Mood Disorders Practice Questions

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

All of the above. **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.

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

Atypical depression. **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.

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

The female to male ratio is 2:1.. **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**.

Q: What is the most common comorbid illness with depression?

Substance use disorder. **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.

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

Panic attack. **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.

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

Depressive disorder. **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.

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

Raising endorphin levels. ### 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.

Question 1

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

Accepted Answer

All of the above

Answer

Benzodiazepines

Answer

Lithium

Answer

Sodium valproate

Question 2

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

Accepted Answer

Melancholia

Answer

Mania

Answer

Schizophrenia

Answer

Major depressive disorder

Question 3

Leaden paralysis is seen in which of the following conditions?

Accepted Answer

Atypical depression

Answer

Severe depression

Answer

Melancholic depression

Answer

Narcolepsy

Question 4

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

Accepted Answer

The female to male ratio is 2:1.

Answer

It has a younger age of onset in women.

Answer

There is a predisposition in aggressive women with masculine traits.

Answer

Diagnosis is reliable across geographic areas.

Question 5

What is the most common comorbid illness with depression?

Accepted Answer

Substance use disorder

Answer

Anxiety disorder

Answer

Obsessive-compulsive disorder

Answer

Comorbid illnesses are rare

Question 6

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

Accepted Answer

Panic attack

Answer

Severe depression

Answer

Bipolar disorder

Answer

Old age

Question 7

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?

Accepted Answer

Mania

Answer

Depression

Answer

Schizophrenia

Answer

Psychosis

Question 8

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?

Accepted Answer

Depressive disorder

Answer

Adjustment disorder

Answer

Acute stress disorder

Answer

Post traumatic stress disorder

Question 9

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

Accepted Answer

Depressive disorder

Answer

Maniac disorder

Answer

Schizophrenia

Answer

Bipolar disorder

Question 10

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

Accepted Answer

Raising endorphin levels

Answer

Increasing pulse pressure

Answer

Improving hemodynamics

Answer

Inducing good sleep

Mood Disorders — MCQs

Mood Disorders — MCQs

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