Mood Disorders Practice Questions

Q: What is the definition of double depression?

Depression superimposed on dysthymia. **Explanation:** **Double depression** is a clinical phenomenon where an acute episode of **Major Depressive Disorder (MDD)** occurs in a patient who already has a baseline of **Dysthymia** (now referred to as Persistent Depressive Disorder or PDD in DSM-5). 1. **Why Option B is Correct:** The core concept involves two layers of depression: a chronic, low-grade mood disturbance (Dysthymia) lasting at least 2 years, upon which a more severe, acute "spike" of Major Depression is superimposed. Patients with double depression typically have a poorer prognosis, higher rates of relapse, and more severe functional impairment compared to those with MDD alone. 2. **Analysis of Incorrect Options:** * **Option A:** This describes recurrent MDD, not double depression. * **Option C:** While it mentions the correct durations (2 weeks for MDD and 2 years for Dysthymia), the definition of double depression specifically emphasizes the *superimposition* of the acute episode on the chronic baseline, rather than just the coexistence of two timeframes. * **Option D:** Dysthymia is only the chronic component; it lacks the acute MDD episode required for the "double" designation. **High-Yield Clinical Pearls for NEET-PG:** * **Dysthymia Criteria:** Depressed mood for most of the day, for more days than not, for at least **2 years** (1 year in children/adolescents). * **Treatment:** Double depression is often more resistant to treatment than MDD alone. SSRIs and cognitive-behavioral therapy (CBT) are first-line. * **Prognosis:** Even after the MDD episode resolves, the patient typically returns to their baseline dysthymic state rather than a normal euthymic mood.

Q: What is the minimum time duration required for the diagnosis of mania?

1 week. **Explanation:** The diagnosis of Mania is primarily based on the duration and severity of symptoms as defined by the **ICD-11** and **DSM-5** criteria. 1. **Why Option A is correct:** According to DSM-5, a **Manic Episode** requires a distinct period of abnormally and persistently elevated, expansive, or irritable mood, and abnormally increased activity or energy, lasting **at least 1 week** and present most of the day, nearly every day. If hospitalization is necessary, the duration criterion of one week is waived. 2. **Why Options B, C, and D are incorrect:** * **2 weeks:** This is the minimum duration required for a **Major Depressive Episode** or Dysthymia (in children). * **4 weeks:** This does not correspond to the acute phase of mood episodes but is often used in assessing response to maintenance therapy. * **Hypomania:** It is crucial to distinguish mania from hypomania, which requires a minimum duration of only **4 consecutive days** and does not involve social/occupational impairment or psychosis. **High-Yield Clinical Pearls for NEET-PG:** * **Mnemonic for Mania (DIG FAST):** **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit (decreased need for sleep), **T**alkativeness (pressured speech). * **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode AND one Major Depressive episode. * **Cyclothymia:** Requires at least **2 years** of fluctuating hypomanic and depressive symptoms that do not meet full criteria.

Q: Which of the following is not a criterion for the diagnosis of depression?

Unexplained visceral pains. To diagnose a **Major Depressive Episode**, clinicians primarily follow the **ICD-11** or **DSM-5** criteria. According to the DSM-5, a patient must exhibit at least five out of nine specific symptoms for a minimum of two weeks. ### Why "Unexplained visceral pains" is the correct answer: While patients with depression often present with somatic symptoms (such as headaches or backaches) in clinical practice—a phenomenon known as **somatization**—"unexplained visceral pains" is **not** a formal diagnostic criterion in the DSM-5 or ICD classification. It is considered an associated feature rather than a core diagnostic requirement. ### Analysis of Incorrect Options: * **Feeling of guilt (Option B):** This is a core cognitive symptom. DSM-5 specifies "excessive or inappropriate guilt," which may even reach delusional proportions. * **Hypersomnia or Insomnia (Option C):** Sleep disturbance is a key neurovegetative symptom. While insomnia (difficulty staying asleep) is more common, atypical depression often presents with hypersomnia. * **Worthlessness (Option D):** Feelings of worthlessness are part of the "Cognitive Triad" of depression and are a standard diagnostic criterion. ### NEET-PG High-Yield Pearls: * **The "SIGECAPS" Mnemonic:** Use this to remember DSM-5 criteria: **S**leep, **I**nterest (Anhedonia), **G**uilt, **E**nergy (Fatigue), **C**oncentration, **A**ppetite, **P**sychomotor (Agitation/Retardation), **S**uicidal ideation. * **Core Symptoms (ICD-10):** Depressed mood, Anhedonia, and Fatigability. * **Atypical Depression:** Characterized by mood reactivity, **hypersomnia**, **leaden paralysis**, and **hyperphagia** (increased appetite). * **Melancholic Depression:** Characterized by early morning awakening (terminal insomnia) and symptoms being worse in the morning.

