Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 231: Alexithymia is:

A. A feeling of intense rapture
B. Pathological sadness
C. Affective flattening
D. Inability to recognise and describe feelings (Correct Answer)

Explanation: **Explanation:** **Alexithymia** (derived from Greek: *a* = lack, *lexis* = word, *thymos* = emotion) is a personality construct characterized by the **inability to identify, process, and describe one’s own emotions**. Patients with alexithymia often struggle to distinguish between emotional states and the physical sensations of emotional arousal. This is the correct answer because the core deficit is a lack of "words for emotions." **Analysis of Incorrect Options:** * **A. A feeling of intense rapture:** This describes **Ecstasy**, often seen in manic episodes or certain psychotic states. * **B. Pathological sadness:** This is the definition of **Depression** or **Melancholia**, characterized by a pervasive and persistent low mood. * **C. Affective flattening:** This refers to a **restriction in the range and intensity of emotional expression** (a "negative symptom" commonly seen in Schizophrenia). While alexithymia involves internal processing, affective flattening is an external observation of reduced emotional reactivity. **High-Yield Clinical Pearls for NEET-PG:** * **Sifneos (1973):** The term was coined by Peter Sifneos. * **Psychosomatic Connection:** Alexithymia is frequently associated with **psychosomatic disorders** (e.g., IBS, essential hypertension), as patients may present with physical complaints instead of expressing emotional distress. * **Dreaming:** Individuals with alexithymia often have a "poverty of fantasy life" and their dreams are usually logical and realistic rather than symbolic. * **Assessment:** The most commonly used scale to measure this trait is the **Toronto Alexithymia Scale (TAS-20)**.

Question 232: Which chromosomal abnormality is associated with tall stature and aggressive or criminal behavior?

A. XXY
B. XYY (Correct Answer)
C. XXXY
D. XXYY

Explanation: ### Explanation **Correct Option: B (XYY Syndrome)** XYY Syndrome, also known as **Jacob’s Syndrome**, is a chromosomal anomaly where a male has an extra Y chromosome. The classic clinical triad associated with this condition is **tall stature**, **severe acne**, and **behavioral problems**. Historically, it was linked to an increased risk of aggressive or antisocial behavior and was overrepresented in prison populations (the "Super-male" theory). While modern psychiatry notes that most XYY individuals are not criminals, for competitive exams like NEET-PG, the association with **impulsivity, lower IQ, and aggressive outbursts** remains a high-yield diagnostic marker. **Incorrect Options:** * **A (XXY - Klinefelter Syndrome):** This is the most common sex chromosome disorder. While it also presents with tall stature, it is characterized by **hypogonadism, gynecomastia, and infertility**. Patients are typically shy and passive rather than aggressive. * **C & D (XXXY and XXYY):** These are rare variants of Klinefelter syndrome. While they involve more severe intellectual disability and skeletal anomalies due to the extra X chromosomes, they are not the classic association for the "criminal genotype" described in psychiatric literature. **High-Yield Clinical Pearls for NEET-PG:** * **Jacob’s Syndrome (XYY):** Look for keywords like "tall stature," "antisocial behavior," and "normal fertility" (unlike Klinefelter). * **Fragile X Syndrome:** The most common *inherited* cause of intellectual disability; look for large ears and macro-orchidism. * **Down Syndrome:** The most common *chromosomal* cause of intellectual disability; associated with early-onset Alzheimer’s disease. * **Psychiatric Comorbidity:** XYY individuals have a higher prevalence of ADHD and Autism Spectrum Disorders.

Question 233: Which of the following medications is primarily used to treat depression in the elderly?

A. Imipramine
B. Dothiepin
C. Fluoxetine (Correct Answer)
D. Mianserine

Explanation: **Explanation:** **Correct Answer: C. Fluoxetine** The primary goal in treating depression in the elderly is to ensure efficacy while minimizing side effects, particularly anticholinergic and cardiovascular risks. **Selective Serotonin Reuptake Inhibitors (SSRIs)**, such as **Fluoxetine**, are considered the first-line treatment for geriatric depression. They are preferred because they lack the sedative, anticholinergic (which can cause confusion/delirium), and orthostatic hypotensive effects commonly associated with older classes of antidepressants. **Analysis of Incorrect Options:** * **A. Imipramine & B. Dothiepin:** These are **Tricyclic Antidepressants (TCAs)**. TCAs are generally avoided in the elderly due to their potent anticholinergic side effects (constipation, urinary retention, blurred vision, and cognitive impairment) and cardiotoxicity (arrhythmias and orthostatic hypotension, which increases the risk of falls and fractures). * **D. Mianserine:** This is a tetracyclic antidepressant. While it has fewer anticholinergic effects than TCAs, it is associated with a risk of **agranulocytosis** and significant sedation, making it a less favorable first-line choice compared to SSRIs in the elderly population. **High-Yield Clinical Pearls for NEET-PG:** * **First-line for Elderly Depression:** SSRIs (e.g., Sertraline, Escitalopram, Fluoxetine). Sertraline is often preferred if the patient has co-morbid cardiac issues due to its safe profile. * **Hyponatremia Risk:** Elderly patients on SSRIs should be monitored for **SIADH**, a common electrolyte complication in this age group. * **Pseudodementia:** Depression in the elderly can often mimic dementia (cognitive impairment). Unlike true dementia, "depressive pseudodementia" has a subacute onset, and patients often answer "I don't know" to questions rather than giving near-miss answers.

