Mood Disorders — MCQs

A 27-year-old nurse, who previously enjoyed trekking and painting, experienced a breakup with her boyfriend. Two months later, she lost interest in her hobbies, became convinced she could no longer work, and felt life was not worth living. She consumed 60 tablets of phenobarbitone in an attempt to end her life. What is the most likely diagnosis?

Q147Easy

Which of the following is NOT typically seen in mania?

Q148Easy

Nihilistic ideas are seen in which of the following conditions?

Q149Easy

What is the minimum duration of symptoms required to diagnose hypomania?

Q150Easy

The technique of Psychological autopsy is useful in studying the causation of?

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 141: A 20-year-old man presents with increased alcohol consumption and sexual indulgence, irritability, lack of sleep, and not feeling fatigued even on prolonged periods of activity. These changes have been present for 3 weeks. What is the most likely diagnosis?

A. Alcohol dependence
B. Schizophrenia
C. Mania (Correct Answer)
D. Impulsive control disorder

Explanation: ### Explanation **Correct Answer: C. Mania** The clinical presentation described is a classic textbook case of a **Manic Episode**. According to ICD and DSM criteria, a diagnosis of mania requires a distinct period of abnormally elevated, expansive, or irritable mood lasting at least **one week**. **Key diagnostic features present in this patient:** 1. **Decreased need for sleep:** Feeling refreshed despite minimal sleep (unlike insomnia, where the patient feels tired). 2. **Psychomotor Agitation:** Prolonged activity without fatigue. 3. **Disinhibition:** Increased sexual indulgence and excessive alcohol consumption (impulsive behavior with high potential for painful consequences). 4. **Irritability:** A common mood manifestation of mania. 5. **Duration:** The symptoms have lasted for 3 weeks (exceeding the 1-week threshold). --- ### Why other options are incorrect: * **A. Alcohol dependence:** While the patient is consuming more alcohol, it is a *symptom* of his behavioral disinhibition rather than the primary cause. Dependence requires features like tolerance, withdrawal, and craving over a longer duration (usually 12 months). * **B. Schizophrenia:** Requires core symptoms like delusions, hallucinations, or disorganized speech/behavior for at least 1–6 months. This patient’s symptoms are primarily mood-driven. * **D. Impulsive control disorder:** This is a category of disorders (like kleptomania or pyromania) characterized by failure to resist an impulse. It does not account for the decreased need for sleep or increased energy levels seen here. --- ### NEET-PG High-Yield Pearls: * **DIGFAST Mnemonic for Mania:** **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressured speech). * **Duration Criteria:** Hypomania (≥ 4 days); Mania (≥ 1 week); Depressive episode (≥ 2 weeks). * **Drug of Choice:** Lithium is the gold standard for long-term prophylaxis of Bipolar Disorder. For acute mania with agitation, atypical antipsychotics or Valproate are often used.

Question 142: Disruption or disorganization of biological rhythm is observed in which of the following conditions?

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

Explanation: **Explanation:** The correct answer is **Depression (Option C)**. **Why Depression is Correct:** Disruption of biological rhythms (circadian rhythms) is a core pathophysiological feature of Major Depressive Disorder (MDD). The "Internal Clock" or the **Suprachiasmatic Nucleus (SCN)** of the hypothalamus often becomes dysregulated in depressed patients. This manifests as: * **Sleep-Wake Cycle Disturbances:** Specifically, **Early Morning Awakening** (terminal insomnia) and reduced REM latency (entering REM sleep faster). * **Diurnal Variation of Mood:** Patients typically feel worse in the morning with slight improvement as the day progresses. * **Hormonal Dysregulation:** Altered secretion patterns of cortisol (loss of normal diurnal rhythm) and melatonin. **Why Other Options are Incorrect:** * **Schizophrenia (A):** While sleep disturbances occur, the primary pathology involves dopaminergic dysregulation and structural brain changes rather than a fundamental disruption of biological rhythms. * **Anxiety (B):** Anxiety is characterized by autonomic hyperactivity and difficulty falling asleep (initial insomnia), but it does not typically involve the systemic disorganization of biological cycles seen in mood disorders. * **Mania (D):** While Mania involves a "decreased need for sleep," the biological rhythm is often described as "driven" or accelerated rather than disorganized. However, in the context of standard psychiatric examinations, "disorganization of biological rhythm" is a classic descriptor specifically linked to the vegetative symptoms of Depression. **NEET-PG High-Yield Pearls:** 1. **Sleep Architecture in Depression:** Increased REM density, decreased REM latency, and decreased Stage 3 & 4 (Slow Wave) sleep. 2. **Dexamethasone Suppression Test (DST):** Often shows "non-suppression" of cortisol in depressed patients due to HPA-axis dysregulation. 3. **Seasonal Affective Disorder (SAD):** A subtype of depression directly linked to light exposure and circadian rhythm disruption, treated with **Phototherapy** (10,000 lux).

