Mood Disorders Practice Questions

Q: A 38-year-old woman with bipolar disorder has been stable on lithium for the past 2 years. She presents with a 2-week history of depressed mood, poor concentration, loss of appetite, and passive suicidal ideation. Which of the following steps should be taken next?

Start the patient on a second mood stabilizer. ### Explanation **Correct Option: A (Start the patient on a second mood stabilizer)** The patient is experiencing a breakthrough depressive episode while on Lithium maintenance. In Bipolar Disorder, the management of breakthrough depression involves optimizing the current dose or adding a second mood stabilizer with proven antidepressant properties. **Quetiapine, Lurasidone, or Lamotrigine** are the preferred agents. Adding a second stabilizer provides synergistic effects and prevents a switch into mania. **Analysis of Incorrect Options:** * **B. Start a long-acting benzodiazepine:** Benzodiazepines are used for acute agitation or insomnia; they have no role in treating the core symptoms of depression or suicidal ideation. * **C. Stop lithium and start an antidepressant:** Lithium should never be stopped abruptly during a breakthrough episode as it increases the risk of relapse and suicide. Antidepressant monotherapy is contraindicated in Bipolar Disorder due to the high risk of inducing a "manic switch." * **D. Start an antidepressant and continue lithium:** While antidepressants can be used as adjuncts, they are generally avoided as a first-line step in bipolar depression due to the risk of rapid cycling. A second mood stabilizer (like Quetiapine) is preferred over an SSRI. **High-Yield Clinical Pearls for NEET-PG:** * **Drug of Choice for Bipolar Depression:** Quetiapine (monotherapy) or Lithium/Valproate + Fluoxetine/Olanzapine combination. * **The "Manic Switch":** TCAs have the highest risk of inducing mania, followed by SNRIs and SSRIs. * **Lithium’s Unique Property:** It is one of the few psychiatric drugs proven to reduce the risk of suicide in patients with mood disorders. * **Lamotrigine:** Excellent for preventing future depressive episodes but requires slow titration to avoid Stevens-Johnson Syndrome.

Q: What is the treatment of choice in acute Bipolar disorder?

Lithium. **Explanation:** **Lithium** remains the "Gold Standard" and the treatment of choice for the acute management of Bipolar Disorder (specifically acute manic episodes) as well as long-term maintenance therapy. Its efficacy is well-established in reducing the severity and frequency of manic episodes and, uniquely, it possesses significant **anti-suicidal properties**, a high-yield fact for NEET-PG. **Analysis of Options:** * **Lithium (Correct):** It is the first-line mood stabilizer. It is particularly effective for classic "euphoric" mania. It has a narrow therapeutic index (0.8–1.2 mEq/L for acute mania), requiring regular serum monitoring. * **Valproate (Incorrect):** While Valproate is a first-line agent and often preferred for **"Mixed Episodes"** or **"Rapid Cycling"** bipolar disorder, Lithium remains the traditional "treatment of choice" in standard academic literature unless specific contraindications exist. * **Lamotrigine (Incorrect):** This drug is effective for the **maintenance** phase and preventing bipolar depression. It is **not effective for acute mania** due to the need for slow titration to avoid Stevens-Johnson Syndrome. * **All of the above (Incorrect):** Since Lamotrigine is ineffective in acute mania, this option is ruled out. **High-Yield Clinical Pearls for NEET-PG:** 1. **Therapeutic Levels:** Acute Mania (0.8–1.2 mEq/L); Maintenance (0.6–0.8 mEq/L); Toxicity (>1.5 mEq/L). 2. **Teratogenicity:** Lithium is associated with **Ebstein’s Anomaly** (atrialization of the right ventricle) if taken during pregnancy. 3. **Side Effects:** L-I-T-H: **L**eukocytosis, **I**nsipidus (Nephrogenic Diabetes Insipidus), **T**remors/Teratogenicity, **H**ypothyroidism. 4. **Drug Interactions:** Thiazides, NSAIDs, and ACE inhibitors can increase Lithium levels, leading to toxicity.

Q: Which of the following is LEAST associated with suicidal tendencies?

Being married. **Explanation:** The risk of suicide is influenced by various sociodemographic and clinical factors. In psychiatry, these are often categorized into **risk factors** and **protective factors**. **Why "Being Married" is the correct answer:** Marriage is considered one of the strongest **protective factors** against suicide. It provides social support, emotional stability, and a sense of responsibility toward family members (especially if children are involved). Statistically, married individuals have the lowest rates of suicide compared to those who are single, divorced, widowed, or separated. **Analysis of Incorrect Options:** * **Being alone (Option A):** Social isolation and living alone are significant risk factors. Lack of a support system increases the likelihood of acting on suicidal ideation. * **Depression (Option B):** Psychiatric illness is the strongest predictor of suicide. Approximately 90% of people who commit suicide have a diagnosable mental disorder, with Major Depressive Disorder being the most common. * **Being male (Option C):** While women make more suicide *attempts* (3:1 ratio), men are more likely to *complete* suicide (4:1 ratio). This is primarily because men tend to use more lethal methods (e.g., firearms, hanging). **NEET-PG High-Yield Pearls:** * **Strongest Risk Factor:** A previous history of suicide attempts. * **Gender Paradox:** Females attempt more; Males complete more. * **Age:** Risk increases with age; the elderly (especially men >65) are at high risk. * **SAD PERSONS Scale:** A mnemonic used to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness). * **Employment:** Unemployment and financial instability increase risk.

