Mood Disorders Practice Questions

Q: All are features of mania, except?

Low self-esteem. ### Explanation The correct answer is **C. Low self-esteem**. In psychiatry, **Mania** is characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood. According to the DSM-5 and ICD-11 criteria, the core features of mania are diametrically opposed to those of depression. **Why Low Self-Esteem is the Correct Answer:** Low self-esteem is a hallmark feature of **Depressive Episodes**, not mania. In mania, patients typically exhibit **inflated self-esteem or grandiosity**, ranging from uncritical self-confidence to delusional beliefs about having special powers, wealth, or status. **Analysis of Incorrect Options:** * **A. Flight of Ideas:** This is a formal thought disorder common in mania where thoughts move rapidly from one topic to another, usually connected by rhymes, puns (clang associations), or distracting stimuli. * **B. Psychomotor Agitation:** Manic patients show a marked increase in goal-directed activity or physical restlessness. They often feel "charged" and have a decreased need for sleep without feeling tired. * **D. Pressure to Talk:** Manic speech is typically loud, rapid, and difficult to interrupt. The patient feels an internal compulsion to keep speaking continuously. **NEET-PG High-Yield Pearls:** * **DIG FAST Mnemonic for Mania:** **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit (decreased need), **T**alkativeness (pressure of speech). * **Duration Criteria:** Symptoms must last at least **1 week** for Mania and **4 days** for Hypomania. * **Key Distinction:** Hypomania does *not* cause marked impairment in social/occupational functioning and *never* features psychotic symptoms. If psychosis is present, the diagnosis is automatically Mania.

Q: Talkativeness and flight of ideas are suggestive of which condition?

Mania. **Explanation:** The correct answer is **Mania**. This condition is a distinct period of abnormally elevated, expansive, or irritable mood and increased energy. **Why Mania is correct:** The core clinical features of Mania are often summarized by the mnemonic **DIG FAST**. **Talkativeness** (Pressure of speech) and **Flight of ideas** (a rapid shifting of ideas where the connection between thoughts is based on rhymes, puns, or chance associations) are hallmark symptoms of psychomotor agitation and racing thoughts. In mania, the patient speaks rapidly, is difficult to interrupt, and jumps from one topic to another while maintaining a logical (though tenuous) thread. **Why other options are incorrect:** * **Schizophrenia:** While "disorganized speech" occurs, the classic finding is **Loosening of Associations** (Knight’s move thinking), where the connection between thoughts is absent or bizarre, unlike the rapid but connected flow in flight of ideas. * **Hysteria (Dissociative/Conversion Disorder):** This typically presents with physical symptoms (e.g., paralysis, seizures) or memory gaps triggered by psychological stress, not a formal thought disorder or pressured speech. * **Tricyclic Antidepressants (TCAs):** These are medications used to treat depression. While they can *trigger* a manic switch in patients with underlying Bipolar Disorder, the drugs themselves are not a "condition" characterized by these symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Flight of ideas** is characteristic of Mania; **Loosening of associations** is characteristic of Schizophrenia. * **Pressure of speech:** The patient speaks so rapidly that it is nearly impossible to interject. * **Clang associations:** Choosing words based on sound (rhyming) rather than meaning; frequently seen alongside flight of ideas. * **Treatment of choice for acute mania:** Lithium or Valproate (Mood stabilizers) and Atypical Antipsychotics.

Q: Thyrotoxicosis is most commonly associated with which of the following psychiatric manifestations?

