Mood Disorders — MCQs

A 27-year-old nurse, who recently experienced a relationship breakup, presented with a two-month history of losing interest in her hobbies and a conviction that she could not work again. She expressed thoughts of life not being worth living and attempted suicide by consuming phenobarbitone. What is the most likely diagnosis?

Q139Easy

In clinical practice, what is the most common psychiatric illness seen?

Q140Easy

Exercise is also prescribed as an adjuvant treatment for depression. Most probably, it acts by:

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 131: Which of the following drugs are used in the management of Bipolar Disorder?

A. Benzodiazepines
B. Lithium
C. Sodium valproate
D. All of the above (Correct Answer)

Explanation: **Explanation:** The management of Bipolar Disorder (BD) requires a multi-faceted pharmacological approach targeting different phases of the illness: acute mania, acute depression, and maintenance (prophylaxis). * **Lithium (Option B):** Considered the **gold standard** and first-line treatment for Bipolar Disorder. It is highly effective for acute mania and is the only drug proven to reduce the risk of suicide in these patients. It is primarily used for maintenance to prevent relapses. * **Sodium Valproate (Option C):** An anticonvulsant that acts as a potent mood stabilizer. It is often preferred over Lithium for **rapid cycling** bipolar disorder and **mixed episodes**. It works by increasing GABA levels in the brain. * **Benzodiazepines (Option D):** While not "mood stabilizers" themselves, drugs like Lorazepam or Clonazepam are essential in the **acute management of mania**. They are used as adjuncts to provide rapid sedation, control psychomotor agitation, and restore sleep patterns until mood stabilizers reach therapeutic levels. Since all three classes play a vital role in the comprehensive management of the disorder, **"All of the above"** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** 1. **Therapeutic Index:** Lithium has a narrow therapeutic index (0.6–1.2 mEq/L). Toxicity occurs >1.5 mEq/L. 2. **Teratogenicity:** Lithium is associated with **Ebstein’s Anomaly** (tricuspid valve defect), while Valproate is associated with **Neural Tube Defects** (e.g., Spina Bifida). 3. **Drug of Choice:** Lithium is the DOC for classic mania; Valproate is the DOC for rapid cycling. 4. **Atypical Antipsychotics:** Drugs like Quetiapine, Olanzapine, and Risperidone are also first-line agents for acute mania.

Question 132: Intense depression and misery without any apparent cause is characteristic of which of the following?

A. Melancholia (Correct Answer)
B. Mania
C. Schizophrenia
D. Major depressive disorder

Explanation: **Explanation:** **1. Why Melancholia is correct:** Melancholia (or Melancholic Depression) is a severe subtype of clinical depression characterized by a complete loss of pleasure (anhedonia) and a lack of reactivity to usually pleasurable stimuli. The hallmark of melancholia is that the intense misery and depression occur **without an apparent external cause** (endogenous origin). Patients often experience "distinct quality" of depressed mood, psychomotor retardation or agitation, and symptoms that are typically worse in the morning (diurnal variation). **2. Why the other options are incorrect:** * **B. Mania:** This is the polar opposite of depression. It is characterized by elation, hyperactivity, pressured speech, and decreased need for sleep. * **C. Schizophrenia:** This is a primary psychotic disorder. While it can involve "flat affect" or "anhedonia," its core features are delusions, hallucinations, and disorganized thinking rather than primary intense misery. * **D. Major Depressive Disorder (MDD):** While melancholia is a type of MDD, the question specifically asks for the characteristic of intense misery *without apparent cause*. MDD is a broad category that can be triggered by external stressors (reactive depression). Melancholia is the specific term for the severe, autonomous, and biological form of depression described. **High-Yield Clinical Pearls for NEET-PG:** * **Somatic Symptoms:** Melancholia is often associated with the "Somatic Syndrome" (ICD-10), which includes early morning awakening (at least 2 hours before usual), significant weight loss, and marked loss of libido. * **Treatment:** Melancholic depression often shows a superior response to biological treatments like TCAs (Tricyclic Antidepressants) and ECT (Electroconvulsive Therapy) compared to non-melancholic depression. * **Cotard’s Syndrome:** In severe melancholia, patients may develop nihilistic delusions (e.g., believing their organs are rotting or they are dead).

