Mood Disorders — MCQs

A 30-year-old man is brought to the emergency department by police, who arrested him because he was in the parking lot of a local mall, yelling "I am a golden god" as he stepped in front of moving cars. When questioned about his identity, he talks incessantly in a rapid fashion and threatens to "unleash God's wrath on those who do not submit." He reports that he has not slept in a week and does not need sleep. He has spent the last week preparing for a secret government mission that only the president knows about. When asked if he ever hears God talking to him, he says, "Of course not, I am God!" Police report that he has had several prior arrests for reckless driving and lewd acts. On examination, he is disheveled and malodorous. It is nearly impossible to get any further history, as he rapidly paces about and mutters, "I must go, I must go" over and over again. Which of the following is the most likely preliminary diagnosis?

Q198Medium

A 19-year-old woman is brought to a psychiatry outpatient clinic by her boyfriend for depression and suicidal thoughts. The boyfriend reports that the patient yesterday expressed extreme sadness and a desire to die. He further reveals that they, along with a couple of friends, were celebrating for the last three days as exams had ended and on further prodding, it was discovered that they had consumed alcohol and 'other things' as well. He also reported that the patient was in great spirits and enjoying herself until yesterday, but subsequently slept for 20 hours, missed college, and was looking very tired. The patient herself reports feeling very low, feeling hungry, and seeing vivid and upsetting dreams during her sleep. Which of the following is the most likely diagnosis in this patient?

Q199Easy

A 25-year-old woman complains of intense depressed mood for 6 months with the inability to enjoy previously pleasurable activities. What is this symptom known as?

Q200Easy

A 22-year-old male presents with decreased sleep, increased sexual activity, excitement, and excessive spending for the past 8 days. What is the most likely diagnosis?

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 191: Essential criteria for major depression are all except?

A. Delusion of grandeur (Correct Answer)
B. Loss of pleasure
C. Insomnia
D. Hypersomnia

Explanation: To answer this question, we must refer to the **ICD-10** and **DSM-5** diagnostic criteria for Major Depressive Disorder (MDD). ### **Why "Delusion of Grandeur" is the correct answer:** Delusion of grandeur (an inflated sense of self-importance, power, or identity) is a hallmark symptom of a **Manic Episode** or Bipolar Disorder, not Major Depression. While depression can present with psychotic features, these are typically **mood-congruent**, such as delusions of guilt, poverty, or nihilism (Cotard syndrome). Grandiosity is diametrically opposed to the low self-esteem seen in depression. ### **Analysis of Incorrect Options:** * **Loss of Pleasure (Anhedonia):** This is one of the two **core symptoms** (along with depressed mood) required for a diagnosis. According to DSM-5, at least one of these two must be present for a 2-week period. * **Insomnia & Hypersomnia:** Sleep disturbance is a key physiological (somatic) criterion for MDD. While **insomnia** (specifically early morning awakening) is more common in melancholic depression, **hypersomnia** is a classic feature of **Atypical Depression**. Both are valid diagnostic criteria. ### **High-Yield Clinical Pearls for NEET-PG:** * **The "SIGECAPS" Mnemonic:** Used to remember MDD symptoms: **S**leep, **I**nterest (Anhedonia), **G**uilt, **E**nergy (Apathy), **C**oncentration, **A**ppetite, **P**sychomotor, **S**uicidal ideation. * **Minimum Duration:** Symptoms must be present for at least **2 weeks** for MDD. * **Most Common Sleep Abnormality:** On Polysomnography, depression shows **reduced REM latency** (entering REM sleep faster) and increased REM density. * **Atypical Depression:** Characterized by mood reactivity, weight gain (hyperphagia), hypersomnia, and "leaden paralysis." These patients often respond better to MAOIs.

Question 192: Which drug is used for recurrent depressive episodes?

