Mood Disorders Practice Questions

Q: Which of the following drugs are used for recurrent depressive episodes?

Fluoxetine. **Explanation:** The core management of **Recurrent Depressive Disorder (RDD)** involves the use of antidepressants to achieve remission and prevent future relapses. **Why Fluoxetine is Correct:** Fluoxetine is a **Selective Serotonin Reuptake Inhibitor (SSRI)**. SSRIs are the first-line pharmacological treatment for depressive episodes due to their superior safety profile, better tolerability, and lower side-effect burden compared to older classes. For recurrent episodes, maintenance therapy with an effective antidepressant (like Fluoxetine) is indicated for at least 2 years or longer to prevent recurrence. **Analysis of Incorrect Options:** * **Imipramine (Option A):** While Imipramine is a Tricyclic Antidepressant (TCA) and effective for depression, it is no longer the first-line choice due to significant side effects (anticholinergic, sedative, and cardiotoxicity in overdose). * **Carbamazepine (Option B) & Valproate (Option D):** These are **Mood Stabilizers** (Anticonvulsants). They are primarily used in the treatment of Bipolar Disorder (to treat mania and prevent mood swings) rather than unipolar recurrent depression. **High-Yield Clinical Pearls for NEET-PG:** * **Maintenance Duration:** After a single episode of depression, continue treatment for 6–9 months. For recurrent episodes (2 or more), continue for at least 2 years. * **Drug of Choice (DOC):** SSRIs are the DOC for Depression, Panic Disorder, OCD, and Social Phobia. * **Fluoxetine Specifics:** It has the longest half-life among SSRIs (due to its active metabolite norfluoxetine), making it the safest option if a patient occasionally misses a dose, but it requires a longer washout period before starting an MAOI to avoid **Serotonin Syndrome**. * **Prophylaxis:** If a patient has had 3 or more episodes, lifelong prophylaxis is often recommended.

Q: Which of the following is seen in mania?

Over activity. **Explanation:** **Mania** is a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least one week. It is a hallmark of Bipolar I Disorder. **1. Why "Over activity" is correct:** Psychomotor agitation or **increased goal-directed activity** is a core diagnostic criterion for mania (as per DSM-5 and ICD-11). Patients experience a surge in energy levels, leading to excessive involvement in activities (social, occupational, or sexual). This "over activity" often manifests as being constantly "on the go," pacing, or starting multiple projects simultaneously without finishing them. **2. Why other options are incorrect:** * **Low activity:** This is a characteristic feature of **Depression**. In depressive episodes, patients experience psychomotor retardation, lethargy, and a lack of energy (anergia). * **Normal activity:** By definition, a manic episode represents a significant deviation from an individual’s baseline (euthymic) functioning. Normal activity levels would not meet the clinical threshold for a mood disorder diagnosis. **Clinical Pearls for NEET-PG:** * **The Triad of Mania:** Elevated mood, flight of ideas (pressured speech), and increased psychomotor activity. * **Sleep Requirement:** A "decreased need for sleep" (feeling rested after only 3 hours) is a highly specific sign of mania, distinct from insomnia where the patient wants to sleep but cannot. * **Judgment:** Mania is often associated with poor impulse control, leading to "hedonistic" activities (e.g., reckless spending, sexual indiscretions). * **Hypomania vs. Mania:** Hypomania lasts at least 4 days, does not cause marked functional impairment, and lacks psychotic features. Mania lasts at least 7 days or requires hospitalization.

Q: The hypocretin system plays a critical role in which of the following disorders?