Question 234: What is the drug of choice for Premenstrual Dysphoric Disorder?

A. Benzodiazepines
B. Tricyclic Antidepressants (TCAs)
C. Progesterone
D. Selective Serotonin Reuptake Inhibitors (SSRIs) (Correct Answer)

Explanation: **Explanation:** **Premenstrual Dysphoric Disorder (PMDD)** is a severe form of Premenstrual Syndrome (PMS) characterized by significant emotional and physical distress that interferes with daily functioning. **Why SSRIs are the Correct Choice:** The underlying pathophysiology of PMDD is linked to a heightened sensitivity to normal hormonal fluctuations, which leads to a relative deficiency in **serotonergic activity** during the luteal phase. **Selective Serotonin Reuptake Inhibitors (SSRIs)** are the first-line treatment (Drug of Choice) because they rapidly increase synaptic serotonin levels. Unlike in Major Depressive Disorder, SSRIs in PMDD often show a rapid onset of action (within days) and can be prescribed either continuously or as **luteal-phase-only dosing** (starting on day 14 and stopping at the onset of menses). Fluoxetine, Sertraline, and Paroxetine are commonly used. **Analysis of Incorrect Options:** * **A. Benzodiazepines:** While they may help with acute anxiety or insomnia, they do not address the core mood symptoms and carry a risk of dependence and sedation. * **B. Tricyclic Antidepressants (TCAs):** Though they affect serotonin, they have a poor side-effect profile (anticholinergic, sedative) compared to SSRIs and are not considered first-line. * **C. Progesterone:** Historically used, but clinical trials have shown that progesterone supplementation is generally no more effective than a placebo for PMDD symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria:** Symptoms must be present during the **luteal phase** and resolve within a few days of the onset of menses (follicular phase). * **Gold Standard Diagnosis:** Prospective daily charting of symptoms for at least **two consecutive menstrual cycles**. * **FDA-Approved SSRIs for PMDD:** Fluoxetine (Sarafem), Sertraline, and Paroxetine CR. * **Second-line treatment:** Oral contraceptive pills (specifically those containing **Drospirenone**) or GnRH agonists (e.g., Leuprolide) for refractory cases.

Question 235: What is the drug of choice for prophylaxis of mania?

A. Lithium (Correct Answer)
B. Haloperidol
C. Clozapine
D. Carbamazepine

Explanation: ### Explanation **1. Why Lithium is the Correct Answer:** Lithium remains the **gold standard** and the **drug of choice (DOC)** for the long-term prophylaxis of Bipolar Affective Disorder (BPAD), specifically for preventing both manic and depressive relapses. It is a mood stabilizer that works by modulating second messenger systems (like the inositol depletion hypothesis) and reducing excitatory neurotransmission. It is particularly effective in patients with a "classic" presentation (euphoric mania followed by depression). **2. Analysis of Incorrect Options:** * **B. Haloperidol:** This is a typical antipsychotic. While highly effective for the **acute management** of severe manic agitation due to its rapid onset, it is not used for prophylaxis because it does not stabilize mood and carries a high risk of Extrapyramidal Side Effects (EPS) and tardive dyskinesia with long-term use. * **C. Clozapine:** This is an atypical antipsychotic reserved for **treatment-resistant** cases of mania or schizophrenia. It is not a first-line prophylactic agent due to its side effect profile, specifically the risk of agranulocytosis. * **D. Carbamazepine:** This is an anticonvulsant used as a **second-line** mood stabilizer. It is preferred in "atypical" cases, such as rapid cycling or mixed episodes, but it is statistically less effective than Lithium for overall prophylaxis. **3. High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Index:** Lithium has a narrow therapeutic index. Prophylactic range: **0.6 – 1.2 mEq/L**; Acute mania range: **0.8 – 1.5 mEq/L**. * **Teratogenicity:** Use of Lithium in pregnancy is associated with **Ebstein’s Anomaly** (atrialization of the right ventricle). * **Monitoring:** Before starting Lithium, always check **Thyroid Function Tests (TFTs)** and **Renal Function Tests (RFTs)**, as it can cause hypothyroidism and nephrogenic diabetes insipidus. * **Anti-suicidal Property:** Lithium is one of the few psychiatric drugs proven to reduce the risk of suicide in patients with mood disorders.

