Mood Disorders Practice Questions

Q: Maximum heritability is seen in which of the following conditions?

Schizophrenia. **Explanation:** Heritability refers to the proportion of variation in a trait that can be attributed to genetic factors. In psychiatric genetics, **Schizophrenia** consistently demonstrates one of the highest heritability rates among major mental illnesses. 1. **Why Schizophrenia is Correct:** Twin studies and large-scale genomic analyses show that the heritability of Schizophrenia is approximately **80%**. If one monozygotic (identical) twin has the disorder, the risk for the other twin is nearly 40-50%, compared to a 1% risk in the general population. This strong genetic loading makes it the most heritable condition among the given options. 2. **Analysis of Incorrect Options:** * **Mania (Bipolar Disorder):** While Bipolar Disorder also has high heritability (approx. 70-75%), it is generally ranked slightly lower than Schizophrenia in most standardized psychiatric textbooks used for NEET-PG. * **Depression (Unipolar):** Major Depressive Disorder has a significantly lower heritability rate, estimated at **30-40%**. Environmental factors and life stressors play a much larger role here than in Schizophrenia. * **Panic Disorder:** This has a moderate heritability of approximately **40%**. While it runs in families, the genetic influence is not as dominant as in psychotic disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Risk of Schizophrenia:** * General Population: 1% * One Parent affected: 10-12% * Both Parents affected: 40% * Dizygotic Twin: 12-15% * Monozygotic Twin: 47-50% * **Order of Heritability (High to Low):** Autism/ADHD (>80%) > Schizophrenia (80%) > Bipolar Disorder (70%) > Depression (35%). * **Note:** If "Autism" or "Bipolar Disorder" are options alongside Schizophrenia, always check for the most updated consensus, but Schizophrenia remains the classic "high heritability" answer in traditional MCQ formats.

Q: What is the minimum duration, in weeks, of depressed mood required to classify someone as suffering from major depressive disorder?

2. **Explanation:** The diagnosis of **Major Depressive Disorder (MDD)** is based on the criteria defined by the DSM-5 and ICD-11. To meet the diagnostic threshold, a patient must experience at least five out of nine symptoms (including either depressed mood or anhedonia) for a **minimum duration of 2 weeks**. These symptoms must represent a change from previous functioning and cause significant clinical distress or impairment. **Analysis of Options:** * **Option A (1 week):** This duration is insufficient for MDD. However, it is the minimum duration required to diagnose a **Manic Episode**. * **Option B (2 weeks):** This is the **correct** standard. The two-week window helps clinicians differentiate between a clinical depressive disorder and transient "blues" or normal fluctuations in mood. * **Option C (3 weeks):** This is an arbitrary timeframe and does not correspond to any specific diagnostic criteria in standard psychiatric classifications. * **Option D (4 weeks):** While symptoms often last much longer, 4 weeks is not the minimum requirement. Notably, in the context of **Postpartum Depression**, symptoms typically onset within 4 weeks of delivery. **High-Yield Clinical Pearls for NEET-PG:** * **SIGECAPS:** Use this mnemonic for MDD symptoms: **S**leep, **I**nterest (Anhedonia), **G**uilt, **E**nergy, **C**oncentration, **A**ppetite, **P**sychomotor, **S**uicidal ideation. * **Dysthymia (Persistent Depressive Disorder):** Requires a depressed mood for at least **2 years** (1 year in children/adolescents). * **Bereavement:** In DSM-5, the "bereavement exclusion" was removed; MDD can be diagnosed even after a loss if criteria are met for 2 weeks. * **First-line treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors) are the drug of choice for MDD.

Q: Which psychological disorder is most commonly associated with myxedema?

Depression. **Explanation:** **Myxedema**, the clinical manifestation of severe hypothyroidism, is most commonly associated with **Depression**. Thyroid hormones play a crucial role in regulating neurotransmitters like serotonin and norepinephrine; a deficiency leads to a "slowing down" of both metabolic and psychological processes. Patients typically present with psychomotor retardation, lethargy, cognitive dulling (pseudodementia), and a low mood that mimics Major Depressive Disorder. **Analysis of Options:** * **B. Depression (Correct):** It is the most frequent psychiatric manifestation of hypothyroidism. In some cases, depression may be the presenting symptom before physical signs of myxedema appear. * **A. Mania:** Mania is typically associated with **hyperthyroidism** (thyrotoxicosis), where an excess of thyroid hormone leads to agitation, emotional lability, and heightened arousal. * **C. Phobia:** Phobic disorders are anxiety-based and do not have a direct, established pathophysiological link with myxedema. * **D. Paranoia:** While severe hypothyroidism can lead to "Myxedema Madness" (psychosis with paranoid delusions), it is much less common than the depressive symptoms seen in the majority of patients. **High-Yield Clinical Pearls for NEET-PG:** * **Myxedema Madness:** A term used for the rare state of psychosis, hallucinations, and paranoia occurring in severe hypothyroidism. * **Screening Rule:** Always rule out thyroid dysfunction (TSH levels) in any patient presenting with a first episode of depression or cognitive decline. * **Rapid Cycling Bipolar Disorder:** Hypothyroidism is a known risk factor for the development of rapid cycling in Bipolar Disorder. * **Treatment:** Psychiatric symptoms often resolve with Levothyroxine (T4) replacement, though adjunctive antidepressants may be needed initially.