Narcolepsy. **Explanation:** **Correct Option: D. Narcolepsy** Hypocretin (also known as **orexin**) is a neuropeptide produced in the lateral hypothalamus that regulates wakefulness and arousal. The pathophysiology of **Narcolepsy Type 1** (narcolepsy with cataplexy) is primarily characterized by the selective autoimmune destruction of these hypocretin-producing neurons. This deficiency leads to an inability to maintain stable wakefulness and the intrusion of REM sleep phenomena into wakefulness (e.g., cataplexy, sleep paralysis). Diagnosis is often confirmed by low levels of Hypocretin-1 in the cerebrospinal fluid (CSF). **Incorrect Options:** * **A. Insomnia:** While orexin receptor antagonists (e.g., Suvorexant) are used to treat insomnia by blocking wakefulness, the primary etiology of insomnia is not a dysfunction of the hypocretin system itself, but rather hyperarousal. * **B. Depression:** Depression is primarily linked to the monoamine hypothesis (deficits in Serotonin, Norepinephrine, and Dopamine). While sleep disturbances occur in depression, hypocretin is not the core neurobiological driver. * **C. Obsessive-compulsive disorder (OCD):** OCD is associated with dysregulation in the Cortico-Striato-Thalamo-Cortical (CSTC) circuits and serotonin imbalance, with no established link to the hypocretin system. **High-Yield Clinical Pearls for NEET-PG:** * **Narcolepsy Tetrad:** Excessive daytime sleepiness, Cataplexy (sudden loss of muscle tone triggered by emotion), Sleep paralysis, and Hypnagogic/Hypnopompic hallucinations. * **HLA Association:** Strong association with **HLA-DQB1*0602**. * **Treatment:** Modafinil is the first-line treatment for daytime sleepiness; Sodium Oxybate is used for cataplexy. * **CSF Findings:** Hypocretin-1 levels **<110 pg/mL** are diagnostic for Narcolepsy Type 1.

Q: Which of the following is true about pseudodementia?

Seen in patients with depression. **Explanation:** **Pseudodementia** (also known as the **Dementia of Depression**) refers to a clinical syndrome where patients with severe depressive disorders present with cognitive deficits that mimic true organic dementia. **Why Option B is Correct:** In elderly patients, depression often manifests with prominent cognitive impairment, such as memory loss, poor concentration, and psychomotor slowing. Unlike true dementia, these deficits are **functional and reversible** with appropriate antidepressant treatment. The underlying medical concept is that the patient’s lack of motivation and "psychomotor retardation" lead to poor performance on cognitive tasks, rather than a structural neurodegenerative process. **Why Other Options are Incorrect:** * **Options A & C:** Pseudodementia is not a type of cortical (e.g., Alzheimer’s) or subcortical (e.g., Parkinson’s) dementia. These are irreversible, progressive organic conditions, whereas pseudodementia is a psychiatric condition. * **Option D:** It is not secondary to an organic condition (like Vitamin B12 deficiency or hypothyroidism). It is a functional impairment secondary to a primary mood disorder. **High-Yield Clinical Pearls for NEET-PG:** To differentiate Pseudodementia from True Dementia (Alzheimer’s), remember these key features: 1. **Onset:** Sudden/Abrupt in pseudodementia; Insidious/Slow in true dementia. 2. **Effort:** Patients with pseudodementia often give **"I don't know"** answers and make little effort. Patients with true dementia often give "near-miss" answers (confabulation) and try hard to compensate. 3. **Awareness:** Patients with pseudodementia are usually distressed by their memory loss and complain loudly about it. In true dementia, patients often have **anosognosia** (lack of insight) and minimize their deficits. 4. **Diurnal Variation:** Cognitive symptoms in pseudodementia may fluctuate with the severity of the depressive mood.

Q: Rett's syndrome is characterized by?

Regression of language and motor milestones. **Explanation:** **Rett’s Syndrome** is a unique neurodevelopmental disorder primarily affecting females (X-linked dominant inheritance, usually due to a mutation in the **MECP2 gene**). It is characterized by a period of normal early development (6–18 months) followed by a distinct **regression of milestones**, particularly in language and motor skills. * **Why Option A is correct:** The hallmark of Rett’s syndrome is the loss of previously acquired purposeful hand skills and spoken language. This is replaced by stereotypical, repetitive hand movements (e.g., **hand-wringing**, clapping, or washing motions) and gait abnormalities (ataxia). * **Why Option B is incorrect:** While some behavioral irritability exists, hyperactivity is not the defining feature. In fact, patients often develop social withdrawal and "autistic-like" features during the regression phase. * **Why Option C is incorrect:** Children with Rett’s syndrome often face growth failure, including low weight and height, as the disease progresses. * **Why Option D is incorrect:** Rett’s syndrome is classically associated with **acquired microcephaly** (deceleration of head growth), not macrocephaly. Macrocephaly is more commonly associated with certain types of Autism Spectrum Disorders or metabolic storage diseases. **High-Yield Clinical Pearls for NEET-PG:** * **Genetics:** Mutation in the **MECP2 gene** on the X chromosome. It is usually lethal in males. * **Key Sign:** **Hand-wringing stereotypes** are the most characteristic diagnostic clue. * **Respiratory Signs:** Episodes of hyperventilation followed by apnea (breath-holding spells) are common. * **Seizures:** Up to 80% of patients develop epilepsy. * **ICD/DSM Classification:** Previously classified under Pervasive Developmental Disorders (PDD), it is now recognized as a distinct genetic neurological entity.