A. Imipramine (Correct Answer)
B. Carbamazepine
C. None of the above
D. Sodium valproate

Explanation: ### Explanation **Correct Option: A. Imipramine** Imipramine is a **Tricyclic Antidepressant (TCA)**. The primary treatment for Unipolar Depression (Recurrent Depressive Disorder) is antidepressant medication. Imipramine works by inhibiting the reuptake of norepinephrine and serotonin, thereby increasing their availability in the synaptic cleft. It is a gold-standard classical antidepressant used for both acute episodes and the prevention of recurrence in patients with recurrent depressive disorder. **Why the other options are incorrect:** * **B & D (Carbamazepine and Sodium Valproate):** These drugs are classified as **Mood Stabilizers** (Anticonvulsants). While they are highly effective in treating Bipolar Disorder (specifically mania and prophylaxis of bipolar episodes), they are not the primary treatment for recurrent unipolar depression. They are generally reserved for "Bipolar Depression" or as augmenting agents in treatment-resistant cases, but they are not the first-line choice for standard recurrent depressive episodes. **High-Yield Clinical Pearls for NEET-PG:** * **DOC for Depression:** SSRIs (e.g., Fluoxetine, Sertraline) are currently the first-line treatment due to a better safety profile compared to TCAs. However, among the options provided, Imipramine is the only antidepressant. * **Imipramine Side Effects:** Being a TCA, it has significant **anticholinergic side effects** (dry mouth, blurred vision, constipation, urinary retention) and is dangerous in overdose due to **cardiotoxicity** (prolongation of QTc interval). * **Other uses of Imipramine:** It is the drug of choice for **Enuresis** (bed-wetting) in children. * **Prophylaxis:** In Recurrent Depressive Disorder, if a patient has had three or more episodes, long-term maintenance therapy with antidepressants is indicated.

Question 193: What is the evidence-based psychological therapy of choice for depression?

A. Group discussion therapy
B. Counselling
C. Cognitive behaviour therapy (Correct Answer)
D. Psychological psychotherapy

Explanation: **Explanation:** **Cognitive Behaviour Therapy (CBT)** is the evidence-based psychological treatment of choice for mild to moderate depression. Developed by Aaron Beck, it is based on the **"Cognitive Triad"** of depression: negative views about oneself, the world, and the future. CBT works by identifying and restructuring these "maladaptive cognitions" (cognitive distortions) and modifying behavior through structured tasks. Large-scale clinical trials and meta-analyses consistently show that CBT is as effective as antidepressant medication for non-psychotic depression and is superior in preventing long-term relapse. **Analysis of Incorrect Options:** * **A. Group discussion therapy:** While group therapy provides social support, it lacks the structured, evidence-based protocols required to be the primary treatment of choice for clinical depression. * **B. Counselling:** This is a broad, supportive intervention focused on problem-solving and active listening. While helpful for life stressors, it is less effective than the targeted cognitive restructuring found in CBT. * **D. Psychological psychotherapy:** This is a generic umbrella term. Specificity is required in clinical practice; "Psychodynamic psychotherapy" is an alternative, but it is generally considered second-line to CBT for depression. **High-Yield Clinical Pearls for NEET-PG:** * **First-line for Mild-Moderate Depression:** CBT or Interpersonal Therapy (IPT). * **First-line for Severe/Psychotic Depression:** Pharmacotherapy (SSRIs) + CBT, or ECT if life-threatening. * **Beck’s Cognitive Triad:** Self, World, Future. * **Relapse Prevention:** CBT has a lower relapse rate than medication alone because it teaches the patient coping skills. * **Other indications for CBT:** Anxiety disorders, OCD, Bulimia Nervosa, and Panic Disorder.

Question 194: All of the following are features of masked depression except?

A. Body aches and pains
B. Gastrointestinal symptoms
C. Functional impairment
D. Depressed mood (Correct Answer)

Explanation: **Explanation:** **Masked Depression** (also known as "Depressive Equivalent") is a clinical phenomenon where the core psychological symptoms of depression—such as sadness of mood, anhedonia, and hopelessness—are hidden or "masked" by prominent physical complaints. 1. **Why "Depressed Mood" is the correct answer:** By definition, in masked depression, the patient does not report a **depressed mood**. Instead, the underlying depressive illness manifests through somatic symptoms. The patient may even deny feeling sad, making "Depressed mood" the feature that is characteristically absent or hidden in this condition. 2. **Analysis of Incorrect Options:** * **Options A & B (Body aches and GI symptoms):** These are classic somatic manifestations of masked depression. Patients frequently present to general practitioners with chronic pain, fatigue, headaches, or vague gastrointestinal disturbances (like dyspepsia) rather than psychiatric complaints. * **Option C (Functional impairment):** Despite the absence of overt sadness, the underlying depressive process still causes significant socio-occupational dysfunction. The patient’s ability to work or maintain relationships is impaired due to the debilitating nature of their physical symptoms and underlying low energy. **NEET-PG High-Yield Pearls:** * **Target Population:** More common in elderly patients and certain cultural backgrounds where mental health stigma prevents the expression of emotional distress. * **Diagnosis:** It is often a diagnosis of exclusion after organic causes for somatic symptoms are ruled out. * **Treatment:** It responds well to standard **Antidepressants (SSRIs/TCAs)**, even though the patient presents with physical pain. * **Key Differentiator:** Unlike Somatization disorder, the physical symptoms in masked depression typically resolve once the underlying depressive episode is treated.