Q: All of the following are true about atypical depression EXCEPT?

Mood reactivity to positive stimuli is absent. **Explanation:** Atypical depression is a subtype of Major Depressive Disorder (MDD) characterized by "reversed" vegetative symptoms. The hallmark feature that distinguishes it from melancholic depression is **mood reactivity**. **1. Why Option D is the correct answer:** In atypical depression, **mood reactivity is preserved**. This means the patient’s mood brightens in response to actual or potential positive events. Option D states that mood reactivity is absent, which is incorrect and actually describes "Anhedonia" seen in typical or melancholic depression. **2. Why other options are incorrect:** * **Options A & B:** Unlike typical depression (where insomnia and weight loss occur), atypical depression presents with **hyperphagia** (increased appetite), **weight gain**, and **hypersomnia** (increased sleep). * **Option C:** A characteristic physical sensation in atypical depression is **Leaden Paralysis**, described as a feeling of heavy, lead-like weights in the arms or legs (fatigue and heaviness). **Clinical Pearls for NEET-PG:** * **Diagnostic Criteria (DSM-5):** Mood reactivity + at least two of: weight gain/increased appetite, hypersomnia, leaden paralysis, or a long-standing pattern of interpersonal rejection sensitivity. * **Treatment of Choice:** While **SSRIs** are the first-line treatment today due to their safety profile, **MAO Inhibitors (MAOIs)** like Phenelzine are historically considered the most effective for atypical depression. * **Epidemiology:** It is more common in women and often has an earlier age of onset compared to melancholic depression.

Q: A post-natal mother who delivered 2 days back presents with increased tearfulness and sleeplessness. There are no features of anhedonia, suicidal thoughts, or lack of interest. What is the most probable diagnosis?

Postpartum blues. ### Explanation **Correct Answer: C. Postpartum blues** **Concept:** Postpartum blues (Baby blues) is the most common mood disturbance following childbirth, affecting up to 50–80% of mothers. It typically presents within **2–4 days** after delivery. The clinical hallmark is its **transient nature** and mild symptoms, including tearfulness, irritability, anxiety, and insomnia. Crucially, there is **no functional impairment**, and the mother maintains interest in the baby. It is self-limiting and usually resolves within 10 days without pharmacological intervention. **Why other options are incorrect:** * **Postpartum Depression (D):** This typically develops later (2–6 weeks postpartum). It is characterized by persistent low mood, **anhedonia**, suicidal ideation, and significant functional impairment. The question explicitly rules out these features. * **Peripartum Psychosis (B):** This is a psychiatric emergency occurring within the first 2 weeks. It involves gross loss of reality, hallucinations, delusions (often regarding the infant), and a high risk of infanticide or suicide. * **Mania (A):** While postpartum onset of Bipolar Disorder can occur, the symptoms described (tearfulness and sleeplessness without euphoria or grandiosity) specifically point toward the "blues." **NEET-PG High-Yield Pearls:** * **Timeline is Key:** * Blues: 2–4 days (resolves by day 10). * Depression: 2–6 weeks. * Psychosis: 2 days to 2 weeks. * **Management:** * Blues: Reassurance and support (No drugs). * Depression: SSRIs (Fluoxetine/Sertraline) and CBT. * Psychosis: Hospitalization, Antipsychotics, and Mood stabilizers. * **Risk Factor:** The strongest predictor for postpartum depression/psychosis is a **prior history** of mood disorders.

Q: A 26-year-old lady has just recovered from an acute manic episode and has a diagnosis of bipolar affective disorder. Which one of the following medications is not used for the prophylaxis of this condition?

