Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 21: Electroconvulsive therapy (ECT) is most useful in which of the following conditions?

A. Panic attack
B. Major depression (Correct Answer)
C. Schizophrenia
D. Manic depressive psychosis

Explanation: **Explanation:** **Electroconvulsive Therapy (ECT)** is a biological treatment involving the induction of a generalized seizure through the application of electrical current to the brain. **Why Major Depression is correct:** While ECT is used for various severe psychiatric conditions, **Major Depressive Disorder (MDD)** is the most common and primary indication. It is specifically indicated for severe depression with psychotic features, high suicidal risk, or treatment-resistant depression. It remains the most effective treatment for rapid symptom relief in severe depression, often showing a faster response than pharmacotherapy. **Analysis of Incorrect Options:** * **A. Panic Attack:** ECT has no role in the management of anxiety disorders or acute panic attacks. These are primarily managed with SSRIs and Benzodiazepines. * **C. Schizophrenia:** While ECT is used in schizophrenia (specifically catatonic or treatment-resistant types), it is a second-line treatment. Antipsychotics remain the mainstay of therapy. * **D. Manic Depressive Psychosis (Bipolar Disorder):** ECT is effective for both severe mania and bipolar depression; however, it is generally reserved for cases resistant to mood stabilizers (Lithium/Valproate). "Major Depression" is considered the classic, most frequent indication in exam scenarios. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** Increased intracranial pressure (ICP) is the only absolute contraindication. * **Most Common Side Effect:** Retrograde amnesia (usually resolves) and post-ictal confusion. * **Mortality Rate:** Approximately 0.01%, similar to that of general anesthesia. * **Mechanism:** It is believed to increase the sensitivity of postsynaptic receptors and alter neurotransmitter levels (Serotonin, Dopamine, NE). * **Modified ECT:** In modern practice, ECT is always "modified" using a muscle relaxant (Succinylcholine) and general anesthesia (Thiopentone/Propofol) to prevent fractures.

Question 22: Rapid cycling Bipolar disorder is characterized by?

A. More than 4 episodes per year (Correct Answer)
B. More common in males
C. High thyroxine levels
D. Bipolar 1 pattern of illness

Explanation: **Explanation:** **Rapid Cycling Bipolar Disorder** is a specifier used to describe a particularly severe course of Bipolar Disorder. 1. **Why Option A is Correct:** According to DSM-5 and ICD-10 criteria, rapid cycling is defined by the occurrence of **at least 4 or more mood episodes** (Manic, Hypomanic, or Depressive) within a single **12-month period**. These episodes must be demarcated by either a partial/full remission of at least 2 months or a switch to an episode of opposite polarity. 2. **Why Other Options are Incorrect:** * **Option B:** Unlike Bipolar Disorder in general (which has an equal sex distribution), rapid cycling is significantly **more common in females** (approx. 70-90% of cases). * **Option C:** Rapid cycling is frequently associated with **Hypothyroidism** (low thyroxine levels), not high levels. Lithium treatment can also induce hypothyroidism, potentially worsening the cycling. * **Option D:** Rapid cycling can occur in both Bipolar I and Bipolar II patterns; however, it is clinically more frequently associated with **Bipolar II** (hypomania and depression). **High-Yield Clinical Pearls for NEET-PG:** * **Triggers:** The most common triggers for rapid cycling are the use of **Antidepressants** (TCAs/SSRIs) and **Hypothyroidism**. * **Treatment:** The drug of choice for rapid cycling is **Valproate** (it is more effective than Lithium in this specific subtype). * **Prognosis:** It is associated with a poorer prognosis, higher suicide risk, and greater functional impairment compared to non-rapid cycling variants.

Question 23: Which of the following is true about psychotic features in depression?

A. Found in severe depression (Correct Answer)
B. Found in moderate depression
C. Mood incongruent psychotic feature
D. Cyclothymia

