Mood Disorders Practice Questions

Q: Delusion of nihilism and early morning insomnia are characteristic features of which psychiatric condition?

Major depression. **Explanation:** The correct answer is **Major Depression**, specifically depression with **melancholic or psychotic features**. 1. **Why Major Depression is correct:** * **Delusion of Nihilism (Cotard’s Syndrome):** This is a specific type of delusion where the patient believes they are dead, non-existent, or that their internal organs/the world have ceased to exist. It is a hallmark of severe psychotic depression. * **Early Morning Insomnia (Terminal Insomnia):** This refers to waking up at least 2 hours before the scheduled time and being unable to fall back asleep. It is a "biological marker" for endogenous or melancholic depression, reflecting a disturbance in the circadian rhythm. 2. **Why other options are incorrect:** * **Mania:** Characterized by a *decreased need for sleep* (feeling refreshed after only 3 hours) rather than insomnia, and delusions are typically **grandiose** (inflated self-worth) rather than nihilistic. * **Personality Disorder:** These are enduring patterns of behavior/inner experience. While they can co-occur with depression, nihilistic delusions and specific sleep architecture changes are symptoms of Axis I clinical disorders, not personality traits. * **Schizophrenia:** While delusions are common (usually persecutory or bizarre), early morning awakening is not a diagnostic feature. Nihilism is specifically tied to the profound "low mood" of depression. **Clinical Pearls for NEET-PG:** * **Beck’s Cognitive Triad:** Hopelessness, Helplessness, and Worthlessness (common in depression). * **Sleep Changes in Depression:** Decreased REM latency (REM sleep starts sooner), increased REM density, and decreased slow-wave (Stage 3 & 4) sleep. * **Cotard’s Syndrome:** Often associated with atrophy in the nondominant cerebral hemisphere or severe depressive states.

Q: Which type of delusion is typically mood-congruent in depression?

Delusion of nihilism. **Explanation:** In psychiatry, delusions in mood disorders are categorized as **mood-congruent** (consistent with the patient's emotional state) or **mood-incongruent**. **1. Why Delusion of Nihilism is correct:** In severe depression (Melancholic or Psychotic depression), the patient’s mood is characterized by extreme hopelessness, guilt, and despair. **Nihilistic delusions** (also known as **Cotard delusion**) involve the belief that oneself, a body part, or the world has ceased to exist or is "dead." This profound sense of loss and non-existence perfectly mirrors the "empty" and "low" emotional state of depression, making it a classic mood-congruent feature. **2. Analysis of Incorrect Options:** * **A. Delusion of Grandeur:** This is a belief in one's own inflated importance, power, or identity. It is **mood-congruent to Mania**, not depression. * **C. Delusional Parasitosis (Ekbom Syndrome):** This is a monosymptomatic hypochondriacal psychosis where patients believe they are infested with insects. It is generally considered mood-neutral. * **D. Delusion of Reference:** The belief that neutral environmental cues (e.g., a news anchor’s comments) are directed specifically at the patient. While it can occur in depression, it is more characteristic of Schizophrenia and is considered **mood-incongruent** in the context of a primary mood disorder. **Clinical Pearls for NEET-PG:** * **Cotard Syndrome:** Often associated with the "Walking Corpse" syndrome; it is a severe form of nihilistic delusion seen in elderly depressed patients. * **Mood-Congruent Delusions in Depression:** Include delusions of guilt, poverty, nihilism, and somatic ruin. * **Prognostic Significance:** The presence of mood-incongruent delusions in a mood disorder usually indicates a poorer prognosis and a higher risk of transitioning to Schizoaffective disorder.

Q: A patient with major depressive disorder is brought in by her mother, complaining that the patient attempted suicide by hanging. She has a history of multiple suicide attempts and frequently talks about death. Electroconvulsive therapy (ECT) is suggested. Which of the following is an absolute contraindication to ECT?