Question 143: Which of the following is true about major depressive disorder?

A. It is commonly seen in females.
B. There is a positive family history of major depression.
C. It is associated with hypothyroidism.
D. All of the above. (Correct Answer)

Explanation: Major Depressive Disorder (MDD) is a multifactorial mood disorder characterized by persistent low mood and anhedonia. The correct answer is **D (All of the above)** because MDD involves a complex interplay of epidemiology, genetics, and endocrine dysfunction. **Detailed Breakdown:** * **A. Gender Distribution:** MDD is significantly more common in **females** than males, with a lifetime prevalence ratio of approximately **2:1**. This disparity is attributed to hormonal fluctuations (estrogen/progesterone), higher rates of psychosocial stressors, and differences in coping mechanisms. * **B. Genetic Predisposition:** There is a strong hereditary component. First-degree relatives of patients with MDD are **2 to 3 times** more likely to develop the disorder. If one monozygotic twin has MDD, the concordance rate is approximately 50%, confirming a positive family history as a major risk factor. * **C. Endocrine Association:** MDD is frequently associated with **hypothyroidism**. Low levels of thyroid hormones (T3/T4) can lead to "secondary depression" presenting with lethargy, weight gain, and psychomotor retardation. Conversely, hypercortisolism (Cushing’s syndrome) is also linked to depressive symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Most common symptom:** Psychomotor retardation is a common objective sign, while depressed mood is the most common subjective symptom. * **Sleep disturbances:** Classically associated with **Early Morning Awakening** (Terminal Insomnia). * **Neurotransmitters:** Primarily involves decreased levels of **Serotonin (5-HT)**, Norepinephrine, and Dopamine. * **First-line treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the drugs of choice due to their favorable safety profile. * **Dexamethasone Suppression Test (DST):** Many MDD patients show "non-suppression" of cortisol, indicating HPA axis hyperactivity.

Question 144: Which mood stabilizer is used in the management of bipolar disorder?

A. lithium (Correct Answer)
B. carbamazepine
C. lamotrigine
D. valproate

Explanation: **Explanation:** **Lithium** is considered the "gold standard" and the first-line mood stabilizer for the long-term prophylaxis and treatment of Bipolar Affective Disorder (BPAD). Its primary mechanism involves the inhibition of the inositol monophosphatase pathway and modulation of G-proteins. It is uniquely effective in reducing the risk of suicide in patients with mood disorders—a high-yield fact for NEET-PG. **Analysis of Options:** * **Lithium (Correct):** It is the drug of choice for classic Bipolar I disorder (euphoric mania). It has a narrow therapeutic index (0.6–1.2 mEq/L) and requires regular serum monitoring. * **Carbamazepine (Incorrect):** While used as a second-line mood stabilizer, especially in rapid cycling or mixed episodes, it is not the primary answer when Lithium is an option. It is an enzyme inducer and carries risks of Stevens-Johnson Syndrome. * **Lamotrigine (Incorrect):** It is primarily used for the **maintenance** phase of Bipolar disorder to prevent depressive episodes. It is not effective for treating acute mania. * **Valproate (Incorrect):** It is the drug of choice for **Rapid Cycling Bipolar Disorder** and mixed episodes. While a potent mood stabilizer, Lithium remains the traditional "first" answer in general medical examinations unless specific subtypes are mentioned. **NEET-PG High-Yield Pearls:** 1. **Teratogenicity:** Lithium causes **Ebstein’s Anomaly** (tricuspid valve displacement); Valproate causes **Neural Tube Defects**. 2. **Side Effects:** Lithium commonly causes nephrogenic diabetes insipidus, hypothyroidism, and fine tremors. 3. **Monitoring:** Check Renal Function Tests (RFT) and Thyroid Function Tests (TFT) before starting Lithium. 4. **Drug Interactions:** Thiazides, NSAIDs, and ACE inhibitors can increase Lithium levels, leading to toxicity.

