Mood Disorders Practice Questions

Q: Early morning awakening is a feature of -

Depression. ***Depression*** - **Early morning awakening** (or terminal insomnia) is a classic symptom of major depressive disorder, where patients wake up several hours before their usual time and cannot return to sleep. - This symptom is often accompanied by other features like **anhedonia**, feelings of worthlessness, fatigue, and **psychomotor retardation** or agitation. *Mania* - Patients experiencing **mania** often have a significantly reduced need for sleep but do not typically report early morning awakening as a distressful symptom. - They may go days with very little sleep, feeling energetic and not tired, which differs from the insomnia associated with depression. *Psychosis* - **Psychotic disorders** can disrupt sleep patterns due to hallucinations, delusions, or disorganized thinking, leading to various sleep disturbances. - However, **early morning awakening** is not a specific or hallmark symptom of psychosis; rather, sleep architecture can be severely fragmented and irregular. *Anxiety neurosis* - **Anxiety neurosis** (now often termed generalized anxiety disorder or panic disorder) can cause sleep initiation difficulties due to racing thoughts and worries. - While anxiety can cause **insomnia**, it more commonly manifests as difficulty falling asleep or nocturnal awakenings, rather than the characteristic early morning awakening seen in depression.

Q: Bright light therapy is used for?

Seasonal affective disorder. ***Seasonal affective disorder*** - **Bright light therapy** is a primary treatment for **seasonal affective disorder (SAD)**, particularly **winter depression**, by simulating natural outdoor light. - Exposure to bright light can help regulate the body's **circadian rhythm** and neurotransmitter levels, which are often disrupted in SAD. *Adjustment disorder* - This disorder is a **stress-related condition** where a person has difficulty coping with a specific stressor or event. - Treatment typically involves **psychotherapy** and addresses the specific stressor, not light therapy. *Anxiety* - **Anxiety disorders** are characterized by excessive worry, fear, or apprehension. - Treatment usually involves **cognitive behavioral therapy (CBT)**, medications (e.g., SSRIs), or a combination thereof, not bright light therapy. *Schizophrenia* - **Schizophrenia** is a chronic and severe mental disorder affecting how a person thinks, feels, and behaves, involving psychosis. - Management primarily relies on **antipsychotic medications** and psychosocial interventions, with no established role for bright light therapy.

Q: A 67-year-old lady is brought in by her six children, who say that she has become senile. Six months after her husband's death, she has become more religious and spiritual, and gives a lot of money in donation. She is occupied with too many activities and sleeps less. She now believes that she has a goal to change society. She does not like being brought to the hospital and is argumentative when questioned about her actions. The diagnosis is:

Mania. ***Mania*** - The patient exhibits classic symptoms of **mania**: increased religiosity, excessive donations, overactivity, reduced sleep, and a **grandiose belief** ("goal to change society"). - Her **argumentativeness** and resistance to evaluation are consistent with the **lack of insight** often seen in manic episodes. *Depression* - While the death of her husband could trigger depression, her symptoms of **increased energy**, reduced sleep, and grandiosity are **contrary to typical depression** (low mood, anhedonia, fatigue). - Depression usually involves feelings of **worthlessness and guilt**, not an inflated sense of self-importance or mission. *Impulse control disorder* - This category usually involves specific problematic behaviors (e.g., gambling, kleptomania) driven by an **irresistible urge**, often preceded by tension and followed by relief. - The patient's broader constellation of symptoms, including grandiosity and reduced sleep, points to a more pervasive mood disturbance rather than a single maladaptive impulse. *Schizophrenia* - Schizophrenia is characterized by **psychosis**, including prominent hallucinations, delusions (often bizarre), disorganization in thought and speech, and negative symptoms. - While she has a **grandiose delusion**, the overall clinical picture, especially the prominent mood and energy changes, is much more indicative of a **manic episode**.

