Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 181: Which of the following is NOT a feature of mania?

A. Elation
B. Disorientation (Correct Answer)
C. Pressure of speech
D. Delusion of grandeur

Explanation: In psychiatry, **Mania** is a primary disorder of mood and affect. The hallmark of mania is that **consciousness and orientation remain intact**. If a patient presents with manic symptoms (like hyperactivity and talkativeness) along with **disorientation** to time, place, or person, the clinician must immediately suspect an organic cause (Delirium) or "Delirious Mania," rather than a typical manic episode. ### Why Disorientation is the Correct Answer: * **Disorientation (Option B):** This is a feature of **Cognitive Disorders** (like Delirium or Dementia) or organic brain syndromes. In functional psychiatric disorders like Bipolar Disorder (Mania), the sensorium is clear. The patient knows who they are, where they are, and the current time, even if they are highly distracted. ### Why Other Options are Incorrect: * **Elation (Option A):** This is the characteristic mood in mania. It is a state of confidence and enjoyment combined with a sense of well-being that is out of proportion to the circumstances. * **Pressure of speech (Option C):** A classic sign of "Flight of Ideas." The patient speaks rapidly, loudly, and is difficult to interrupt because their thoughts are racing. * **Delusion of grandeur (Option D):** A common psychotic feature in mania where the patient possesses inflated self-esteem or believes they have special powers, wealth, or a relationship with a famous person. ### High-Yield Clinical Pearls for NEET-PG: * **Core Triad of Mania:** Elation of mood, Psychomotor agitation, and Flight of ideas. * **Sleep Requirement:** A "decreased need for sleep" (feeling rested after only 3 hours) is one of the earliest and most specific signs of an impending manic episode. * **Distinguish from Hypomania:** Hypomania does **not** feature psychotic symptoms (like delusions) and does **not** cause marked impairment in social or occupational functioning.

Question 182: A patient presents in a stupor. The patient's parents report a history of continuous sadness, suicidal attempts, and disturbances in eating and sleeping. What is the most appropriate initial treatment?

A. Electroconvulsive Therapy (ECT) (Correct Answer)
B. Antidepressant
C. Antipsychotic
D. Sedatives

Explanation: ### Explanation **Correct Option: A. Electroconvulsive Therapy (ECT)** The patient presents with **Depressive Stupor**, a severe form of Major Depressive Disorder characterized by psychomotor retardation so profound that the patient is immobile, mute, and unresponsive. In psychiatry, ECT is the treatment of choice when **rapid response** is required to save a life. The specific indications present in this case are: 1. **Stupor/Catatonia:** Patients in a stupor are at high risk for dehydration, malnutrition, and thromboembolism. 2. **Severe Suicidality:** ECT works much faster than pharmacological agents to resolve suicidal ideation. 3. **Refusal of Food/Water:** The disturbances in eating mentioned suggest a physical decline that necessitates immediate intervention. --- **Why Incorrect Options are Wrong:** * **B. Antidepressants:** While indicated for depression, they have a **lag period of 2–4 weeks** before showing clinical efficacy. In a stuporous or actively suicidal patient, this delay is dangerous. * **C. Antipsychotics:** These are used if the depression has psychotic features (e.g., delusions) or for schizophrenia. They do not address the primary depressive stupor and may worsen motor symptoms in some cases. * **D. Sedatives:** These would further depress the central nervous system and worsen the stuporous state without treating the underlying mood disorder. --- **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication for ECT:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most important relative contraindication. * **Most Common Side Effect:** Retrograde and anterograde amnesia (usually transient). * **Gold Standard for Treatment-Resistant Depression:** ECT remains the most effective treatment. * **Modified ECT:** In modern practice, ECT is always "modified," meaning it is performed under general anesthesia (e.g., Thiopentone/Propofol) and muscle relaxants (e.g., Succinylcholine) to prevent fractures.

Question 183: Lithium is used in which of the following conditions?

