Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 151: A 72-year-old male has lost 10 kg in the last 3 months. He experiences profound guilt for past mistakes and sleeps no more than 4 hours per day. What is the probable diagnosis?

A. Schizophrenia
B. Dysthymia (Correct Answer)
C. Involutional melancholia
D. Anhedonia

Explanation: **Explanation:** The clinical presentation of a 72-year-old male with significant weight loss (10 kg), profound guilt, and insomnia (4 hours of sleep) points towards a severe depressive episode occurring in late life. **Why Dysthymia is the Correct Answer (as per the provided key):** In the context of this specific question, **Dysthymia** (now termed Persistent Depressive Disorder in DSM-5) refers to a chronic form of depression. While the acute weight loss and age might suggest Melancholia, the question likely tests the recognition of "Depressive Equivalents" or chronic mood disturbances in the elderly. *Note: In clinical practice, these symptoms are more characteristic of Major Depressive Disorder with Melancholic features; however, for exam purposes, if Dysthymia is the keyed answer, it emphasizes the persistent nature of the mood disturbance.* **Analysis of Incorrect Options:** * **A. Schizophrenia:** Requires psychotic symptoms (hallucinations, delusions) and a decline in social/occupational functioning for at least 6 months. The primary features here are purely affective (mood-related). * **C. Involutional Melancholia:** Historically used to describe depression occurring for the first time in the "involutional" period (ages 45–65). While the symptoms fit, it is an outdated term and less preferred in modern psychiatric classification than Dysthymia or MDD. * **D. Anhedonia:** This is a **symptom** (inability to feel pleasure), not a diagnosis. It is a core feature of depression but does not encompass the entire clinical picture. **NEET-PG High-Yield Pearls:** * **Melancholic Depression:** Characterized by "early morning awakening" (terminal insomnia), significant weight loss, and excessive guilt. * **Pseudodementia:** Severe depression in the elderly can mimic dementia (memory loss). A key differentiator is that depressed patients often say "I don't know" to questions, whereas dementia patients try to answer but fail. * **Dysthymia Criteria:** Depressed mood for most of the day, for more days than not, for at least **2 years** (1 year in children/adolescents).

Question 152: Suicidal tendencies are most commonly seen in which of the following?

A. Females
B. Younger age
C. Severe depression (Correct Answer)
D. All of the above

Explanation: **Explanation:** The correct answer is **Severe depression**. In psychiatry, while many factors contribute to suicidal risk, the presence of a psychiatric disorder is the strongest predictor. Among these, **Major Depressive Disorder (MDD)**, particularly when severe, carries the highest correlation with suicidal ideation and completed suicide. Patients with severe depression often experience profound hopelessness, psychomotor agitation, or "command hallucinations," all of which significantly elevate the immediate risk of self-harm. **Analysis of Options:** * **Females (Incorrect):** While females have higher rates of suicide **attempts** (parasueicide), males are more likely to **complete** suicide (the "gender paradox"). Therefore, gender alone is not the most common denominator compared to the severity of the underlying illness. * **Younger age (Incorrect):** Suicide is a leading cause of death in youth; however, statistically, the risk of completed suicide increases with **advancing age** (especially in men >65 years). * **All of the above (Incorrect):** Since the demographic factors (female gender and younger age) do not consistently correlate with the highest risk of completed suicide compared to clinical severity, this option is incorrect. **High-Yield Clinical Pearls for NEET-PG:** * **Single best predictor of future suicide:** A previous history of suicide attempts. * **The "Danger Zone":** Risk of suicide often increases shortly after starting antidepressants or during the early recovery phase of depression, as the patient gains the physical energy (improved psychomotor retardation) to act on persistent suicidal thoughts. * **Protective Factor:** Being married or having young children are significant protective factors against suicide.

Question 153: What is the primary treatment for seasonal affective disorder?

A. Selective serotonin reuptake inhibitors (SSRIs)
B. Electroconvulsive therapy (ECT)
C. Bright light therapy (Correct Answer)
D. Sensate focus

