Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 161: The period of normalcy is seen between two psychotic episodes. What is the diagnosis?

A. Schizophrenia
B. Manic depressive psychosis (Correct Answer)
C. Alcoholism
D. Depression

Explanation: **Explanation:** The hallmark of **Manic Depressive Psychosis (MDP)**, now clinically referred to as Bipolar Disorder, is the **episodic nature** of the illness. In MDP, patients experience distinct episodes of mania or depression, but these are separated by periods of **inter-episodic normalcy** (euthymia). During these intervals, the patient typically returns to their baseline level of functioning with no residual psychotic or cognitive symptoms. This "restitution ad integrum" (restoration to the original state) is a key diagnostic differentiator. **Why other options are incorrect:** * **Schizophrenia:** This is characterized by a **chronic, deteriorating course**. While symptoms may fluctuate, there is usually a decline from the baseline functioning and the presence of residual symptoms (like apathy or social withdrawal) between acute exacerbations. * **Alcoholism:** This is a substance use disorder characterized by dependence and withdrawal. While there are periods of sobriety, it does not follow the cyclical "psychotic episode vs. normalcy" pattern inherent to primary mood disorders. * **Depression:** While Unipolar Depression is episodic, the question specifies "psychotic episodes." While severe depression can have psychotic features, MDP is the more classic representation of alternating psychotic states with clear intervening periods. **High-Yield Clinical Pearls for NEET-PG:** * **Prognosis:** MDP generally has a **better prognosis** than Schizophrenia because of the preservation of the personality and the period of normalcy. * **Kraepelin’s Dichotomy:** Emil Kraepelin distinguished "Dementia Praecox" (Schizophrenia) as deteriorating and "Manic Depressive Insanity" as episodic/non-deteriorating. * **Lithium:** It is the gold standard for prophylaxis to maintain this period of normalcy in Bipolar Disorder.

Question 162: A 26-year-old female diagnosed with depression has developed suicidal tendencies, thoughts, and ideas over the past 2 days. What is the best treatment?

A. Amitriptyline
B. Selegiline
C. Haloperidol + Chlorpromazine
D. Electroconvulsive Therapy (ECT) (Correct Answer)

Explanation: ### Explanation The correct answer is **Electroconvulsive Therapy (ECT)**. **Why ECT is the correct choice:** In psychiatry, the presence of **active suicidal ideation or intent** is considered a psychiatric emergency. While antidepressants are the mainstay for long-term management of depression, they typically have a "therapeutic lag" of 2–4 weeks before significant improvement is seen. In contrast, ECT provides the **fastest clinical response** and is the treatment of choice when rapid improvement is necessary to ensure patient safety. **Analysis of Incorrect Options:** * **Amitriptyline (Option A):** This is a Tricyclic Antidepressant (TCA). It is contraindicated in suicidal patients because it is highly cardiotoxic in overdose (arrhythmias via sodium channel blockade). Furthermore, its slow onset of action makes it unsuitable for acute suicidal crises. * **Selegiline (Option B):** An MAO-B inhibitor used primarily in Parkinson’s disease (or as an antidepressant at higher doses). Like other antidepressants, it lacks the rapid onset required to manage immediate suicidal risk. * **Haloperidol + Chlorpromazine (Option C):** These are typical antipsychotics. While they may help with agitation or psychotic depression, they are not the primary treatment for suicidal tendencies in a patient with standard depression. **Clinical Pearls for NEET-PG:** * **Indications for ECT:** Severe suicidality (most common acute indication), treatment-resistant depression, catatonia, and severe depression during pregnancy (where drugs may be teratogenic). * **Absolute Contraindication:** There are no absolute contraindications for ECT, but **increased intracranial pressure (ICP)** is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde and anterograde amnesia (usually transient). * **Pre-ECT Medication:** Atropine (to reduce secretions/bradycardia), Methohexital/Propofol (anesthetic), and Succinylcholine (muscle relaxant to prevent fractures).

