Mood Disorders Practice Questions

Q: Alexithymia is:

Inability to recognise and describe feelings. **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)**.

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

XYY. ### 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.

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

Fluoxetine. **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.

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

Cerebrovascular disorder. **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.

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

Manic-depressive disorder. **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.

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

Depression. **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.

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

TCAs are better than MAO and SSRI for treatment. **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.

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

It is two times more common in men than women.. **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.

Question 1

Alexithymia is:

Accepted Answer

Inability to recognise and describe feelings

Answer

A feeling of intense rapture

Answer

Pathological sadness

Answer

Affective flattening

Question 2

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

Accepted Answer

XYY

Answer

XXY

Answer

XXXY

Answer

XXYY

Question 3

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

Accepted Answer

Fluoxetine

Answer

Imipramine

Answer

Dothiepin

Answer

Mianserine

Question 4

What is the drug of choice for Premenstrual Dysphoric Disorder?

Accepted Answer

Selective Serotonin Reuptake Inhibitors (SSRIs)

Answer

Benzodiazepines

Answer

Tricyclic Antidepressants (TCAs)

Answer

Progesterone

Question 5

What is the drug of choice for prophylaxis of mania?

Accepted Answer

Lithium

Answer

Haloperidol

Answer

Clozapine

Answer

Carbamazepine

Question 6

Depression is associated with which of the following neurological conditions?

Accepted Answer

Cerebrovascular disorder

Answer

Multiple sclerosis

Answer

Epilepsy

Answer

None of the above

Question 7

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

Accepted Answer

Manic-depressive disorder

Answer

Schizophrenia

Answer

Acute depression

Answer

Conversion reaction

Question 8

Suicidal tendency is common in which of the following conditions?

Accepted Answer

Depression

Answer

Mania

Answer

Schizophrenia

Answer

Obsessive compulsive disorder

Question 9

Which of the following is not a feature of atypical depression?

Accepted Answer

TCAs are better than MAO and SSRI for treatment

Answer

Variable mood responding to positive stimuli in surroundings

Answer

Increased sleep and weight gain

Answer

Marked fatigue and heaviness in the body

Question 10

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

Accepted Answer

It is two times more common in men than women.

Answer

Its incidence increases with increasing age.

Answer

In affected females, the onset is typically in adulthood.

Answer

It has a genetic origin.

Mood Disorders — MCQs

Mood Disorders — MCQs

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