Mood Disorders — MCQs

An 82-year-old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is consulted at the request of her daughters, who think their mother is depressed because she is tearful, often talks about her dead husband, and states that she has heard his voice several times. She blames herself for not having gone with him on his last visit to his sister and cries frequently. She has never seen a psychiatrist before and has been "strong" all her life. Which of the following is the most likely diagnosis?

Q225Easy

What is dysthymia?

Q226Easy

Which of the following is true about major depression?

Q227Easy

Early morning awakening and reduced latency of REM sleep is suggestive of which of the following conditions?

Q228Medium

An elderly lady is becoming increasingly irritable. She displays unusual anger at the noise made by her children and sometimes harms them. What kind of psychiatric disorder does this lady have?

Q229Easy

Electroconvulsive therapy (ECT) is most effective in which of the following conditions?

Q230Medium

What is the drug of choice for an elderly patient with depression and coronary artery disease?

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 221: Depressive delusions that the world and everything related to it cease to exist is called:

A. Persecutory delusion
B. Delusion of infidelity
C. Nihilistic delusion (Correct Answer)
D. Delusion of reference

Explanation: ### Explanation **Correct Answer: C. Nihilistic delusion** **Nihilistic delusion** (also known as **Cotard’s delusion** or Cotard’s syndrome) is a specific psychopathology where the patient believes that they, a part of their body, or the entire world no longer exists. In the context of severe depression (Psychotic Depression), patients may claim their internal organs are rotting or that the world has ended. This stems from an extreme sense of hopelessness and "psychic death." **Analysis of Incorrect Options:** * **A. Persecutory delusion:** The false belief that one is being conspired against, spied on, or harmed by others. It is the most common type of delusion across psychiatric disorders (e.g., Schizophrenia). * **B. Delusion of infidelity (Othello Syndrome):** The irrational belief that one’s partner is being unfaithful. It is often associated with chronic alcoholism or organic brain syndromes. * **C. Delusion of reference:** The false belief that insignificant remarks, events, or objects in the environment have personal meaning or significance (e.g., believing a news anchor is sending them a secret message). **Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome:** Often described as "walking corpse syndrome." It is a high-yield association with **Severe Depressive Episode with Psychotic Symptoms.** * **Mood-Congruent vs. Incongruent:** Nihilistic delusions are considered **mood-congruent** in depression because the "nothingness" matches the low mood. * **Treatment:** Severe depression with nihilistic delusions is a medical emergency due to the high risk of self-neglect or suicide. **Electroconvulsive Therapy (ECT)** is often the treatment of choice for rapid response.

Question 222: Which of the following is part of the definition of clinical depression?

A. Depressed mood
B. Slowed thinking
C. Psychomotor retardation
D. All of the above (Correct Answer)

Explanation: Clinical depression, most commonly defined by the **ICD-10** or **DSM-5** criteria for Major Depressive Disorder (MDD), is a syndrome characterized by a cluster of emotional, cognitive, and physical symptoms. **Explanation of the Correct Answer:** The correct answer is **D (All of the above)** because clinical depression is not merely a feeling of sadness; it involves a global slowing of mental and physical functions. * **Depressed mood:** This is a core emotional symptom (one of the "A" criteria in DSM-5). * **Slowed thinking:** This represents the cognitive impairment seen in depression, often manifesting as poor concentration, indecisiveness, or "pseudo-dementia" in elderly patients. * **Psychomotor retardation:** This is a hallmark physical sign where the patient exhibits slowed speech, decreased movement, and increased reaction time. **Analysis of Options:** * **Option A:** While correct, it is incomplete. Depressed mood is the most common symptom but must be accompanied by other features for a clinical diagnosis. * **Options B & C:** These represent the "biological" and "cognitive" limbs of the disorder. In NEET-PG, remember that psychomotor changes (either retardation or agitation) are objective signs observable by the clinician. **High-Yield Clinical Pearls for NEET-PG:** 1. **DSM-5 Criteria:** Diagnosis requires at least **5 out of 9 symptoms** for at least **2 weeks**. One symptom must be either **Depressed Mood** or **Anhedonia** (loss of interest). 2. **ICD-10 Core Symptoms:** Depressed mood, Anhedonia, and **Fatigability** (Low energy). 3. **Psychomotor Retardation:** When severe, it can progress to **Depressive Stupor**. 4. **Cognitive triad of Beck:** Negative views about the **Self, World, and Future**. 5. **Most common sleep disturbance:** Early morning awakening (Terminal insomnia).