Question 163: Reactive depression is similar to which of the following conditions?

A. Dysthymia
B. Double depression
C. Adjustment disorder (Correct Answer)
D. Post-traumatic stress disorder

Explanation: ### Explanation **Reactive Depression** is a clinical term used to describe a depressive episode that occurs in direct response to a specific external stressor (e.g., job loss, divorce, or bereavement). In modern psychiatric classification (DSM-5/ICD-11), this is most closely represented by **Adjustment Disorder with Depressed Mood**. #### Why Adjustment Disorder is Correct: Adjustment disorder is characterized by emotional or behavioral symptoms developing within **3 months** of an identifiable stressor. The distress is out of proportion to the severity of the stressor and leads to significant functional impairment. Like reactive depression, the symptoms are "reactive" to life events rather than being endogenous or biological in origin. #### Why Other Options are Incorrect: * **Dysthymia (Persistent Depressive Disorder):** This is a chronic form of depression where symptoms last for at least **2 years**. It is defined by its duration and "low-grade" nature rather than its relationship to a specific triggering event. * **Double Depression:** This occurs when a patient with underlying Dysthymia experiences an overlay of a Major Depressive Episode (MDE). It refers to the clinical course, not the reaction to a stressor. * **Post-Traumatic Stress Disorder (PTSD):** While PTSD is triggered by a stressor, that stressor must be **catastrophic or life-threatening** (e.g., war, sexual assault). PTSD also requires specific symptoms like flashbacks, hyperarousal, and avoidance, which are not core features of reactive depression. #### High-Yield Clinical Pearls for NEET-PG: * **Timeline:** Adjustment disorder symptoms must resolve within **6 months** once the stressor (or its consequences) has terminated. * **Endogenous vs. Reactive:** Endogenous depression (Melancholic) is thought to be biological/genetic and occurs without a clear trigger, whereas Reactive depression is psychogenic. * **Treatment of Choice:** For Adjustment Disorder, **Psychotherapy** (Brief Dynamic or CBT) is the first-line treatment, unlike Major Depression where pharmacotherapy is often primary.

Question 164: What is the drug of choice for depression in elderly patients?

A. Fluoxetine (Correct Answer)
B. Buspirone
C. Amitriptyline
D. Imipramine

Explanation: **Explanation:** **1. Why Fluoxetine is the Correct Answer:** In elderly patients, the primary goal of antidepressant therapy is to maximize efficacy while minimizing side effects, particularly anticholinergic and cardiovascular risks. **Selective Serotonin Reuptake Inhibitors (SSRIs)**, such as **Fluoxetine**, are considered the **first-line drug of choice** for geriatric depression. They are preferred because they lack the sedative, orthostatic, and cardiotoxic effects associated with older classes of antidepressants. Fluoxetine, specifically, has a long half-life, which can be beneficial in patients with poor medication adherence. **2. Analysis of Incorrect Options:** * **Amitriptyline & Imipramine (Options C & D):** These are Tricyclic Antidepressants (TCAs). They are generally **avoided in the elderly** due to potent anticholinergic side effects (confusion, urinary retention, constipation, blurred vision) and antihistaminic effects (sedation). Most importantly, they pose a high risk of **orthostatic hypotension** (increasing fall risk) and **cardiac arrhythmias**. * **Buspirone (Option B):** This is an anxiolytic (5-HT1A partial agonist) used primarily for Generalized Anxiety Disorder (GAD). It is not an antidepressant and is ineffective as a monotherapy for clinical depression. **3. Clinical Pearls for NEET-PG:** * **Start Low, Go Slow:** In the elderly, the initial dose of SSRIs should be half the usual adult dose to minimize side effects like GI upset or hyponatremia (SIADH). * **Sertraline:** Often considered the safest SSRI in elderly patients with **co-morbid cardiac disease** due to its minimal drug-drug interactions. * **Pseudodementia:** Always rule out depression in elderly patients presenting with cognitive decline; unlike true dementia, "depressive pseudodementia" is reversible with antidepressants. * **ECT:** Electroconvulsive therapy remains the most effective treatment for severe, treatment-resistant, or suicidal depression in the elderly.