Q: Which of the following drugs is/are used in the management of bipolar disorder?

All of the above. **Explanation:** The management of Bipolar Disorder (BD) primarily involves **Mood Stabilizers**, which are drugs effective in treating acute manic/depressive episodes and preventing future relapses without inducing a switch to the opposite pole. 1. **Lithium Carbonate:** This is the **Gold Standard** and the first-line treatment for bipolar disorder. It is particularly effective for classic mania and is the only drug proven to reduce the risk of **suicide** in these patients. 2. **Sodium Valproate:** An anticonvulsant that has become a mainstay in BD management. It is often preferred over Lithium for **Rapid Cycling** bipolar disorder and **Mixed Episodes**. 3. **Phenytoin:** While primarily an anti-epileptic, Phenytoin has historically been used as an adjunct or alternative in refractory cases of mania. Although not a first-line choice like Lithium or Valproate, clinical studies (including those by Misra et al.) have demonstrated its efficacy in controlling manic symptoms, making it a valid option in the broader pharmacological management of the disorder. **High-Yield Clinical Pearls for NEET-PG:** * **Lithium:** Therapeutic range is **0.8–1.2 mEq/L** (acute mania) and **0.6–1.0 mEq/L** (maintenance). It is associated with Ebstein’s anomaly if used in pregnancy. * **Valproate:** Drug of choice for **Rapid Cyclers** (>4 episodes/year). It is highly teratogenic (Neural Tube Defects). * **Other Mood Stabilizers:** Carbamazepine and Lamotrigine (specifically for bipolar depression). * **Atypical Antipsychotics:** (e.g., Olanzapine, Quetiapine) are also used as mood stabilizers in modern practice.

Q: What is the most common type of post-puerperal psychosis?

Depression. **Explanation:** Post-puerperal (postpartum) psychosis is a severe psychiatric emergency occurring in approximately 1 to 2 per 1,000 deliveries. While the condition is characterized by a rapid onset of hallucinations, delusions, and cognitive impairment, it is fundamentally considered a **mood disorder** variant. **1. Why Depression is Correct:** The most common clinical presentation of postpartum psychosis is **Depressive Psychosis**. Although the condition often presents with "organic" features like confusion or delirium-like states, the underlying affective polarity is most frequently depressive. Patients exhibit profound psychomotor retardation or agitation, coupled with nihilistic delusions or delusions concerning the infant's health. **2. Analysis of Incorrect Options:** * **Anxiety:** While anxiety is a common symptom in postpartum "blues" or "postpartum depression," it is not the primary diagnostic feature of a psychotic episode. * **Mania:** Manic presentations (Postpartum Mania) do occur and are highly characteristic of Bipolar Disorder triggered by childbirth; however, statistically, depressive psychosis remains more prevalent. * **Suicide:** Suicide is a catastrophic *outcome* or complication of postpartum psychosis (along with infanticide), but it is a behavior/event rather than a "type" of psychosis. **High-Yield Clinical Pearls for NEET-PG:** * **Onset:** Usually within the first 2 weeks postpartum (often by day 3–10). * **Risk Factors:** Personal or family history of Bipolar Disorder is the strongest predictor. * **Management:** Requires immediate hospitalization. **ECT (Electroconvulsive Therapy)** is the treatment of choice due to its rapid response and safety during breastfeeding (compared to high-dose polypharmacy). * **Prognosis:** High risk of recurrence (up to 50%) in subsequent pregnancies.

Q: Kleptomania is:

Impulse. **Explanation:** **Kleptomania** is classified under **Impulse Control Disorders**. It is characterized by the recurrent failure to resist urges to steal objects that are not needed for personal use or monetary value. 1. **Why "Impulse" is correct:** The core psychopathology involves an increasing sense of **tension** immediately before committing the theft, followed by **pleasure, gratification, or relief** at the time of committing the act. This "tension-release" cycle is the hallmark of impulsive behavior. Unlike purposeful theft, the act is unplanned and ego-syntonic during the moment of the impulse. 2. **Why other options are incorrect:** * **Delusion:** This is a fixed, false belief held with absolute certainty despite evidence to the contrary. Kleptomania involves an action/urge, not a belief system. * **Obsession:** These are recurrent, intrusive, and senseless thoughts or images that cause anxiety. While the urge to steal is recurrent, it is not an intrusive thought but a behavioral drive. * **Compulsion:** Compulsions are repetitive behaviors performed to *neutralize* anxiety caused by an obsession (ego-dystonic). In kleptomania, the act is performed for *pleasure or gratification*, not merely to ward off dread. **Clinical Pearls for NEET-PG:** * **Gender:** More common in females (3:1 ratio). * **Comorbidity:** Highly associated with Mood Disorders (Depression), Anxiety, and Eating Disorders (Bulimia Nervosa). * **Treatment:** Cognitive Behavioral Therapy (CBT) is the psychological treatment of choice. Pharmacotherapy includes **SSRIs** or **Naltrexone** (to reduce the "rush" associated with the impulse). * **Legal Note:** Unlike professional shoplifting, kleptomania is not done for profit or out of anger/vengeance.