Q: Pseudodementia is seen in:

Depression. ***Depression*** - **Pseudodementia** refers to cognitive deficits (e.g., memory, concentration) that mimic dementia but are caused by a psychiatric condition, most commonly **severe depression**. - These cognitive impairments often resolve with effective treatment of the underlying depressive disorder. *Schizophrenia* - While schizophrenia can present with cognitive impairments, these are typically considered integral to the disorder itself rather than a "pseudo" presentation of dementia. - The cognitive deficits in schizophrenia often involve executive function, attention, and memory, but are distinct from a primary neurodegenerative process. *Alcoholism* - Chronic alcoholism can lead to **alcohol-related dementia** or other permanent cognitive impairments, such as **Wernicke-Korsakoff syndrome**, which are true organic brain disorders, not pseudodementia. - These conditions are characterized by actual brain damage and are not typically reversible by simply treating the alcoholism. *Mania* - Mania can cause significant cognitive dysfunction, including distractibility, impaired judgment, and difficulty concentrating due to racing thoughts and heightened activity. - However, these are typically transient and directly related to the acute manic state, not a sustained pattern resembling dementia that would be termed "pseudodementia."

Q: An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?

ECT. ***ECT*** - **Electroconvulsive therapy (ECT)** is the **treatment of choice** for severe depression with **suicidal ideation** due to its rapid onset of action and high efficacy. - It is particularly indicated when there is an urgent need for symptom remission to prevent self-harm, as verbal therapies and medications take longer to exert their full effects. *Olanzapine* - **Olanzapine** is an **antipsychotic medication** with some antidepressant properties, but it is not the first-line treatment for severe depression with suicidal tendencies. - It is often used as an **adjunctive treatment** in treatment-resistant depression or in psychotic depression with delusions. *Mirtazapine* - **Mirtazapine** is an **antidepressant** that can be very effective in cases of major depressive disorder, especially when insomnia and appetite loss are prominent. - However, its onset of action is not as rapid as ECT, making it less suitable for situations requiring immediate intervention for **severe suicidal risk**. *Clozapine* - **Clozapine** is an **antipsychotic medication** primarily used for **treatment-resistant schizophrenia** and reducing suicidal behavior in schizophrenia. - It is highly effective but has significant side effects, including **agranulocytosis**, and is not a first-line treatment for major depressive disorder with suicidal tendencies.

Q: A 68-year-old lady thinks that she has committed a sin, she is not worthy to live in this world, she is also having anorexia and insomnia, she is suffering from -

Endogenous depression. ***Endogenous depression*** - This older classification term describes **severe depressive symptoms** that arise without a clear external precipitating factor and are characterized by **melancholic/biological features**. - The patient presents with classic features: profound guilt (\"committed a sin\"), worthlessness (\"not worthy to live\"), and significant **vegetative symptoms** including **anorexia** and **insomnia**. - These symptoms align with what is now termed **Major Depressive Disorder with Melancholic Features** in modern classification (DSM-5/ICD-11). - The endogenous nature suggests a **biological/biochemical basis** rather than purely reactive symptoms. *Dissociative disorder* - This disorder involves disruption of **consciousness, memory, identity, or perception** (e.g., dissociative amnesia, depersonalization). - The core features presented—guilt, worthlessness, anorexia, insomnia—are **mood and vegetative symptoms**, not dissociative phenomena. - While depression and dissociation can co-occur, this presentation is primarily a **mood disorder**. *Exogenous depression* - Also called **reactive depression**, this type is triggered by an **identifiable external stressor** (e.g., bereavement, job loss, trauma). - The question provides **no history of external precipitant**, and the severity of guilt and biological symptoms suggests an endogenous process. - Modern equivalent would be depression clearly linked to a psychosocial stressor. *Neurotic depression* - This outdated term historically referred to **milder depression** with prominent **anxiety features** and thought to be related to personality factors. - The patient's presentation is **too severe**—profound guilt, worthlessness, and marked vegetative symptoms indicate a more severe depressive episode. - This better fits **melancholic/endogenous depression** rather than a neurotic-level disorder.

Q: Nitric Oxide (NO) is a novel neurotransmitter which is considered to have an effect in the pathophysiology of which of the following psychiatric conditions?