Question 165: A patient reports a persistent feeling of guilt. Which of the following is most commonly associated with this symptom?

A. Obsessive-compulsive disorder
B. Depression (Correct Answer)
C. Mania
D. Schizophrenia

Explanation: **Explanation:** **1. Why Depression is the Correct Answer:** Persistent and inappropriate feelings of guilt are a hallmark symptom of **Major Depressive Disorder (MDD)**. According to the DSM-5 and ICD-10 criteria, guilt is one of the core psychological symptoms of depression. It often manifests as self-reproach or excessive rumination over minor past failings. In severe cases, this can escalate into **depressive delusions** (e.g., the patient believes they are responsible for a global catastrophe), which is a key feature of Psychotic Depression. **2. Why Other Options are Incorrect:** * **Obsessive-Compulsive Disorder (OCD):** While patients with OCD may feel distress or responsibility regarding their obsessions, the primary clinical features are intrusive thoughts and repetitive compulsions, not a pervasive mood of guilt. * **Mania:** Mania is characterized by an abnormally elevated, expansive, or irritable mood. Patients typically exhibit **inflated self-esteem or grandiosity**, which is the polar opposite of the worthlessness and guilt seen in depression. * **Schizophrenia:** The core symptoms are hallucinations, delusions (usually persecutory), and disorganized thinking. While guilt can occur, it is not a diagnostic or defining feature of the disorder. **3. High-Yield Clinical Pearls for NEET-PG:** * **Beck’s Cognitive Triad:** Depression involves negative views about the **Self** (guilt/worthlessness), the **World**, and the **Future** (hopelessness). * **Nihilistic Delusions (Cotard Syndrome):** A severe form of depressive guilt/despair where the patient believes they are dead or their internal organs have rotted away. * **Suicide Risk:** Persistent guilt is a significant risk factor for suicidal ideation; always screen for safety when this symptom is present. * **Melancholic Depression:** Specifically associated with excessive or inappropriate guilt and a total loss of pleasure (anhedonia).

Question 166: Which of the following best characterizes Bipolar II disorder?

A. Severe mania and severe depression
B. Hypomania and severe depression (Correct Answer)
C. Only hypomania
D. Only severe depression

Explanation: **Explanation:** Bipolar II Disorder is clinically defined by the occurrence of at least one **Hypomanic Episode** and at least one **Major Depressive Episode**. The hallmark of this condition is that the patient never experiences a full-blown manic episode. While hypomania is less severe than mania, the depressive episodes in Bipolar II are often frequent, severe, and carry a high risk of suicide. **Analysis of Options:** * **Option A (Incorrect):** This describes **Bipolar I Disorder**, which requires at least one episode of mania. In Bipolar I, major depression is common but not strictly required for diagnosis (though it occurs in the vast majority of cases). * **Option C (Incorrect):** Hypomania alone does not meet the criteria for Bipolar II. Furthermore, if a patient has only hypomania without depression, it is rarely diagnosed as a clinical disorder unless it evolves into Bipolar I. * **Option D (Incorrect):** This describes **Unipolar Depression** (Major Depressive Disorder). The presence of any history of hypomania or mania excludes this diagnosis. **NEET-PG High-Yield Pearls:** * **Bipolar I vs. II:** The "Gold Standard" differentiator is the severity of the "up" mood. **Mania + Depression = Bipolar I**; **Hypomania + Depression = Bipolar II**. * **Cyclothymia:** A chronic mood disturbance (at least 2 years) involving periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for a major episode. * **Treatment:** Lithium is the classic mood stabilizer. However, in Bipolar II, treating the depressive phase is the primary challenge; antidepressants should generally be avoided as monotherapy to prevent "switching" into hypomania. * **Mnemonic:** Bipolar **1** is "Higher" (Mania); Bipolar **2** is "Lower" (Hypomania).

