Mood Disorders Practice Questions

Q: Otto Veraguth sign is seen in which of the following conditions?

Depression. **Explanation:** **Veraguth’s Sign** (or Veraguth’s fold) is a classic clinical sign associated with **Major Depressive Disorder**. It refers to a characteristic triangular fold in the nasal corner of the upper eyelid, caused by the contraction of the corrugator supercilii muscle. This gives the patient a look of persistent sorrow or "omega melancholicum." * **Why Depression is correct:** In severe depression (melancholic type), chronic contraction of the facial muscles involved in frowning leads to this specific skin fold. It is considered an objective physical marker of a depressed mood. * **Why other options are incorrect:** * **Mania:** Characterized by psychomotor agitation and "bright eyes" rather than specific eyelid folds. * **OCD:** Primarily involves repetitive thoughts and behaviors; it lacks specific pathognomonic facial skin signs. * **Anxiety:** Often presents with horizontal forehead wrinkling (due to frontalis muscle contraction) and a "startled" expression, but not the specific triangular fold of Veraguth. **High-Yield Clinical Pearls for NEET-PG:** * **Schüle’s Sign:** Another sign of depression; it is an "omega-shaped" (Ω) wrinkling of the forehead skin between the eyebrows. * **Omega Melancholicum:** The combination of Veraguth’s sign and Schüle’s sign. * **Darwin’s Ear:** Often confused in exams, this is a congenital ear prominence and is unrelated to psychiatry. * **Key Association:** Always link Veraguth’s sign with **Melancholic Depression** and **Psychomotor Retardation**.

Q: Which of the following is NOT characteristic of Type A personality?

Experiencing mood fluctuations. **Explanation:** The concept of **Type A Personality**, first described by cardiologists Friedman and Rosenman, refers to a specific pattern of behavior and emotion characterized by a chronic struggle to achieve more in less time. It is clinically significant because it is strongly associated with an increased risk of **Coronary Artery Disease (CAD)**. **Why Option D is correct:** **Experiencing mood fluctuations** is not a defining feature of Type A personality. Mood instability or emotional lability is more characteristic of **Cluster B Personality Disorders** (specifically Borderline Personality Disorder) or **Cyclothymic Disorder**. Type A individuals are generally consistent in their high-drive, high-stress baseline rather than shifting between emotional extremes. **Why the other options are incorrect:** * **A. Hostility:** This is considered the most "toxic" component of Type A behavior. It is the strongest predictor of cardiovascular morbidity. * **B. Feeling of time urgency:** Also known as "hurry sickness," these individuals are obsessed with deadlines, speak rapidly, and are impatient with delays. * **C. Competitiveness:** Type A individuals possess a high achievement drive and often view life as a constant competition, leading to significant occupational stress. **NEET-PG High-Yield Pearls:** * **Type A:** High risk for CAD; key traits are Hostility, Impatience, and Ambition. * **Type B:** The opposite of Type A; relaxed, easy-going, and less prone to stress-related heart disease. * **Type C:** "Cancer-prone" personality; characterized by suppressing emotions (especially anger), being overly cooperative, and passive. * **Type D:** "Distressed" personality; characterized by negative affectivity and social inhibition; also linked to poor cardiac outcomes.

Q: A violent manic patient should not be treated with:

Cognitive therapy. **Explanation:** The management of a **violent manic patient** constitutes a psychiatric emergency. The primary goal is rapid stabilization, sedation, and safety. **Why Cognitive Therapy is the Correct Answer:** Cognitive Behavioral Therapy (CBT) and other psychotherapies are **strictly contraindicated** during an acute manic episode, especially when the patient is violent. 1. **Lack of Insight:** Manic patients lack the insight and judgment necessary for psychotherapy. 2. **Cognitive Impairment:** The flight of ideas and distractibility make it impossible for the patient to engage in structured talk therapy. 3. **Agitation:** Attempting therapy can further frustrate and provoke a violent patient. Psychotherapy is only indicated during the **maintenance phase** once the patient is euthymic. **Analysis of Incorrect Options:** * **A. Benzodiazepines:** These are first-line for acute agitation. Drugs like Lorazepam provide rapid sedation and help control violent behavior. * **C. Atypical Antipsychotics:** These (e.g., Olanzapine, Risperidone) are the mainstay of treatment for acute mania due to their rapid onset of action in controlling psychotic symptoms and agitation. * **D. Quetiapine:** An atypical antipsychotic frequently used in mania for its sedative and mood-stabilizing properties. **NEET-PG High-Yield Pearls:** * **Drug of Choice (DOC) for Acute Mania:** Lithium is the gold standard, but for **acute agitation/violence**, injectable antipsychotics (Haloperidol) or Benzodiazepines are preferred for immediate control. * **Lithium vs. Valproate:** Lithium is preferred for "classic" mania; Valproate is preferred for "mixed" episodes or rapid cycling. * **Safe in Pregnancy:** High-potency antipsychotics (Haloperidol) are preferred over Lithium (Ebstein’s anomaly) in acute settings.

Q: Which of the following is pathognomonic of a manic episode?

Grandiosity. **Explanation:** **Grandiosity** is considered the most characteristic and pathognomonic feature of a manic episode. While many symptoms overlap with other psychiatric conditions, the presence of inflated self-esteem or grandiosity—ranging from uncritical self-confidence to grandiose delusions (e.g., believing one has special powers or a divine mission)—is a hallmark of mania. **Analysis of Options:** * **Elevated mood (Option A):** While a core feature of mania, it is not pathognomonic. Elevated or euphoric mood can be seen in substance-induced states (e.g., stimulant use) or hyperthyroidism. Furthermore, mania can sometimes present as irritable mood rather than elevated mood. * **Decreased appetite (Option C):** This is a non-specific vegetative symptom. While manic patients may "forget" to eat due to hyperactivity, decreased appetite is more classically associated with depressive episodes or medical illnesses. * **Increased sleep (Option D):** This is incorrect. A hallmark of mania is a **decreased need for sleep** (feeling rested after only 3 hours), whereas increased sleep (hypersomnia) is often seen in atypical depression. **Clinical Pearls for NEET-PG:** * **DIG FAST Mnemonic:** Used to remember manic symptoms: **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressure of speech). * **Duration Criteria:** According to DSM-5, symptoms must last at least **1 week** for a Manic Episode and **4 days** for a Hypomanic Episode. * **Psychosis:** The presence of hallucinations or delusions (like grandiosity) automatically upgrades a diagnosis from hypomania to **Mania**.

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

All of the above. **Explanation:** Suicidal ideation and behavior are not exclusive to mood disorders; they are significant complications across a wide spectrum of psychiatric illnesses. The correct answer is **All of the above** because each of these conditions significantly elevates the risk of self-harm through different psychopathological mechanisms. 1. **Substance Abuse:** Chronic substance use disorders (especially alcohol and opioids) are the second most common psychiatric risk factor for suicide after mood disorders. Mechanisms include increased impulsivity, social isolation, and the "depressant" effects of the substances themselves. 2. **Post-Traumatic Stress Disorder (PTSD):** Patients with PTSD often experience intense psychological distress, "survivor guilt," and comorbid depression. The chronic state of hyperarousal and emotional numbing often leads to a desire to escape the mental pain. 3. **Schizophrenia:** Approximately 5–10% of patients with schizophrenia die by suicide. High-risk periods include the early stages of the illness, periods of post-psychotic depression, or when acting upon "command hallucinations" (auditory hallucinations ordering the patient to hurt themselves). **Clinical Pearls for NEET-PG:** * **Single most important risk factor for suicide:** A previous history of suicide attempts. * **Most common psychiatric diagnosis in completed suicides:** Depressive disorders (approx. 60–70%). * **SAD PERSONS Scale:** A high-yield mnemonic used to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol, Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness). * **Protective Factor:** Strong social support and pregnancy (in most studies) are considered significant protective factors.