Question 133: Leaden paralysis is seen in which of the following conditions?

A. Severe depression
B. Melancholic depression
C. Atypical depression (Correct Answer)
D. Narcolepsy

Explanation: **Explanation:** **Atypical Depression** is a subtype of Major Depressive Disorder (MDD) characterized by specific clinical features that differ from "classic" or melancholic depression. **Leaden paralysis** is a hallmark symptom of this condition; it refers to a heavy, weighted-down feeling in the arms or legs, often described by patients as if their limbs are made of lead. According to the DSM-5, the diagnosis of Atypical Depression requires **Mood Reactivity** (the ability to feel better in response to positive events) plus at least two of the following: 1. **Leaden paralysis.** 2. **Hyperphagia** (increased appetite or weight gain). 3. **Hypersomnia** (increased sleep). 4. **Long-standing pattern of interpersonal rejection sensitivity.** **Analysis of Incorrect Options:** * **Severe/Melancholic Depression:** These are characterized by "vegetative" symptoms which are the opposite of atypical features. Patients typically experience **insomnia** (specifically early morning awakening) and **anorexia** (weight loss), rather than hypersomnia and hyperphagia. * **Narcolepsy:** While narcolepsy involves sleep disturbances and **cataplexy** (sudden loss of muscle tone), it does not feature the chronic heavy-limb sensation defined as leaden paralysis. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** SSRIs are the first-line treatment. However, **MAO Inhibitors** (like Phenelzine) are historically noted for being exceptionally effective for atypical depression if SSRIs fail. * **Mood Reactivity** is the "must-have" core feature for the DSM-5 specifier. * Atypical depression often has an earlier age of onset and a more chronic course compared to melancholic depression.

Question 134: All of the following statements concerning bipolar disorder (manic-depressive psychosis) are true EXCEPT:

A. It has a younger age of onset in women.
B. The female to male ratio is 2:1. (Correct Answer)
C. There is a predisposition in aggressive women with masculine traits.
D. Diagnosis is reliable across geographic areas.

Explanation: **Explanation:** **1. Why Option B is the correct answer (The False Statement):** In **Bipolar Disorder (BPAD)**, the prevalence is **equal among men and women (1:1 ratio)**. This is a crucial distinction from Major Depressive Disorder (MDD), where the female-to-male ratio is indeed 2:1. In BPAD, while the overall prevalence is equal, clinical presentations differ: manic episodes are more common in men, whereas depressive episodes and rapid cycling are more frequent in women. **2. Analysis of Incorrect Options (True Statements):** * **Option A:** Studies indicate that women often have an earlier age of onset for bipolar symptoms compared to men, frequently presenting with a depressive episode as their first manifestation. * **Option C:** Historically, psychoanalytic and personality theories (such as those by Kretschmer) suggested a predisposition to bipolarity in individuals with "cyclothymic" temperaments or specific personality traits, including aggressive or assertive behaviors in women. * **Option D:** Unlike some personality disorders, the diagnostic criteria for Bipolar Disorder (based on ICD-11 or DSM-5) are highly standardized. The core symptoms of mania (elation, pressured speech, decreased need for sleep) are cross-culturally consistent and reliable. **Clinical Pearls for NEET-PG:** * **Mean age of onset:** 20–25 years (Earlier than MDD). * **Strongest Genetic Link:** BPAD has the highest heritability among major psychiatric disorders (Concordance rate: ~70-80% in monozygotic twins). * **First-line treatment:** Lithium is the gold standard for prophylaxis. * **Postpartum risk:** Women with BPAD have a significantly higher risk of developing **Postpartum Psychosis**.