Question 167: What is the drug of choice for Mixed Depressive-Manic (MDM) episodes?

A. Lithium (Correct Answer)
B. Diazepam
C. Olanzapine
D. Carbamazepine

Explanation: ### Explanation **Correct Option: A. Lithium** Lithium remains the **gold standard** and the drug of choice (DOC) for the treatment and prophylaxis of Bipolar Affective Disorder (BPAD), including mixed episodes. In a mixed episode (where symptoms of mania and depression occur simultaneously or in rapid succession), Lithium is highly effective in stabilizing mood and, crucially, is the only drug proven to **reduce the risk of suicide**, which is significantly higher during mixed states. **Why the other options are incorrect:** * **B. Diazepam:** This is a benzodiazepine used for short-term management of anxiety, insomnia, or acute agitation. It has no mood-stabilizing properties and does not treat the underlying pathology of a mixed episode. * **C. Olanzapine:** While atypical antipsychotics like Olanzapine are effective for acute mania and can be used as adjuncts in mixed episodes, they are generally considered second-line or used in combination with mood stabilizers. They are not the primary DOC. * **D. Carbamazepine:** This is an anticonvulsant used as a mood stabilizer. It is typically reserved for "Rapid Cyclers" or patients who do not respond to Lithium/Valproate. It is not the first-line choice due to its side effect profile and drug-drug interactions (enzyme induction). **High-Yield Clinical Pearls for NEET-PG:** * **DOC for Acute Mania:** Lithium (Valproate is often preferred if the patient is highly irritable or has a mixed episode in clinical practice, but Lithium remains the classic textbook answer). * **DOC for Rapid Cycling BPAD:** Sodium Valproate. * **Therapeutic Index of Lithium:** Narrow (0.6–1.2 mEq/L). Toxicity starts >1.5 mEq/L. * **Teratogenicity:** Lithium is associated with **Ebstein’s Anomaly** (tricuspid valve abnormality) if taken during pregnancy. * **Monitoring:** Before starting Lithium, always check Renal Function Tests (RFT) and Thyroid Function Tests (TFT), as it can cause nephrogenic diabetes insipidus and hypothyroidism.

Question 168: All of the following are true about bipolar disorder except?

A. Prevalence is more amongst females than males (Correct Answer)
B. Lifetime prevalence is around 1%
C. Mean age of onset is 21 years
D. Prevalence varies according to socioeconomic status

Explanation: **Explanation:** **1. Why Option A is the correct answer (The Exception):** In Bipolar Affective Disorder (BPAD), the prevalence is **equal among males and females** (1:1 ratio). This is a high-yield distinction from Major Depressive Disorder (MDD), where the prevalence is significantly higher in females (2:1). While the overall prevalence is equal, gender differences exist in clinical presentation: manic episodes are more common in men, whereas depressive episodes and "rapid cycling" patterns are more common in women. **2. Analysis of Incorrect Options (True Statements):** * **Option B:** The lifetime prevalence of Bipolar I disorder is consistently cited as approximately **1%** (ranging from 0.8% to 1.6% in various studies). * **Option C:** The mean age of onset for BPAD is typically in the **early 20s** (approximately 21 years). It is generally lower than the age of onset for Unipolar Depression. * **Option D:** Unlike Schizophrenia (which is more common in lower socioeconomic groups), Bipolar Disorder is often found to have a higher prevalence in **upper socioeconomic classes**, indicating that prevalence does indeed vary with status. **Clinical Pearls for NEET-PG:** * **Strongest Genetic Link:** BPAD has the highest heritability among all major psychiatric disorders (monozygotic twin concordance is ~70-80%). * **Lithium:** The gold standard mood stabilizer; it is the only drug proven to reduce suicide risk in BPAD patients. * **Bipolar II vs. I:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode AND one Major Depressive episode. * **Cyclothymia:** A chronic mood disturbance (at least 2 years) involving hypomanic and depressive symptoms that do not meet full criteria for BPAD.

