Mood Disorders — MCQs
On this page
Otto Veraguth sign is seen in which of the following conditions?
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?
Which of the following is NOT characteristic of Type A personality?
A violent manic patient should not be treated with:
A distinguishing feature of psychotic disorders is
Which of the following is pathognomonic of a manic episode?
Suicidal tendencies are seen in which of the following conditions?
To diagnose depression, symptoms should last for at least what duration?
Repeated transcranial magnetic stimulation (rTMS) of the brain is used in the treatment of which of the following conditions?
Which neurotransmitter is associated with suicidal tendencies?
Mood Disorders Indian Medical PG Practice Questions and MCQs
Question 171: Otto Veraguth sign is seen in which of the following conditions?
- A. Mania
- B. Obsessive-Compulsive Disorder
- C. Anxiety
- D. Depression (Correct Answer)
Explanation: **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**.
Question 172: 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?
- A. Generalized Anxiety Disorder (GAD) (Correct Answer)
- B. Mixed anxiety and depression
- C. Adjustment disorder
- D. Mild depressive episode
Explanation: ### Explanation The correct diagnosis is **Generalized Anxiety Disorder (GAD)**. **Why GAD is the correct answer:** The patient presents with physical symptoms of autonomic arousal (palpitations) and somatic complaints (insomnia, loss of appetite) alongside psychological distress. While she reports "sadness," the crucial clinical indicator is the **preservation of socio-occupational functioning**. In GAD, patients often maintain their daily routines and professional responsibilities despite chronic worry and physical tension. The absence of core depressive features like hopelessness and suicidal ideation further points away from a primary mood disorder. **Why the other options are incorrect:** * **Mixed Anxiety and Depression:** This diagnosis is reserved for cases where symptoms of both anxiety and depression are present, but neither set is severe enough or prominent enough to justify a specific diagnosis. In this case, the lack of hopelessness and the patient's high level of functioning make GAD a more specific fit. * **Adjustment Disorder:** This requires a **clear identifiable stressor** (precipitating event) occurring within 3 months of symptom onset. The question explicitly states there is no past history of any precipitating event. * **Mild Depressive Episode:** According to ICD-10/DSM-5, depression requires at least two weeks of core symptoms (low mood, anhedonia, or fatigue). The absence of hopelessness, suicidal thoughts, and the fact that she is "remarkably well" in social and office life contradicts the functional impairment typically seen even in mild depression. ### High-Yield Clinical Pearls for NEET-PG: * **GAD Key Feature:** "Free-floating anxiety" and excessive worry about everyday events for at least 6 months (ICD-10). * **Physical Symptoms:** Often presents with "Somatic Anxiety" (muscle tension, palpitations, sweating, and sleep disturbances). * **Functioning:** Unlike Major Depressive Disorder (MDD), GAD patients are often "high-functioning" but "high-worrying." * **First-line Treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the gold standard for long-term management; Benzodiazepines are used only for short-term symptomatic relief.
Question 173: Which of the following is NOT characteristic of Type A personality?
- A. Hostility
- B. Feeling of time urgency
- C. Competitiveness
- D. Experiencing mood fluctuations (Correct Answer)
Explanation: **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.
Question 174: A violent manic patient should not be treated with:
- A. Benzodiazepines
- B. Cognitive therapy (Correct Answer)
- C. Atypical antipsychotics
- D. Quetiapine
Explanation: **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.
Question 175: A distinguishing feature of psychotic disorders is
- A. Suspiciousness
- B. Obsessions and Compulsions
- C. Confusion between fantasy and reality (Correct Answer)
- D. Presence of severe depression
Explanation: ### Explanation **1. Why the correct answer is right:** The hallmark of a **psychotic disorder** is the loss of **reality testing**. This manifests as an inability to distinguish between internal subjective experiences (fantasy/hallucinations) and external objective reality (facts). Patients with psychosis experience delusions (fixed false beliefs) and hallucinations (sensory perceptions without stimuli), which represent a profound "confusion between fantasy and reality." This impairment in reality testing is what separates psychosis from neurosis. **2. Why the other options are incorrect:** * **A. Suspiciousness:** While common in Paranoid Schizophrenia or Delusional Disorder, suspiciousness is a non-specific symptom. It can also be seen in personality disorders (e.g., Paranoid Personality Disorder) where reality testing remains largely intact. * **B. Obsessions and Compulsions:** These are the core features of **Obsessive-Compulsive Disorder (OCD)**, which is traditionally classified as an anxiety-related or "neurotic" disorder. In OCD, patients usually have "insight"—they recognize their thoughts as irrational and originating from their own minds. * **C. Presence of severe depression:** Severe depression is a **mood disorder**. While "Psychotic Depression" exists, the presence of depression itself does not define psychosis. Many psychotic patients (e.g., in Hebephrenic Schizophrenia) may actually show a flat or inappropriate affect rather than depression. **3. Clinical Pearls for NEET-PG:** * **Insight:** The most important clinical marker to differentiate Psychosis from Neurosis is the **absence of insight** in psychosis. * **Schneider’s First Rank Symptoms (FRS):** These are high-yield diagnostic criteria for Schizophrenia (e.g., thought insertion, broadcasting, third-person auditory hallucinations). * **Formal Thought Disorder (FTD):** This refers to a disturbance in the *form* of thought (e.g., loosening of associations), which is a key feature of psychotic spectrum disorders.
Question 176: Which of the following is pathognomonic of a manic episode?
- A. Elevated mood
- B. Grandiosity (Correct Answer)
- C. Decreased appetite
- D. Increased sleep
Explanation: **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**.
Question 177: Suicidal tendencies are seen in which of the following conditions?
- A. Substance abuse
- B. Post-traumatic stress disorder (PTSD)
- C. Schizophrenia
- D. All of the above (Correct Answer)
Explanation: **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.
Question 178: To diagnose depression, symptoms should last for at least what duration?
- A. 4 weeks
- B. 6 months
- C. 2 weeks (Correct Answer)
- D. 6 weeks
Explanation: 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.
Question 179: Repeated transcranial magnetic stimulation (rTMS) of the brain is used in the treatment of which of the following conditions?
- A. Depression (Correct Answer)
- B. Resistant schizophrenia
- C. Resistant OCD
- D. Acute psychosis
Explanation: **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.
Question 180: Which neurotransmitter is associated with suicidal tendencies?
- A. Serotonin (Correct Answer)
- B. GABA
- C. Norepinephrine
- D. Acetylcholine
Explanation: **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.
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
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free