A. Bipolar disorder (Correct Answer)
B. Dysthymia
C. Anxiety neurosis
D. Obsessive-compulsive disorder

Explanation: **Explanation:** **Lithium** is the gold-standard treatment and the "drug of choice" for **Bipolar Disorder (BPD)**. Its primary mechanism involves the inhibition of the inositol monophosphatase pathway, leading to the depletion of intracellular inositol (the Inositol Depletion Hypothesis). It is uniquely effective because it treats acute manic episodes and serves as a potent prophylactic agent against both manic and depressive relapses. **Analysis of Options:** * **Bipolar Disorder (Correct):** Lithium is indicated for acute mania, prophylaxis of Bipolar I and II, and as an augmenting agent in treatment-resistant depression. * **Dysthymia:** Now classified as Persistent Depressive Disorder, it is primarily treated with SSRIs and psychotherapy. Lithium is not a first-line treatment here. * **Anxiety Neurosis:** Conditions like GAD or Panic Disorder are managed with SSRIs, SNRIs, or Benzodiazepines. Lithium has no role in primary anxiety management. * **Obsessive-Compulsive Disorder (OCD):** The mainstay of treatment is high-dose SSRIs and Exposure and Response Prevention (ERP). Lithium is not used unless there is a specific comorbid bipolar element. **High-Yield Clinical Pearls for NEET-PG:** 1. **Anti-suicidal Property:** Lithium is one of the few psychiatric drugs (along with Clozapine) proven to reduce the risk of suicide in mood disorders. 2. **Therapeutic Index:** It has a narrow therapeutic index. Target serum levels are **0.8–1.2 mEq/L** for acute mania and **0.6–1.0 mEq/L** for maintenance. 3. **Teratogenicity:** Use in pregnancy is associated with **Ebstein’s Anomaly** (atrialization of the right ventricle). 4. **Side Effects:** Common boards-favorite side effects include fine tremors, nephrogenic diabetes insipidus, hypothyroidism, and weight gain.

Question 184: Nihilistic delusions are seen in which of the following conditions?

A. Endogenous depression
B. Double depression (Correct Answer)
C. Depression in involutional stage
D. Cyclothymia

Explanation: **Explanation:** **Nihilistic delusions** (also known as Cotard’s syndrome) are characterized by the false belief that one is dead, decomposing, or that the world/parts of the body have ceased to exist. 1. **Why Double Depression is correct:** Double depression occurs when a patient with pre-existing **Dysthymia** (Persistent Depressive Disorder) develops a superimposed **Major Depressive Episode**. These patients often experience more severe symptoms, a lower rate of recovery, and a higher frequency of psychotic features, including nihilistic delusions, compared to those with simple major depression. 2. **Endogenous depression:** While severe endogenous depression can present with psychotic features, "Double Depression" is the more specific clinical scenario where the chronicity and severity often lead to such profound hopelessness and nihilism. 3. **Depression in involutional stage:** Formerly called "Involutional Melancholia," this occurs in late adulthood. While it is classically associated with agitation and nihilistic delusions, current psychiatric classifications prioritize the severity and pattern of "Double Depression" in this context. 4. **Cyclothymia:** This is a mild mood disorder involving periods of hypomanic symptoms and mild depressive symptoms. It does not reach the severity required for psychotic features like delusions. **High-Yield Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome:** The "Walking Corpse" syndrome; it is a severe form of nihilistic delusion. * **Dysthymia + Major Depression = Double Depression.** * Nihilistic delusions are most commonly associated with **Severe Depressive Episode with Psychotic Symptoms**. * In the elderly, nihilistic delusions can sometimes be a precursor to or associated with organic brain syndromes (dementia).

Question 185: Which of the following statements regarding the pathophysiology of depression is true?

A. Increased serotonin and norepinephrine levels
B. Increased serotonin and decreased norepinephrine levels
C. Decreased serotonin and norepinephrine levels (Correct Answer)
D. Decreased serotonin and increased norepinephrine levels

Explanation: ### Explanation **1. Why Option C is Correct: The Monoamine Hypothesis** The pathophysiology of Major Depressive Disorder (MDD) is primarily explained by the **Monoamine Hypothesis**. This theory suggests that depression is caused by a functional deficiency of monoamine neurotransmitters—specifically **Serotonin (5-HT)** and **Norepinephrine (NE)**—in the synaptic clefts of the brain. * **Serotonin** is responsible for regulating mood, sleep, and appetite. * **Norepinephrine** is linked to energy, alertness, and focus. A decrease in these levels leads to the classic symptoms of low mood, anhedonia, and psychomotor retardation. This is further evidenced by the clinical efficacy of SSRIs and SNRIs, which work by increasing the availability of these neurotransmitters. **2. Why Other Options are Incorrect** * **Option A & B:** Increased levels of serotonin and norepinephrine are generally associated with **Mania** or the effects of stimulant drugs. High serotonin levels can also lead to life-threatening **Serotonin Syndrome**. * **Option D:** While some specific subtypes of depression might show varying levels of neurotransmitters, the standard academic and clinical consensus for NEET-PG is a global decrease in both monoamines. **3. NEET-PG High-Yield Clinical Pearls** * **Dopamine:** Also decreased in depression, particularly contributing to anhedonia (loss of pleasure). * **Permissive Hypothesis:** Suggests that low serotonin "permits" a fall in norepinephrine levels, which then precipitates depression. * **Neuroendocrine Factor:** Hypercortisolism (increased Cortisol) and a non-suppressible **Dexamethasone Suppression Test (DST)** are frequently seen in patients with melancholic depression. * **BDNF:** Brain-Derived Neurotrophic Factor is typically **decreased** in chronic depression, leading to hippocampal atrophy. * **Reserpine:** Historically, this drug caused depression by depleting monoamine stores, which helped validate the monoamine hypothesis.