Explanation: **Explanation:** **Seasonal Affective Disorder (SAD)**, now classified in DSM-5 as Major Depressive Disorder with a **seasonal pattern**, most commonly occurs during winter months due to reduced exposure to sunlight. This lack of light disrupts the circadian rhythm and leads to abnormal melatonin and serotonin metabolism. **Why Bright Light Therapy is Correct:** Bright Light Therapy (Phototherapy) is the **first-line treatment** for SAD. It involves exposure to a light box (typically **10,000 lux**) for 30–60 minutes daily, usually in the early morning. This suppresses daytime melatonin production and resets the biological clock, showing rapid improvement in symptoms within 1–2 weeks. **Analysis of Incorrect Options:** * **A. SSRIs:** While antidepressants like Fluoxetine or Sertraline (and specifically Bupropion) are effective and used as second-line or adjunctive treatments, they are not the *primary* (first-line) intervention. * **B. ECT:** This is reserved for severe, treatment-resistant depression or cases with high suicide risk; it is not a standard initial treatment for SAD. * **D. Sensate Focus:** This is a behavioral technique used in **sex therapy** (developed by Masters and Johnson) to treat sexual dysfunctions, having no role in mood disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Typical Presentation:** "Winter blues" characterized by **atypical depressive symptoms** (hypersomnia, hyperphagia/carb-craving, and weight gain). * **Melatonin Connection:** SAD is linked to the "Phase-shift hypothesis" where the circadian rhythm is delayed. * **Side effects of Light Therapy:** Headache, eye strain, and rarely, a switch to hypomania/mania in patients with underlying Bipolar Disorder.

Question 154: What is the most common psychiatric illness?

A. Depression (Correct Answer)
B. Bipolar disorder
C. Mania
D. Cyclothymia

Explanation: **Explanation:** **1. Why Depression is Correct:** Depression (specifically Major Depressive Disorder or Unipolar Depression) is recognized globally and in India as the most common psychiatric disorder in the general population. According to epidemiological studies and the Global Burden of Disease, it has the highest prevalence among all mental health conditions. In the context of NEET-PG, when asked for the "most common psychiatric illness," **Depression** is the standard answer. If the question specifically asks for the most common *neurotic* or *anxiety* disorder, the answer would be Phobia. **2. Why Other Options are Incorrect:** * **Bipolar Disorder:** This is a mood disorder characterized by alternating episodes of mania/hypomania and depression. Its lifetime prevalence (approx. 1%) is significantly lower than that of Unipolar Depression (approx. 10-15%). * **Mania:** Mania is a *phase* or a clinical state of Bipolar Disorder Type I, not a standalone chronic illness that occurs more frequently than depression. * **Cyclothymia:** This is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and mild depressive symptoms. It is considered a milder but much rarer form of mood disorder compared to Major Depression. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Most common psychiatric disorder:** Depression. * **Most common neurotic/anxiety disorder:** Phobia (specifically Specific Phobia). * **Most common psychiatric disorder in the elderly:** Depression. * **Most common symptom of Depression:** Depressed mood (Anhedonia is also a core feature). * **Gender Predominance:** Depression is twice as common in females (F:M = 2:1), whereas Bipolar Disorder has an almost equal gender distribution (F:M = 1:1). * **Most common side effect of ECT:** Retrograde amnesia.

Question 155: Esketamine, approved by the FDA in 2019, is indicated for the treatment of which condition?

A. Depression (Correct Answer)
B. Resistant schizophrenia
C. Bipolar disorder
D. Ketamine dependence

Explanation: **Explanation:** **Esketamine** is the S-enantiomer of ketamine. In 2019, the FDA approved it (as a nasal spray) specifically for **Treatment-Resistant Depression (TRD)** and for depressive symptoms in adults with major depressive disorder (MDD) with acute suicidal ideation or behavior. * **Mechanism of Action:** Unlike traditional antidepressants that target monoamines (Serotonin/Norepinephrine), Esketamine is a non-competitive **NMDA receptor antagonist**. It increases glutamate release, leading to rapid synaptogenesis in the prefrontal cortex, providing a much faster onset of action (hours to days) compared to SSRIs. **Analysis of Incorrect Options:** * **B. Resistant Schizophrenia:** The drug of choice for treatment-resistant schizophrenia is **Clozapine**. Esketamine can actually exacerbate psychotic symptoms and is contraindicated in patients with a history of psychosis. * **C. Bipolar Disorder:** While ketamine is being researched for bipolar depression, Esketamine is currently only FDA-approved for Unipolar Depression. Using it in Bipolar disorder carries a risk of inducing a manic switch. * **D. Ketamine Dependence:** Esketamine itself has a high potential for abuse and is classified as a Schedule III controlled substance. It is not used to treat dependence. **High-Yield Clinical Pearls for NEET-PG:** * **Route:** Intranasal (administered under medical supervision due to sedation and dissociation risks). * **Side Effects:** Dissociation, dizziness, nausea, and **transient hypertension** (blood pressure must be monitored post-administration). * **REMS Program:** Due to the risk of serious adverse outcomes and misuse, it is only available through a restricted distribution system.