Explanation: Psychotic features in Major Depressive Disorder (MDD) are a hallmark of **Severe Depressive Episodes**. According to ICD and DSM criteria, psychosis does not occur in mild or moderate depression; its presence automatically upgrades the diagnosis to "Severe Depression with Psychotic Features." ### **Explanation of Options:** * **A (Correct):** Psychotic symptoms (delusions and hallucinations) occur only when the severity of the depressive episode is high. These patients often require hospitalization and a combination of antidepressants and antipsychotics or Electroconvulsive Therapy (ECT). * **B (Incorrect):** Moderate depression is characterized by a significant number of symptoms and functional impairment, but it lacks the loss of reality testing required for a diagnosis of psychosis. * **C (Incorrect):** While psychotic features in depression can be mood-incongruent, they are **typically mood-congruent** (e.g., delusions of guilt, poverty, or nihilism/Cotard syndrome). Mood-congruence is more characteristic of depression than incongruence. * **D (Incorrect):** Cyclothymia is a chronic, mild mood disorder involving hypomanic and depressive symptoms that do not meet the full criteria for a major episode. By definition, it does not include psychotic features. ### **High-Yield Clinical Pearls for NEET-PG:** * **Cotard Syndrome:** A specific nihilistic delusion found in severe depression where the patient believes they are dead, rotting, or do not exist. * **Treatment of Choice:** The combination of an **Antidepressant + Antipsychotic** is superior to either alone. * **ECT:** Severe depression with psychotic features or suicidal ideation is a prime indication for **Electroconvulsive Therapy**, often showing a faster response than pharmacotherapy. * **Prognosis:** The presence of psychosis in depression generally indicates a poorer prognosis and a higher risk of recurrence.

Question 24: Major depression is defined as depressed mood on a daily basis for a minimum duration of how long?

A. 2 weeks (Correct Answer)
B. 4 weeks
C. 6 weeks
D. 8 weeks

Explanation: **Explanation:** The diagnosis of **Major Depressive Disorder (MDD)** is based on standardized clinical criteria outlined in the **DSM-5** and **ICD-11**. According to these guidelines, a patient must experience a depressed mood or loss of interest/pleasure (anhedonia) for a minimum duration of **2 weeks** to meet the threshold for a major depressive episode. **Why Option A is correct:** The "2-week" rule is the diagnostic cornerstone for MDD. This duration is used to differentiate a clinical mood disorder from transient "blues" or normal fluctuations in mood. Along with the duration, the patient must exhibit at least 5 out of 9 symptoms (the **SIGECAPS** mnemonic) nearly every day, causing significant functional impairment. **Why other options are incorrect:** * **4 weeks (Option B):** While symptoms often last much longer than a month, waiting four weeks to diagnose would unnecessarily delay treatment for a high-risk condition. * **6 to 8 weeks (Options C & D):** These durations are more relevant to assessing **treatment response**. For instance, an antidepressant trial is typically evaluated for efficacy after 6–8 weeks of therapy. **High-Yield Clinical Pearls for NEET-PG:** * **SIGECAPS Mnemonic:** **S**leep (insomnia/hypersomnia), **I**nterest (anhedonia), **G**uilt, **E**nergy (fatigue), **C**oncentration, **A**ppetite (weight change), **P**sychomotor (agitation/retardation), **S**uicidal ideation. * **Dysthymia (Persistent Depressive Disorder):** Requires a depressed mood for at least **2 years** (1 year in children/adolescents). * **Post-stroke Depression:** The most common psychiatric complication following a stroke; also requires the 2-week criteria. * **Bereavement:** In DSM-5, the "bereavement exclusion" was removed; depression following the loss of a loved one can be diagnosed if it meets the 2-week criteria.

Question 25: Which statement regarding Electroconvulsive Therapy (ECT) for depression is true?

A. Depression with suicidal tendencies requires ECT. (Correct Answer)
B. Chronic depression requires ECT.
C. Reactive depression responds better to ECT.
D. ECT is the treatment of choice for atypical depression.

Explanation: **Explanation:** The correct answer is **A: Depression with suicidal tendencies requires ECT.** Electroconvulsive Therapy (ECT) is the most effective and rapid treatment for severe depression. In clinical practice, the primary indications for ECT are situations where a rapid response is life-saving. **Severe suicidality** is a top-priority indication because antidepressant medications typically take 2–4 weeks to show effect, whereas ECT can significantly reduce suicidal ideation within a few sessions. Other urgent indications include depressive stupor, catatonia, and severe food refusal. **Analysis of Incorrect Options:** * **B. Chronic depression:** Chronic depression (or Dysthymia/Persistent Depressive Disorder) is generally managed with long-term psychotherapy and pharmacotherapy. ECT is reserved for "Treatment-Resistant Depression" (failure of two or more adequate trials of antidepressants), not simply because the duration is long. * **C. Reactive depression:** This refers to depression triggered by external stressors (Adjustment Disorder). These patients usually respond better to psychotherapy and environmental modification rather than biological interventions like ECT. Endogenous (biological) depression responds better to ECT. * **D. Atypical depression:** The treatment of choice for atypical depression (characterized by mood reactivity, hyperphagia, and hypersomnia) is **SSRIs** (historically MAOIs). ECT is less effective for atypical features compared to melancholic features. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most important relative contraindication. * **Most Common Side Effect:** Retrograde and anterograde amnesia (transient). * **Mechanism:** It is believed to work by increasing the seizure threshold and modulating neurotransmitter receptors (upregulation of serotonin/downregulation of beta-receptors). * **Gold Standard:** ECT remains the most effective treatment for **Psychotic Depression**.