Question 195: Hypomania is differentiated from mania when?

A. Clinical symptoms are less severe
B. Clinical symptoms are present for fewer days (Correct Answer)
C. Symptoms cause social or occupational impairment
D. All of the above

Explanation: ### Explanation The differentiation between Mania and Hypomania is a high-yield topic for NEET-PG, primarily based on the **duration** and **severity** of symptoms as defined by DSM-5 and ICD criteria. **Why Option B is Correct:** The most objective diagnostic threshold for differentiation is the duration of symptoms. * **Mania:** Symptoms must persist for at least **one week** (7 days) or require hospitalization. * **Hypomania:** Symptoms must persist for at least **four consecutive days**. Therefore, hypomania is diagnosed when symptoms are present for fewer days than the threshold required for mania. **Analysis of Incorrect Options:** * **Option A:** While hypomania is clinically "less severe" than mania, "severity" is a subjective clinical observation. The diagnostic criteria specifically use duration and the absence of functional impairment to distinguish the two. * **Option C:** This is a defining **exclusion** for hypomania. In Mania, there is marked impairment in social or occupational functioning. In Hypomania, the episode is *not* severe enough to cause marked impairment or necessitate hospitalization. If there is social/occupational impairment, it is classified as Mania by definition. * **Option D:** Incorrect because Options A and C do not serve as the primary diagnostic differentiator in the same way duration does. **High-Yield Clinical Pearls for NEET-PG:** 1. **Psychotic Features:** If hallucinations or delusions are present, the diagnosis is **always Mania**, regardless of duration. Hypomania never includes psychosis. 2. **Hospitalization:** If the patient requires hospitalization to prevent harm to self or others, it is classified as **Mania**. 3. **Bipolar Types:** * **Bipolar I:** At least one Manic episode. * **Bipolar II:** At least one Hypomanic episode + at least one Major Depressive episode. 4. **Cyclothymia:** Chronic mood disturbance (2+ years) with hypomanic and depressive symptoms that do not meet full criteria for episodes.

Question 196: Which of the following is a classical symptom of depression?

A. Early morning insomnia (Correct Answer)
B. Weight loss
C. Guilt
D. Decreased appetite

Explanation: **Explanation:** In psychiatry, particularly for competitive exams like NEET-PG, it is crucial to distinguish between general symptoms of depression and **"Biological" (Melancholic) symptoms**. **Early morning insomnia** (also known as terminal insomnia or late insomnia) is considered a hallmark biological marker of Major Depressive Disorder (MDD). It is defined as waking up at least 2 hours before the usual time and being unable to fall back asleep. This symptom reflects a significant disturbance in the circadian rhythm and is highly specific to endogenous depression. **Analysis of Options:** * **B, C, and D (Weight loss, Guilt, Decreased appetite):** While these are all common symptoms of depression according to DSM-5/ICD-10 criteria, they are not as "classical" or specific as early morning awakening. In **Atypical Depression**, patients may actually experience weight *gain* and *increased* appetite (hyperphagia), making options B and D variable. While guilt is a core psychological symptom, it lacks the objective biological specificity of sleep disturbances. **Clinical Pearls for NEET-PG:** * **Sleep Disturbances:** The most common sleep abnormality in depression is **reduced REM latency** (entering REM sleep faster) and increased REM density. * **Diurnal Variation:** Patients with classical depression often feel worse in the morning and slightly better as the day progresses. * **Atypical Depression:** Characterized by "Mood Reactivity" (mood brightens in response to positive events), leaden paralysis, and reversed vegetative symptoms (hypersomnia and hyperphagia). The drug of choice historically was MAO inhibitors. * **Pseudo-dementia:** Depression in the elderly can mimic dementia; however, in depression, the patient usually complains of memory loss, whereas in true dementia, the patient often tries to hide it.

Question 197: A 30-year-old man is brought to the emergency department by police, who arrested him because he was in the parking lot of a local mall, yelling "I am a golden god" as he stepped in front of moving cars. When questioned about his identity, he talks incessantly in a rapid fashion and threatens to "unleash God's wrath on those who do not submit." He reports that he has not slept in a week and does not need sleep. He has spent the last week preparing for a secret government mission that only the president knows about. When asked if he ever hears God talking to him, he says, "Of course not, I am God!" Police report that he has had several prior arrests for reckless driving and lewd acts. On examination, he is disheveled and malodorous. It is nearly impossible to get any further history, as he rapidly paces about and mutters, "I must go, I must go" over and over again. Which of the following is the most likely preliminary diagnosis?