Question 223: Which of the following brain areas is less likely to play a role in depressive disorder?

A. Amygdala
B. Hippocampus
C. Anterior cingulate cortex
D. Corpus callosum (Correct Answer)

Explanation: ### Explanation Depressive disorders are primarily associated with structural and functional abnormalities in the **limbic-cortical circuit**, which regulates emotion, executive function, and memory. **Why Option D is Correct:** The **Corpus Callosum** is a white matter structure responsible for interhemispheric communication. While some studies suggest subtle changes in white matter integrity in chronic depression, it is primarily a structural bridge rather than a functional center for emotional processing. Compared to the other options, it is the "least likely" to be a primary driver of depressive pathology. **Why Incorrect Options are Wrong:** * **A. Amygdala:** This is the emotional center of the brain. In depression, the amygdala often shows **increased activity**, correlating with heightened negative affect and anxiety. * **B. Hippocampus:** This area is crucial for memory and learning. Chronic depression is strongly linked to **hippocampal atrophy** (decreased volume) due to hypercortisolemia (stress-induced neurotoxicity). * **C. Anterior Cingulate Cortex (ACC):** The ACC acts as an interface between emotion and cognition. Reduced volume and activity in the subgenual ACC (Brodmann area 25) are hallmark findings in major depressive disorder (MDD). **NEET-PG High-Yield Pearls:** 1. **Neurobiology of MDD:** Associated with **decreased** volume of the Hippocampus and Prefrontal Cortex, but **increased** activity in the Amygdala. 2. **Subgenual ACC:** This is a specific target for Deep Brain Stimulation (DBS) in treatment-resistant depression. 3. **HPA Axis:** Depression is often characterized by a failure of the dexamethasone suppression test, indicating hypercortisolemia. 4. **Neurogenesis:** Antidepressants (like SSRIs) are thought to work partly by increasing **BDNF** (Brain-Derived Neurotrophic Factor), which promotes neurogenesis in the hippocampus.

Question 224: An 82-year-old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is consulted at the request of her daughters, who think their mother is depressed because she is tearful, often talks about her dead husband, and states that she has heard his voice several times. She blames herself for not having gone with him on his last visit to his sister and cries frequently. She has never seen a psychiatrist before and has been "strong" all her life. Which of the following is the most likely diagnosis?

A. Depression secondary to general medical condition
B. Dysthymia
C. Grief reaction (Correct Answer)
D. Major depressive disorder

Explanation: ### Explanation **1. Why Grief Reaction is Correct:** The patient is experiencing a **Normal Grief Reaction (Bereavement)**. Following the loss of a loved one, it is normal to experience sadness, tearfulness, and preoccupation with the deceased. Key features in this case that point toward grief rather than clinical depression include: * **Timeline:** Symptoms started 6 weeks ago (within the expected window of acute grief). * **Nature of Guilt:** Her guilt is specific to the deceased (not going on the last visit), rather than a generalized sense of worthlessness. * **Hallucinations:** Hearing the voice of the deceased (pseudohallucinations) is a common and normal finding in bereavement and does not signify psychosis. * **Functioning:** Despite her sadness, there is no mention of global functional impairment or pervasive suicidal ideation. **2. Why Other Options are Incorrect:** * **A. Depression secondary to GMC:** While she has cardiac issues, her symptoms are clearly linked to the psychological stressor of her husband’s death. * **B. Dysthymia (Persistent Depressive Disorder):** This requires a depressed mood for at least **2 years** (1 year in children). Her symptoms are acute (6 weeks). * **D. Major Depressive Disorder (MDD):** While grief can evolve into MDD, this patient lacks "SIGECAPS" severity. In MDD, guilt is usually pervasive/delusional, and hallucinations are typically not limited to the deceased. **3. Clinical Pearls for NEET-PG:** * **Normal Grief vs. MDD:** In grief, self-esteem is usually preserved. In MDD, feelings of worthlessness and self-loathing are prominent. * **Persistent Complex Bereavement Disorder:** Diagnosed if symptoms cause significant impairment and persist for at least **12 months** (DSM-5). * **Management:** Normal grief requires support and monitoring, not immediate antidepressants. * **Kubler-Ross Stages:** Denial, Anger, Bargaining, Depression, Acceptance (**DABDA**).

