Mood Disorders — MCQs

A 27-year-old woman has been feeling low for the past 2 weeks. She has little energy and has trouble concentrating. She states that 6 weeks ago she had been feeling very good, with lots of energy and no need for sleep. This pattern has been occurring for at least the past 3 years, although the episodes have never been severe enough to prevent her from working. What is the most likely diagnosis?

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 271: Rapid cycling is associated with which psychiatric illness?

A. Substance abuse disorder
B. Schizophrenia
C. Bipolar disorder (Correct Answer)
D. Panic disorder

Explanation: **Explanation:** **Rapid Cycling** is a specific course specifier defined in the DSM-5 for **Bipolar Disorder** (both Type I and Type II) [2]. It is characterized by the occurrence of **four or more distinct mood episodes** (mania, hypomania, or depression) within a single 12-month period [1]. These episodes must be demarcated by either a partial or full remission of at least two months or a switch to an episode of the opposite polarity. **Why Bipolar Disorder is correct:** Rapid cycling is an intrinsic subtype of Bipolar Disorder [3]. It is more common in women and is often associated with a longer duration of illness, greater morbidity, and a higher risk of suicide [1]. **Why other options are incorrect:** * **Substance Abuse Disorder:** While substances (like cocaine or amphetamines) can cause mood fluctuations, "rapid cycling" is a formal diagnostic term reserved for primary mood disorders. * **Schizophrenia:** This is primarily a psychotic disorder characterized by delusions, hallucinations, and disorganized thinking, rather than cyclical mood disturbances. * **Panic Disorder:** This is an anxiety disorder characterized by recurrent, unexpected panic attacks. While patients may have frequent attacks, it does not follow the episodic mood pattern of rapid cycling. **High-Yield Clinical Pearls for NEET-PG:** * **Triggers:** Rapid cycling can be precipitated or worsened by the use of **antidepressants** (especially TCAs) and **hypothyroidism** [1]. * **Treatment:** The drug of choice for rapid cycling is **Valproate** (Divalproex), as these patients often show a poor response to Lithium. * **Gender:** It is significantly more prevalent in **females** (approx. 70-90% of rapid cyclers) [1]. * **Ultra-rapid cycling:** Defined as mood switches occurring within days (not a formal DSM category but frequently asked).

Question 272: A young lady experiencing job loss reports loss of appetite and wakes up at 3 am. What is the most likely diagnosis?

A. Depression (Correct Answer)
B. Schizophrenia
C. Obsessive-Compulsive Disorder
D. Mania

Explanation: **Explanation:** The clinical presentation of this patient—triggered by a stressful life event (job loss) and characterized by **biological symptoms**—is a classic description of **Depression**. The two hallmark features mentioned are: 1. **Loss of appetite:** A common somatic symptom of a depressive episode. 2. **Early Morning Awakening (EMA):** The patient wakes up at 3 AM (terminal insomnia). In psychiatry, waking up at least 2 hours before the usual time is a highly specific "biological marker" for **Melancholic Depression**. **Why other options are incorrect:** * **Schizophrenia:** Characterized by "Schneiderian" first-rank symptoms like hallucinations, delusions, and disorganized thinking, rather than primary mood disturbances. * **Obsessive-Compulsive Disorder (OCD):** Involves intrusive, repetitive thoughts (obsessions) and ritualistic behaviors (compulsions) to neutralize anxiety. * **Mania:** The polar opposite of depression; it presents with decreased *need* for sleep (feeling energetic despite little sleep), pressured speech, and grandiosity. **High-Yield Clinical Pearls for NEET-PG:** * **ICD-11/DSM-5 Criteria:** Diagnosis of Depression requires symptoms for at least **2 weeks**. * **Sleep Disturbances:** While EMA is classic for Melancholic Depression, **Initial Insomnia** (difficulty falling asleep) is more common in Anxiety disorders. * **Diurnal Variation:** Depressive symptoms are often worse in the morning and improve slightly as the day progresses. * **First-line Treatment:** Selective Serotonin Reuptake Inhibitors (SSRIs) are the drug of choice.

Question 273: Which of the following diseases is seen exclusively in females?

