Mood Disorders Practice Questions

Q: Which of the following is false about bipolar disorder?

Unipolar mania is more common than bipolar disorder. ***Unipolar mania is more common than bipolar disorder*** - This statement is **false** because **unipolar mania is extremely rare**, while **bipolar disorder (which includes both manic and depressive episodes)** is significantly more common. - **Unipolar mania** refers to recurrent manic episodes without any depressive episodes, a presentation that is seldom observed clinically. *Genetic factors play important role* - This statement is **true**, as **bipolar disorder has a strong genetic component**, with **heritability estimated between 60-80%**. - **First-degree relatives** of individuals with bipolar disorder are at a significantly higher risk of developing the condition. *Rapid cycling is more common in females* - This statement is **true**; **rapid cycling (4 or more mood episodes per year)** occurs more frequently in females with bipolar disorder. - **Women with bipolar disorder** are also more likely to experience **mixed features** and **more depressive episodes** compared to males. *Age of onset is earlier than unipolar depression* - This statement is **true** because the **typical age of onset for bipolar disorder is in early adulthood (late teens to early 20s)**, whereas **unipolar depression often has a later average onset**, though both can occur at any age. - An earlier age of onset in bipolar disorder is linked to poorer prognosis and more severe illness course.

Q: A 22-year-old woman presents with a complaint of low energy levels for the past 6 months. She feels as if she has no energy to do anything and has lost interest in photography, which she was previously passionate about. Feelings of hopelessness occupy her mind and she can no longer focus at work. She says she forces herself to hang out with her friends at weekends but would rather stay home. She denies any suicidal ideation. Her past medical history is significant for bulimia nervosa, which was diagnosed when she was a teen and was controlled with cognitive behavioral therapy. In addition, she has gastroesophageal reflux, which is being treated with esomeprazole. The patient has a 10-pack-year smoking history but denies any alcohol or recreational drug use. On examination, she is afebrile and vital signs are within normal limits. Her BMI is 24 kg/m2. Further physical examination is unremarkable. Which of the following aspects of this patient’s history is a contraindication to using bupropion as an antidepressant?

History of bulimia nervosa. ***History of bulimia nervosa*** - Bupropion is **contraindicated** in patients with a history of **eating disorders** such as bulimia nervosa or anorexia nervosa due to an increased risk of **seizures**. - This risk is thought to be related to **electrolyte imbalances** and metabolic abnormalities often seen in eating disorders, which significantly lower the seizure threshold. *BMI of 24 kg/m2* - A BMI of 24 kg/m2 is within the **healthy weight range** (18.5-24.9 kg/m2) and therefore does not pose a contraindication to bupropion use. - Bupropion is sometimes used to aid in **weight loss**, so a healthy BMI would not typically be a concern. *Smoking cessation* - Bupropion is **approved for smoking cessation** (as Zyban) and can be beneficial in patients trying to quit smoking. - This aspect of the patient's history is an **indication** for bupropion, not a contraindication. *Age of 22 years* - Bupropion is generally **safe and effective** for use in adults, including young adults like a 22-year-old. - There are no specific age-related contraindications for bupropion in this age group, though caution is advised in adolescents due to increased risk of suicidality.

Q: A woman has mild depressive symptoms a few days after delivery that disappear within 2 weeks postpartum. The most likely cause is ______

Postpartum blues. ***Postpartum blues*** - **Mild depressive symptoms** that onset a few days after delivery and resolve within **two weeks postpartum** are characteristic of postpartum blues. - This condition is very common, affecting 50-80% of new mothers, and is thought to be due to **hormonal shifts** and **sleep deprivation**. *Major depression* - **Major depression** involves more severe and persistent symptoms that last for **at least two weeks** and significantly impair functioning, often requiring intervention. - While it can occur postpartum (postpartum depression), the **mild nature** and rapid resolution of symptoms in this case make it less likely. *Mania* - **Mania** is characterized by elevated mood, increased energy, racing thoughts, and decreased need for sleep, which are not described here. - This condition is typically associated with **bipolar disorder** and represents a distinct mood disturbance from the mild depressive symptoms described. *Postpartum psychosis* - **Postpartum psychosis** is a severe and rare psychiatric emergency characterized by **hallucinations, delusions, and disorganized behavior**. - Its rapid onset, severe symptoms, and high risk of harm to mother and baby are distinct from the mild, self-resolving symptoms presented.