Question 225: What is dysthymia?

A. Chronic depression (Correct Answer)
B. Chronic mania
C. Bipolar disorder
D. Personality disorder

Explanation: **Explanation:** **Dysthymia**, now clinically referred to as **Persistent Depressive Disorder (PDD)** in DSM-5, is characterized as a **chronic, low-grade depression**. 1. **Why Option A is Correct:** The hallmark of Dysthymia is a depressed mood that lasts for most of the day, for more days than not, for at least **two years** (one year in children/adolescents). While the symptoms are less severe than Major Depressive Disorder (MDD), their chronic nature leads to significant functional impairment. Patients often describe it as "always being sad" or "part of their personality." 2. **Why Other Options are Incorrect:** * **B. Chronic Mania:** Mania is a state of elevated mood. Chronic mania is not a standard clinical diagnosis; persistent mood elevation is usually part of Bipolar Disorder or Cyclothymia. * **C. Bipolar Disorder:** This requires episodes of mania or hypomania alternating with depression. Dysthymia is a unipolar condition (depressive spectrum only). * **D. Personality Disorder:** While Dysthymia can coexist with personality disorders (like Borderline or Avoidant), it is classified as a **Mood (Affective) Disorder**. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of 2":** Symptoms must persist for **2 years**, and the patient is never without symptoms for more than **2 months** at a time. * **Double Depression:** This occurs when a patient with underlying Dysthymia experiences an episode of Major Depressive Disorder (MDD). * **Treatment:** A combination of Pharmacotherapy (SSRIs are first-line) and Psychotherapy (CBT or Interpersonal Therapy) is more effective than either alone. * **Cyclothymia vs. Dysthymia:** Cyclothymia involves periods of hypomanic symptoms and depressive symptoms for 2 years, whereas Dysthymia is purely depressive.

Question 226: Which of the following is true about major depression?

A. Common in males
B. Markedly diminished interest in all activities most of the day but no fatigue or loss of energy or psychomotor retardation
C. Feeling of worthlessness or excessive guilt (Correct Answer)
D. All of the above

Explanation: **Explanation:** Major Depressive Disorder (MDD) is a common psychiatric condition characterized by a persistent low mood and loss of interest. According to the **DSM-5 criteria**, a diagnosis requires at least five out of nine symptoms to be present for a minimum of **2 weeks**, representing a change from previous functioning. **Why Option C is Correct:** Feelings of **worthlessness or excessive/inappropriate guilt** (which may be delusional) are core diagnostic criteria for MDD. These cognitive symptoms reflect the negative triad of depression (negative views of self, world, and future). **Analysis of Incorrect Options:** * **Option A:** Major depression is actually **twice as common in females** than in males (2:1 ratio). This gender disparity is a high-yield fact often tested in exams. * **Option B:** While "markedly diminished interest" (anhedonia) is a core symptom, the statement that there is "no fatigue or psychomotor retardation" is incorrect. In fact, **fatigue (loss of energy)** and **psychomotor agitation or retardation** are key diagnostic symptoms of MDD. * **Option D:** Since A and B are factually incorrect, "All of the above" cannot be the answer. **High-Yield Clinical Pearls for NEET-PG:** * **Core Symptoms (SIGECAPS):** **S**leep (insomnia/hypersomnia), **I**nterest (anhedonia), **G**uilt, **E**nergy (fatigue), **C**oncentration, **A**ppetite, **P**sychomotor, **S**uicidal ideation. * **Most common symptom:** Depressed mood (in adults) or irritability (in children). * **Biological markers:** Increased cortisol (nonsuppression on Dexamethasone Suppression Test) and decreased REM latency (entering REM sleep faster) are characteristic findings. * **First-line treatment:** SSRIs (Selective Serotonin Reuptake Inhibitors).