Q: Delusion of grandiosity is commonly seen in:

Mania. **Explanation:** **1. Why Mania is the Correct Answer:** Delusion of grandiosity is a hallmark feature of **Mania** (and Bipolar Disorder). It is a fixed, false belief where the patient possesses inflated self-esteem, extraordinary power, wealth, or a special relationship with a deity or famous person. In Mania, this occurs alongside a "congruent" elevated or expansive mood. According to ICD and DSM criteria, grandiosity is a key diagnostic feature of a manic episode, often manifesting as the patient claiming they have a "cure for cancer" or are "sent by God." **2. Why Other Options are Incorrect:** * **Schizophrenia:** While delusions of grandeur can occur in the Paranoid subtype, they are usually fragmented or bizarre. However, Mania is the *most common* and classic association for this specific delusion in psychiatric exams. * **Depression:** The typical delusions here are "mood-congruent" to a low state, such as **delusions of guilt, poverty, or nihilism** (Cotard’s syndrome). Grandiosity is diametrically opposite to the depressive mindset. * **Dementia:** Patients with dementia (like Alzheimer’s) primarily present with cognitive deficits and memory loss. While they may have delusions (often persecutory, like "people are stealing my things"), grandiosity is not a primary or common feature. **Clinical Pearls for NEET-PG:** * **Mood-Congruent Delusions:** In Mania, grandiosity matches the "high" mood. In Depression, nihilism matches the "low" mood. * **Schneiderian First Rank Symptoms (SFRS):** If a patient has delusions of grandeur *without* mood symptoms, consider Schizophrenia. * **Differential:** Always rule out **General Paresis of Insane (Neurosyphilis)**, which is a classic organic cause of grandiosity. * **Management:** Acute mania with delusions is treated with a combination of **Lithium/Valproate** and **Antipsychotics**.

Q: Aaron Beck's cognitive triad of depression includes all of the following except?

Negative thoughts of friends. **Explanation:** Aaron Beck, the father of Cognitive Behavioral Therapy (CBT), proposed the **Cognitive Triad** (also known as the Negative Triad) to explain the cognitive etiology of depression. According to this model, depressed individuals possess negative, automatic, and distorted belief patterns regarding three specific domains: 1. **The Self (Option A):** The individual views themselves as deficient, inadequate, or unworthy (e.g., "I am a failure"). 2. **The Environment/World (Option D):** The individual perceives the world as presenting insuperable obstacles or making excessive demands (e.g., "The world is a cruel place"). 3. **The Future (Option B):** The individual expects current difficulties to continue indefinitely, leading to hopelessness (e.g., "Things will never get better"). **Why Option C is correct:** "Negative thoughts of friends" is **not** a component of Beck’s Triad. While a depressed patient may have strained social relationships, Beck categorized these perceptions under the broader umbrella of the "Environment/World." **High-Yield Clinical Pearls for NEET-PG:** * **Cognitive Distortions:** These are biased ways of thinking (e.g., All-or-nothing thinking, Catastrophizing) that maintain the Cognitive Triad. * **Cognitive Schemas:** These are deep-seated, stable internal structures of stored generic knowledge that guide information processing. * **Therapeutic Goal:** CBT aims to identify, challenge, and modify these negative schemas and the components of the triad to alleviate depressive symptoms. * **Learned Helplessness:** Often confused with Beck's theory, this is **Martin Seligman’s** model of depression based on animal studies.

Q: Which of the following medical conditions can present with depression?

All of the above. **Explanation:** Secondary depression (depression due to a general medical condition) is a high-yield topic in NEET-PG. Several endocrine and metabolic disorders can manifest with depressive symptoms, often preceding the physical diagnosis. **1. Hypothyroidism (Option A):** This is the most classic endocrine cause of depression. Low levels of thyroid hormones lead to psychomotor retardation, fatigue, cognitive slowing ("pseudodementia"), and depressed mood. It is a standard practice to screen for TSH levels in any patient presenting with a first episode of depression. **2. Cushing Syndrome (Option B):** Hypercortisolism is strongly associated with psychiatric morbidity. Approximately 50–60% of patients with Cushing syndrome experience significant depression. It can also present with mania, irritability, or psychosis. **3. Addison’s Disease (Option C):** Adrenocortical insufficiency often presents with "vague" psychiatric symptoms before a crisis occurs. Depression, apathy, fatigue, and social withdrawal are common early manifestations. **Why "All of the above" is correct:** Depression is a multi-systemic manifestation. Since thyroid dysfunction (Hypo), adrenal excess (Cushing), and adrenal insufficiency (Addison) all disrupt the hypothalamic-pituitary-adrenal (HPA) or thyroid axes—which regulate mood and energy—all three conditions are recognized medical causes of depression. **Clinical Pearls for NEET-PG:** * **Hyperparathyroidism:** Often associated with the mnemonic "Moans" (psychiatric moans/depression) due to hypercalcemia. * **Pancreatic Cancer:** Depression is often a **prodromal symptom** (occurring before physical symptoms like jaundice or pain). * **Vitamin Deficiencies:** B12 (Cobalamin) and Folate deficiency are common reversible causes of depression and cognitive decline. * **Post-Stroke Depression:** Most common in lesions involving the **left frontal cortex**.