A. Autism
B. Asperger's syndrome
C. Rett's disease (Correct Answer)
D. Collard's disease

Explanation: **Explanation:** The correct answer is **Rett’s disease (Rett Syndrome)**. **1. Why Rett’s Disease is Correct:** Rett syndrome is an X-linked dominant neurodevelopmental disorder caused by a mutation in the **MECP2 gene**. It is seen almost exclusively in females because the mutation is typically **lethal in hemizygous males** (males have only one X chromosome, so they lack a functional backup copy of the gene, leading to in-utero death or severe neonatal encephalopathy). Affected females survive due to X-inactivation (lyonization), which allows some cells to express a normal copy of the gene. **2. Why Other Options are Incorrect:** * **Autism & Asperger’s Syndrome:** Both are part of the Autism Spectrum Disorders (ASD). These conditions are significantly **more common in males** (ratio approx. 4:1), but they are certainly not exclusive to them. * **Collard’s Disease:** This is not a recognized psychiatric or neurodevelopmental entity in standard medical literature (likely a distractor). **3. High-Yield Clinical Pearls for NEET-PG:** * **Clinical Presentation:** Characterized by a period of normal development (6–18 months) followed by a **regression** of milestones. * **Pathognomonic Sign:** Loss of purposeful hand movements replaced by **stereotypical hand-wringing**, clapping, or washing movements. * **Other Features:** Deceleration of head growth (acquired microcephaly), seizures, ataxia, and loss of verbal communication. * **Genetics:** MECP2 gene mutation on the X chromosome.

Question 274: All symptoms are included in the diagnostic criteria of major depression, except?

A. Indecisiveness
B. Insomnia
C. Poor concentration
D. None of the above (Correct Answer)

Explanation: To diagnose **Major Depressive Disorder (MDD)** according to the DSM-5 criteria, a patient must experience at least five out of nine specific symptoms for a minimum of two weeks. At least one of the symptoms must be either depressed mood or loss of interest/pleasure (anhedonia). ### **Explanation of Options** The correct answer is **"None of the above"** because all three listed options are core diagnostic criteria for MDD: * **Indecisiveness & Poor Concentration (Options A & C):** These fall under the cognitive domain of depression. The DSM-5 specifically lists "diminished ability to think or concentrate, or indecisiveness, nearly every day" as a criterion. * **Insomnia (Option B):** Sleep disturbance is a hallmark vegetative symptom. While insomnia (difficulty falling or staying asleep) is more common, hypersomnia (excessive sleeping) also meets the criteria. ### **Clinical Pearls for NEET-PG** To remember the DSM-5 criteria for MDD, use the mnemonic **SIGECAPS**: * **S**leep (Insomnia or Hypersomnia) * **I**nterest (Anhedonia - loss of pleasure) * **G**uilt (Feelings of worthlessness or inappropriate guilt) * **E**nergy (Fatigue or loss of energy) * **C**oncentration (Diminished ability to think or **indecisiveness**) * **A**ppetite (Weight loss/gain or change in appetite) * **P**sychomotor (Agitation or retardation) * **S**uicidal ideation (Recurrent thoughts of death) **High-Yield Note:** For NEET-PG, remember that "Grief" is no longer an exclusion criterion for MDD in DSM-5. Additionally, the most common sleep abnormality in depression is **Early Morning Awakening** (terminal insomnia) and reduced REM latency on EEG.

Question 275: Which chromosome is associated with bipolar disease?

A. Chromosome 16
B. Chromosome 13
C. Chromosome 18 (Correct Answer)
D. Chromosome 11

Explanation: ### Explanation **Correct Option: C (Chromosome 18)** Bipolar Disorder (BD) is a highly heritable psychiatric condition with a complex polygenic inheritance pattern. Extensive linkage studies and genome-wide association studies (GWAS) have consistently identified **Chromosome 18** (specifically regions 18p and 18q) as a major susceptibility locus. It is considered one of the most replicated findings in the genetics of bipolar disorder, particularly linked to Bipolar I subtype. **Analysis of Incorrect Options:** * **Option A: Chromosome 16:** While some studies suggest a minor link to Chromosome 16 in general psychiatric vulnerability, it is not a primary or classic association for Bipolar Disorder. * **Option B: Chromosome 13:** Chromosome 13 (specifically 13q) is more strongly associated with **Schizophrenia** (linked to the *G72/DAOA* gene) rather than being the primary marker for Bipolar Disorder. * **Option D: Chromosome 11:** Chromosome 11 contains the gene for Tyrosine Hydroxylase and has been studied in relation to Bipolar Disorder, but the evidence for Chromosome 18 is statistically more robust and frequently tested in exams. **High-Yield Clinical Pearls for NEET-PG:** * **Other Associated Chromosomes:** Besides 18, Chromosomes **21q** and **22q** (DiGeorge syndrome region) are also frequently implicated in Bipolar Disorder. * **Genetics:** The risk of BD in a child with one affected parent is ~10-25%; if both parents are affected, the risk rises to ~50-75%. * **Monozygotic Twins:** The concordance rate for Bipolar Disorder in identical twins is high, ranging from **40% to 70%**. * **Key Gene:** The *ANK3* (Ankyrin G) and *CACNA1C* (Calcium channel) genes are modern high-yield genetic associations found in GWAS for Bipolar Disorder.

Question 276: In mood disorder, what defines a rapid cycler?

