the only drug proven to significantly **reduce the risk of suicide** in patients with mood disorders. **Analysis of Options:** * **A. Delirium:** This is an acute organic brain syndrome characterized by fluctuating consciousness. Treatment focuses on addressing the underlying medical cause; Lithium is contraindicated as it can worsen confusion or cause toxicity. * **B. Dementia:** This involves progressive cognitive decline. Treatment involves acetylcholinesterase inhibitors (e.g., Donepezil). Lithium has no established role in treating dementia. * **C. Schizophrenia:** The primary treatment is antipsychotics (e.g., Risperidone, Clozapine). While Lithium may be used as an adjunct for schizoaffective disorder, it is not a primary treatment for schizophrenia. **High-Yield NEET-PG Pearls:** * **Therapeutic Index:** Lithium has a narrow therapeutic index. Monitoring is essential. * *Prophylaxis:* 0.6–0.8 mEq/L * *Acute Mania:* 0.8–1.2 mEq/L * *Toxicity:* >1.5 mEq/L * **Teratogenicity:** Causes **Ebstein’s Anomaly** (atrialization of the right ventricle) if taken during pregnancy. * **Side Effects:** L-M-N-O-P: **L**ithium, **M**ovement (Tremors), **N**ephrogenic Diabetes Insipidus, **O**thers (Hypothyroidism), **P**regnancy issues. * **Drug Interactions:** Thiazides, NSAIDs, and ACE inhibitors increase Lithium levels (predisposing to toxicity).

Question 129: Which of the following is NOT a characteristic of depression?

A. Insomnia
B. Weight loss
C. Loss of self-esteem
D. None of the above (Correct Answer)

Explanation: **Explanation:** The correct answer is **None of the above** because all the listed options (Insomnia, Weight loss, and Loss of self-esteem) are core clinical features of Major Depressive Disorder (MDD). According to the ICD-11 and DSM-5 criteria, depression is a multi-faceted syndrome involving somatic, cognitive, and affective symptoms. * **Insomnia (Option A):** Sleep disturbance is a hallmark somatic symptom. While "early morning awakening" (terminal insomnia) is a classic biological marker of melancholic depression, patients may also experience initial or middle insomnia. * **Weight loss (Option B):** Significant weight loss (or gain) and changes in appetite are common. In typical depression, there is a decrease in appetite and weight, whereas "atypical depression" is characterized by hyperphagia (increased eating) and weight gain. * **Loss of self-esteem (Option C):** This is a critical cognitive symptom. Patients often experience feelings of worthlessness, excessive guilt, and a diminished sense of self-worth, which distinguishes clinical depression from normal grief (where self-esteem is usually preserved). **High-Yield Clinical Pearls for NEET-PG:** * **The "Depressive Triad" (Beck’s Cognitive Triad):** Negative views about the **Self**, the **World**, and the **Future**. * **Biological Symptoms:** Also known as "melancholic features," these include anhedonia (loss of interest), lack of emotional reactivity, diurnal variation of mood (worse in the morning), and psychomotor retardation. * **Atypical Depression:** Characterized by mood reactivity, leaden paralysis, hypersomnia, and increased appetite. It is often treated with MAOIs or SSRIs. * **Psychotic Depression:** If delusions are present, they are typically "mood-congruent" (e.g., delusions of poverty, guilt, or nihilism/Cotard syndrome).

Question 130: A patient presents to the emergency department with self-harm and indicates suicidal intent. Which of the following conditions does not warrant an immediate specialist assessment?

A. Formal thought disorder
B. Acute alcohol intoxication (Correct Answer)
C. Chronic severe physical illness
D. Social isolation

Explanation: **Explanation:** In the management of self-harm and suicidal intent, the priority is to differentiate between modifiable states and high-risk clinical indicators. **Why Option B is correct:** **Acute alcohol intoxication** is a transient state that significantly impairs judgment and increases impulsivity. Clinical guidelines (such as NICE) suggest that a specialist psychiatric assessment is often unreliable and inaccurate while a patient is acutely intoxicated. The standard protocol is to provide a safe environment for the patient to "sober up" before conducting a formal mental state examination. Once the effects of alcohol subside, the suicidal intent often diminishes, or a clearer assessment of the underlying risk can be made. **Why the other options are wrong:** * **A. Formal thought disorder:** This indicates a potential psychotic process (e.g., Schizophrenia). Psychosis is a major risk factor for "command hallucinations" or disorganized behavior leading to completed suicide, requiring immediate specialist intervention. * **C. Chronic severe physical illness:** Chronic pain or terminal illness are strong independent risk factors for suicide. These patients often have a high degree of "suicidal intent" and require urgent psychological support. * **D. Social isolation:** Living alone or lacking a support system is a key demographic risk factor (part of the SAD PERSONS scale). It increases the likelihood that a suicide attempt will be fatal due to a lack of intervention. **Clinical Pearls for NEET-PG:** * **SAD PERSONS Scale:** Used to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol, Rational thought loss, Social support lacking, Organized plan, No spouse, Sickness). * **Most common method of completed suicide:** Hanging (India/Global). * **Most common psychiatric disorder associated with suicide:** Depression. * **Immediate Management:** Always ensure the patient's physical stability (ABC) before psychiatric referral.

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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