A. Antisocial personality disorder
B. Bipolar disorder (Correct Answer)
C. Borderline personality disorder
D. Post traumatic stress disorder

Explanation: **Explanation:** The patient presents with a classic **Manic Episode**, which is the hallmark of **Bipolar I Disorder**. According to DSM-5/ICD-11 criteria, a manic episode requires a distinct period of abnormally elevated or irritable mood and increased energy lasting at least one week. **Why Bipolar Disorder is correct:** The patient exhibits several diagnostic "DIG FAST" symptoms: * **D**istractibility/Agitation: Pacing and muttering. * **I**mpulsivity: Stepping in front of cars, reckless driving, lewd acts. * **G**randiosity: Claiming to be a "golden god" and on a "secret government mission." * **F**light of ideas: Rapid, incessant speech (pressured speech). * **A**ctivity increase: Psychomotor agitation. * **S**leep deficit: No sleep for a week without feeling tired. * **T**alkativeness: Pressured speech. The presence of **psychotic features** (delusions of grandeur/identity) automatically classifies this as a severe manic episode. **Why other options are incorrect:** * **Antisocial Personality Disorder:** While he has a history of arrests, his current presentation involves acute psychosis, pressured speech, and decreased need for sleep, which are biological markers of mood disorders, not personality traits. * **Borderline Personality Disorder:** Characterized by emotional instability and fear of abandonment. It does not typically present with sustained grandiosity or a decreased need for sleep. * **Post-Traumatic Stress Disorder (PTSD):** Presents with re-experiencing trauma, avoidance, and hyperarousal, not grandiose delusions or manic energy. **NEET-PG High-Yield Pearls:** 1. **Decreased need for sleep** is the most characteristic symptom of mania. 2. **Bipolar I** requires at least one manic episode; a major depressive episode is common but not required for diagnosis. 3. **Treatment of choice (Acute Mania):** Lithium, Valproate, or Atypical Antipsychotics (e.g., Haloperidol for rapid control). 4. **Delusions in Mania:** Usually mood-congruent (grandiosity). If mood-incongruent, prognosis is generally poorer.

Question 198: A 19-year-old woman is brought to a psychiatry outpatient clinic by her boyfriend for depression and suicidal thoughts. The boyfriend reports that the patient yesterday expressed extreme sadness and a desire to die. He further reveals that they, along with a couple of friends, were celebrating for the last three days as exams had ended and on further prodding, it was discovered that they had consumed alcohol and 'other things' as well. He also reported that the patient was in great spirits and enjoying herself until yesterday, but subsequently slept for 20 hours, missed college, and was looking very tired. The patient herself reports feeling very low, feeling hungry, and seeing vivid and upsetting dreams during her sleep. Which of the following is the most likely diagnosis in this patient?

A. Alcohol withdrawal
B. Bipolar disorder
C. Cocaine withdrawal (Correct Answer)
D. Major depressive disorder

Explanation: The clinical presentation described is a classic case of **Cocaine Withdrawal**, often referred to as a "crash." [1] ### **Why Cocaine Withdrawal is Correct** The patient exhibits the characteristic **triad of cocaine withdrawal**: [1] 1. **Mood disturbances:** Dysphoria, irritability, and suicidal ideation. 2. **Sleep disturbances:** Hypersomnolence (sleeping for 20 hours) and vivid, unpleasant dreams (REM rebound). 3. **Physical symptoms:** Increased appetite (hyperphagia) and profound fatigue/exhaustion. The history of "celebrating" for three days with "other things" suggests a binge of stimulants (Cocaine or Amphetamines). Once the drug is discontinued, dopamine levels plummet, leading to the "crash" symptoms described. [1] ### **Why Other Options are Incorrect** * **Alcohol Withdrawal:** Typically presents with autonomic hyperactivity (tachycardia, tremors, sweating, hypertension) and insomnia, rather than hypersomnolence and increased appetite. * **Bipolar Disorder:** While the "great spirits" followed by depression might mimic Bipolar I (Manic episode), the acute onset following a 3-day party and the specific symptoms of hyperphagia and hypersomnolence point strongly toward substance withdrawal. * **Major Depressive Disorder (MDD):** MDD requires symptoms to persist for at least 2 weeks. The acute onset and the context of substance use make withdrawal a more likely primary diagnosis. ### **Clinical Pearls for NEET-PG** * **Stimulant Withdrawal (Cocaine/Amphetamines):** Think of it as the "opposite" of the high. High = euphoria, insomnia, anorexia. Withdrawal = dysphoria, hypersomnia, hyperphagia. * **Suicide Risk:** Cocaine withdrawal is high-yield because it is associated with a significant, albeit transient, risk of **suicidal ideation**. [1] * **Treatment:** Usually supportive. Symptoms are self-limiting, though severe depression may require observation. [1]