A. 4 or more episodes per year (Correct Answer)
B. Mania occurring during summer
C. Mania consistent throughout the lunar year
D. Depressive episodes occurring during winter

Explanation: ### Explanation **1. Why Option A is Correct:** In psychiatry, **Rapid Cycling** is a specifier used in Bipolar Disorder (I or II). According to DSM-5 and ICD criteria, it is defined by the occurrence of **4 or more mood episodes** (Manic, Hypomanic, or Depressive) within a single **12-month period**. These episodes must be demarcated by either a period of partial or full remission for at least 2 months or a switch to an episode of opposite polarity (e.g., Mania to Depression). **2. Why Other Options are Incorrect:** * **Options B and D:** These describe **Seasonal Affective Disorder (SAD)** or the "Seasonal Pattern" specifier. While mood changes linked to seasons (e.g., depression in winter, mania in summer) are common, they do not define the frequency required for "rapid cycling." * **Option C:** This is a distractor. While historical theories linked mood to lunar cycles (the origin of the word "lunacy"), there is no clinical definition of rapid cycling based on the lunar year in modern psychiatry. **3. Clinical Pearls for NEET-PG:** * **Demographics:** Rapid cycling is more common in **women** (approx. 70-90% of cases). * **Risk Factors:** It is frequently associated with **hypothyroidism**, substance abuse, and the long-term use of **antidepressants** (which can trigger "cycling"). * **Treatment:** The drug of choice for rapid cycling is **Valproate** (Sodium Valproate/Divalproex), as these patients often show a poor response to Lithium. * **Ultra-rapid cycling:** Defined as episodes occurring within weeks or days. * **Ultradian cycling:** Defined as mood shifts occurring within a single day (less than 24 hours).

Question 277: A patient is more talkative than usual and used to speak loudly. While talking, he rapidly shifts from topic to topic and keeps himself busy in chatting or messaging friends. What is the likely diagnosis in such a case?

A. Mania (Correct Answer)
B. Attention Deficit Hyperactivity Disorder
C. Depression
D. Obsessive Compulsive Disorder

Explanation: ### Explanation The clinical presentation described is a classic manifestation of a **Manic Episode**, a key component of Bipolar Disorder. **1. Why Mania is Correct:** The patient exhibits the "triad" of mania: **elevated/irritable mood, increased psychomotor activity, and flight of ideas.** * **Pressure of Speech:** Being "more talkative than usual" and speaking loudly indicates increased rate and volume of speech. * **Flight of Ideas:** Rapidly shifting from topic to topic suggests a flow of thought that is accelerated, where ideas follow each other rapidly. * **Increased Social/Goal-Directed Activity:** Keeping busy with constant messaging and chatting reflects the increased energy and decreased need for social inhibition characteristic of mania. **2. Why Other Options are Incorrect:** * **ADHD:** While it involves hyperactivity and distractibility, it is a neurodevelopmental disorder typically starting in childhood. The rapid "shifting of topics" in speech (flight of ideas) is more specific to the thought disorder seen in mania. * **Depression:** This is the polar opposite of the described symptoms. Depression presents with psychomotor retardation, poverty of speech, and low energy. * **Obsessive-Compulsive Disorder (OCD):** OCD is characterized by intrusive thoughts (obsessions) and repetitive behaviors (compulsions). It does not typically involve pressured speech or flight of ideas. **3. High-Yield Clinical Pearls for NEET-PG:** * **DIGFAST Mnemonic for Mania:** **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). * **Duration Criteria:** For a diagnosis of Mania (ICD-10/DSM-5), symptoms must last at least **one week** and cause significant functional impairment. If symptoms last 4 days without significant impairment or psychosis, it is **Hypomania**. * **Drug of Choice:** Lithium is the gold standard for long-term prophylaxis; Atypical Antipsychotics (e.g., Haloperidol, Risperidone) are used for acute management.

Question 278: Which of the following is a treatment for Bipolar disorder?

A. Anti-depressant drugs
B. Lithium carbonate
C. Electroconvulsive therapy (ECT)
D. All of the above (Correct Answer)

Explanation: **Explanation:** Bipolar disorder is a chronic mood disorder characterized by episodes of mania, hypomania, and depression. Its management requires a multi-modal approach depending on the current polarity of the episode (manic vs. depressive) and the phase of treatment (acute vs. maintenance). * **Lithium Carbonate (Option B):** This is the **gold standard** mood stabilizer. It is effective in treating acute mania, preventing future manic/depressive relapses, and is uniquely known for its **anti-suicidal properties**. * **Anti-depressant drugs (Option A):** These are used during the **depressive phase** of bipolar disorder. However, they are typically prescribed in conjunction with a mood stabilizer to prevent "manic switching" (triggering a shift from depression to mania). * **Electroconvulsive Therapy (Option C):** ECT is a highly effective intervention for bipolar disorder, particularly in cases of **treatment-resistant mania**, severe bipolar depression with suicidal ideation, or **catatonia**. Since all three modalities are utilized in different clinical scenarios of the illness, **Option D** is the correct answer. **High-Yield Clinical Pearls for NEET-PG:** 1. **Lithium Toxicity:** Occurs at serum levels >1.5 mEq/L. Early signs include coarse tremors, vomiting, and diarrhea. 2. **Drug of Choice (DOC):** Lithium is the DOC for classic mania; **Valproate** is preferred for rapid cycling or mixed episodes. 3. **Teratogenicity:** Lithium is associated with **Ebstein’s Anomaly** (tricuspid valve malformation) if taken during pregnancy. 4. **Lurasidone and Quetiapine:** These are preferred atypical antipsychotics for treating **Bipolar Depression**.