Q: Chronic hepatitis C infection is associated with which psychological illness that may worsen with interferon treatment?

Depression. **Explanation:** The correct answer is **Depression**. Chronic Hepatitis C (HCV) infection is frequently associated with neuropsychiatric complications, most notably **Major Depressive Disorder**. The pathophysiology involves systemic inflammation and the release of pro-inflammatory cytokines that cross the blood-brain barrier, altering neurotransmitter metabolism (specifically serotonin and dopamine). **Interferon-alpha (IFN-α)**, historically a mainstay of HCV treatment, is notorious for inducing or exacerbating depression. It increases the activity of the enzyme *indoleamine 2,3-dioxygenase (IDO)*, which shunts tryptophan away from serotonin synthesis toward the neurotoxic kynurenine pathway. This "Interferon-induced depression" can be severe, leading to suicidal ideation, and often requires pretreatment screening or prophylactic SSRIs. **Analysis of Incorrect Options:** * **A. OCD & B. PTSD:** While patients with chronic illness may experience anxiety, there is no specific pathophysiological link between HCV/Interferon and the development of OCD or PTSD. * **D. Schizophrenia:** While interferon can occasionally cause acute psychosis or delirium, it is not classically associated with the development of Schizophrenia. **High-Yield Clinical Pearls for NEET-PG:** * **Screening:** Always screen for depression using tools like the PHQ-9 before starting Interferon therapy. * **Management:** SSRIs (like Paroxetine or Sertraline) are the first-line treatment for Interferon-induced depression. * **Modern Context:** With the advent of Direct-Acting Antivirals (DAAs) like Sofosbuvir, the use of Interferon has significantly declined, reducing the incidence of treatment-induced depression. * **Other Side Effects:** Interferon is also associated with "flu-like symptoms," irritability, and cognitive "brain fog."

Question 1

What is the definition of double depression?

Accepted Answer

Depression superimposed on dysthymia

Answer

Depression with two distinct episodes

Answer

Depression lasting for at least two weeks accompanied by dysthymia lasting for at least two years

Answer

Dysthymia

Question 2

What is the minimum time duration required for the diagnosis of mania?

Accepted Answer

1 week

Answer

2 weeks

Answer

3 weeks

Answer

4 weeks

Question 3

Which of the following is not a criterion for the diagnosis of depression?

Accepted Answer

Unexplained visceral pains

Answer

Feeling of guilt

Answer

Hypersomnia or Insomnia

Answer

Worthlessness

Question 4

Which of the following drugs is/are used in the management of bipolar disorder?

Accepted Answer

All of the above

Answer

Lithium carbonate

Answer

Sodium valproate

Answer

Phenytoin

Question 5

What is the most common type of post-puerperal psychosis?

Accepted Answer

Depression

Answer

Anxiety

Answer

Mania

Answer

Suicide

Question 6

Electroconvulsive therapy (ECT) in the depressive phase of manic-depressive disorder (bipolar disorder) is useful because it:

Accepted Answer

Shortens duration

Answer

Produces recurrence

Answer

Reduces recurrence

Answer

Increases drug effects

Question 7

Kleptomania is:

Accepted Answer

Impulse

Answer

Delusion

Answer

Obsession

Answer

Compulsion

Question 8

A 60-year-old male presents with profound guilt, believing he has committed sins throughout his life. He exhibits depressive symptoms and has contemplated suicide. He has sought guidance from a spiritual guru and is resistant to reassurance from his wife about his virtuous life. How would you manage this patient?

Accepted Answer

Antipsychotic combined with antidepressant

Answer

Antidepressant monotherapy

Answer

Antidepressant combined with cognitive behavioral therapy

Answer

Antidepressant with continued spiritual guidance and counseling

Question 9

A 60-year-old man, whose wife passed away 3 months prior, now believes his intestines have rotted away and that he is responsible for his wife's death and should be sent to prison. What is the likely diagnosis?

Accepted Answer

Psychotic depression

Answer

Delusional disorder

Answer

Grief psychosis

Answer

Schizophrenia

Question 10

Chronic hepatitis C infection is associated with which psychological illness that may worsen with interferon treatment?

Accepted Answer

Depression

Answer

Obsessive-compulsive disorder (OCD)

Answer

Post-traumatic stress disorder (PTSD)

Answer

Schizophrenia

Mood Disorders — MCQs

Mood Disorders — MCQs

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