Q: Which of the following psychiatric disorders is most commonly associated with stroke?

Schizophrenia. ### Explanation **Correct Option: B. Depression** *(Note: There appears to be a discrepancy in the provided key. In clinical psychiatry and standard medical literature, **Depression** is the most common psychiatric complication following a stroke, not Schizophrenia.)* **Why Depression is the Correct Answer:** Post-stroke depression (PSD) affects approximately **30-35%** of stroke survivors. The underlying medical concept involves both biological and psychosocial factors: 1. **Biological:** Ischemic damage to the prefrontal cortex, basal ganglia, and disruption of amine pathways (serotonin and norepinephrine) leads to mood dysregulation. 2. **Psychosocial:** The sudden loss of autonomy, physical disability, and cognitive impairment contribute to reactive depression. **Analysis of Incorrect Options:** * **A. Mania:** Post-stroke mania is rare and usually associated with lesions in the **right hemisphere** (specifically the orbitofrontal cortex or basotemporal cortex). * **C. Bipolar Disorder:** While mood swings occur, a full-blown bipolar diathesis is less common than unipolar depression post-stroke. * **D. Schizophrenia:** Psychotic symptoms are relatively rare after a stroke. While "Post-stroke Psychosis" exists (often linked to right parietal lesions), it does not reach the prevalence of depression. **NEET-PG High-Yield Pearls:** * **Most common psychiatric sequela of stroke:** Depression. * **Anatomical Correlation:** Left frontal lobe and left basal ganglia lesions are most strongly associated with the severity of post-stroke depression. * **Treatment:** SSRIs (like Sertraline or Escitalopram) are the first-line treatment and have been shown to improve both mood and functional recovery. * **Pseudobulbar Affect:** Another common post-stroke condition characterized by involuntary laughing or crying, often confused with depression.

Q: What is the primary treatment for acute manic episodes?

Electroconvulsive Therapy (ECT). **Explanation:** In the management of acute manic episodes, the choice of treatment depends on the severity and urgency of the clinical presentation. While pharmacotherapy is the standard first-line approach for most patients, **Electroconvulsive Therapy (ECT)** is considered the most effective and rapid treatment for severe acute mania, especially when it is life-threatening, associated with exhaustion, or resistant to medications. In the context of this specific question (where it is marked as the correct choice), ECT is prioritized for its rapid onset of action in stabilizing the patient. **Analysis of Options:** * **ECT (Correct):** It is indicated for "Delirious Mania," severe psychomotor agitation, or when rapid stabilization is required to prevent physical exhaustion or injury. It has a higher response rate than medications in refractory cases. * **Diazepam (Incorrect):** This is a benzodiazepine used only as an adjunct for sedation or to control acute agitation. It does not treat the underlying pathophysiology of mania. * **Sodium Valproate (Incorrect):** While Valproate is a first-line **mood stabilizer** for acute mania (particularly for mixed episodes or rapid cycling), it has a slower onset of action compared to ECT and may be contraindicated in certain patients (e.g., liver disease). **NEET-PG High-Yield Pearls:** * **First-line Drugs:** Lithium or Sodium Valproate + Atypical Antipsychotics (e.g., Haloperidol, Risperidone). * **Lithium:** Best for classic "euphoric" mania; requires 5–7 days for effect. Therapeutic range for acute mania: **0.8–1.2 mEq/L**. * **Drug of Choice for Rapid Cyclers:** Sodium Valproate. * **Pregnancy:** ECT is considered the safest and most effective treatment for severe mania during pregnancy to avoid the teratogenic effects of Lithium (Ebstein’s Anomaly) and Valproate (Neural Tube Defects).