Question 236: Depression is associated with which of the following neurological conditions?

A. Cerebrovascular disorder (Correct Answer)
B. Multiple sclerosis
C. Epilepsy
D. None of the above

Explanation: **Explanation:** **1. Why Cerebrovascular Disorder is Correct:** Depression is most strongly and frequently associated with **Cerebrovascular Disorders**, particularly stroke. This is known as **Post-Stroke Depression (PSD)**, affecting approximately 30% of survivors. The underlying mechanism involves the disruption of neural circuits (specifically the prefrontal cortex and basal ganglia) and the depletion of biogenic amines (serotonin and norepinephrine) due to ischemic injury. Furthermore, the "Vascular Depression" hypothesis suggests that silent small-vessel disease in the elderly can predispose individuals to late-onset depression. **2. Why the Other Options are Incorrect:** * **B. Multiple Sclerosis (MS):** While MS is associated with mood changes, it is more characteristically linked to **Euphoria** (La belle indifférence) or pathological laughing and crying (pseudobulbar affect). While depression can occur, the classic association tested in psychiatric exams for cerebrovascular events is much stronger. * **C. Epilepsy:** Epilepsy is more commonly associated with **Psychosis** (Interictal psychosis) or personality changes (Geschwind syndrome). While comorbid depression exists, it is not the primary neurological hallmark compared to the established link with vascular events. **3. NEET-PG High-Yield Clinical Pearls:** * **Post-Stroke Depression:** Most common in patients with **left frontal lobe** or **left basal ganglia** lesions. * **Pseudodementia:** Severe depression in the elderly can mimic dementia; it is reversible with antidepressants (unlike true dementia). * **Organic Mood Disorder:** When depression is caused by a medical condition (like hypothyroidism, Cushing’s, or Stroke), it is classified under "Mood disorder due to a general medical condition." * **Drug-Induced Depression:** Always rule out drugs like **Reserpine**, Beta-blockers, and Steroids in clinical vignettes.

Question 237: Lithium is used in the prophylactic treatment of which of the following conditions?

A. Schizophrenia
B. Manic-depressive disorder (Correct Answer)
C. Acute depression
D. Conversion reaction

Explanation: **Explanation:** **Lithium** is the gold-standard mood stabilizer and remains the first-line agent for the **prophylactic (maintenance) treatment of Bipolar Disorder**, historically known as **Manic-depressive disorder**. Its primary role is to prevent the recurrence of both manic and depressive episodes, though it is generally more effective at preventing mania. * **Why B is correct:** Lithium stabilizes mood by modulating neurotransmitters (reducing dopamine/glutamate and increasing GABA) and inhibiting the inositol depletion pathway. It is the only drug proven to reduce the risk of suicide in patients with mood disorders. * **Why A is incorrect:** Schizophrenia is primarily treated with antipsychotics (e.g., Risperidone, Olanzapine). While Lithium may be used as an adjunct in schizoaffective disorder, it is not the primary treatment for schizophrenia. * **Why C is incorrect:** For acute unipolar depression, SSRIs are the first line. While Lithium can "augment" antidepressants in treatment-resistant cases, it is not the standard treatment for an acute depressive episode. * **Why D is incorrect:** Conversion reaction (Functional Neurological Symptom Disorder) is a somatoform disorder treated with psychotherapy (CBT) and physical therapy, not mood stabilizers. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Index:** Lithium has a narrow therapeutic index. * Prophylaxis range: **0.6 – 0.8 mEq/L**. * Acute Mania range: **0.8 – 1.2 mEq/L**. * Toxicity: >1.5 mEq/L. * **Side Effects:** L-I-T-H: **L**eukocytosis, **I**nsipidus (Nephrogenic Diabetes Insipidus), **T**remors/Teratogenicity (Ebstein’s Anomaly), **H**ypothyroidism. * **Monitoring:** Before starting, check Renal Function Tests (RFT), Thyroid Function Tests (TFT), and ECG.

Question 238: Suicidal tendency is common in which of the following conditions?