Question 135: What is the most common comorbid illness with depression?

A. Anxiety disorder
B. Substance use disorder (Correct Answer)
C. Obsessive-compulsive disorder
D. Comorbid illnesses are rare

Explanation: **Explanation:** In the context of psychiatric epidemiology, **Substance Use Disorder (SUD)** is recognized as the most common comorbid condition associated with Major Depressive Disorder (MDD). This relationship is bidirectional: patients often use substances (most commonly alcohol) as a form of "self-medication" to alleviate depressive symptoms, while chronic substance abuse can lead to neurochemical imbalances that precipitate or worsen depression. According to various clinical studies and textbooks (including Kaplan & Sadock), approximately one-third to one-half of individuals with a mood disorder will meet the criteria for a substance use disorder during their lifetime. **Analysis of Options:** * **Option A (Anxiety Disorder):** While anxiety symptoms are extremely common in depression (often termed "Anxious Distress"), and comorbid anxiety disorders are frequent, epidemiological data consistently rank SUD as the most prevalent co-occurring condition in clinical populations. * **Option C (Obsessive-Compulsive Disorder):** Although OCD and depression frequently coexist, the prevalence of this specific comorbidity is significantly lower than that of substance use or generalized anxiety. * **Option D (Rare):** This is incorrect; comorbidity is the rule rather than the exception in psychiatry. Over 50% of patients with MDD have at least one other psychiatric diagnosis. **Clinical Pearls for NEET-PG:** * **Alcohol** is the most common substance associated with depression. * **Dual Diagnosis:** This term refers to the coexistence of a mental health disorder and a substance use disorder. * **Prognosis:** Comorbid SUD in depression is a high-yield fact because it is associated with an increased risk of **suicide**, poorer treatment compliance, and a more chronic disease course. * **Gender Difference:** In women, depression often precedes the substance use; in men, the substance use often precedes the depression.

Question 136: In all of the following conditions, suicidal attempts are more common, EXCEPT?

A. Panic attack (Correct Answer)
B. Severe depression
C. Bipolar disorder
D. Old age

Explanation: **Explanation:** The core of this question lies in distinguishing between **suicidal ideation/risk** and the acute presentation of an anxiety disorder. **Why Panic Attack is the correct answer:** While patients experiencing a **Panic Attack** often feel an "impending sense of doom" or a "fear of dying," they do not typically have an active intent to end their lives during the episode. Panic attacks are characterized by intense autonomic hyperactivity (tachycardia, sweating, tremors). While chronic Panic Disorder can increase long-term suicide risk due to comorbidity, an isolated panic attack is not a condition where suicidal *attempts* are a hallmark feature, unlike the other options. **Analysis of Incorrect Options:** * **Severe Depression:** This is the most common psychiatric condition associated with suicide. Feelings of hopelessness, worthlessness, and anhedonia are strong drivers for suicidal attempts. * **Bipolar Disorder:** Patients with Bipolar Disorder (especially during **mixed episodes** or the depressive phase) have a significantly higher rate of suicide attempts compared to the general population. The impulsivity associated with the illness increases the lethality of attempts. * **Old Age:** Elderly individuals (especially males) are a high-risk demographic. Factors like social isolation, chronic physical illness, bereavement, and "silent suicide" (refusing food/meds) contribute to higher rates of completed suicides in this group. **NEET-PG High-Yield Pearls:** * **Strongest Predictor of Suicide:** A previous history of suicide attempts. * **Most Common Method (India):** Poisoning (Pesticides), followed by Hanging. * **Gender Paradox:** Females attempt suicide more frequently, but males complete suicide more often (due to more lethal methods). * **Protective Factor:** Strong social/family support and pregnancy are significant protective factors against suicide.

Question 137: A 30-year-old lady is described as being very talkative, even to strangers. She frequently compares herself to her colleagues and exhibits agitation, moving from one task to another due to hyperactivity. Which of the following is the most likely diagnosis?

