Mood Disorders Practice Questions

Q: Episodes of depression in major depressive disorder tend to:

Increase in frequency with age. **Explanation:** The correct answer is **A: Increase in frequency with age.** Major Depressive Disorder (MDD) is often a recurrent illness. According to the natural history of the disease, as a patient ages, the **inter-episodic remission periods tend to shorten**, while the **frequency and severity of episodes tend to increase**. This phenomenon is sometimes explained by the "Kindling Hypothesis," which suggests that initial episodes require a significant environmental stressor, but subsequent episodes occur more spontaneously and frequently due to electrobiological changes in the brain. **Analysis of Incorrect Options:** * **B. Decrease in length with age:** Incorrect. As the disease progresses, untreated episodes typically tend to **increase in duration**, not decrease. * **C. Last for about 9 months when treated:** Incorrect. An untreated episode typically lasts 6 to 13 months. With appropriate antidepressant treatment, episodes generally last about **3 months**. * **D. Have a rapid onset:** Incorrect. Depression usually has a **gradual onset**, developing over weeks to months. In contrast, Bipolar Disorder (Manic episodes) often presents with a more acute or rapid onset. **High-Yield Clinical Pearls for NEET-PG:** * **Recurrence Risk:** After one episode of MDD, the risk of a second is 50%. After two episodes, it rises to 70%, and after three, it is 90%. * **Treatment Duration:** For a first episode, continue medication for **6–9 months** after remission to prevent relapse. * **Most Common Symptom:** Psychomotor retardation is the most common objective finding, while depressed mood and anhedonia are core subjective symptoms. * **Suicide Risk:** The risk is highest as the patient begins to recover and their energy levels (psychomotor activity) improve before their mood does.

Q: Which of the following indications of deep brain stimulation is not FDA approved?

Major depression. **Explanation:** Deep Brain Stimulation (DBS) involves the surgical implantation of electrodes into specific brain nuclei, connected to a pulse generator. While it is a revolutionary tool in neuromodulation, its FDA approval status varies significantly across psychiatric and neurological conditions. **Why Major Depression is the Correct Answer:** Although DBS (targeting the **Subgenual Cingulate Cortex/Area 25**) has shown promise in clinical trials for treatment-resistant depression, it is **not yet FDA-approved**. It remains an experimental treatment. In contrast, other neuromodulation techniques like ECT, rTMS, and Vagus Nerve Stimulation (VNS) *are* FDA-approved for depression. **Analysis of Incorrect Options:** * **Parkinsonism (Option C):** This was the first FDA-approved indication for DBS (1997). It typically targets the **Subthalamic Nucleus (STN)** or **Globus Pallidus interna (GPi)** to manage motor fluctuations and tremors. * **Dystonia (Option D):** Approved in 2003 under a Humanitarian Device Exemption (HDE) for chronic, intractable primary dystonia. * **OCD (Option A):** Approved in 2009 (HDE) for treatment-resistant OCD. The common target is the **Ventral Striatum** or the **Anterior Limb of the Internal Capsule (ALIC)**. **NEET-PG High-Yield Pearls:** * **DBS Targets:** * Parkinson’s: STN (most common) or GPi. * Essential Tremor: Ventral Intermediate Nucleus (Vim) of the Thalamus. * OCD: Internal Capsule/Ventral Striatum. * **FDA Status:** Remember that for psychiatric disorders, only **OCD** has FDA approval for DBS; Depression and Addiction are still under investigation. * **Contraindication:** DBS is generally avoided in patients with active psychosis or severe cognitive impairment.

Q: A 22-year-old male presents with decreased sleep, increased sexual activity, excitement, and excessive spending for the past 8 days. What is the most likely diagnosis?