Anxiety. **Explanation:** Thyrotoxicosis (Hyperthyroidism) is a hypermetabolic state caused by excess thyroid hormones ($T_3$ and $T_4$), which significantly impact the central nervous system and the autonomic nervous system. **1. Why Anxiety is the Correct Answer:** Anxiety is the **most common** psychiatric manifestation of thyrotoxicosis. Excess thyroid hormones increase the sensitivity of beta-adrenergic receptors to catecholamines. This leads to a clinical picture that mimics a generalized anxiety disorder or panic attack, characterized by restlessness, irritability, emotional lability, palpitations, and tremors. **2. Analysis of Incorrect Options:** * **B. Paranoid states:** While "myxedema madness" is classically associated with hypothyroidism, severe thyrotoxicosis can occasionally cause psychosis (Thyroid Psychosis). However, it is far less frequent than anxiety. * **C. Mania:** Hyperthyroidism can mimic manic symptoms (hyperactivity, decreased sleep, pressured speech), but true secondary mania is rare compared to the prevalence of anxiety symptoms. * **D. Delirium:** This is typically seen only in **Thyroid Storm**, a life-threatening medical emergency. It is an acute, severe manifestation rather than a common psychiatric presentation. **High-Yield Clinical Pearls for NEET-PG:** * **Differential Diagnosis:** Always rule out thyrotoxicosis in a patient presenting with a new-onset panic disorder or late-onset anxiety. * **Hypothyroidism:** Most commonly associated with **Depression** and cognitive impairment ("pseudodementia"). * **Treatment:** Propanolol (a non-selective beta-blocker) is often used to provide rapid symptomatic relief of the psychiatric and peripheral manifestations of thyrotoxicosis. * **Rapid Fact:** If the question asks for the most common symptom of *Hypothyroidism*, the answer is Depression; for *Hyperthyroidism*, it is Anxiety.

Q: Which of the following disorders is most closely associated with thyroid disease?

Depression. **Explanation:** The correct answer is **Depression**. The endocrine system and mood regulation are intricately linked via the hypothalamic-pituitary-thyroid (HPT) axis. **Why Depression is the Correct Answer:** Thyroid hormones (T3 and T4) play a crucial role in modulating neurotransmitters like serotonin and norepinephrine in the brain. * **Hypothyroidism** is classically associated with "pseudodepression," presenting with symptoms such as low mood, psychomotor retardation, fatigue, and cognitive impairment (often termed "myxedema madness" if severe). * **Hyperthyroidism** can also present with depressive symptoms, though it more commonly mimics anxiety or mania. * In clinical practice, Thyroid Function Tests (TFTs) are a mandatory screening tool for any patient presenting with a first episode of depression. **Analysis of Incorrect Options:** * **Schizophrenia:** While some endocrine abnormalities can occur, there is no primary causative link between thyroid dysfunction and the core pathophysiology of schizophrenia. * **Alcohol Use Disorder:** Chronic alcohol use can affect the HPT axis, but the association is secondary to liver disease or malnutrition rather than a direct etiological link. * **Phobia:** Phobias are anxiety disorders typically triggered by specific environmental stimuli and are not primarily driven by hormonal imbalances. **NEET-PG High-Yield Pearls:** 1. **L-Thyroxine Augmentation:** In patients with treatment-resistant depression, adding T3 (Liothyronine) can enhance the antidepressant response, even in euthyroid patients. 2. **Lithium & Thyroid:** Lithium (used for Bipolar Disorder) commonly causes **hypothyroidism** as a side effect; monitoring TSH is essential. 3. **Rapid Cycling Bipolar Disorder:** This condition is frequently associated with hypothyroidism. 4. **Postpartum Thyroiditis:** Always consider this in new mothers presenting with "Postpartum Depression."

Q: Lithium is best used in which of the following conditions?

Manic-depressive illness - Bipolar disorder. **Explanation:** **Lithium** is the "gold standard" mood stabilizer and the drug of choice for the prophylaxis and treatment of **Bipolar Disorder (Manic-Depressive Illness)**. 1. **Why Option A is Correct:** Lithium is most effective in classic Bipolar I disorder characterized by distinct episodes of mania and depression with relatively symptom-free intervals. It is highly effective in treating acute mania and is the only drug proven to significantly reduce the risk of suicide in these patients. It works by modulating second messenger systems (like the IP3 pathway) and inhibiting glycogen synthase kinase-3 (GSK-3). 2. **Why Other Options are Incorrect:** * **Option B (Unipolar Disorder):** While Lithium can be used as an *augmentation* strategy in treatment-resistant depression, it is not the first-line treatment for Unipolar Depression (where SSRIs are preferred). * **Option C (Rapid Cycling):** Rapid cycling is defined as ≥4 mood episodes in a year. Lithium is notoriously less effective in rapid cyclers and mixed episodes; **Sodium Valproate** or Carbamazepine are the preferred treatments here. * **Option D (Depression):** Lithium has limited efficacy as a monotherapy for acute depressive episodes compared to its anti-manic and prophylactic properties. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Index:** Narrow (0.6–1.2 mEq/L). Toxicity starts >1.5 mEq/L. * **Side Effects:** L-I-T-H: **L**eukocytosis, **I**nsipidus (Diabetes Insipidus), **T**remors/Teratogenicity (Ebstein’s Anomaly), **H**ypothyroidism. * **Monitoring:** Check Thyroid Function Tests (TFT) and Renal Function Tests (RFT) before starting. * **Drug Interactions:** Thiazides, NSAIDs, and ACE inhibitors increase Lithium levels (Risk of toxicity).