Question 145: Flight of ideas is a characteristic symptom of which psychiatric condition?

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

Explanation: **Explanation:** **Flight of Ideas** is a formal thought disorder characterized by a rapid succession of thoughts where the connection between ideas is based on superficial associations, such as **rhyming (clanging)** or **puns**. While the direction of thought shifts frequently, a logical connection can usually still be traced by the listener. 1. **Why Mania is Correct:** Flight of ideas is a hallmark feature of the **Manic Phase of Bipolar Disorder**. It occurs due to "pressure of thought," where the patient’s thinking process is so accelerated that it manifests as rapid, continuous speech (pressure of speech) with frequent shifts in topics. 2. **Why Other Options are Incorrect:** * **Schizophrenia:** The characteristic thought disorder here is **Loosening of Associations (Knight’s Move thinking)**. Unlike flight of ideas, the transitions between thoughts in schizophrenia are illogical and lack any discernible connection to the listener. * **Depression:** This is typically associated with **Poverty of Ideas** or "Psychomotor Retardation," where thought processes are slowed down (the opposite of mania). * **Delirium:** While speech may be incoherent, the primary deficit is a **clouding of consciousness** and disorientation, rather than a specific pattern of rapid ideation. **Clinical Pearls for NEET-PG:** * **Flight of ideas + Pressure of speech = Mania.** * If the connection between ideas is completely lost, it is **Loosening of Associations** (Schizophrenia). * **Clang Association:** Choosing words based on sound rather than meaning; frequently seen alongside flight of ideas. * **Circumstantiality:** The patient includes excessive unnecessary detail but eventually reaches the point (seen in Epilepsy/OCD). * **Tangentiality:** The patient moves away from the topic and never returns to the original point.

Question 146: A 27-year-old nurse, who previously enjoyed trekking and painting, experienced a breakup with her boyfriend. Two months later, she lost interest in her hobbies, became convinced she could no longer work, and felt life was not worth living. She consumed 60 tablets of phenobarbitone in an attempt to end her life. What is the most likely diagnosis?

A. Adjustment disorder (Correct Answer)
B. Conversion disorder
C. Depressive disorder
D. Post-traumatic stress disorder (PTSD)

Explanation: **Explanation:** The correct diagnosis is **Adjustment Disorder**. This condition is characterized by the development of emotional or behavioral symptoms in response to an identifiable stressor (in this case, a breakup) occurring within **3 months** of the onset of the stressor. **Why Adjustment Disorder is correct:** The patient’s symptoms (loss of interest, hopelessness, and a serious suicide attempt) are clinically significant but occur in direct temporal relationship to a specific life stressor. According to DSM-5/ICD-11, if the symptoms are out of proportion to the severity of the stressor or cause significant impairment in social/occupational functioning, Adjustment Disorder is diagnosed. While the suicide attempt is severe, the short duration (2 months) and the clear precipitant point toward this diagnosis. **Why other options are incorrect:** * **Depressive Disorder:** While the symptoms mimic depression, a diagnosis of Major Depressive Disorder (MDD) usually requires symptoms to be independent of a specific situational stressor or persist beyond the resolution of the stressor. In exam scenarios, if a clear stressor is provided and the timeline is <3 months, Adjustment Disorder is the preferred answer. * **Conversion Disorder (Functional Neurological Symptom Disorder):** This involves unexplained voluntary motor or sensory deficits (e.g., paralysis, blindness) often triggered by psychological conflict, which are not present here. * **PTSD:** This requires exposure to a "catastrophic" or "life-threatening" event (e.g., war, sexual assault). A breakup is considered a "stressor," not a "trauma" in the context of PTSD criteria. **Clinical Pearls for NEET-PG:** * **Timeline:** Symptoms must start within 3 months of the stressor and typically resolve within 6 months once the stressor is removed. * **Suicide Risk:** Adjustment disorder is a common diagnosis in Emergency Departments following "impulsive" suicide attempts after interpersonal conflicts. * **Treatment of Choice:** Crisis intervention and Brief Psychodynamic Psychotherapy. Pharmacotherapy is usually secondary.