Q: A primigravida female presents with feelings of depression and emotional lability soon after delivery. What is the most likely cause?

Postpartum blues. **Explanation:** The clinical presentation of a primigravida experiencing mild depressive symptoms and emotional lability shortly after delivery is classic for **Postpartum Blues** (also known as "Baby Blues"). **1. Why Postpartum Blues is correct:** Postpartum blues is the most common puerperal mood disturbance, affecting up to 50–80% of new mothers. It typically onset within **3–5 days** of delivery and is characterized by emotional lability, irritability, tearfulness, and sleep disturbances. Crucially, it is **self-limiting** (resolving within 10–14 days) and does not significantly impair the mother's ability to function or care for the infant. **2. Why other options are incorrect:** * **Postpartum Depression (PPD):** This is more severe and persistent, usually peaking at 2–4 weeks postpartum. It involves functional impairment, loss of interest (anhedonia), and sometimes suicidal ideation. It requires formal psychiatric treatment. * **Postpartum Psychosis:** A psychiatric emergency (incidence 0.1–0.2%) characterized by delusions, hallucinations (often involving the infant), and gross disorientation. It typically requires hospitalization. * **Postpartum Pinks:** A transient state of euphoria or hypomania sometimes seen immediately after birth; it is the opposite of the "blues" and is not a depressive state. **High-Yield Clinical Pearls for NEET-PG:** * **Management:** Postpartum blues requires only **reassurance and support**; pharmacotherapy is not indicated. * **Risk Factors:** History of PMS or a family history of mood disorders increases the risk. * **Timeline Rule:** Blues (Days 3–5) → Depression (Weeks 2–6) → Psychosis (Early weeks, sudden onset). * **Edinburgh Postnatal Depression Scale (EPDS):** The gold standard screening tool for identifying postpartum mood disorders.

Question 1

What is true about mania?

Accepted Answer

Elevation of mood

Answer

Defect in content of thought

Answer

Delusion of grandeur

Answer

Increased psychomotor activity

Question 2

A 40-year-old female patient presents with a history of early morning awakening, loss of appetite, and lack of interest in her routines and activities for the past 3 months. Her husband died 8 months ago, contributing to her loneliness. Which of the following statements is TRUE regarding the management of this patient?

Accepted Answer

Antidepressant treatment should be considered based on the side effect profile.

Answer

No treatment is necessary.

Answer

Manage with combination therapy of 2 antidepressant drugs.

Answer

SSRIs are the most efficacious among the available antidepressant drugs.

Question 3

A 38-year-old woman with bipolar disorder has been stable on lithium for the past 2 years. She presents with a 2-week history of depressed mood, poor concentration, loss of appetite, and passive suicidal ideation. Which of the following steps should be taken next?

Accepted Answer

Start the patient on a second mood stabilizer

Answer

Start the patient on a long-acting benzodiazepine

Answer

Stop the lithium and start an antidepressant

Answer

Start an antidepressant and continue the lithium

Question 4

What is the treatment of choice in acute Bipolar disorder?

Accepted Answer

Lithium

Answer

Valproate

Answer

Lamotrigine

Answer

All of the above

Question 5

A male patient with bipolar disorder is controlled on medications. Symptoms of mania start to appear whenever he himself tapers down the drugs. What type of treatment can improve compliance in this patient?

Accepted Answer

Psychoeducation

Answer

Cognitive Behavioral Therapy (CBT)

Answer

Supportive psychotherapy

Answer

Insight-oriented psychotherapy

Question 6

Which of the following is LEAST associated with suicidal tendencies?

Accepted Answer

Being married

Answer

Being alone

Answer

Depression

Answer

Being male

Question 7

Delusion of grandiosity is commonly seen in:

Accepted Answer

Mania

Answer

Schizophrenia

Answer

Depression

Answer

Dementia

Question 8

Aaron Beck's cognitive triad of depression includes all of the following except?

Accepted Answer

Negative thoughts of friends

Answer

Negative thoughts of self

Answer

Negative thoughts of the future

Answer

Negative thoughts of the environment

Question 9

Which of the following medical conditions can present with depression?

Accepted Answer

All of the above

Answer

Hypothyroidism

Answer

Cushing syndrome

Answer

Addison's disease

Question 10

A primigravida female presents with feelings of depression and emotional lability soon after delivery. What is the most likely cause?

Accepted Answer

Postpartum blues

Answer

Postpartum psychosis

Answer

Postpartum depression

Answer

Postpartum pinks

Mood Disorders — MCQs

Mood Disorders — MCQs

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