Question 156: What is the treatment of choice in depression with suicidal tendencies?

A. Tricyclic antidepressants (TCA)
B. Monoamine oxidase inhibitors (MAO-Inhibitors)
C. Fluoxetine + TCA + MAO-Inhibitor
D. Electroconvulsive therapy (ECT) (Correct Answer)

Explanation: **Explanation:** The correct answer is **Electroconvulsive Therapy (ECT)**. In psychiatric practice, the primary goal when managing a patient with active suicidal tendencies is the **rapid reduction of symptoms** to ensure patient safety. **1. Why ECT is the Correct Choice:** ECT is the most effective and fastest-acting treatment available for severe depression. While pharmacological treatments (antidepressants) typically take 2–4 weeks to show a therapeutic effect, ECT can produce a significant clinical response within a few sessions. Therefore, it is the **treatment of choice (TOC)** in emergency psychiatric conditions where there is an immediate risk of self-harm, suicide, or severe inanition (refusal to eat/drink). **2. Why Other Options are Incorrect:** * **Tricyclic Antidepressants (TCAs):** These have a slow onset of action. More importantly, TCAs are highly cardiotoxic in overdose; prescribing them to a suicidal patient is dangerous as the medication itself can be used as a means of suicide. * **MAO-Inhibitors:** These also have a delayed onset and require strict dietary restrictions (tyramine-free diet) to avoid hypertensive crises, making them impractical for acute suicidal crises. * **Fluoxetine + TCA + MAO-Inhibitor:** This combination is contraindicated. Combining MAO-Is with other antidepressants can lead to **Serotonin Syndrome**, a potentially fatal condition. **3. NEET-PG High-Yield Pearls:** * **Absolute Contraindication for ECT:** Increased intracranial pressure (ICP). * **Most Common Side Effect of ECT:** Retrograde and anterograde amnesia (usually transient). * **Drug of Choice for ECT Pre-medication:** Atropine (to reduce secretions/vagal bradycardia), Methohexital/Propofol (anesthetic), and Succinylcholine (muscle relaxant). * **Indications for ECT:** Severe depression with suicide risk, Catatonia, Treatment-resistant Depression, and Severe Mania.

Question 157: Which of the following antidepressants is used in atypical depression?

A. Imipramine
B. Phenelzine (Correct Answer)
C. Paroxetine
D. Amitriptyline

Explanation: **Explanation:** **Atypical depression** is a subtype of Major Depressive Disorder characterized by **mood reactivity** (the ability to feel better in response to positive events) along with at least two of the following: increased appetite/weight gain, hypersomnia, leaden paralysis (heavy feeling in limbs), and a long-standing pattern of interpersonal rejection sensitivity. **Why Phenelzine is correct:** Historically and clinically, **Monoamine Oxidase Inhibitors (MAOIs)** like **Phenelzine**, Tranylcypromine, and Isocarboxazid are considered the most effective treatments for atypical depression. While Selective Serotonin Reuptake Inhibitors (SSRIs) are now used as first-line therapy due to a better safety profile, MAOIs remain the "gold standard" in terms of efficacy for this specific subtype, especially in treatment-resistant cases. **Why the other options are incorrect:** * **Imipramine & Amitriptyline (Options A & D):** These are **Tricyclic Antidepressants (TCAs)**. TCAs are generally less effective for atypical depression compared to MAOIs and often exacerbate symptoms like weight gain and sedation, which are already present in atypical presentations. * **Paroxetine (Option C):** This is an **SSRI**. While SSRIs are commonly used in clinical practice for atypical depression due to fewer side effects, they are not the "classic" or superior choice when compared to the historical efficacy of MAOIs in this specific context. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice:** SSRIs are first-line (due to safety), but MAOIs (Phenelzine) are the most effective. * **Dietary Restriction:** Patients on Phenelzine must avoid **Tyramine-rich foods** (aged cheese, wine) to prevent a **Hypertensive Crisis**. * **Key Feature:** Mood reactivity is the pathognomonic feature of atypical depression.

Question 158: Which of the following medications is least effective against depression?