Question 147: Which of the following is NOT typically seen in mania?

A. Hypersexuality
B. Hyperactivity
C. Decreased sleep
D. Clouding of consciousness (Correct Answer)

Explanation: **Explanation:** In psychiatry, **Mania** is characterized by a distinct period of abnormally elevated, expansive, or irritable mood. The core features involve a "speeding up" of mental and physical processes. **Why "Clouding of Consciousness" is the correct answer:** Clouding of consciousness refers to a state of reduced wakefulness, impaired alertness, and disorientation. This is the hallmark of **Delirium (Organic Brain Syndrome)**, not functional psychiatric disorders like Mania. In a typical manic episode, the sensorium remains clear; the patient is fully awake and oriented, even if they are highly distractible or agitated. If clouding of consciousness is present, a clinician must first rule out organic causes (e.g., drug toxicity, metabolic imbalance, or infection). **Analysis of Incorrect Options:** * **Hypersexuality (A):** A common symptom of mania involving increased libido, loss of inhibitions, and sometimes indiscreet sexual behavior. * **Hyperactivity (B):** Manic patients exhibit increased psychomotor activity, often engaging in multiple projects or goal-directed activities without feeling fatigued. * **Decreased Sleep (C):** Specifically, this is a **"decreased need for sleep."** Unlike insomnia (where the patient wants to sleep but can't), a manic patient feels fully rested after only 2–3 hours of sleep. **High-Yield Clinical Pearls for NEET-PG:** * **DIGFAST Mnemonic for Mania:** **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressure of speech). * **Delirious Mania:** A rare, severe form of mania where clouding of consciousness *can* occur, but it is an exception rather than a "typical" feature. * **First-line treatment:** Lithium or Valproate (Mood stabilizers) and Atypical Antipsychotics.

Question 148: Nihilistic ideas are seen in which of the following conditions?

A. Simple schizophrenia
B. Paranoid schizophrenia
C. Cotard's syndrome (Correct Answer)
D. Mania

Explanation: **Explanation:** **Nihilistic delusions** are the hallmark of **Cotard’s Syndrome**. This is a rare neuropsychiatric condition where a patient holds the delusional belief that they are dead, do not exist, are putrefying, or have lost their internal organs, blood, or soul. It is most commonly associated with **severe psychotic depression**, though it can occur in schizophrenia or organic brain lesions. **Analysis of Options:** * **Cotard’s Syndrome (Correct):** Also known as "Walking Corpse Syndrome," it is characterized by nihilistic delusions ranging from "I have no heart" to "The world has ended." * **Simple Schizophrenia:** Characterized by the insidious development of negative symptoms (apathy, social withdrawal) without prominent hallucinations or delusions. * **Paranoid Schizophrenia:** Typically involves delusions of persecution or grandeur and auditory hallucinations. While nihilistic ideas *can* occur in any psychosis, they are the defining feature of Cotard’s. * **Mania:** Characterized by expansive, elevated mood and delusions of **grandeur** (the opposite of nihilism). **Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome** is often considered a severe form of **Depressive Psychosis**. * **Capgras Syndrome:** The delusion that a familiar person has been replaced by an identical-looking impostor (an "illusion of doubles"). * **Fregoli Syndrome:** The delusion that different people are actually a single person in disguise. * **De Clerambault’s Syndrome (Erotomania):** The delusion that a person (usually of higher status) is in love with the patient. * **Treatment:** For Cotard’s syndrome, **Electroconvulsive Therapy (ECT)** is often the treatment of choice due to the severity of the underlying depression.