A. Mania (Correct Answer)
B. Depression
C. Schizophrenia
D. Psychosis

Explanation: ### Explanation **Correct Option: A. Mania** The clinical presentation of the patient—**increased talkativeness (pressure of speech)**, **hyperactivity**, and **agitation**—is characteristic of a manic episode. In Mania, patients often exhibit a "flight of ideas" or distractibility, leading them to move rapidly from one task to another without completion. The comparison to colleagues often stems from **inflated self-esteem or grandiosity**, where the patient feels superior or more capable than others. According to ICD-10/DSM-5 criteria, these symptoms must persist for at least one week and cause significant functional impairment to qualify as Mania. **Why other options are incorrect:** * **B. Depression:** This is the polar opposite of the described state. Depression presents with low mood, anhedonia, psychomotor retardation (slowness), and decreased energy. * **C. Schizophrenia:** While agitation can occur, Schizophrenia is primarily characterized by "Schneiderian First Rank Symptoms" like delusions, hallucinations, and thought disorders, rather than pure mood and activity disturbances. * **D. Psychosis:** This is a broad umbrella term (a symptom, not a specific diagnosis) referring to a loss of contact with reality. While Mania can have psychotic features, "Mania" is the more specific and accurate diagnosis for this clinical triad of mood, speech, and activity changes. **NEET-PG High-Yield Pearls:** * **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), **T**alkativeness. * **Key Difference:** If symptoms last $\geq$ 4 days without significant social/occupational impairment and no psychosis, it is **Hypomania**. * **Drug of Choice:** **Lithium** is the gold standard for long-term management and prophylaxis of Bipolar Disorder. For acute agitation in mania, atypical antipsychotics or Valproate are often used.

Question 138: A 27-year-old nurse, who recently experienced a relationship breakup, presented with a two-month history of losing interest in her hobbies and a conviction that she could not work again. She expressed thoughts of life not being worth living and attempted suicide by consuming phenobarbitone. What is the most likely diagnosis?

A. Adjustment disorder
B. Acute stress disorder
C. Depressive disorder (Correct Answer)
D. Post traumatic stress disorder

Explanation: ### Explanation The patient presents with the classic triad of **Major Depressive Disorder (MDD)**: low mood (implied), anhedonia (loss of interest in hobbies), and low energy/worthlessness (conviction she cannot work). **1. Why Depressive Disorder is Correct:** According to ICD and DSM criteria, a diagnosis of a depressive episode requires symptoms to persist for at least **2 weeks**. This patient has a **2-month history**, meeting the temporal criteria. Furthermore, the presence of **suicidal ideation and a serious suicide attempt** (phenobarbitone overdose) signifies a severe depressive episode. While a breakup can be a stressor, the severity and duration of symptoms shift the diagnosis from a simple reaction to a clinical mood disorder. **2. Why Other Options are Incorrect:** * **Adjustment Disorder:** This involves emotional or behavioral symptoms in response to an identifiable stressor. However, it is a "diagnosis of exclusion." If the symptoms meet the full criteria for MDD (as they do here), MDD takes diagnostic precedence. * **Acute Stress Disorder (ASD):** ASD occurs within **1 month** of a traumatic event and lasts for less than a month. It is characterized by dissociative symptoms and re-experiencing the trauma. This patient’s symptoms have lasted 2 months and lack the specific features of ASD. * **Post-Traumatic Stress Disorder (PTSD):** PTSD requires symptoms to last **more than 1 month** following a life-threatening traumatic event. A relationship breakup is generally considered a "stressor" rather than a "traumatic event" (like war or assault) required for a PTSD diagnosis. **Clinical Pearls for NEET-PG:** * **Duration Criteria:** MDD (2 weeks), ASD (3 days to 1 month), PTSD (>1 month), Dysthymia (2 years). * **Suicide Risk:** A history of a previous attempt is the strongest predictor of a completed suicide. * **First-line Treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the gold standard for MDD.

