Mood Disorders Practice Questions

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

Manic depressive psychosis. **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.

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

Depression. **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).

Q: Which of the following best characterizes Bipolar II disorder?

Hypomania and severe depression. **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).

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

Prevalence is more amongst females than males. **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.

Q: Which theory of depression was developed by Beck?

Beck. **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).

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

Lithium. **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.

Question 1

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

Accepted Answer

Manic depressive psychosis

Answer

Schizophrenia

Answer

Alcoholism

Answer

Depression

Question 2

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?

Accepted Answer

Electroconvulsive Therapy (ECT)

Answer

Amitriptyline

Answer

Selegiline

Answer

Haloperidol + Chlorpromazine

Question 3

Reactive depression is similar to which of the following conditions?

Accepted Answer

Adjustment disorder

Answer

Dysthymia

Answer

Double depression

Answer

Post-traumatic stress disorder

Question 4

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

Accepted Answer

Fluoxetine

Answer

Buspirone

Answer

Amitriptyline

Answer

Imipramine

Question 5

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

Accepted Answer

Depression

Answer

Obsessive-compulsive disorder

Answer

Mania

Answer

Schizophrenia

Question 6

Which of the following best characterizes Bipolar II disorder?

Accepted Answer

Hypomania and severe depression

Answer

Severe mania and severe depression

Answer

Only hypomania

Answer

Only severe depression

Question 7

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

Accepted Answer

Lithium

Answer

Diazepam

Answer

Olanzapine

Answer

Carbamazepine

Question 8

All of the following are true about bipolar disorder except?

Accepted Answer

Prevalence is more amongst females than males

Answer

Lifetime prevalence is around 1%

Answer

Mean age of onset is 21 years

Answer

Prevalence varies according to socioeconomic status

Question 9

Which theory of depression was developed by Beck?

Accepted Answer

Beck

Answer

Ellis

Answer

Godfrey

Answer

Meichenbaum

Question 10

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

Accepted Answer

Lithium

Answer

Amphetamine

Answer

Diazepam

Answer

Alprazolam

Mood Disorders — MCQs

Mood Disorders — MCQs

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