No absolute contraindication. **Explanation:** The correct answer is **D. No absolute contraindication.** In modern psychiatry, **Electroconvulsive Therapy (ECT)** is considered one of the safest procedures performed under general anesthesia. While several conditions significantly increase the risk of complications, current medical consensus (including guidelines from the APA) maintains that there are **no absolute medical contraindications** to ECT. If the psychiatric condition (e.g., severe suicidal intent or catatonia) is life-threatening, ECT can be performed even in high-risk patients, provided they are stabilized and monitored by a multidisciplinary team. **Analysis of Incorrect Options:** * **A. Brain tumor:** Previously considered an absolute contraindication due to the risk of increased intracranial pressure (ICP) and herniation. It is now a **relative contraindication**; with the use of steroids and antihypertensives, ECT can be safely administered. * **B. Myocardial disease:** Recent myocardial infarction (within 3 months) is a major **relative contraindication** due to the transient tachycardia and hypertension during the seizure. However, it is not absolute if the cardiac status is optimized. * **C. Aortic aneurysm:** This is a **relative contraindication** because the surge in blood pressure during the convulsion could lead to rupture. It is managed with beta-blockers and careful pressure control. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves within 6 months). * **Most common cause of death:** Cardiovascular complications (arrhythmias/MI). * **Drug of choice for anesthesia:** Methohexital (Gold standard); Thiopentone is also used. * **Muscle relaxant of choice:** Succinylcholine. * **Indications:** Severe depression with suicidal risk (fastest response), Catatonia, and Treatment-resistant Schizophrenia.

Q: Which drug is primarily used to decrease suicidal tendencies in manic bipolar disorder?

Lithium. **Explanation:** **Lithium** is the gold standard treatment for Bipolar Disorder and is uniquely recognized for its **anti-suicidal properties**. While many medications treat the symptoms of mania or depression, Lithium is one of the few drugs in psychiatry (along with Clozapine) proven to significantly reduce the risk of completed suicide and suicidal attempts. It achieves this independently of its mood-stabilizing effect, likely by reducing impulsivity and aggression. **Analysis of Incorrect Options:** * **Fluoxetine (A):** An SSRI used for depression. In Bipolar Disorder, antidepressants can actually worsen the condition by inducing "mood switching" into mania and may potentially increase suicidal ideation in younger patients. * **Carbamazepine (C):** An anticonvulsant used as a second-line mood stabilizer. While effective for rapid cycling or acute mania, it does not possess the specific evidence-based anti-suicidal benefits that Lithium offers. * **Risperidone (D):** An atypical antipsychotic used to control acute psychotic symptoms in mania. While it stabilizes the acute phase, it is not the primary drug indicated for long-term suicide prevention. **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Index:** Lithium has a narrow therapeutic index. Target serum levels are **0.8–1.2 mEq/L** for acute mania and **0.6–0.8 mEq/L** for maintenance. * **Monitoring:** Before starting Lithium, always check **Thyroid Function Tests (TFT)** and **Renal Function Tests (RFT)**, as it can cause hypothyroidism and nephrogenic diabetes insipidus. * **Teratogenicity:** Use in pregnancy is associated with **Ebstein’s Anomaly** (tricuspid valve malformation). * **Drug of Choice:** Lithium remains the first-line treatment for classic "euphoric" mania.

Q: What is the treatment for depression with suicidal tendencies?

ECT. **Explanation:** **1. Why ECT is the Correct Answer:** Electroconvulsive Therapy (ECT) is the gold-standard treatment for severe depression with **active suicidal ideation**. While antidepressants take 2–4 weeks to show clinical effects, ECT provides a **rapid therapeutic response**, making it life-saving in emergency psychiatric situations. It is the treatment of choice when a quick reduction in suicidal risk or depressive stupor is required. **2. Analysis of Incorrect Options:** * **Clozapine (A):** This is an atypical antipsychotic used for treatment-resistant schizophrenia. While it is the only drug FDA-approved specifically to reduce suicidal behavior in **schizophrenia**, it is not the primary treatment for suicidal depression. * **Mirtazapine (B):** An antidepressant (NaSSA) often used for depression with insomnia or weight loss. However, like all oral antidepressants, its onset of action is too slow for an acute suicidal crisis. * **Olanzapine (D):** An atypical antipsychotic used in bipolar disorder or as an adjunct in depression, but it does not have a primary role in the acute management of suicidal tendencies. **3. High-Yield Clinical Pearls for NEET-PG:** * **Indications for ECT:** Severe depression with suicide risk (Top priority), Catatonia, Depressive Stupor, and Treatment-resistant Depression. * **Most common side effect of ECT:** Retrograde amnesia (usually transient). * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Lithium:** Along with Clozapine, Lithium is one of the few pharmacological agents proven to reduce the long-term risk of suicide (specifically in Bipolar Disorder).