Question 139: In clinical practice, what is the most common psychiatric illness seen?

A. Maniac disorder
B. Schizophrenia
C. Depressive disorder (Correct Answer)
D. Bipolar disorder

Explanation: **Explanation:** **1. Why Depressive Disorder is Correct:** Depressive disorder (specifically Major Depressive Disorder) is the most common psychiatric illness encountered in clinical practice globally and in India. According to the National Mental Health Survey (NMHS) and WHO data, depression has the highest prevalence among all mental disorders, affecting approximately 5% of the adult population. It is the leading cause of disability worldwide and a major contributor to the global burden of disease. In a clinical setting, patients often present not only with core psychological symptoms (low mood, anhedonia) but also with somatic complaints, making it the most frequent diagnosis in both psychiatry and primary care. **2. Why Other Options are Incorrect:** * **A. Manic Disorder:** Pure mania is relatively rare as a standalone diagnosis; it is typically a phase of Bipolar Disorder. * **B. Schizophrenia:** While highly debilitating and significant in inpatient settings, its prevalence is much lower (approximately 1% of the population) compared to depression. * **D. Bipolar Disorder:** This involves fluctuations between mania/hypomania and depression. Its lifetime prevalence (approx. 1-2%) is significantly lower than that of Unipolar Depressive Disorder. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common psychiatric disorder in the community:** Anxiety disorders (as a group), but **Depression** is the most common individual clinical diagnosis. * **Most common symptom of Depression in India:** Somatic complaints (e.g., body aches, fatigue) rather than verbalizing "sadness." * **Gender Predominance:** Depression is twice as common in females (2:1 ratio). * **Genetic Link:** The risk of depression is higher in first-degree relatives; however, Bipolar Disorder has a stronger genetic component than Unipolar Depression.

Question 140: Exercise is also prescribed as an adjuvant treatment for depression. Most probably, it acts by:

A. Increasing pulse pressure
B. Improving hemodynamics
C. Raising endorphin levels (Correct Answer)
D. Inducing good sleep

Explanation: ### Explanation **Correct Option: C. Raising endorphin levels** Exercise is a well-established adjuvant therapy for mild-to-moderate depression. The primary neurobiological mechanism is the **"Endorphin Hypothesis."** Physical activity triggers the release of endogenous opioids (beta-endorphins) from the pituitary gland and hypothalamus. These endorphins bind to mu-opioid receptors in the brain, leading to an analgesic effect and a sense of euphoria (often called the "runner's high"), which directly counteracts depressive symptoms and improves mood. Additionally, exercise increases levels of Brain-Derived Neurotrophic Factor (BDNF), promoting neuroplasticity in the hippocampus. **Why other options are incorrect:** * **A & B (Pulse pressure and Hemodynamics):** While exercise improves cardiovascular health and systemic circulation, these are physiological adaptations of the autonomic and circulatory systems. They do not have a direct, evidence-based psychoactive effect on the core neurochemical pathology of depression. * **D (Inducing good sleep):** While exercise improves sleep hygiene and circadian rhythms (which is beneficial for depressed patients), it is considered a secondary benefit. The primary, immediate biochemical mechanism for mood elevation during exercise is the surge in neurochemicals like endorphins and monoamines. **NEET-PG High-Yield Pearls:** * **First-line for Mild Depression:** Lifestyle modifications, including exercise and CBT, are often preferred over pharmacotherapy for mild cases. * **Monoamine Hypothesis:** Exercise also increases the availability of Serotonin, Norepinephrine, and Dopamine, mimicking the action of antidepressants. * **Neurogenesis:** Chronic exercise is linked to increased volume in the **hippocampus**, a region often shrunken in chronic MDD. * **Adjuvant Role:** In moderate-to-severe depression, exercise is an *adjuvant* (add-on) to SSRIs/SNRIs, not a replacement.

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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