A. Mania
B. Depression (Correct Answer)
C. Schizophrenia
D. Obsessive compulsive disorder

Explanation: **Explanation:** **Correct Answer: B. Depression** Suicidal ideation and completed suicide are most strongly associated with **Major Depressive Disorder (MDD)**. The core symptoms of depression—specifically **hopelessness, helplessness, and worthlessness**—are the strongest psychological predictors of suicidal intent. Statistically, about 15% of patients with severe depression eventually die by suicide. In the context of mood disorders, the risk is highest during the early recovery phase (when energy levels improve before the mood lifts) or during a "Mixed Episode." **Why other options are incorrect:** * **A. Mania:** While patients in a manic episode exhibit poor judgment and impulsivity, the predominant mood is euphoric or irritable. Suicide is rare in pure mania unless it is a **Mixed State** (features of both mania and depression). * **C. Schizophrenia:** There is a significant risk (approx. 5-10%), often due to "command hallucinations" or post-psychotic depression, but it is statistically less frequent than in primary Depressive Disorders. * **D. Obsessive Compulsive Disorder (OCD):** While OCD causes significant distress and functional impairment, it is not primarily characterized by the suicidal drive seen in mood disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Predictor:** A **previous history of suicide attempts** is the single best predictor of a future completed suicide. * **The "SAD PERSONS" Scale:** A common mnemonic used to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness). * **Gender Paradox:** Females attempt suicide more frequently, but **males complete suicide more often** (due to the use of more lethal methods). * **Neurobiology:** Low levels of **5-HIAA** (a serotonin metabolite) in the Cerebrospinal Fluid (CSF) are associated with impulsive and violent suicide attempts.

Question 239: Which of the following is not a feature of atypical depression?

A. TCAs are better than MAO and SSRI for treatment (Correct Answer)
B. Variable mood responding to positive stimuli in surroundings
C. Increased sleep and weight gain
D. Marked fatigue and heaviness in the body

Explanation: **Explanation:** Atypical depression is a subtype of Major Depressive Disorder characterized by specific "reversed" vegetative symptoms. **Why Option A is the correct answer (The False Statement):** Historically, atypical depression shows a **poor response to Tricyclic Antidepressants (TCAs)**. The first-line pharmacological treatment is **SSRIs** (due to their safety profile). However, **MAO Inhibitors (MAOIs)** are considered the most effective (gold standard) for treatment-resistant atypical depression. Therefore, stating TCAs are better than MAOIs/SSRIs is clinically incorrect. **Analysis of Incorrect Options (Features of Atypical Depression):** * **Option B (Mood Reactivity):** This is the hallmark feature. Unlike melancholic depression, patients with atypical depression experience a brightening of mood in response to actual or potential positive events. * **Option C (Reversed Vegetative Symptoms):** While typical depression involves insomnia and anorexia, atypical depression is characterized by **hyperphagia** (increased appetite/weight gain) and **hypersomnia** (increased sleep). * **Option D (Leaden Paralysis):** This refers to a pathological clinical sensation where the patient feels a heavy, weighted-down feeling in the arms or legs, often described as "leaden." **High-Yield Clinical Pearls for NEET-PG:** * **Interpersonal Rejection Sensitivity:** A long-standing trait in these patients where they are overly sensitive to perceived slights or rejection, leading to significant social/occupational impairment. * **DSM-5 Criteria:** Requires Mood Reactivity **PLUS** two or more of: Weight gain/increased appetite, Hypersomnia, Leaden paralysis, or Rejection sensitivity. * **Demographics:** More common in younger patients and females compared to melancholic depression.

Question 240: Which of the following is NOT true about Major Depressive Disorder?

A. It is two times more common in men than women. (Correct Answer)
B. Its incidence increases with increasing age.
C. In affected females, the onset is typically in adulthood.
D. It has a genetic origin.

Explanation: **Explanation:** **1. Why Option A is the Correct Answer (The False Statement):** In Major Depressive Disorder (MDD), the prevalence is significantly higher in females than in males. Epidemiological studies consistently show that **MDD is twice as common in women as in men** (a 2:1 ratio). This disparity is attributed to hormonal differences (estrogen/progesterone fluctuations), higher rates of psychosocial stressors, and differences in coping mechanisms. Therefore, the statement that it is more common in men is incorrect. **2. Analysis of Other Options:** * **Option B (Incidence increases with age):** While the peak age of onset is often cited between 20-40 years, the overall cumulative incidence and prevalence of depressive symptoms tend to increase with advancing age due to factors like chronic medical illnesses, social isolation, and bereavement. * **Option C (Onset in adulthood):** The mean age of onset for MDD is approximately 40 years. While it can occur in childhood, the majority of clinical presentations in females occur during their reproductive and adult years. * **Option D (Genetic origin):** MDD has a strong genetic component. First-degree relatives of patients with MDD are 2 to 3 times more likely to develop the disorder. Heritability is estimated at approximately 30-40%. **High-Yield Clinical Pearls for NEET-PG:** * **Most common psychiatric disorder:** MDD is often cited as the most common mood disorder in the general population. * **Neurotransmitters:** Primarily involves decreased levels of **Serotonin (5-HT)** and **Norepinephrine**. * **Sleep Changes:** Classic MDD features **Reduced REM latency** (entering REM sleep faster) and increased REM density. * **Treatment:** SSRIs are the first-line pharmacological treatment. For treatment-resistant or severe depression with suicidal ideation, **ECT (Electroconvulsive Therapy)** remains the most effective intervention.

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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