Question 199: A 25-year-old woman complains of intense depressed mood for 6 months with the inability to enjoy previously pleasurable activities. What is this symptom known as?

A. Anhedonia (Correct Answer)
B. Avolition
C. Apathy
D. Amotivation

Explanation: **Explanation:** The correct answer is **Anhedonia**. **1. Why Anhedonia is correct:** Anhedonia is defined as the **inability to experience pleasure** from activities that were previously found enjoyable. It is a core symptom of Major Depressive Disorder (MDD) and is one of the two "gateway" symptoms required for diagnosis according to DSM-5 (the other being depressed mood). In this clinical scenario, the patient’s "inability to enjoy previously pleasurable activities" is a textbook description of this phenomenon. **2. Why other options are incorrect:** * **Avolition:** This refers to a total lack of motivation or "will" to initiate and persist in goal-directed activities (e.g., sitting for hours without doing anything). It is a common "negative symptom" of Schizophrenia. * **Apathy:** This is a state of indifference or a lack of emotional responsiveness, interest, or concern. While it overlaps with depression, it specifically denotes a lack of feeling rather than a lack of pleasure. * **Amotivation:** Similar to avolition, this is a lack of desire or drive to engage in activities. It is often seen in the "Amotivational Syndrome" associated with chronic cannabis use. **Clinical Pearls for NEET-PG:** * **Snaith-Hamilton Pleasure Scale (SHAPS):** A commonly used clinical scale to measure anhedonia. * **Biological Basis:** Anhedonia is linked to dysfunction in the **mesolimbic reward pathway** (dopaminergic system), particularly the Nucleus Accumbens. * **Melancholic Depression:** Anhedonia is a hallmark feature of the "Melancholic" subtype of MDD, which often responds well to TCAs or ECT. * **The "A"s of Schizophrenia:** Remember that Avolition, Anhedonia, Apathy, Alogia, and Affective flattening are the classic negative symptoms.

Question 200: A 22-year-old male presents with decreased sleep, increased sexual activity, excitement, and excessive spending for the past 8 days. What is the most likely diagnosis?

A. Confusion
B. Mania (Correct Answer)
C. Hyperactivity
D. Loss of memory

Explanation: ### Explanation **Correct Option: B (Mania)** The clinical presentation of this patient—decreased need for sleep, increased psychomotor activity (excitement), hypersexuality, and impulsivity (excessive spending)—is a classic triad of symptoms for a **Manic Episode**. According to ICD-11 and DSM-5 criteria, a diagnosis of Mania requires a distinct period of abnormally elevated or irritable mood and increased energy lasting **at least 1 week**. This patient’s 8-day duration fits the criteria perfectly. The symptoms represent a significant change from baseline functioning and involve the "DIG FAST" domains (Distractibility, Indiscretion/Spending, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, and Talkativeness). **Why other options are incorrect:** * **A. Confusion:** This refers to a clouding of consciousness or disorientation, typically seen in Delirium or Organic Brain Syndromes, not primary mood disorders. * **C. Hyperactivity:** While hyperactivity is a *symptom* of mania (increased psychomotor agitation), it is not a diagnosis. It can also be seen in ADHD or hyperthyroidism. * **D. Loss of memory:** This is a cognitive deficit characteristic of Dementia or Amnestic syndromes; it is not a core feature of a manic episode. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** Mania (≥7 days), Hypomania (≥4 days). * **Hypomania vs. Mania:** Hypomania does *not* cause significant social/occupational impairment and *never* features psychotic symptoms or requires hospitalization. * **Drug of Choice:** **Lithium** is the gold standard for long-term prophylaxis and acute mania. For acute agitation in mania, atypical antipsychotics (e.g., Haloperidol or Olanzapine) are often used first. * **Most common mood disorder** in the general population is Depression, but the **most common psychiatric cause of "decreased need for sleep"** is Mania.

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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