Question 26: Which of the following are indications for Electroconvulsive Therapy (ECT)?

A. Psychotic depression
B. Catatonic schizophrenia (Correct Answer)
C. Cyclothymia
D. Dysthymia

Explanation: ### Explanation Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry, primarily indicated for conditions requiring a rapid clinical response or where pharmacological interventions have failed. **Why Catatonic Schizophrenia is Correct:** Catatonia is a medical emergency characterized by motor immobility, mutism, or extreme agitation. **Catatonic schizophrenia** is a first-line indication for ECT because it offers a rapid resolution of life-threatening symptoms (such as refusal to eat/drink or exhaustion). ECT is also indicated in severe Major Depressive Disorder (MDD) with suicidal intent, treatment-resistant mania, and neuroleptic malignant syndrome. **Analysis of Incorrect Options:** * **Psychotic Depression:** While ECT is an effective treatment for psychotic depression, it is generally considered a second-line option after a trial of antidepressants combined with antipsychotics, unless there is an immediate risk of suicide or severe malnutrition. In the context of this specific question, catatonia represents a more urgent, classic indication. * **Cyclothymia:** This is a chronic, milder form of bipolar disorder characterized by hypomanic and depressive symptoms that do not meet full criteria for MDD or Mania. It is managed with mood stabilizers and psychotherapy, not ECT. * **Dysthymia (Persistent Depressive Disorder):** This is a low-grade, chronic depression. ECT is reserved for severe, acute episodes; it is not indicated for mild, chronic depressive symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** There are **no absolute contraindications** for ECT, but increased intracranial pressure (ICP) is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde amnesia (usually resolves) and post-ictal confusion. * **Pre-ECT Medications:** Atropine (to decrease secretions/vagal bradycardia), Methohexital/Propofol (anesthetic), and Succinylcholine (muscle relaxant to prevent fractures). * **Gold Standard:** ECT remains the most effective treatment for **treatment-resistant depression.**

Question 27: A persistent feeling of guilt is characteristic of which of the following conditions?

A. Obsessive-compulsive disorder (OCD)
B. Depression (Correct Answer)
C. Mania
D. Schizophrenia

Explanation: **Explanation:** **1. Why Depression is Correct:** Persistent and pervasive feelings of **guilt** are a core symptom of **Major Depressive Disorder (MDD)**. According to the ICD-10 and DSM-5 criteria, "excessive or inappropriate guilt" (which may be delusional) is one of the psychological symptoms of depression. This guilt often manifests as self-reproach or ruminating over minor past failings. It is a key component of **Beck’s Cognitive Triad**, which includes negative views about the self, the world, and the future. **2. Why Other Options are Incorrect:** * **Mania:** Characterized by an abnormally elevated, expansive, or irritable mood. Instead of guilt, patients typically exhibit **inflated self-esteem or grandiosity**. * **Obsessive-Compulsive Disorder (OCD):** While patients may feel distress or anxiety regarding their obsessions, the hallmark is repetitive, intrusive thoughts and ritualistic behaviors, not a primary persistent mood of guilt. * **Schizophrenia:** Primarily a thought disorder characterized by delusions, hallucinations, and disorganized speech. While "guilt" can be a theme in a delusion, it is not a defining characteristic of the illness itself. **Clinical Pearls for NEET-PG:** * **Beck’s Cognitive Triad:** Negative thoughts about Self, World, and Future (High-yield for Depression). * **Depressive Delusions:** In severe depression, guilt can reach delusional proportions (e.g., believing one is responsible for a world disaster). * **Nihilistic Delusions (Cotard Syndrome):** Belief that one is dead or parts of the body do not exist; often seen in severe psychotic depression. * **Biological Markers:** Look for "Early morning awakening" and "Diurnal variation of mood" (worse in the morning) as classic somatic signs of depression.

Question 28: A 40-year-old female presented with agitated depression, attempted suicide, and feelings of guilt. What is the first-line treatment?