Q: Which category of the International Classification of Diseases (ICD) is associated with mood disorders?

F3. **Explanation:** In the **ICD-10** (International Classification of Diseases, 10th Revision), Chapter V (F) is dedicated to Mental and Behavioral Disorders. These disorders are categorized into blocks based on their clinical presentation and etiology. **Correct Answer: D (F3)** The **F30–F39** block is specifically designated for **Mood (Affective) Disorders**. This category includes conditions where the fundamental disturbance is a change in affect or mood (usually towards depression or elation). Key examples include: * **F30:** Manic episode * **F31:** Bipolar affective disorder * **F32/F33:** Depressive episodes/Recurrent depressive disorder * **F34:** Persistent mood disorders (e.g., Cyclothymia, Dysthymia) **Analysis of Incorrect Options:** * **A (F0): Organic Mental Disorders.** This includes symptomatic mental disorders like Dementia and Delirium caused by brain disease or systemic injury. * **B (F1): Mental and Behavioral Disorders due to Psychoactive Substance Use.** This covers disorders resulting from the use of alcohol, opioids, cannabinoids, and stimulants. * **C (F2): Schizophrenia, Schizotypal, and Delusional Disorders.** This block focuses on psychotic disorders characterized by distortions of thinking and perception. **High-Yield Clinical Pearls for NEET-PG:** 1. **ICD-11 Update:** In the newer ICD-11, Mood Disorders are moved to **Category 06** (Mental, behavioral or neurodevelopmental disorders). 2. **Dysthymia vs. Cyclothymia:** Dysthymia is a chronic low-grade depression (≥2 years), while Cyclothymia involves persistent instability of mood involving numerous periods of depression and mild elation. 3. **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode plus a major depressive episode.

Q: Reduced latency of REM sleep is a feature of which of the following conditions?

Depression. **Explanation:** The correct answer is **Depression**. Sleep disturbances are a hallmark of Major Depressive Disorder (MDD), and polysomnography (sleep study) reveals specific diagnostic changes in sleep architecture. **Why Depression is correct:** In patients with depression, the **REM latency** (the time interval between falling asleep and the first REM episode) is characteristically **decreased** (usually <60 minutes, compared to the normal 90 minutes). Other high-yield sleep findings in depression include: * **Increased REM density:** More frequent and intense eye movements during REM. * **Increased total REM sleep duration:** Especially in the early part of the night. * **Decreased Slow Wave Sleep (N3):** Reduction in deep sleep. * **Early morning awakening:** Terminal insomnia. **Why other options are incorrect:** * **Schizophrenia:** While sleep fragmentation and decreased total sleep time occur, reduced REM latency is not a core diagnostic feature. * **Insomnia:** Primary insomnia typically involves increased sleep latency (difficulty falling asleep) and decreased sleep efficiency, but does not specifically target REM latency. * **Narcolepsy:** This is characterized by **Sleep-Onset REM (SOREM)**, where REM occurs almost immediately (<15 minutes). While REM latency is technically reduced, "Reduced REM latency" as a classic board-exam descriptor is most traditionally associated with the biological markers of **Melancholic Depression**. **NEET-PG High-Yield Pearls:** 1. **REM Latency** is the most sensitive biological marker for Depression. 2. **Cholinergic-Aminergic Imbalance:** Depression is thought to involve an overactive cholinergic system, which triggers REM sleep earlier. 3. **Antidepressants** (like SSRIs and TCAs) typically **increase REM latency** and decrease total REM sleep, which is often linked to their therapeutic effect.