Mood Disorders. ***Mood Disorders*** - **Nitric oxide (NO)** has been implicated in the pathophysiology of **mood disorders**, such as major depressive disorder and bipolar disorder, due to its role in **neurotransmission** and **neuronal plasticity**. - NO can modulate the activity of various neurotransmitter systems (e.g., serotonergic, dopaminergic) that are known to be dysregulated in mood disorders, influencing **affect** and **emotional regulation**. *Schizophrenia* - While **NO dysfunction** has been investigated in schizophrenia, its role is less clearly established as a primary effector compared to neurotransmitters like **dopamine** and **glutamate**. - Research in schizophrenia often focuses on the **dopamine hypothesis** or **glutamate hypofunction**, with NO having a more modulatory role. *Substance Misuse* - NO is known to be involved in pathways related to **reward** and **addiction**, but it is generally considered a **modulator** of neurotransmission rather than a primary neurotransmitter in the development of substance misuse. - The pathophysiology of substance misuse is highly complex, involving multiple neurotransmitter systems and circuits, including **dopamine** and the mesolimbic reward system. *OCD* - The primary neurotransmitter theories for **Obsessive-Compulsive Disorder (OCD)** largely focus on **serotonin dysregulation**, with treatments like SSRIs being highly effective. - While NO may have some modulatory effects on brain circuits involved in OCD, it is not considered a central player in its pathophysiology compared to other conditions.

Q: Which of the following conditions is characterized by intense depression and misery?

Major depressive disorder. ***Major depressive disorder*** - This condition is primarily defined by a period of at least two weeks of **depressed mood** or **loss of interest or pleasure** (anhedonia). - Patients often experience profound **feelings of sadness, hopelessness, and misery**, along with other symptoms like changes in sleep, appetite, energy, and concentration. - **MDD is the primary diagnostic category** for conditions characterized by intense depression and misery. *Schizophrenia* - Schizophrenia is characterized by **psychotic symptoms** such as hallucinations, delusions, disorganized thought, and negative symptoms. - While people with schizophrenia might experience periods of low mood, the primary defining features are not intense depression and misery, but rather a **break from reality**. *Mania* - Mania is characterized by an **elevated or irritable mood**, increased energy, and hyperactivity, which are the opposite of depression. - Symptoms include **racing thoughts, decreased need for sleep, grandiosity, and impulsive behavior**, not intense depression. *Melancholia* - Melancholia is a **specifier for major depressive disorder**, not a standalone condition in DSM-5/ICD-11. - While melancholia describes a **particularly severe form** of depression with profound despondency, it is a **subtype or qualifier** applied to MDD, not a separate diagnostic entity. - **The question asks for a "condition"** - MDD is the primary condition, while melancholic features describe characteristics within that condition.

Q: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

Major depressive disorder plus psychosis. ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.

Question 1

Early morning awakening is a feature of -

Accepted Answer

Depression

Answer

Mania

Answer

Psychosis

Answer

Anxiety neurosis

Question 2

Bright light therapy is used for?

Accepted Answer

Seasonal affective disorder

Answer

Adjustment disorder

Answer

Anxiety

Answer

Schizophrenia

Question 3

A 67-year-old lady is brought in by her six children, who say that she has become senile. Six months after her husband's death, she has become more religious and spiritual, and gives a lot of money in donation. She is occupied with too many activities and sleeps less. She now believes that she has a goal to change society. She does not like being brought to the hospital and is argumentative when questioned about her actions. The diagnosis is:

Accepted Answer

Mania

Answer

Depression

Answer

Impulse control disorder

Answer

Schizophrenia

Question 4

Pseudodementia is seen in:

Accepted Answer

Depression

Answer

Schizophrenia

Answer

Alcoholism

Answer

Mania

Question 5

An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?

Accepted Answer

ECT

Answer

Olanzapine

Answer

Mirtazapine

Answer

Clozapine

Question 6

A 68-year-old lady thinks that she has committed a sin, she is not worthy to live in this world, she is also having anorexia and insomnia, she is suffering from -

Accepted Answer

Endogenous depression

Answer

Dissociative disorder

Answer

Exogenous depression

Answer

Neurotic depression

Question 7

Intense nihilism, somatization and agitation in old age are the hallmark symptoms of -

Accepted Answer

Involutional melancholia

Answer

Depressive stupor

Answer

Atypical depression

Answer

Somatized depression

Question 8

Nitric Oxide (NO) is a novel neurotransmitter which is considered to have an effect in the pathophysiology of which of the following psychiatric conditions?

Accepted Answer

Mood Disorders

Answer

Schizophrenia

Answer

Substance Misuse

Answer

OCD

Question 9

Which of the following conditions is characterized by intense depression and misery?

Accepted Answer

Major depressive disorder

Answer

Schizophrenia

Answer

Mania

Answer

Melancholia

Question 10

A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

Accepted Answer

Major depressive disorder plus psychosis

Answer

Schizophrenia

Answer

Schizoaffective disorder

Answer

Schizotypal personality disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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