Q: Suicide is most common in which of the following conditions?

Depression. **Explanation:** **1. Why Depression is Correct:** Depression (Major Depressive Disorder) is the psychiatric condition most strongly associated with completed suicide. Statistically, approximately **15% of patients** with severe depression eventually die by suicide. The core symptoms of hopelessness, worthlessness, and psychomotor retardation (or agitation) create a high-risk profile. Hopelessness, in particular, is considered the strongest psychological predictor of suicidal intent. **2. Analysis of Incorrect Options:** * **Alcohol Dependence:** While substance abuse significantly increases impulsivity and is the second most common psychiatric diagnosis associated with suicide, the lifetime risk (approx. 7%) is lower than that of primary mood disorders. * **Dementia:** Patients with dementia may experience depression or confusion, but they have a lower overall rate of completed suicide compared to functional psychiatric disorders, often due to cognitive and physical limitations. * **Schizophrenia:** There is a significant risk in schizophrenia (approx. 5-10% lifetime risk), particularly in young patients with high premorbid functioning who have "insight" into their deteriorating condition (post-psychotic depression). However, it remains statistically lower than Major Depression. **3. High-Yield Clinical Pearls for NEET-PG:** * **Single most important risk factor:** A previous history of suicide attempts. * **Strongest predictor of suicide:** Hopelessness (Beck’s Hopelessness Scale). * **Demographics:** Men "commit" suicide more often (higher lethality), while women "attempt" suicide more frequently. * **Protective Factor:** Pregnancy and strong social/family support are significant protective factors. * **Bipolar Disorder:** The risk of suicide is actually higher during the **depressive phase** or **mixed episodes** than in pure mania.

Question 1

Delusion of nihilism and early morning insomnia are characteristic features of which psychiatric condition?

Accepted Answer

Major depression

Answer

Mania

Answer

Personality disorder

Answer

Schizophrenia

Question 2

Which type of delusion is typically mood-congruent in depression?

Accepted Answer

Delusion of nihilism

Answer

Delusion of grandeur

Answer

Delusional parasitosis

Answer

Delusion of reference

Question 3

Which of the following neurotransmitters is most consistently associated with an increased risk of suicide?

Accepted Answer

Serotonin

Answer

Noradrenaline

Answer

GABA

Answer

Dopamine

Question 4

A patient with major depressive disorder is brought in by her mother, complaining that the patient attempted suicide by hanging. She has a history of multiple suicide attempts and frequently talks about death. Electroconvulsive therapy (ECT) is suggested. Which of the following is an absolute contraindication to ECT?

Accepted Answer

No absolute contraindication

Answer

Brain tumor

Answer

Myocardial disease

Answer

Aortic aneurysm

Question 5

Which of the following is NOT a risk factor for suicide in patients with depression?

Accepted Answer

Female gender

Answer

Male gender over 45 years of age

Answer

Childhood conduct disorder

Answer

Family history of suicide

Question 6

Which drug is primarily used to decrease suicidal tendencies in manic bipolar disorder?

Accepted Answer

Lithium

Answer

Fluoxetine

Answer

Carbamazepine

Answer

Risperidone

Question 7

What is the treatment for depression with suicidal tendencies?

Accepted Answer

ECT

Answer

Clozapine

Answer

Mirtazapine

Answer

Olanzapine

Question 8

Neurotic depression may be characterized by all of the following except?

Accepted Answer

Ravenous appetite

Answer

Hypersomnia

Answer

Increased libido

Answer

Weight gain

Question 9

In developing countries, which of the following features is most prominently shown by patients with depression?

Accepted Answer

Vague body aches

Answer

Low mood

Answer

Sleep disturbance

Answer

Suicidal tendency

Question 10

Suicide is most common in which of the following conditions?

Accepted Answer

Depression

Answer

Alcohol dependence

Answer

Dementia

Answer

Schizophrenia

Mood Disorders — MCQs

Mood Disorders — MCQs

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