Mania. ### **Explanation** The clinical presentation of this 22-year-old male—characterized by a **decreased need for sleep**, **hypersexuality**, **psychomotor excitement**, and **impulsivity (excessive spending)**—is a classic description of a **Manic Episode**. **Why Mania is Correct:** According to ICD-11 and DSM-5 criteria, a diagnosis of Mania requires a distinct period of abnormally elevated, expansive, or irritable mood and increased energy lasting **at least 1 week**. Key symptoms include: * **Decreased need for sleep:** Feeling rested after only 3 hours of sleep (distinct from insomnia). * **Increased goal-directed activity:** Often manifesting as increased libido or social activity. * **Poor judgment:** Excessive involvement in activities with high potential for painful consequences (e.g., spending sprees, foolish investments). **Why Other Options are Incorrect:** * **Confusion:** Refers to a clouding of consciousness or disorientation (common in Delirium), which is not the primary feature here. * **Hyperactivity:** This is a non-specific symptom. While present in mania, it is also seen in ADHD or hyperthyroidism. Mania is a comprehensive mood syndrome, not just a physical state. * **Memory Loss:** This is a cognitive deficit (Dementia/Amnesia) and is not associated with the expansive, high-energy state described. **NEET-PG High-Yield Pearls:** 1. **Duration Criteria:** Mania ≥ 7 days; Hypomania ≥ 4 days. 2. **Hypomania vs. Mania:** Hypomania does **not** cause marked impairment in social/occupational functioning and **never** includes psychotic features or requires hospitalization. 3. **Drug of Choice:** **Lithium** is the gold standard for long-term prophylaxis of Bipolar Disorder. 4. **DIG FAST Mnemonic:** **D**istractibility, **I**ndiscretion (spending/sex), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit, **T**alkativeness.

Q: Which of the following symptoms must be present for the diagnosis of major depressive disorder?

Loss of interest or pleasure. To diagnose **Major Depressive Disorder (MDD)** according to DSM-5 criteria, a patient must experience at least five symptoms for a minimum of 2 weeks. Crucially, at least one of these symptoms **must** be one of the two "core" symptoms: 1. **Depressed mood** 2. **Loss of interest or pleasure (Anhedonia)** ### Why Option A is Correct **Loss of interest or pleasure (Anhedonia)** is one of the two mandatory gateway symptoms. Without either a depressed mood or anhedonia, a diagnosis of MDD cannot be made, regardless of how many other physical or cognitive symptoms are present. ### Why Other Options are Incorrect While **Recurrent suicidal ideation (B)**, **Insomnia (C)**, and **Indecisiveness (D)** are all recognized diagnostic criteria for MDD under the DSM-5, they are considered **accessory symptoms**. A patient can be diagnosed with MDD without having these specific symptoms, provided they meet the overall threshold (5/9 symptoms) including one core symptom. ### NEET-PG High-Yield Pearls * **Mnemonic for MDD Criteria:** **SIGECAPS** (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal ideation). * **Duration:** Symptoms must persist for at least **2 weeks** and cause significant functional impairment. * **Exclusion:** Symptoms must not be attributable to substance use or another medical condition (e.g., Hypothyroidism). * **Pseudodementia:** In elderly patients, MDD often presents as cognitive impairment (memory loss), which is reversible with antidepressants—a common NEET-PG differentiator from Alzheimer’s.

Q: A female presents with symptoms of being excessively talkative, hyperactive, sleeping very little, and spending large amounts of money on shopping sprees. When confronted, she becomes irritable. What is the most likely diagnosis?

Bipolar I + Mania. ***Bipolar I + Mania***- The presentation of *pressured speech* (excessively talkative), *decreased need for sleep*, *hyperactivity*, and severe *impulsivity* (large spending) meets the criteria for a **full manic episode**.- A manic episode is defined by lasting at least one week, causing severe functional impairment, and is necessary for the diagnosis of **Bipolar I Disorder**.*Bipolar II + Hypomania*- Symptoms of a **hypomanic episode** are similar but are less severe, last a minimum of 4 consecutive days, and *do not cause marked functional impairment* or require hospitalization.- The patient’s severe symptoms (reckless spending, irritability upon confrontation) leading to major social/occupational problems indicate **mania**, not hypomania.*Obsessive-compulsive disorder*- This disorder is characterized by intrusive, recurrent **obsessions** (thoughts) and repetitive **compulsions** (behaviors) performed to relieve anxiety, which are not the primary symptoms here.- While spending could be impulsive, it is part of a cluster of mood and activity disturbances, not an ego-dystonic ritualistic compulsion.*Schizophrenia*- The primary features of **Schizophrenia** involve psychosis, such as **hallucinations**, **delusions**, and **disorganized thinking**, which are not described in this presentation.- Although irritability and hyperactivity may overlap, the core presentation is dominated by symptoms of a disruptive mood state, making a primary mood disorder more likely.

