Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 261: Which of the following drugs are used for recurrent depressive episodes?

A. Imipramine
B. Carbamazepine
C. Fluoxetine (Correct Answer)
D. Valproate

Explanation: **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.

Question 262: Which of the following is seen in mania?

A. Low activity
B. Over activity (Correct Answer)
C. Normal activity
D. None of the above

Explanation: **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.

Question 263: 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?

A. Postpartum blues (Correct Answer)
B. Manic depression
C. Neurosis
D. Psychosis

Explanation: ### Explanation **Postpartum Blues (Baby Blues)** is the most common mood disturbance following childbirth, affecting up to 50–80% of women. It typically manifests within **3 to 5 days** after delivery. The clinical picture includes emotional lability, tearfulness (crying spells), irritability, insomnia, and mild anxiety. The key diagnostic feature is that symptoms are **mild, self-limiting**, and do not significantly impair the mother's ability to function or care for the infant. Since the patient’s physical exam is normal and the symptoms appeared on day 5, "Postpartum Blues" is the most accurate diagnosis. Management is supportive; it usually resolves within 10 days without pharmacological intervention. **Why other options are incorrect:** * **Manic Depression (Bipolar Disorder):** Characterized by alternating episodes of mania (euphoria, racing thoughts) and depression. The symptoms described here are too mild and specific to the immediate postpartum period to warrant this diagnosis. * **Neurosis:** An outdated term for a class of functional mental disorders involving chronic distress (like OCD or Phobias). It does not specifically describe the transient emotional state following delivery. * **Psychosis (Postpartum Psychosis):** This is a psychiatric emergency occurring in 0.1–0.2% of deliveries. It involves delusions, hallucinations, and thoughts of harming the baby. This patient lacks these severe symptoms. **NEET-PG High-Yield Pearls:** 1. **Timeline is Key:** * **Blues:** Onset 3–5 days; lasts <2 weeks. (Treatment: Reassurance). * **Depression:** Onset 2–4 weeks; lasts months. (Treatment: SSRIs/Therapy). * **Psychosis:** Onset within 2 weeks; (Treatment: Hospitalization/Antipsychotics). 2. **Postpartum Blues** is considered a "normal" physiological adjustment rather than a true psychiatric disorder. 3. The most significant risk factor for **Postpartum Psychosis** is a personal or family history of Bipolar Disorder.

Question 264: Reduction in central _____ plays a vital role in suicidal behavior.

A. Dopamine
B. Acetylcholine
C. Serotonin (Correct Answer)
D. Epinephrine

Explanation: **Explanation:** The neurobiology of suicidal behavior is most strongly linked to a deficit in the **Serotonergic system**. Research consistently shows that low levels of **5-HIAA** (5-Hydroxyindoleacetic acid), the primary metabolite of serotonin, in the cerebrospinal fluid (CSF) are a significant predictor of both completed suicide and impulsive, aggressive suicidal attempts. **Why Serotonin is Correct:** Serotonin (5-HT) is responsible for impulse control and mood regulation. A reduction in central serotonergic activity, particularly in the prefrontal cortex, leads to increased impulsivity and aggression, which are key components of suicidal behavior. This finding remains consistent across various psychiatric diagnoses, including depression and schizophrenia. **Analysis of Incorrect Options:** * **Dopamine:** While dopamine is central to the "reward system" and its deficiency is linked to anhedonia (inability to feel pleasure), it is not the primary neurotransmitter specifically implicated in the act of suicide itself. * **Acetylcholine:** Increased cholinergic activity is sometimes associated with depression (the cholinergic-aminergic imbalance hypothesis), but it does not have a direct, established correlation with suicidal behavior. * **Epinephrine:** Also known as adrenaline, it is primarily involved in the "fight or flight" stress response. While it plays a role in the physiological response to stress, it is not the neurochemical marker for suicide. **High-Yield Clinical Pearls for NEET-PG:** * **CSF 5-HIAA:** Low levels are the most consistent biochemical marker for **impulsive violence** and **suicide**. * **Post-mortem findings:** Studies of suicide victims often show decreased serotonin transporter binding in the prefrontal cortex. * **Antidepressants:** While SSRIs increase serotonin, patients must be monitored closely during the initial phase of treatment as an increase in energy (reversal of psychomotor retardation) may occur before the improvement in mood, potentially providing the energy to act on suicidal ideation.

Question 265: The hypocretin system plays a critical role in which of the following disorders?

A. Insomnia
B. Depression
C. Obsessive-compulsive disorder
D. Narcolepsy (Correct Answer)

Explanation: **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.

Question 266: Which of the following is true about pseudodementia?

A. A form of cortical dementia
B. Seen in patients with depression (Correct Answer)
C. A form of subcortical dementia
D. Dementia secondary to an organic condition

Explanation: **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.

Question 267: Rett's syndrome is characterized by?

A. Regression of language and motor milestones (Correct Answer)
B. Hyperactive child
C. Normal weight
D. Macrocephaly

Explanation: **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.

Question 268: Which of the following psychiatric disorders is most commonly associated with stroke?

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

Explanation: ### 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.

Question 269: What is the primary treatment for acute manic episodes?

A. Electroconvulsive Therapy (ECT)
B. Electroconvulsive Therapy (ECT) (Correct Answer)
C. Diazepam
D. Sodium valproate

Explanation: **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).

Question 270: Which of the following medications is NOT used in the management of bipolar disorder?

A. Carbamazepine
B. Phenytoin (Correct Answer)
C. Sodium valproate
D. Lamotrigine

Explanation: ### 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.

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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