Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 211: A woman with major depressive disorder underwent electroconvulsive therapy (ECT). Which of the following increases with ECT?

A. 5-hydroxyindoleacetic acid
B. Dopamine
C. Serotonin
D. Brain derived neurotrophic factor (Correct Answer)

Explanation: **Explanation:** **Correct Answer: D. Brain-derived neurotrophic factor (BDNF)** The neurotrophic hypothesis of depression suggests that chronic stress and depression lead to a decrease in neurotrophic factors, causing neuronal atrophy, particularly in the hippocampus. **Electroconvulsive Therapy (ECT)** is one of the most potent stimulators of neuroplasticity. It significantly increases the expression of **Brain-derived neurotrophic factor (BDNF)** and its receptor (TrkB). This increase promotes neurogenesis, synaptogenesis, and neuronal survival, which is believed to be a key mechanism behind the rapid antidepressant effect of ECT. **Analysis of Incorrect Options:** * **A. 5-hydroxyindoleacetic acid (5-HIAA):** This is the primary metabolite of serotonin. Studies have shown that ECT does not consistently increase 5-HIAA levels in the cerebrospinal fluid (CSF). In fact, low 5-HIAA is more classically associated with impulsive aggression and suicidal behavior. * **B & C. Dopamine and Serotonin:** While ECT modulates various neurotransmitter systems (increasing post-synaptic sensitivity to serotonin and dopamine), it does not consistently increase the absolute levels or synthesis of these monoamines in the same way it induces neurotrophic factors. The therapeutic effect of ECT is more closely linked to **receptor sensitivity changes** and **neuroplasticity** rather than a simple increase in monoamine levels. **Clinical Pearls for NEET-PG:** * **Most common side effect of ECT:** Retrograde amnesia (usually resolves, but is the most distressing). * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **ECT in Pregnancy:** It is considered safe and is often the treatment of choice for severe depression or psychosis in pregnant patients. * **Gold Standard:** ECT remains the most effective treatment for treatment-resistant depression and catatonia.

Question 212: Major depression is thought to be caused by changes in which of the following?

A. Histamine synapses in the Basal Ganglia
B. Monoamine synapses in the Basal Ganglia
C. GABA synapses in the Cerebellum
D. Monoamine synapses in the Limbic System (Correct Answer)

Explanation: **Explanation:** The pathophysiology of Major Depressive Disorder (MDD) is primarily explained by the **Monoamine Hypothesis**. This theory suggests that depression results from a functional deficiency of monoamine neurotransmitters—specifically **Serotonin (5-HT), Norepinephrine (NE), and Dopamine (DA)**—at the synaptic cleft. **Why Option D is Correct:** The **Limbic System** (including the hippocampus, amygdala, and anterior cingulate cortex) is the anatomical center for emotional regulation, memory, and affect. In depression, structural and functional changes occur in these areas due to depleted monoamines. Most antidepressants (SSRIs, SNRIs, TCAs) work by increasing the concentration of these monoamines within the limbic synapses to alleviate depressive symptoms. **Why Other Options are Incorrect:** * **Option A & B:** The **Basal Ganglia** are primarily involved in motor control and executive function. While they play a role in psychomotor agitation or retardation, they are not the primary site for the core emotional pathology of depression. Furthermore, **Histamine** (Option A) is more closely associated with arousal and sleep-wake cycles rather than the primary etiology of mood disorders. * **Option C:** **GABA** is the brain's primary inhibitory neurotransmitter. While GABAergic dysfunction is linked to Anxiety Disorders, the **Cerebellum** is traditionally associated with motor coordination and balance, not the primary emotional processing seen in MDD. **High-Yield Clinical Pearls for NEET-PG:** * **Reserpine Connection:** The monoamine theory was bolstered by the observation that Reserpine (which depletes monoamine vesicles) induced depression in patients. * **Neuroplasticity:** Modern theories also suggest that chronic depression leads to decreased **BDNF (Brain-Derived Neurotrophic Factor)**, causing hippocampal atrophy. * **Metabolites:** Low levels of **5-HIAA** (serotonin metabolite) in CSF are strongly associated with impulsivity and suicidal behavior.

Question 213: Maximum heritability is seen in which of the following conditions?

A. Depression
B. Mania
C. Schizophrenia (Correct Answer)
D. Panic Disorder

Explanation: **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.

Question 214: What is the minimum duration, in weeks, of depressed mood required to classify someone as suffering from major depressive disorder?

A. 1
B. 2 (Correct Answer)
C. 3
D. 4

Explanation: **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.

Question 215: What is true regarding postpartum psychosis?

A. It carries a good prognosis.
B. Recurrence in a future pregnancy is the rule.
C. It usually occurs around 2 weeks postpartum. (Correct Answer)
D. It has an insidious onset.

Explanation: **Postpartum Psychosis** is a psychiatric emergency characterized by a rapid onset of psychotic symptoms, mood lability, and confusion following childbirth. ### **Explanation of the Correct Option** **C. It usually occurs around 2 weeks postpartum:** Postpartum psychosis typically has a **dramatic and sudden onset**, usually within the first **2 to 4 weeks** after delivery (most commonly within the first 10 days). While symptoms can begin as early as 48–72 hours post-delivery, the 2-week window is the classic clinical presentation tested in exams. ### **Analysis of Incorrect Options** * **A. It carries a good prognosis:** This is incorrect. Postpartum psychosis is a severe condition with a high risk of **infanticide and suicide**. While the acute episode can be treated, it often signifies an underlying bipolar diathesis. * **B. Recurrence in a future pregnancy is the rule:** While the risk of recurrence is high (approximately 30–50%), it is **not "the rule"** (which implies 100%). However, it is a significant risk factor for future episodes. * **D. It has an insidious onset:** This is incorrect. The onset is characteristically **abrupt and acute**, often starting with insomnia, irritability, and restlessness before progressing to delusions and hallucinations. ### **High-Yield NEET-PG Pearls** * **Strongest Risk Factor:** A personal or family history of **Bipolar Disorder**. * **Clinical Features:** Often presents as "delirious mania"—a mix of psychotic symptoms (e.g., delusions about the baby being possessed) and cognitive clouding/confusion. * **Management:** Requires **immediate hospitalization**. The treatment of choice includes antipsychotics and mood stabilizers. **ECT (Electroconvulsive Therapy)** is highly effective and preferred if rapid response is needed or if the patient is severely suicidal. * **Differential:** Must be distinguished from **Postpartum Blues** (mild, peaks at day 5, self-limiting) and **Postpartum Depression** (onset within 4 weeks, no psychosis).

Question 216: Which psychological disorder is most commonly associated with myxedema?

A. Mania
B. Depression (Correct Answer)
C. Phobia
D. Paranoia

Explanation: **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.

Question 217: All of the following are true about atypical depression EXCEPT?

A. Increased sleep and appetite are present
B. Weight gain can be seen
C. Fatigue and heaviness of the lower limbs are present
D. Mood reactivity to positive stimuli is absent (Correct Answer)

Explanation: **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.

Question 218: 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?

A. Mania
B. Peripartum psychosis
C. Postpartum blues (Correct Answer)
D. Postpartum depression

Explanation: ### 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.

Question 219: 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?

A. Carbamazepine
B. Lithium
C. Semisodium Valproate
D. Chlorpromazine (Correct Answer)

Explanation: **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.

Question 220: Erotomania is a?

A. Mood disorder
B. Impulse control disorder
C. Delusional disorder (Correct Answer)
D. Personality disorder

Explanation: **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**.

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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