Question 149: What is the minimum duration of symptoms required to diagnose hypomania?

A. 1 day
B. 4 days (Correct Answer)
C. 1 week
D. 2 weeks

Explanation: ### Explanation The diagnosis of a **Hypomanic Episode** is based on specific duration and severity criteria defined by the DSM-5 and ICD-11. **1. Why Option B (4 days) is correct:** According to DSM-5 criteria, hypomania is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally increased activity or energy, lasting **at least 4 consecutive days**. Unlike mania, hypomania is not severe enough to cause marked impairment in social or occupational functioning, does not require hospitalization, and lacks psychotic features. **2. Why the other options are incorrect:** * **Option A (1 day):** This is too short for a clinical diagnosis. While mood can fluctuate daily, a sustained period of 4 days is required to distinguish a pathological state from normal mood variations. * **Option C (1 week):** This is the minimum duration required to diagnose a **Manic Episode**. If symptoms last a week or require hospitalization (regardless of duration), the diagnosis upgrades from hypomania to mania. * **Option D (2 weeks):** This is the minimum duration required for a **Major Depressive Episode (MDE)** or Dysthymia (which requires 2 years in adults). **3. High-Yield Clinical Pearls for NEET-PG:** * **Bipolar II vs. Bipolar I:** Bipolar II requires at least one Hypomanic Episode AND at least one Major Depressive Episode. If a patient has even one Manic Episode in their life, the diagnosis is Bipolar I. * **Cyclothymia:** Requires at least **2 years** (1 year in children) of hypomanic and depressive symptoms that do not meet full criteria for an episode. * **Key Distinction:** The presence of **psychotic features** (hallucinations/delusions) automatically classifies the episode as **Mania**, regardless of the duration. Hypomania never includes psychosis.

Question 150: The technique of Psychological autopsy is useful in studying the causation of?

A. Schizophrenia
B. Personality disorders
C. Drug dependence
D. Suicide (Correct Answer)

Explanation: **Explanation:** **Psychological Autopsy** is a retrospective investigative strategy used to understand the psychological state of a person prior to their death. It is the most powerful tool available for studying the risk factors and causation of **Suicide (Option D)**. ### Why Suicide is the Correct Answer: Since the individual is deceased, clinicians cannot perform a direct mental status examination. Instead, they conduct extensive interviews with family members, friends, and healthcare providers, and review personal documents (diaries, social media, medical records). The goal is to reconstruct the deceased's mental state, identify undiagnosed psychiatric illnesses (most commonly Depression), and understand the stressors or "proximal triggers" that led to the act of suicide. ### Why Other Options are Incorrect: * **Schizophrenia (Option A) & Personality Disorders (Option B):** These are chronic conditions diagnosed through direct clinical observation and longitudinal history of a living patient. While psychological autopsy might reveal these diagnoses post-mortem, the technique is specifically designed to investigate the *cause of death*, not to serve as a primary diagnostic tool for these disorders. * **Drug Dependence (Option C):** While substance abuse is a major risk factor for suicide, the term "Psychological Autopsy" is specifically synonymous with the study of completed suicides rather than the etiology of addiction itself. ### NEET-PG High-Yield Pearls: * **Origin:** The term was coined by **Edwin Shneidman** (the father of modern Suicidology). * **Most Common Finding:** Psychological autopsies reveal that over **90%** of people who commit suicide had a diagnosable mental disorder at the time of death (Mood disorders being the most frequent). * **Key Utility:** It helps in legal cases (equivocal deaths) to determine if a death was accidental, homicidal, or suicidal.

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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