Q: To diagnose depression, symptoms should last for at least what duration?

2 weeks. To diagnose a **Major Depressive Episode**, both the **ICD-11** and **DSM-5** criteria require symptoms to be present for a minimum duration of **2 weeks**. This timeframe is essential to differentiate a clinical mood disorder from transient periods of sadness or "the blues" that occur in response to daily stressors. ### Why 2 Weeks is Correct: According to the DSM-5, a patient must experience at least five out of nine symptoms (including either depressed mood or anhedonia) for most of the day, nearly every day, for at least **14 consecutive days**. This duration represents the clinical threshold where the persistence of symptoms indicates a significant neurochemical or psychological disturbance requiring intervention. ### Why Other Options are Incorrect: * **4 weeks (A):** This is not a standard diagnostic cutoff for depression. However, in some contexts, 4 weeks is used to define "postpartum onset" if symptoms begin within a month of delivery. * **6 months (B):** This is the duration required to diagnose **Persistent Depressive Disorder (Dysthymia)** in children/adolescents (though it is 2 years for adults) or **Generalized Anxiety Disorder (GAD)**. * **6 weeks (D):** This is often the timeframe required to assess the full therapeutic response to an antidepressant medication, but it is not the diagnostic threshold. ### High-Yield Clinical Pearls for NEET-PG: * **Core Symptoms (ICD-11):** Depressed mood, Anhedonia (loss of interest), and Decreased energy (easy fatigability). * **Dysthymia:** Chronic low-grade depression lasting for at least **2 years**. * **Bereavement:** In DSM-5, the "bereavement exclusion" was removed; depression can now be diagnosed even if it follows the loss of a loved one, provided the 2-week criteria are met. * **Most common symptom:** Psychomotor retardation is a common objective sign, but depressed mood is the most common subjective complaint.

Q: Repeated transcranial magnetic stimulation (rTMS) of the brain is used in the treatment of which of the following conditions?

Depression. **Explanation:** **Correct Option: A. Depression** Repeated Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuromodulation technique that uses electromagnetic induction to generate small electrical currents in specific brain regions. In the treatment of **Major Depressive Disorder (MDD)**, rTMS is typically applied to the **Left Dorsolateral Prefrontal Cortex (DLPFC)**. High-frequency stimulation (10–20 Hz) in this area increases neuronal excitability and neurotransmitter release, which is often diminished in depressed patients. It is FDA-approved for patients who have not responded to at least one antidepressant medication. **Analysis of Incorrect Options:** * **B & C (Resistant Schizophrenia/OCD):** While rTMS is being researched for auditory hallucinations in schizophrenia (targeting the temporoparietal cortex) and for OCD (targeting the SMA or anterior cingulate), it is **not** the first-line or standard clinical indication compared to Depression. For NEET-PG, Depression remains the primary established indication. * **D (Acute Psychosis):** Acute psychosis is a psychiatric emergency requiring rapid stabilization, usually via antipsychotics or ECT. rTMS is not indicated for acute management due to its slower onset of action and limited efficacy in psychotic states. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Electromagnetic induction (Faraday’s Law). * **Primary Target:** Left DLPFC (High frequency/Excitatory) or Right DLPFC (Low frequency/Inhibitory). * **Contraindication:** Presence of metallic implants (e.g., pacemakers, cochlear implants) or history of seizures (as rTMS can rarely induce seizures). * **Advantage over ECT:** No anesthesia required, no memory impairment, and no systemic side effects.

Q: Which neurotransmitter is associated with suicidal tendencies?