Chlorpromazine. **Explanation:** The management of Bipolar Affective Disorder (BPAD) is divided into two phases: **Acute treatment** (to control current symptoms) and **Maintenance/Prophylaxis** (to prevent future relapses). **Why Chlorpromazine is the correct answer:** Chlorpromazine is a typical (first-generation) antipsychotic. While it is highly effective in the **acute management** of manic episodes due to its sedative and dopamine-blocking properties, it is **not used for long-term prophylaxis**. Long-term use of typical antipsychotics is avoided in BPAD maintenance due to the risk of extrapyramidal side effects (EPS), tardive dyskinesia, and the potential to worsen depressive symptoms. **Analysis of incorrect options (Prophylactic agents):** * **Lithium (Option B):** The "Gold Standard" for prophylaxis. It is effective in preventing both manic and depressive relapses and is the only drug proven to reduce suicide risk in BPAD. * **Semisodium Valproate (Option C):** A first-line mood stabilizer, particularly effective for rapid cycling and mixed episodes. * **Carbamazepine (Option A):** Used as a second-line prophylactic agent, especially in patients who do not respond to Lithium or Valproate. **High-Yield Clinical Pearls for NEET-PG:** * **First-line Prophylaxis:** Lithium, Valproate, or Quetiapine. * **Lamotrigine:** Primarily used for the prophylaxis of the **depressive phase** of BPAD (not effective for acute mania). * **Therapeutic Window of Lithium:** 0.8–1.2 mEq/L for acute mania; **0.6–1.0 mEq/L** for prophylaxis. * **Atypical Antipsychotics:** Unlike Chlorpromazine, certain atypical antipsychotics (e.g., Olanzapine, Quetiapine, Aripiprazole) are FDA-approved for maintenance therapy.

Q: Erotomania is a?

Delusional disorder. **Explanation:** **Erotomania** (also known as **de Clérambault’s Syndrome**) is a subtype of **Delusional Disorder**. It is characterized by the fixed, false belief that another person—usually of higher social status, a celebrity, or a public figure—is deeply in love with the patient. Despite clear evidence to the contrary, the patient maintains this conviction and often attempts to contact the object of their affection. **Why the other options are incorrect:** * **Mood Disorders:** While mood symptoms can sometimes coexist, erotomania is primarily a disorder of thought content (delusion) rather than a primary disturbance of affect (like Depression or Bipolar Disorder). * **Impulse Control Disorders:** These involve a failure to resist an urge or temptation (e.g., Kleptomania). While an erotomanic patient may act impulsively to reach their "lover," the core pathology is the delusion itself. * **Personality Disorders:** These are enduring, pervasive patterns of inner experience and behavior. While certain personalities (like Paranoid) may predispose one to delusional thinking, Erotomania is classified as a specific psychotic disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** It is more commonly diagnosed in females, though males may exhibit more aggressive or stalking behaviors. * **DSM-5 Criteria:** For a diagnosis of Delusional Disorder, the delusion must persist for **at least 1 month**, and the patient’s global functioning is otherwise not markedly impaired. * **Management:** The primary treatment involves **Antipsychotics** (e.g., Risperidone) and psychotherapy to manage social consequences. * **Key Association:** It is often categorized under "Paranoid Disorders" in older texts but remains a classic example of a **non-bizarre delusion**.

Question 1

A woman with major depressive disorder underwent electroconvulsive therapy (ECT). Which of the following increases with ECT?

Accepted Answer

Brain derived neurotrophic factor

Answer

5-hydroxyindoleacetic acid

Answer

Dopamine

Answer

Serotonin

Question 2

Major depression is thought to be caused by changes in which of the following?

Accepted Answer

Monoamine synapses in the Limbic System

Answer

Histamine synapses in the Basal Ganglia

Answer

Monoamine synapses in the Basal Ganglia

Answer

GABA synapses in the Cerebellum

Question 3

Maximum heritability is seen in which of the following conditions?

Accepted Answer

Schizophrenia

Answer

Depression

Answer

Mania

Answer

Panic Disorder

Question 4

What is the minimum duration, in weeks, of depressed mood required to classify someone as suffering from major depressive disorder?

Accepted Answer

2

Answer

1

Answer

3

Answer

4

Question 5

What is true regarding postpartum psychosis?

Accepted Answer

It usually occurs around 2 weeks postpartum.

Answer

It carries a good prognosis.

Answer

Recurrence in a future pregnancy is the rule.

Answer

It has an insidious onset.

Question 6

Which psychological disorder is most commonly associated with myxedema?

Accepted Answer

Depression

Answer

Mania

Answer

Phobia

Answer

Paranoia

Question 7

All of the following are true about atypical depression EXCEPT?

Accepted Answer

Mood reactivity to positive stimuli is absent

Answer

Increased sleep and appetite are present

Answer

Weight gain can be seen

Answer

Fatigue and heaviness of the lower limbs are present

Question 8

A post-natal mother who delivered 2 days back presents with increased tearfulness and sleeplessness. There are no features of anhedonia, suicidal thoughts, or lack of interest. What is the most probable diagnosis?

Accepted Answer

Postpartum blues

Answer

Mania

Answer

Peripartum psychosis

Answer

Postpartum depression

Question 9

A 26-year-old lady has just recovered from an acute manic episode and has a diagnosis of bipolar affective disorder. Which one of the following medications is not used for the prophylaxis of this condition?

Accepted Answer

Chlorpromazine

Answer

Carbamazepine

Answer

Lithium

Answer

Semisodium Valproate

Question 10

Erotomania is a?

Accepted Answer

Delusional disorder

Answer

Mood disorder

Answer

Impulse control disorder

Answer

Personality disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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