Q: Suicidal tendency is associated with:

All of the above. ### Explanation Suicide is a complex psychiatric emergency associated with multiple mental health conditions. While often linked primarily to depression, it is a multi-factorial outcome seen across various psychiatric spectra. **1. Why "All of the Above" is Correct:** * **Depression:** This is the most common psychiatric condition associated with suicide. Approximately 15% of patients with severe Depressive Disorder eventually die by suicide. Key drivers include feelings of hopelessness and worthlessness. * **Schizophrenia:** About 5–10% of patients with schizophrenia commit suicide. High-risk periods include the early stages of the illness, periods of post-psychotic depression, or when acting upon "command hallucinations" (voices telling the patient to harm themselves). * **Impulsive Disorders:** Impulsivity is a core trait in several conditions (like Borderline Personality Disorder or Substance Use Disorders). High impulsivity reduces the "threshold" between suicidal ideation and the actual act, making these patients highly vulnerable during acute crises. **2. Clinical Pearls for NEET-PG:** * **Single Best Predictor:** The strongest predictor of a future completed suicide is a **previous suicide attempt**. * **Gender Paradox:** Females attempt suicide more frequently, but **males complete suicide more often** (due to the use of more lethal methods). * **Protective Factors:** Pregnancy and strong social/family support are significant protective factors. * **High-Yield Risk Factor:** **Hopelessness** (measured by the Beck Hopelessness Scale) is a better predictor of eventual suicide than the severity of depression itself. * **Neurobiology:** Low levels of **5-HIAA** (a metabolite of serotonin) in the cerebrospinal fluid (CSF) are associated with increased impulsivity and violent suicide attempts.

Question 1

All are features of mania, except?

Accepted Answer

Low self-esteem

Answer

Flight of ideas

Answer

Psychomotor agitation

Answer

Pressure to talk

Question 2

Talkativeness and flight of ideas are suggestive of which condition?

Accepted Answer

Mania

Answer

Schizophrenia

Answer

Hysteria

Answer

Tricyclic antidepressants

Question 3

Thyrotoxicosis is most commonly associated with which of the following psychiatric manifestations?

Accepted Answer

Anxiety

Answer

Paranoid states

Answer

Mania

Answer

Delirium

Question 4

Which of the following disorders is most closely associated with thyroid disease?

Accepted Answer

Depression

Answer

Schizophrenia

Answer

Alcohol use disorder

Answer

Phobia

Question 5

A male patient with bipolar disorder has experienced 5 episodes of mania and 1 episode of depression in the last 8 years. His condition is currently controlled by a mood stabilizer, but manic symptoms reappear when he tapers down the medication. Which of the following interventions should be carried out to improve drug compliance?

Accepted Answer

Psychoeducation

Answer

Cognitive Behavioral Therapy (CBT)

Answer

Supportive psychotherapy

Answer

Insight-oriented psychotherapy

Question 6

Lithium is best used in which of the following conditions?

Accepted Answer

Manic-depressive illness - Bipolar disorder

Answer

Manic-depressive illness - Unipolar disorder

Answer

Manic-depressive illness - Rapid cycling

Answer

Depression

Question 7

Which category of the International Classification of Diseases (ICD) is associated with mood disorders?

Accepted Answer

F3

Answer

F0

Answer

F1

Answer

F2

Question 8

Reduced latency of REM sleep is a feature of which of the following conditions?

Accepted Answer

Depression

Answer

Schizophrenia

Answer

Insomnia

Answer

Narcolepsy

Question 9

In which age group is "copycat suicide" most commonly observed?

Accepted Answer

Adolescence

Answer

Childhood

Answer

Adulthood

Answer

Old age

Question 10

Suicidal tendency is associated with:

Accepted Answer

All of the above

Answer

Depression

Answer

Schizophrenia

Answer

Impulsive disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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