A. Pentotal interview to resolve guilt (Correct Answer)
B. Electroconvulsive therapy (ECT)
C. Psychotherapy
D. Antidepressant medication

Explanation: **Explanation:** The correct answer is **Pentotal interview to resolve guilt**. This question focuses on the management of **Agitated Depression** where the patient presents with intense psychological distress and overwhelming guilt. **Why Option A is Correct:** In cases of severe agitated depression where guilt is a predominant and paralyzing feature, a **Pentotal (Thiopental) interview**, also known as "Narcoanalysis," is traditionally considered a rapid intervention to bypass conscious resistance. It helps the patient verbalize repressed thoughts and facilitates the resolution of intense guilt, which is often the driving force behind the agitation and suicidal ideation. **Analysis of Incorrect Options:** * **B. Electroconvulsive therapy (ECT):** While ECT is the most effective treatment for severe depression with high suicidal risk, it is typically considered when pharmacological or psychotherapeutic interventions are insufficient or when immediate life-saving intervention is needed. In the specific context of "resolving guilt" in an agitated state, the interview technique is prioritized in this classical question. * **C. Psychotherapy:** While essential for long-term management, psychotherapy is ineffective in the acute phase of agitated depression because the patient is too distressed and cognitively overwhelmed to engage in "talk therapy." * **D. Antidepressant medication:** These are the mainstay of long-term treatment but have a **lag period of 2–3 weeks** before showing efficacy. In an acutely suicidal and agitated patient, they do not provide the immediate relief required. **Clinical Pearls for NEET-PG:** * **Agitated Depression:** Characterized by depression plus psychomotor agitation (pacing, hand-wringing) rather than retardation. * **Pentotal Interview:** Uses Sodium Pentotal (a short-acting barbiturate) to induce a state of relaxation where the patient can communicate more freely. * **Suicide Risk:** Always prioritize safety. If the question asks for the *most effective* treatment for suicidal depression, the answer is usually **ECT**. If it asks for the *first-line to resolve guilt* in an agitated state, consider the Pentotal interview.

Question 29: Which of the following is a clinical feature of mania?

A. Anhedonia
B. Elated mood (Correct Answer)
C. Avolition
D. All of the above

Explanation: **Explanation:** The core clinical feature of **Mania** is a distinct period of abnormally and persistently elevated, expansive, or irritable mood. In mania, the **Elated mood** (Option B) is characterized by intense happiness, optimism, and enthusiasm that is often out of proportion to the individual’s circumstances. This is frequently accompanied by increased energy, pressured speech, flight of ideas, and decreased need for sleep. **Analysis of Incorrect Options:** * **Anhedonia (Option A):** This refers to the inability to feel pleasure in normally pleasurable activities. It is a hallmark symptom of **Depression**, not mania. * **Avolition (Option B):** This is a "negative symptom" characterized by a lack of motivation or ability to initiate and persist in self-directed purposeful activities. It is commonly seen in **Schizophrenia** and severe depressive episodes. **High-Yield Clinical Pearls for NEET-PG:** * **Diagnostic Criteria (DSM-5/ICD-11):** For a diagnosis of Mania, the symptoms must last for at least **one week** (or any duration if hospitalization is required). For Hypomania, the duration is at least **4 days**. * **The "DIG FAST" Mnemonic:** * **D**istractibility * **I**ndiscretion (excessive involvement in pleasurable activities with high risk) * **G**randiosity * **F**light of ideas * **A**ctivity increase (Psychomotor agitation) * **S**leep (decreased need) * **T**alkativeness (Pressured speech) * **Key Distinction:** The presence of **psychotic features** (delusions/hallucinations) or the need for **hospitalization** automatically classifies the episode as Mania, never Hypomania.

Question 30: All of the following are true regarding depression except?

A. More common in women
B. Most common psychiatric disorder overall (Correct Answer)
C. Most common age group is middle age
D. Is genetic in origin

Explanation: **Explanation:** The correct answer is **B**, as it is a false statement. While depression is a leading cause of disability worldwide, **Anxiety Disorders** are statistically the most common psychiatric disorders in the general population. Depression (Major Depressive Disorder) is the most common **mood disorder**, but not the most common psychiatric disorder overall. **Analysis of other options:** * **A. More common in women:** This is true. The prevalence of depression is approximately twice as high in women as in men (2:1 ratio), likely due to hormonal differences, psychosocial stressors, and higher rates of reporting. * **C. Most common age group is middle age:** This is true. While depression can occur at any age, the mean age of onset is in the late 30s to 40s. The peak prevalence is typically seen in the middle-aged population. * **D. Is genetic in origin:** This is true. Depression has a strong hereditary component. First-degree relatives of patients with MDD are 2-3 times more likely to develop the condition. Heritability is estimated at approximately 30-40%. **High-Yield Clinical Pearls for NEET-PG:** * **Most common psychiatric disorder:** Anxiety Disorders (specifically Specific Phobias). * **Most common mood disorder:** Major Depressive Disorder (MDD). * **Lifetime prevalence of MDD:** Approximately 15-17%. * **Neurotransmitter changes:** Decreased levels of Serotonin (5-HT), Norepinephrine, and Dopamine. * **Sleep changes in depression:** Reduced REM latency (earlier onset of REM), increased REM duration, and decreased slow-wave sleep.

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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