Q: A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?

Bipolar disorder - manic episode. ***Bipolar disorder - manic episode*** - The constellation of extremely elevated mood features, including **rapid speech** (or pressured speech), severely **decreased need for sleep**, highly aggressive and **hyperactive behavior** (psychomotor agitation), defines a **manic episode**.- Discontinuation of established mood-stabilizing medication is a very strong predictor for relapse into a full-blown manic state in individuals with **bipolar disorder (Type I)**.*Depression* - Depression typically manifests with symptoms opposite to those observed, such as **low energy**, pervasive sadness, **anhedonia**, and often psychomotor **retardation**.- The patient's **aggression**, **hyperactivity**, and **pressured speech** are inconsistent with the core diagnostic features of a depressive episode.*Schizophrenia* - Schizophrenia is characterized fundamentally by prominent **psychotic symptoms** (hallucinations, delusions) and profound **disorganization** in speech and thought.- While agitation can occur, the cyclical mood features, specifically the dramatic decrease in the **need for sleep** and **pressured speech**, are hallmarks of mania, not schizophrenia.*Substance- induced mood disorder* - This diagnosis requires symptoms to be directly attributable to the physiological effects of **substance intoxication** or withdrawal.- Although substance use can mimic mania, the presence of a known **psychiatric disorder** and the exacerbation following cessation of **prescribed medication** make primary Bipolar I disorder relapse the most likely explanation.

Q: Which of the following is not an ICD-10 diagnostic criterion for depression?

Persistent worry about everyday matters. ### Explanation The diagnosis of a **Depressive Episode** according to **ICD-10** is based on a specific cluster of symptoms. The criteria are divided into **Typical (Core)** symptoms and **Other common** symptoms. #### Why Option D is Correct **Persistent worry about everyday matters** is the hallmark feature of **Generalized Anxiety Disorder (GAD)**, not Depression. While anxiety often co-exists with depression (comorbidity), it is not a diagnostic criterion for a depressive episode under ICD-10. #### Why Other Options are Incorrect Options A, B, and C represent the **three core (typical) symptoms** of depression in ICD-10. For a diagnosis, at least two of these must be present for a minimum of **2 weeks**: * **Low mood (Depressed mood):** To a degree that is definitely abnormal for the individual, present for most of the day and almost every day. * **Loss of interest or pleasure (Anhedonia):** In activities that are normally enjoyable. * **Low energy (Fatigability):** Increased fatigability or marked decrease in activity. #### High-Yield Clinical Pearls for NEET-PG/INI-CET * **ICD-10 Classification:** Depression is coded under **F32** (Depressive episode) and **F33** (Recurrent depressive disorder). * **Somatic Syndrome:** ICD-10 allows for a "somatic" specifier if symptoms like early morning awakening (2 hours early), diurnal variation (worse in morning), and psychomotor retardation are present. * **Severity Grading:** * **Mild:** 2 core + 2 others. * **Moderate:** 2 core + 3–4 others. * **Severe:** 3 core + $\geq$ 4 others. * **DSM-5 Difference:** Unlike ICD-10, **DSM-5** requires 5 out of 9 symptoms (must include either depressed mood or anhedonia) and does not list "low energy" as a separate core category in the same way.

Q: Which one of the following is correct regarding postpartum psychosis?

Recurrence rate in subsequent pregnancy is 60-70 %.. ***Recurrence rate in subsequent pregnancy is 60-70%.*** - Postpartum psychosis carries a **high recurrence risk**, making subsequent pregnancies a concern for women with a history of the condition. - This high recurrence rate (ranging from 50-80% across studies) underscores the importance of close monitoring and prophylactic treatment in future pregnancies. *Electro convulsive therapy is the first treatment of choice.* - **ECT** is considered for severe cases of postpartum psychosis, particularly when there is rapid deterioration, severe suicidality, or catatonia, rather than being the first-line treatment. - Initial management typically involves a combination of **antipsychotics and mood stabilizers**, often in an inpatient setting for safety. *There is often no family history of psychosis.* - A **family history of psychosis**, especially bipolar disorder or schizophrenia, is a **significant risk factor** for postpartum psychosis. - Genetic predisposition plays a substantial role, making this statement incorrect—family history is commonly present. *Its onset is usually within 4 days of delivery.* - While postpartum psychosis has a **rapid onset**, stating "usually within 4 days" is too restrictive. - The condition typically manifests within the **first 2-4 weeks after delivery**, with approximately **50% of cases occurring within the first week** and peak incidence in the first 2 weeks. - This makes the 4-day timeframe an underestimate of the typical onset window.