Q: Which of the following medications is NOT used in the management of bipolar disorder?

Phenytoin. ### Explanation The management of Bipolar Disorder (BD) primarily involves **Mood Stabilizers**, which are drugs effective in treating mania, depression, or preventing relapses. While several anticonvulsants serve as excellent mood stabilizers, not all anti-epileptics possess psychotropic properties. **Why Phenytoin is the Correct Answer:** **Phenytoin** is a classic anti-epileptic drug used for tonic-clonic seizures. Unlike other anticonvulsants, it has **no proven efficacy** as a mood stabilizer in Bipolar Disorder. It does not possess the specific neuromodulatory effects (such as GABA enhancement or glutamate inhibition in the limbic system) required to stabilize mood fluctuations. **Analysis of Incorrect Options:** * **Carbamazepine (Option A):** An effective mood stabilizer, particularly useful in **Rapid Cycling Bipolar Disorder** and acute mania. It acts by blocking voltage-gated sodium channels. * **Sodium Valproate (Option C):** Often considered a first-line treatment for **Acute Mania** and mixed episodes. It works by increasing GABA levels and modulating intracellular signaling. * **Lamotrigine (Option D):** Specifically indicated for the **maintenance phase** of Bipolar Disorder to prevent **Bipolar Depression**. It is less effective for acute mania. --- ### High-Yield Clinical Pearls for NEET-PG: * **Gold Standard:** **Lithium** remains the gold standard for Bipolar Disorder, especially for suicidal ideation prophylaxis. * **Drug of Choice for Rapid Cycling:** Sodium Valproate or Carbamazepine. * **Bipolar Depression:** Quetiapine, Lurasidone, or Lamotrigine are preferred. * **Teratogenicity:** Avoid Valproate in pregnancy (Neural Tube Defects); Lithium is associated with **Ebstein’s Anomaly**. * **Lamotrigine Warning:** Always monitor for **Stevens-Johnson Syndrome (SJS)**; the dose must be titrated slowly.

Question 1

Which of the following drugs are used for recurrent depressive episodes?

Accepted Answer

Fluoxetine

Answer

Imipramine

Answer

Carbamazepine

Answer

Valproate

Question 2

Which of the following is seen in mania?

Accepted Answer

Over activity

Answer

Low activity

Answer

Normal activity

Answer

None of the above

Question 3

After 5 days of a normal vaginal delivery, a woman presents with crying, loss of appetite, difficulty sleeping, and low self-esteem. Her general physical and pelvic examinations are unremarkable. What is the most appropriate term to describe her symptoms postpartum?

Accepted Answer

Postpartum blues

Answer

Manic depression

Answer

Neurosis

Answer

Psychosis

Question 4

Reduction in central _____ plays a vital role in suicidal behavior.

Accepted Answer

Serotonin

Answer

Dopamine

Answer

Acetylcholine

Answer

Epinephrine

Question 5

The hypocretin system plays a critical role in which of the following disorders?

Accepted Answer

Narcolepsy

Answer

Insomnia

Answer

Depression

Answer

Obsessive-compulsive disorder

Question 6

Which of the following is true about pseudodementia?

Accepted Answer

Seen in patients with depression

Answer

A form of cortical dementia

Answer

A form of subcortical dementia

Answer

Dementia secondary to an organic condition

Question 7

Rett's syndrome is characterized by?

Accepted Answer

Regression of language and motor milestones

Answer

Hyperactive child

Answer

Normal weight

Answer

Macrocephaly

Question 8

Which of the following psychiatric disorders is most commonly associated with stroke?

Accepted Answer

Schizophrenia

Answer

Mania

Answer

Depression

Answer

Bipolar disorder

Question 9

What is the primary treatment for acute manic episodes?

Accepted Answer

Electroconvulsive Therapy (ECT)

Answer

Diazepam

Answer

Sodium valproate

Question 10

Which of the following medications is NOT used in the management of bipolar disorder?

Accepted Answer

Phenytoin

Answer

Carbamazepine

Answer

Sodium valproate

Answer

Lamotrigine

Mood Disorders — MCQs

Mood Disorders — MCQs

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