Question 169: Which theory of depression was developed by Beck?

A. Ellis
B. Beck (Correct Answer)
C. Godfrey
D. Meichenbaum

Explanation: **Explanation:** The correct answer is **Beck**. Aaron Beck developed the **Cognitive Theory of Depression**, which posits that depression is maintained by distorted thinking patterns. The hallmark of this theory is the **Beck’s Cognitive Triad**, consisting of negative views about: 1. **The Self** (e.g., "I am worthless") 2. **The World/Environment** (e.g., "Everything is unfair") 3. **The Future** (e.g., "Things will never get better") According to Beck, these negative schemas lead to cognitive distortions (like overgeneralization or catastrophizing), which are the primary drivers of depressive symptoms. This theory forms the basis of **Cognitive Behavioral Therapy (CBT)**. **Analysis of Incorrect Options:** * **Ellis:** Albert Ellis developed **Rational Emotive Behavior Therapy (REBT)**. His model focuses on the **ABC technique** (Activating event, Beliefs, and Consequences), emphasizing that it is our irrational beliefs about events, rather than the events themselves, that cause emotional distress. * **Meichenbaum:** Donald Meichenbaum is known for **Cognitive Behavior Modification** and **Stress Inoculation Training**, which helps patients prepare for and cope with stressful situations. * **Godfrey:** This is a distractor and is not associated with a major foundational theory of depression in standard psychiatric curricula. **High-Yield Clinical Pearls for NEET-PG:** * **Learned Helplessness:** Proposed by **Martin Seligman**; it suggests depression occurs when individuals feel they have no control over repeated negative events. * **CBT Indications:** It is the first-line psychotherapy for mild-to-moderate depression and is often as effective as antidepressants. * **Cognitive Distortions:** Common examples include **Arbitrary Inference** (jumping to conclusions) and **Selective Abstraction** (focusing only on negative details).

Question 170: What is the drug of choice for a patient experiencing a manic episode of bipolar disorder?

A. Lithium (Correct Answer)
B. Amphetamine
C. Diazepam
D. Alprazolam

Explanation: **Explanation:** **Lithium (Option A)** is the gold-standard treatment and the drug of choice for the management of acute manic episodes in Bipolar Affective Disorder (BPAD). It acts as a potent mood stabilizer by modulating neurotransmitters (decreasing dopamine and glutamate, increasing GABA) and inhibiting the inositol monophosphatase pathway. Beyond its efficacy in treating mania, Lithium is uniquely high-yield for its **anti-suicidal properties** and its role in long-term prophylaxis. **Why the other options are incorrect:** * **Amphetamine (Option B):** This is a CNS stimulant that increases synaptic dopamine. It can actually *precipitate* or worsen a manic episode and is contraindicated in BPAD. * **Diazepam and Alprazolam (Options C & D):** These are benzodiazepines. While they may be used as adjuncts to manage agitation or insomnia during mania, they do not treat the underlying mood pathology. They are not primary mood stabilizers. **High-Yield Clinical Pearls for NEET-PG:** 1. **Therapeutic Index:** Lithium has a narrow therapeutic index. For **acute mania**, the target serum level is **0.8–1.2 mEq/L**; for **maintenance**, it is **0.6–0.8 mEq/L**. 2. **Alternative:** If Lithium is contraindicated (e.g., renal failure), **Sodium Valproate** is the preferred alternative. 3. **Teratogenicity:** Lithium use during pregnancy is associated with **Ebstein’s Anomaly** (tricuspid valve malformation). 4. **Side Effects:** Common side effects include fine tremors, polyuria (nephrogenic diabetes insipidus), and hypothyroidism.

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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