Mood Disorders Practice Questions

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

Severe depression. **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.

Q: What is the primary treatment for seasonal affective disorder?

Bright light therapy. **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.

Q: What is the most common psychiatric illness?

Depression. **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.

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

Depression. **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.

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

Electroconvulsive therapy (ECT). **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.

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

Phenelzine. **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.

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

Valproate. **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.

Q: What is the most common cause of suicide?

Reactive depression. **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 1

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?

Accepted Answer

Dysthymia

Answer

Schizophrenia

Answer

Involutional melancholia

Answer

Anhedonia

Question 2

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

Accepted Answer

Severe depression

Answer

Females

Answer

Younger age

Answer

All of the above

Question 3

What is the primary treatment for seasonal affective disorder?

Accepted Answer

Bright light therapy

Answer

Selective serotonin reuptake inhibitors (SSRIs)

Answer

Electroconvulsive therapy (ECT)

Answer

Sensate focus

Question 4

What is the most common psychiatric illness?

Accepted Answer

Depression

Answer

Bipolar disorder

Answer

Mania

Answer

Cyclothymia

Question 5

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

Accepted Answer

Depression

Answer

Resistant schizophrenia

Answer

Bipolar disorder

Answer

Ketamine dependence

Question 6

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

Accepted Answer

Electroconvulsive therapy (ECT)

Answer

Tricyclic antidepressants (TCA)

Answer

Monoamine oxidase inhibitors (MAO-Inhibitors)

Answer

Fluoxetine + TCA + MAO-Inhibitor

Question 7

Which of the following antidepressants is used in atypical depression?

Accepted Answer

Phenelzine

Answer

Imipramine

Answer

Paroxetine

Answer

Amitriptyline

Question 8

Which of the following medications is least effective against depression?

Accepted Answer

Valproate

Answer

Lamotrigine

Answer

Lithium

Answer

Aripiprazole

Question 9

What is the most common cause of suicide?

Accepted Answer

Reactive depression

Answer

Childhood depression

Answer

Depression in the evolutionary stage

Answer

Psychiatric depression

Question 10

Mania is characterized by which of the following?

Accepted Answer

High self-esteem

Answer

Paranoid delusion

Answer

Loss of orientation

Answer

All of the above

Mood Disorders — MCQs

Mood Disorders — MCQs

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