Serotonin. **Explanation:** The correct answer is **Serotonin (5-HT)**. **1. Why Serotonin is Correct:** Low levels of serotonin and its primary metabolite, **5-HIAA (5-Hydroxyindoleacetic acid)**, in the cerebrospinal fluid (CSF) are strongly associated with increased impulsivity, aggression, and suicidal behavior. This finding is consistent across various psychiatric diagnoses, including depression and personality disorders. Specifically, low 5-HIAA levels are a significant predictor of violent suicide attempts. **2. Why Incorrect Options are Wrong:** * **GABA:** This is the primary inhibitory neurotransmitter. While it is implicated in anxiety disorders and the mechanism of benzodiazepines, it is not the primary marker for suicidal tendencies. * **Norepinephrine:** While dysregulation of the noradrenergic system is linked to depression and arousal (the "Catecholamine Hypothesis"), it is less specifically linked to the impulsive-aggressive drive of suicide compared to serotonin. * **Acetylcholine:** This neurotransmitter is primarily associated with cognitive functions (memory) and the parasympathetic nervous system. Its role in mood disorders is secondary and not a diagnostic marker for suicide risk. **3. NEET-PG High-Yield Pearls:** * **Gold Standard Marker:** Low **CSF 5-HIAA** is the most high-yield biochemical marker associated with completed suicide and violent attempts. * **Brain Region:** Reduced serotonergic activity in the **ventromedial prefrontal cortex** is linked to the failure to inhibit suicidal impulses. * **Dexamethasone Suppression Test (DST):** Non-suppression on the DST (indicating hypothalamic-pituitary-adrenal axis hyperactivity) is also associated with a higher risk of suicide in depressed patients. * **Antisuicidal Drugs:** **Lithium** (in Bipolar Disorder) and **Clozapine** (in Schizophrenia) are the two primary medications proven to reduce the risk of suicide.

Question 1

Otto Veraguth sign is seen in which of the following conditions?

Accepted Answer

Depression

Answer

Mania

Answer

Obsessive-Compulsive Disorder

Answer

Anxiety

Question 2

A 25-year-old lady presented with sadness, palpitation, loss of appetite, and insomnia. There is no complaint of hopelessness, suicidal thoughts, and no past history of any precipitating event. She is remarkably well in other areas of life, doing her office job normally, and her social life is also normal. What is the probable diagnosis in this case?

Accepted Answer

Generalized Anxiety Disorder (GAD)

Answer

Mixed anxiety and depression

Answer

Adjustment disorder

Answer

Mild depressive episode

Question 3

Which of the following is NOT characteristic of Type A personality?

Accepted Answer

Experiencing mood fluctuations

Answer

Hostility

Answer

Feeling of time urgency

Answer

Competitiveness

Question 4

A violent manic patient should not be treated with:

Accepted Answer

Cognitive therapy

Answer

Benzodiazepines

Answer

Atypical antipsychotics

Answer

Quetiapine

Question 5

A distinguishing feature of psychotic disorders is

Accepted Answer

Confusion between fantasy and reality

Answer

Suspiciousness

Answer

Obsessions and Compulsions

Answer

Presence of severe depression

Question 6

Which of the following is pathognomonic of a manic episode?

Accepted Answer

Grandiosity

Answer

Elevated mood

Answer

Decreased appetite

Answer

Increased sleep

Question 7

Suicidal tendencies are seen in which of the following conditions?

Accepted Answer

All of the above

Answer

Substance abuse

Answer

Post-traumatic stress disorder (PTSD)

Answer

Schizophrenia

Question 8

To diagnose depression, symptoms should last for at least what duration?

Accepted Answer

2 weeks

Answer

4 weeks

Answer

6 months

Answer

6 weeks

Question 9

Repeated transcranial magnetic stimulation (rTMS) of the brain is used in the treatment of which of the following conditions?

Accepted Answer

Depression

Answer

Resistant schizophrenia

Answer

Resistant OCD

Answer

Acute psychosis

Question 10

Which neurotransmitter is associated with suicidal tendencies?

Accepted Answer

Serotonin

Answer

GABA

Answer

Norepinephrine

Answer

Acetylcholine

Mood Disorders — MCQs

Mood Disorders — MCQs

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