Mood Disorders — MCQs

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?

Q259Medium

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?

Q260Easy

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

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 251: What is the definition of double depression?

A. Depression with two distinct episodes
B. Depression superimposed on dysthymia (Correct Answer)
C. Depression lasting for at least two weeks accompanied by dysthymia lasting for at least two years
D. Dysthymia

Explanation: **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.

Question 252: What is the minimum time duration required for the diagnosis of mania?

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

Explanation: **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.

Question 253: Which of the following is not a criterion for the diagnosis of depression?

A. Unexplained visceral pains (Correct Answer)
B. Feeling of guilt
C. Hypersomnia or Insomnia
D. Worthlessness

Explanation: 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.

Question 254: Which of the following drugs is/are used in the management of bipolar disorder?

A. Lithium carbonate
B. Sodium valproate
C. Phenytoin
D. All of the above (Correct Answer)

Explanation: **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.

Question 255: What is the most common type of post-puerperal psychosis?

A. Depression (Correct Answer)
B. Anxiety
C. Mania
D. Suicide

Explanation: **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.

Question 256: Electroconvulsive therapy (ECT) in the depressive phase of manic-depressive disorder (bipolar disorder) is useful because it:

A. Produces recurrence
B. Reduces recurrence
C. Shortens duration (Correct Answer)
D. Increases drug effects

Explanation: **Explanation:** The primary therapeutic goal of Electroconvulsive Therapy (ECT) in acute psychiatric conditions is the **rapid resolution of symptoms**. In the depressive phase of bipolar disorder, ECT is considered the most effective treatment for achieving quick remission, especially when there is a high risk of suicide or treatment resistance. **Why "Shortens duration" is correct:** ECT does not "cure" the underlying bipolar diathesis, nor does it prevent future episodes. Instead, it acts as an acute intervention that significantly **shortens the duration of the current episode** by inducing a series of generalized seizures that modulate neurotransmitter receptors (upregulation of serotonin and dopamine) and enhance neuroplasticity. It works much faster than pharmacological antidepressants, which typically take 2–4 weeks to show effects. **Analysis of Incorrect Options:** * **A & B (Recurrence):** ECT is primarily an acute treatment. While it resolves the current episode, it does **not** significantly reduce the long-term risk of recurrence unless followed by maintenance ECT or mood stabilizers. In some cases, if used without a mood stabilizer, ECT can occasionally trigger a "switch" into mania. * **D (Increases drug effects):** While ECT can be used alongside medications, its primary mechanism is independent. It is not used for the purpose of potentiation (synergy) of drugs, but rather as a superior alternative or adjunct for rapid response. **High-Yield Clinical Pearls for NEET-PG:** * **Indications:** Severe depression with suicidal ideation (Number 1 indication), treatment-resistant depression, and catatonia. * **Absolute Contraindication:** Increased intracranial pressure (ICP). * **Most Common Side Effect:** Retrograde amnesia. * **Mortality:** Extremely low (approx. 0.01%), usually due to cardiovascular complications. * **Electrode Placement:** Bilateral ECT is more effective but has more cognitive side effects compared to Unilateral (D'Elia placement).

Question 257: Kleptomania is:

A. Delusion
B. Obsession
C. Impulse (Correct Answer)
D. Compulsion

Explanation: **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.

Question 258: 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?

A. Antidepressant monotherapy
B. Antipsychotic combined with antidepressant (Correct Answer)
C. Antidepressant combined with cognitive behavioral therapy
D. Antidepressant with continued spiritual guidance and counseling

Explanation: ### Explanation **Diagnosis: Major Depressive Disorder with Psychotic Features (Psychotic Depression)** The patient presents with core symptoms of depression (suicidality, low mood) accompanied by **delusions of guilt**. His belief that he has committed unforgivable sins, despite evidence to the contrary (resistance to reassurance), is a classic **mood-congruent delusion**. In a 60-year-old, the presence of psychotic symptoms in depression significantly increases the risk of suicide and requires aggressive management. **1. Why Option B is Correct:** The gold standard treatment for Psychotic Depression is the **combination of an antidepressant and an antipsychotic**. Antidepressants alone are often ineffective for the delusional component, while antipsychotics alone do not address the underlying mood pathology. Alternatively, **Electroconvulsive Therapy (ECT)** is considered a first-line treatment, especially if there is a high risk of suicide or poor oral intake. **2. Why Other Options are Incorrect:** * **Option A:** Antidepressant monotherapy has a high failure rate in psychotic depression. The psychosis must be addressed with a dopamine antagonist. * **Option C:** While CBT is excellent for mild-to-moderate depression, it is ineffective as a primary treatment when a patient is actively delusional and lacks insight. * **Option D:** Spiritual guidance and counseling are supportive but do not address the neurochemical imbalance of psychotic depression. Delaying medical treatment in a suicidal patient is dangerous. **High-Yield Clinical Pearls for NEET-PG:** * **Mood-Congruent Delusions:** In depression, these typically involve themes of guilt, poverty, or somatic illness (e.g., Cotard’s syndrome/nihilistic delusions). * **First-line Treatment:** SSRI + Atypical Antipsychotic (e.g., Sertraline + Olanzapine) OR ECT. * **ECT Indications:** Psychotic depression is one of the strongest indications for ECT, particularly in the elderly or those with high suicidal intent. * **Differential:** Always rule out organic causes (e.g., dementia or metabolic issues) in a first-episode geriatric depression.

Question 259: 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?

A. Delusional disorder
B. Psychotic depression (Correct Answer)
C. Grief psychosis
D. Schizophrenia

Explanation: **Explanation:** The patient presents with symptoms of **Major Depressive Disorder with Psychotic Features** (Psychotic Depression). The diagnosis is based on the presence of severe depressive themes following a significant loss, coupled with specific types of delusions. **1. Why Psychotic Depression is correct:** The patient exhibits **mood-congruent delusions**, which are characteristic of psychotic depression. * **Cotard’s Syndrome (Nihilistic Delusion):** The belief that his "intestines have rotted away" is a classic nihilistic delusion where the patient believes they are dead, decaying, or non-existent. * **Delusion of Guilt:** Believing he is responsible for his wife's death and deserves imprisonment reflects pathological guilt, a hallmark of depressive psychosis. * **Timeline:** While grief is normal at 3 months, the presence of psychosis and nihilistic delusions shifts the diagnosis to a clinical depressive disorder. **2. Why other options are incorrect:** * **Delusional Disorder:** Characterized by non-bizarre delusions (e.g., being followed) without prominent mood symptoms or the bizarre nihilistic quality seen here. * **Grief Psychosis:** This is not a standard DSM-5 or ICD-10 diagnosis. While "Persistent Complex Bereavement Disorder" exists, it does not typically involve Cotard’s syndrome. * **Schizophrenia:** Requires at least 6 months of symptoms and usually involves mood-incongruent delusions or hallucinations (e.g., bizarre thought insertion) rather than focused themes of guilt and decay. **Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome:** Often associated with severe depression in the elderly. * **Treatment of Choice:** For psychotic depression, the most effective treatment is **Electroconvulsive Therapy (ECT)** or a combination of an Antidepressant + Antipsychotic. * **Mood-Congruence:** If the delusion matches the mood (e.g., "I am poor" during depression), it points toward a Mood Disorder rather than Schizophrenia.

Question 260: Chronic hepatitis C infection is associated with which psychological illness that may worsen with interferon treatment?

A. Obsessive-compulsive disorder (OCD)
B. Post-traumatic stress disorder (PTSD)
C. Depression (Correct Answer)
D. Schizophrenia

Explanation: **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."

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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