Q: Which one of the following factors is the most significant as a risk factor for post-partum psychosis?

History of post-partum psychosis. ***History of post-partum psychosis*** - A **prior episode of postpartum psychosis** is the strongest risk factor for recurrence, with recurrence rates estimated to be as high as 50-70%. - This indicates a heightened **biological vulnerability** to the hormonal and psychosocial stresses of the postpartum period. *Primiparity* - While primiparity can be associated with increased stress, it is a **less significant risk factor** for postpartum psychosis compared to a history of the condition. - The stress of a first pregnancy and childbirth can contribute to other perinatal mood disorders, but does not carry the same high recurrence risk as previous psychosis. *Undesired pregnancy* - An undesired pregnancy is often associated with **increased maternal stress, anxiety, and depression**, but it is generally a **weaker predictor** of postpartum psychosis than a personal history of the disorder. - While it can complicate the perinatal period, it doesn't confer the same high risk for a severe psychotic episode. *Unmarried status* - Unmarried status may increase the risk of **postpartum depression** due to lack of social support or increased stress, but it is **not a primary risk factor** for postpartum psychosis itself. - The familial and social support systems are important for overall well-being, but a previous psychotic episode is a much stronger predictor.

Question 1

Episodes of depression in major depressive disorder tend to:

Accepted Answer

Increase in frequency with age

Answer

Decrease in length with age

Answer

Last for about 9 months when treated

Answer

Have a rapid onset

Question 2

Which of the following statements regarding myocardial infarction and depression is false?

Accepted Answer

Only cognitive behavioral therapy is used after myocardial infarction.

Answer

Depression is a risk factor for myocardial infarction.

Answer

Myocardial infarction is a risk factor for depression.

Answer

Selective serotonin reuptake inhibitors (SSRIs) can be used post-myocardial infarction for the treatment of depression.

Question 3

Which of the following indications of deep brain stimulation is not FDA approved?

Accepted Answer

Major depression

Answer

OCD

Answer

Parkinsonism

Answer

Dystonia

Question 4

A 22-year-old male presents with decreased sleep, increased sexual activity, excitement, and excessive spending for the past 8 days. What is the most likely diagnosis?

Accepted Answer

Mania

Answer

Confusion

Answer

Hyperactivity

Answer

Memory loss

Question 5

Which of the following symptoms must be present for the diagnosis of major depressive disorder?

Accepted Answer

Loss of interest or pleasure

Answer

Recurrent suicidal ideation

Answer

Insomnia

Answer

Indecisiveness

Question 6

A female presents with symptoms of being excessively talkative, hyperactive, sleeping very little, and spending large amounts of money on shopping sprees. When confronted, she becomes irritable. What is the most likely diagnosis?

Accepted Answer

Bipolar I + Mania

Answer

Schizophrenia

Answer

Obsessive-compulsive disorder

Answer

Bipolar II + Hypomania

Question 7

A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?

Accepted Answer

Bipolar disorder - manic episode

Answer

Schizophrenia

Answer

Substance-induced mood disorder

Answer

Depression

Question 8

Which of the following is not an ICD-10 diagnostic criterion for depression?

Accepted Answer

Persistent worry about everyday matters

Answer

Low energy levels

Answer

Low mood for most of the day

Answer

Loss of interest in pleasurable things

Question 9

Which one of the following is correct regarding postpartum psychosis?

Accepted Answer

Recurrence rate in subsequent pregnancy is 60-70 %.

Answer

Electro convulsive therapy is the first treatment of choice.

Answer

There is often no family history of psychosis.

Answer

Its onset is usually within 4 days of delivery.

Question 10

Which one of the following factors is the most significant as a risk factor for post-partum psychosis?

Accepted Answer

History of post-partum psychosis

Answer

Primiparity

Answer

Undesired pregnancy

Answer

Unmarried status

Mood Disorders — MCQs

Mood Disorders — MCQs

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