Question 227: Early morning awakening and reduced latency of REM sleep is suggestive of which of the following conditions?

A. Delirium
B. Depression (Correct Answer)
C. Schizophrenia
D. Anxiety

Explanation: **Explanation:** The correct answer is **Depression**. Sleep disturbances are a hallmark of Major Depressive Disorder (MDD), occurring in approximately 90% of patients. **Why Depression is correct:** In clinical psychiatry, "Early Morning Awakening" (terminal insomnia) is considered a classic biological marker for melancholic depression. Furthermore, polysomnography in depressed patients characteristically shows specific changes in the architecture of REM (Rapid Eye Movement) sleep: 1. **Reduced REM Latency:** The time from sleep onset to the first REM period is shortened (usually <60 minutes). 2. **Increased REM Density:** An increase in the frequency of rapid eye movements during REM sleep. 3. **Increased REM Duration:** The first REM period lasts longer than usual. 4. **Reduced Slow-Wave Sleep (N3):** A decrease in deep, restorative sleep. **Why other options are incorrect:** * **Delirium:** Characterized by a reversal of the sleep-wake cycle and fragmented sleep, but not specific REM latency changes. * **Schizophrenia:** While sleep disturbances occur, they are non-specific (usually increased sleep latency or fragmentation). * **Anxiety:** Typically presents with "initial insomnia" (difficulty falling asleep) rather than early morning awakening. **High-Yield Clinical Pearls for NEET-PG:** * **Biological Markers of Depression:** Hypercortisolemia (failure to suppress on the Dexamethasone Suppression Test) and reduced REM latency are the most frequently tested markers. * **Sleep Patterns:** Initial insomnia = Anxiety; Terminal insomnia = Depression. * **Narcolepsy:** Also features reduced REM latency (Sleep-Onset REM periods or SOREMPs), but is distinguished by daytime cataplexy and sleep attacks.

Question 228: An elderly lady is becoming increasingly irritable. She displays unusual anger at the noise made by her children and sometimes harms them. What kind of psychiatric disorder does this lady have?

A. Severe depression (Correct Answer)
B. Schizophrenia
C. Paranoia
D. Phobia

Explanation: **Explanation:** The correct answer is **Severe Depression (Option A)**. While depression is typically associated with sadness and lethargy, in certain populations—particularly the **elderly** and children—it often manifests as **irritability** rather than overt sadness. This is known as "irritable depression." In severe cases, patients may experience a significant decrease in frustration tolerance, leading to outbursts of anger or even aggressive behavior toward family members (as seen in this scenario). This is often a manifestation of psychomotor agitation or a reaction to the overwhelming cognitive and emotional burden of the depressive episode. In the elderly, these symptoms can sometimes be part of "Depressive Pseudodementia," where cognitive impairment and irritability mask the underlying mood disorder. **Why other options are incorrect:** * **Schizophrenia (Option B):** This would typically present with "positive symptoms" like hallucinations and delusions, or "negative symptoms" like social withdrawal and flat affect, rather than isolated irritability and anger. * **Paranoia (Option C):** While paranoia can lead to aggression (defensive in nature), the question does not mention suspiciousness, delusions of persecution, or the belief that others are conspiring against her. * **Phobia (Option D):** Phobias involve an irrational, persistent fear of a specific object or situation leading to avoidance behavior, not generalized irritability or outward aggression. **Clinical Pearls for NEET-PG:** * **Atypical Presentation:** In elderly patients, depression often presents with somatic complaints, irritability, or cognitive decline (Pseudodementia) rather than a "depressed mood." * **Agitated Depression:** A subtype of depression characterized by restlessness, irritability, and insomnia; it carries a higher risk of suicide. * **Treatment:** SSRIs are the first-line treatment for elderly depression due to their favorable side-effect profile compared to TCAs.