Question 279: Tricyclic antidepressants are contraindicated in:

A. Glaucoma (Correct Answer)
B. Brain tumor
C. Bronchial asthma
D. Hypertension

Explanation: **Explanation:** Tricyclic Antidepressants (TCAs), such as Amitriptyline and Imipramine, possess potent **anticholinergic (antimuscarinic) properties**. These drugs block M1 receptors, leading to pupillary dilation (mydriasis) and cycloplegia. In patients with narrow-angle glaucoma, mydriasis can further obstruct the drainage of aqueous humor through the canal of Schlemm, acutely increasing intraocular pressure and potentially precipitating an attack of **acute angle-closure glaucoma**. Therefore, they are strictly contraindicated in such patients. **Analysis of Incorrect Options:** * **B. Brain Tumor:** While TCAs lower the seizure threshold (caution in epilepsy), they are not specifically contraindicated in brain tumors unless the tumor is causing uncontrolled seizures or specific neurological complications where anticholinergic effects interfere with monitoring. * **C. Bronchial Asthma:** TCAs do not cause bronchoconstriction. In fact, their anticholinergic effect might theoretically cause slight bronchodilation, though they are not used for this purpose. * **D. Hypertension:** TCAs are more commonly associated with **orthostatic hypotension** (due to alpha-1 blockade). While they can occasionally cause tachycardia or interact with antihypertensives, hypertension is not a primary contraindication. **High-Yield NEET-PG Pearls:** * **Cardiac Toxicity:** TCAs are cardiotoxic in overdose, causing **prolongation of the QRS complex** and QTc interval. Sodium bicarbonate is the antidote for TCA-induced arrhythmias. * **Side Effect Profile:** Remember the "3 Cs" of TCA toxicity: **C**oma, **C**onvulsions, and **C**ardiotoxicity. * **Other Contraindications:** Recent Myocardial Infarction (MI), heart block, and prostatic hypertrophy (due to urinary retention).

Question 280: A 27-year-old woman has been feeling low for the past 2 weeks. She has little energy and has trouble concentrating. She states that 6 weeks ago she had been feeling very good, with lots of energy and no need for sleep. This pattern has been occurring for at least the past 3 years, although the episodes have never been severe enough to prevent her from working. What is the most likely diagnosis?

A. Borderline personality disorder
B. Seasonal affective disorder
C. Cyclothymic disorder (Correct Answer)
D. Major depression, recurrent

Explanation: ### Explanation The correct diagnosis is **Cyclothymic Disorder**. **1. Why Cyclothymic Disorder is correct:** The patient presents with a chronic pattern (at least **2 years** in adults) of fluctuating moods. These include periods of **hypomanic symptoms** (high energy, decreased need for sleep) and periods of **depressive symptoms** (low mood, low energy). Crucially, the symptoms have never met the full diagnostic criteria for a Major Depressive Episode or a Manic Episode, and they are not severe enough to cause significant social or occupational impairment (she continues to work). **2. Why the other options are incorrect:** * **Borderline Personality Disorder:** While characterized by mood instability, it is primarily defined by unstable relationships, self-image issues, impulsivity, and a chronic fear of abandonment, which are not described here. * **Seasonal Affective Disorder:** This is a subtype of Major Depression or Bipolar disorder where episodes occur at specific times of the year (usually winter). The history here describes a 3-year pattern not linked to seasons. * **Major Depression, Recurrent:** This requires episodes of severe depression lasting at least 2 weeks. It does not account for the periods of high energy and decreased need for sleep (hypomanic symptoms) described in the vignette. **3. NEET-PG Clinical Pearls:** * **Duration Criteria:** For Cyclothymia, symptoms must be present for at least **2 years** (1 year in children/adolescents), with symptoms present at least half the time and never absent for more than 2 months. * **The "Milder" Spectrum:** Think of Cyclothymia as a chronic, lower-intensity version of Bipolar II disorder. * **Treatment:** Mood stabilizers (e.g., Lithium or Valproate) are the first-line treatment; antidepressants should be used cautiously as they may trigger "switching" into hypomania.

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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