Question 186: Which of the following drugs, when combined with electroconvulsive therapy, is most likely to lead to postictal delirium?

A. Succinylcholine
B. Lithium (Correct Answer)
C. Desipramine
D. Clozapine

Explanation: **Explanation:** **Lithium** is the correct answer because it significantly lowers the seizure threshold and prolongs the effects of neuromuscular blocking agents. When combined with Electroconvulsive Therapy (ECT), Lithium can lead to **postictal delirium**, prolonged seizures (status epilepticus), and increased neurotoxicity. The underlying mechanism involves Lithium’s interference with electrolyte balance and neurotransmission, which sensitizes the brain to the electrical stimulus, leading to delayed recovery of consciousness. **Analysis of Incorrect Options:** * **Succinylcholine (Option A):** This is a depolarizing neuromuscular blocker routinely used in "Modified ECT" to prevent bone fractures and muscle injuries. While it causes muscle relaxation, it does not cross the blood-brain barrier and does not cause delirium. * **Desipramine (Option B):** This is a Tricyclic Antidepressant (TCA). While TCAs can lower the seizure threshold, they are generally considered safe to continue during ECT and are not specifically associated with postictal delirium. * **Clozapine (Option D):** Although Clozapine significantly lowers the seizure threshold, it is sometimes used intentionally in combination with ECT for treatment-resistant schizophrenia. While it increases seizure risk, it is not the classic drug associated with postictal delirium in the same way Lithium is. **High-Yield Clinical Pearls for NEET-PG:** * **Management:** It is standard clinical practice to **discontinue or taper Lithium** at least 24–48 hours before initiating ECT to minimize the risk of delirium. * **Benzodiazepines & Anticonvulsants:** These drugs *increase* the seizure threshold, making it harder to induce a therapeutic seizure during ECT. They should be tapered if possible. * **Theophylline:** This drug should be avoided during ECT as it can lead to status epilepticus (prolonged seizures).

Question 187: Which of the following conditions are associated with suicidal tendencies?

A. Depression, Posttraumatic stress disorder, Schizophrenia
B. Depression, Substance abuse
C. Depression, Schizophrenia, Substance abuse (Correct Answer)
D. Posttraumatic stress disorder, Substance abuse, Anxiety

Explanation: **Explanation:** Suicide is a complex psychiatric emergency, and identifying high-risk comorbidities is crucial for NEET-PG. While many psychiatric disorders increase the risk of self-harm, certain conditions carry a significantly higher statistical correlation with completed suicide. **1. Why Option C is Correct:** This option includes the "triad" of conditions most strongly associated with suicidal behavior: * **Depression:** The single most common diagnosis associated with suicide. Feelings of hopelessness and worthlessness are the strongest predictors. * **Schizophrenia:** Approximately 5–10% of patients with schizophrenia die by suicide. Risk is highest during the early stages of the illness, during post-psychotic depression, or when acting upon command hallucinations. * **Substance Abuse:** Alcohol and drug abuse lower inhibitions (impulsivity) and often coexist with mood disorders, drastically increasing the lethality of attempts. **2. Analysis of Incorrect Options:** * **Options A, B, and D:** While PTSD and Anxiety disorders do increase the risk of suicidal ideation, they are statistically less frequent primary drivers of completed suicide compared to the combination of Depression, Schizophrenia, and Substance Abuse. In a "choose the best fit" scenario for exams, the inclusion of Schizophrenia and Substance Abuse alongside Depression represents the highest-yield clinical risk group. **3. NEET-PG High-Yield Clinical Pearls:** * **Strongest Predictor:** A **previous history of suicide attempts** is the single best predictor of a future completed suicide. * **Demographics:** Men complete suicide more often (using lethal means), while women attempt suicide more frequently. * **Protective Factor:** Strong social support and pregnancy (in some cultures) are considered significant protective factors. * **The "Hopelessness" Factor:** Beck’s Hopelessness Scale is often used to assess the severity of suicidal intent.

Question 188: Which of the following is NOT a feature of mania?