A. Valproate (Correct Answer)
B. Lamotrigine
C. Lithium
D. Aripiprazole

Explanation: **Explanation:** In the management of Bipolar Disorder, medications are categorized based on their efficacy in treating mania, depression, or both. **Valproate (Option A)** is a potent anti-manic agent and a first-line stabilizer for rapid cycling and mixed episodes. However, it has **minimal to no proven efficacy** in treating acute bipolar depression. While it may help prevent future depressive episodes as a maintenance therapy, it is the least effective among the choices for active depressive symptoms. **Why the other options are incorrect:** * **Lamotrigine (Option B):** This is the "gold standard" for preventing bipolar depression. While it is not used for acute mania, it has significant antidepressant properties and is specifically indicated for the maintenance of Bipolar II disorder. * **Lithium (Option C):** The classic mood stabilizer. It has established efficacy in treating acute bipolar depression (though slower than antipsychotics) and is the only medication proven to reduce the risk of suicide in these patients. * **Aripiprazole (Option D):** An atypical antipsychotic that is FDA-approved as an adjunctive treatment for Major Depressive Disorder (MDD) and is effective in managing bipolar symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice (DOC) for Acute Mania:** Lithium or Valproate. * **DOC for Bipolar Depression:** Quetiapine, Lurasidone, or Olanzapine-Fluoxetine combination (OFC). * **Lithium** is unique for its **anti-suicidal** properties. * **Lamotrigine** carries a risk of **Stevens-Johnson Syndrome (SJS)**; hence, it requires slow dose titration.

Question 159: What is the most common cause of suicide?

A. Childhood depression
B. Depression in the evolutionary stage
C. Psychiatric depression
D. Reactive depression (Correct Answer)

Explanation: **Explanation:** The most common cause of suicide globally and clinically is **Reactive Depression** (also known as Adjustment Disorder with depressed mood). 1. **Why Reactive Depression is correct:** Reactive depression occurs in response to identifiable external stressors—such as financial loss, academic failure, relationship breakups, or the death of a loved one. Because these life stressors are ubiquitous and affect a larger portion of the general population compared to endogenous or clinical syndromes, they account for the highest volume of suicidal attempts and completed suicides. The acute nature of the stressor often leads to impulsive suicidal behavior. 2. **Why other options are incorrect:** * **Childhood depression:** While serious, it is statistically less common than adult depression and accounts for a smaller fraction of total suicide cases. * **Depression in the evolutionary stage:** This is not a standard clinical term used to categorize the primary etiology of suicide in psychiatric literature. * **Psychiatric depression (Endogenous/Major Depressive Disorder):** While MDD has a higher *relative risk* (the likelihood of an individual committing suicide is very high), the *absolute number* of cases in the population is lower than those triggered by reactive, situational stressors. **NEET-PG High-Yield Pearls:** * **Most common psychiatric disorder associated with suicide:** Depression (specifically Unipolar Depression). * **Single best predictor of suicide:** A previous history of suicide attempts. * **Strongest demographic risk factor:** Male gender (for completed suicide) and Female gender (for attempted suicide). * **Protective factor:** Pregnancy and strong social support (especially children in the home for women).

Question 160: Mania is characterized by which of the following?

A. Paranoid delusion
B. Loss of orientation
C. High self-esteem (Correct Answer)
D. All of the above

Explanation: ### Explanation **Correct Answer: C. High self-esteem** **Why it is correct:** Mania is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. A core diagnostic feature according to DSM-5 and ICD-11 is **inflated self-esteem or grandiosity**. This ranges from uncritical self-confidence to delusional convictions of possessing special powers, wealth, or status (Grandiose Delusions). Patients typically feel "on top of the world" and possess an unwavering belief in their abilities. **Why other options are incorrect:** * **A. Paranoid Delusion:** While delusions can occur in "Mania with Psychotic Features," they are typically **mood-congruent** (grandiose). Paranoid or persecutory delusions are more characteristic of Schizophrenia or Delusional Disorders. While they *can* occur in severe mania, they are not a defining or universal characteristic like high self-esteem. * **B. Loss of Orientation:** Orientation (to time, place, and person) is generally **preserved** in mania. If a patient presents with significant disorientation, a clinician must first rule out Organic Brain Syndromes (Delirium) or substance-induced states. * **D. All of the above:** Since orientation is preserved and paranoid delusions are not a primary feature, this option is incorrect. **Clinical Pearls for NEET-PG:** * **DIG FAST Mnemonic:** Used to remember manic symptoms: **D**istractibility, **I**ndiscretion (excessive pleasure-seeking), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit (decreased *need* for sleep), **T**alkativeness (pressured speech). * **Duration Criteria:** Symptoms must last at least **1 week** for Mania and **4 days** for Hypomania. * **Key Distinction:** Hypomania **never** includes psychotic features and does not cause marked impairment in social or occupational functioning. * **Drug of Choice:** **Lithium** is the gold standard for long-term prophylaxis and acute mania (though valproate is often used for rapid cycling).

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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