Question 229: Electroconvulsive therapy (ECT) is most effective in which of the following conditions?

A. Conversion disorder
B. Severe depression (Correct Answer)
C. Mania
D. Dissociative disorder

Explanation: **Explanation:** **Electroconvulsive therapy (ECT)** is a biological treatment involving the induction of a generalized seizure through the application of electrical current to the brain. **Why Option B is correct:** Severe depression, particularly **Major Depressive Disorder (MDD) with psychotic features or suicidal ideation**, is the primary and most effective indication for ECT. It is considered the "gold standard" for rapid symptom relief when a patient is at high risk of self-harm, refuses to eat, or is resistant to pharmacological treatments. The response rate for ECT in severe depression is approximately 80-90%, which is higher than any antidepressant medication. **Why the other options are incorrect:** * **Options A & D (Conversion and Dissociative Disorders):** These are neurotic, stress-related disorders primarily managed with psychotherapy (like CBT) and stress management. ECT has no proven efficacy in treating the core symptoms of dissociation or conversion. * **Option C (Mania):** While ECT is effective in treating acute mania (especially delirious mania or lithium-resistant cases), it is generally considered a **second-line** treatment after mood stabilizers and antipsychotics. Severe depression remains the most common and effective indication. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves within 6 months). * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Mortality rate:** Approximately 0.01% (similar to general anesthesia). * **Electrode placement:** Bilateral ECT is more effective but carries a higher risk of cognitive side effects compared to Unilateral (d'Elia) placement. * **Drug of choice for anesthesia:** Methohexital (Barbiturate); Succinylcholine is used as a muscle relaxant to prevent fractures.

Question 230: What is the drug of choice for an elderly patient with depression and coronary artery disease?

A. Fluoxetine (Correct Answer)
B. Dothiepin
C. Mianserin
D. Amoxapine

Explanation: **Explanation:** The drug of choice for depression in elderly patients, especially those with comorbid medical conditions like coronary artery disease (CAD), is a **Selective Serotonin Reuptake Inhibitor (SSRI)**. **Fluoxetine (Option A)** is an SSRI. SSRIs are preferred in cardiac patients because they lack the significant anticholinergic, antihistaminic, and alpha-1 adrenergic blocking properties that cause cardiovascular side effects. Most importantly, SSRIs do not cause orthostatic hypotension or cardiac conduction delays (unlike TCAs), making them safe for patients with CAD. **Why the other options are incorrect:** * **Dothiepin (Option B):** This is a Tricyclic Antidepressant (TCA). TCAs are strictly contraindicated in patients with heart disease because they are "quinidine-like"; they prolong the PR and QT intervals and can trigger arrhythmias or cause orthostatic hypotension, leading to falls in the elderly. * **Mianserin (Option C):** A tetracyclic antidepressant. While it has fewer cardiac effects than TCAs, it is associated with a risk of agranulocytosis in the elderly and is generally not the first-line choice compared to SSRIs. * **Amoxapine (Option D):** A tetracyclic antidepressant with dopamine-blocking properties. It carries a risk of extrapyramidal side effects and is not preferred in cardiac or elderly populations. **Clinical Pearls for NEET-PG:** * **Sertraline** is often considered the *safest* SSRI post-myocardial infarction (SADHEART trial). * **Avoid Fluoxetine** if the patient is on multiple other medications due to its long half-life and potent CYP450 inhibition; however, among the given options, it remains the best choice. * **Citalopram/Escitalopram** should be used cautiously in high doses in cardiac patients due to dose-dependent QT prolongation.

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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