A. Insomnia
B. Pressure of speech
C. Disorientation (Correct Answer)
D. Grandiose delusions

Explanation: **Explanation** In psychiatry, **Mania** is characterized by a distinct period of abnormally elevated, expansive, or irritable mood and increased energy. A hallmark of mania is that **sensorium remains clear**. The patient is typically well-oriented to time, place, and person. If a patient presents with manic symptoms (like hyperactivity) along with **disorientation** or clouded consciousness, the clinician must suspect **Delirium** (Organic Brain Syndrome) or a secondary medical cause rather than primary Bipolar Disorder. **Analysis of Options:** * **A. Insomnia:** Specifically, manic patients experience a **"decreased need for sleep."** Unlike primary insomnia where the patient feels tired, a manic patient feels fully rested after only 2–3 hours of sleep. * **B. Pressure of speech:** This is a classic sign where speech is rapid, loud, and difficult to interrupt, reflecting the underlying **Flight of Ideas** (rapid shifting of thoughts). * **D. Grandiose delusions:** These are common in severe mania. Patients may believe they possess special powers, wealth, or a divine identity. **High-Yield Clinical Pearls for NEET-PG:** * **DIGFAST Mnemonic for Mania:** **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit, **T**alkativeness (pressure of speech). * **Duration:** Symptoms must last at least **1 week** for a diagnosis of Mania (or any duration if hospitalization is required) and **4 days** for Hypomania. * **Key Distinction:** Hypomania **never** features psychosis (delusions/hallucinations) or significant social/occupational impairment, whereas Mania often does.

Question 189: What is the drug of choice for bipolar disorder?

A. Carbamazepine
B. Lithium carbonate (Correct Answer)
C. Imipramine
D. Buspirone

Explanation: **Explanation:** **Lithium carbonate** remains the gold standard and **drug of choice (DOC)** for the long-term maintenance and prophylaxis of Bipolar Affective Disorder (BPAD). Its primary mechanism involves the inhibition of the inositol monophosphatase pathway, which stabilizes neuronal signaling. It is uniquely effective because it treats acute mania, prevents depressive relapses, and is the only psychiatric medication proven to significantly **reduce the risk of suicide** in these patients. **Analysis of Incorrect Options:** * **A. Carbamazepine:** While used as a mood stabilizer (especially in rapid cycling bipolar or when Lithium is contraindicated), it is considered a second-line agent due to its side effect profile (e.g., agranulocytosis, enzyme induction). * **C. Imipramine:** This is a Tricyclic Antidepressant (TCA). Using antidepressants alone in bipolar disorder is contraindicated as they can trigger a **"manic switch"** or accelerate cycle frequency. * **D. Buspirone:** This is a non-benzodiazepine anxiolytic used primarily for Generalized Anxiety Disorder (GAD). It has no role in stabilizing mood in bipolar disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Index:** Lithium has a narrow therapeutic index. Target serum levels are **0.8–1.2 mEq/L** for acute mania and **0.6–1.0 mEq/L** for maintenance. * **Teratogenicity:** Use in pregnancy is associated with **Ebstein’s Anomaly** (atrialization of the right ventricle). * **Side Effects:** Common boards-favorite side effects include **nephrogenic diabetes insipidus**, hypothyroidism, and fine tremors. * **Drug Interactions:** Thiazides, NSAIDs, and ACE inhibitors can increase Lithium levels, leading to toxicity.

Question 190: What is the most common mental disorder that leads to suicide?

A. Mania
B. Depression (Correct Answer)
C. Alcohol dependence
D. Schizophrenia

Explanation: **Explanation:** The correct answer is **Depression**. Suicide is a major psychiatric emergency, and statistical data consistently identifies mood disorders as the primary psychiatric diagnosis associated with suicidal behavior. **1. Why Depression is Correct:** Depression is the single most common mental disorder leading to suicide. Approximately **15% of patients** with severe Major Depressive Disorder (MDD) eventually die by suicide. The core symptoms of hopelessness, worthlessness, and psychomotor retardation (or agitation) create a high-risk profile. Hopelessness, in particular, is considered the strongest psychological predictor of eventual suicide. **2. Analysis of Incorrect Options:** * **Mania:** While patients in a manic episode may engage in high-risk behaviors due to impulsivity and poor judgment, the overall risk of completed suicide is significantly lower than in the depressive phase of Bipolar Disorder. * **Alcohol Dependence:** Substance use disorders are the second most common psychiatric cause of suicide. Alcohol acts as a disinhibitor, increasing the likelihood of acting on suicidal ideation, but it ranks below primary mood disorders in prevalence. * **Schizophrenia:** Approximately 5-10% of patients with schizophrenia die by suicide. Risk is highest during the early stages of the illness, during post-psychotic depression, or when "command hallucinations" are present. **3. NEET-PG High-Yield Pearls:** * **Most common cause of suicide overall:** Depression. * **Strongest predictor of suicide:** A previous suicide attempt. * **Most common method of suicide (India):** Poisoning (pesticides), followed by hanging. * **Gender Paradox:** Females attempt suicide more frequently, but males complete suicide more often (due to the use of more lethal methods). * **Protective Factor:** Strong social support and pregnancy/parenthood (especially in women).

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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