Q: During a manic episode, a patient typically exhibits:

Grandiosity. ***Grandiosity*** - **Grandiosity**, characterized by an inflated sense of self-esteem, importance, or power, is a **hallmark symptom** of a manic episode. - Patients often believe they have special talents, abilities, or connections that are not based in reality. - This is one of the **core diagnostic criteria** for mania per DSM-5. *Delusion of persecution* - **Delusions of persecution**, where an individual believes they are being harmed or conspired against, are more characteristic of **schizophrenia** or **paranoid disorders**. - While psychotic features can occur in severe mania, **persecutory delusions** are less common than grandiose delusions during a manic episode. *Crying spells* - **Crying spells** are typically associated with **depressive episodes**, emotional lability, or conditions like **pseudobulbar affect**. - Manic episodes are marked by an **elevated or irritable mood**, and while irritability can lead to emotional outbursts, sustained crying spells are not typical. *Low self-esteem* - **Low self-esteem** is a core feature of **depressive episodes**, where individuals feel worthless, guilty, or inadequate. - In stark contrast, a manic episode is characterized by **inflated self-esteem** and grandiosity, not low self-esteem.

Q: Double depression is seen in:

Depression with dysthymia. ***Depression with dysthymia*** - **Double depression** is a specific mood disorder characterized by the co-occurrence of a **major depressive episode** on top of a pre-existing **dysthymic disorder** (persistent depressive disorder). - This means an individual experiences the chronic, milder symptoms of dysthymia, which are then worsened by the more severe symptoms of a major depressive episode. *Depression with anxiety attack* - While depression and anxiety attacks can co-occur, this specific combination is not referred to as **double depression**. - **Anxiety attacks** are acute episodes of intense fear and discomfort, often associated with panic disorder, and are distinct from chronic low-grade depressive symptoms. *Major depression with OCD* - **Obsessive-compulsive disorder (OCD)** is a distinct anxiety disorder characterized by obsessions and compulsions, which can co-occur with major depression. - However, the term **double depression** specifically refers to the combination of major depression and dysthymia, not other psychiatric comorbidities. *Major depressive disorder from 2 years* - Experiencing **major depressive disorder for 2 years** implies a chronic course of major depression. - If the symptoms meet the criteria for major depressive disorder continuously for at least two years, it might be termed **chronic major depressive disorder**, but not double depression, unless there was an underlying dysthymia.

Q: A 72 year old lady is severely depressed. For the past 2 days she has suicidal thoughts with an actual intent to die. Which of the following is best suitable to alleviate the symptoms?

ECT. ***ECT (Electroconvulsive Therapy)*** - **ECT** is the most effective and rapid treatment for severe depression, especially when associated with active **suicidal ideation** and intent. - Its quick onset of action (often within days) makes it vital in situations requiring urgent symptom alleviation to ensure patient safety. - **First-line treatment** for geriatric depression with suicidal risk and when rapid response is needed. *Selegiline* - **Selegiline** is a monoamine oxidase inhibitor (MAOI) used for depression and Parkinson's disease, but its antidepressant effects are not immediate. - It would not sufficiently address the patient's acute suicidal intent due to its slower therapeutic onset (several weeks). *Haloperidol + Chlorpromazine* - This combination consists of **antipsychotics**, primarily used for conditions with psychotic features or severe agitation but not as a primary treatment for severe depression with suicidal ideation. - While they might provide some sedation, they do not treat the underlying depressive disorder effectively and rapidly enough to resolve acute suicidal intent. *Amitriptyline* - **Amitriptyline** is a tricyclic antidepressant (TCA) that can be effective for depression but has a delayed onset of action (2-4 weeks). - **Highly contraindicated in suicidal patients** due to its extreme lethality in overdose (cardiotoxic effects). - Its slow therapeutic effect would not be appropriate for an urgent situation involving active suicidal thoughts with intent.

Q: First agent shown to be effective in manic phase of Bipolar Disorder -

Lithium. ***Lithium*** - **Lithium** was the first mood stabilizer specifically demonstrating efficacy in treating the **manic phase of bipolar disorder**, revolutionizing its management. - Its discovery in the 1940s and subsequent clinical trials established it as the **gold standard** for acute mania and maintenance therapy. *Valproate* - While effective in treating **acute mania** and bipolar depression, **valproate** was introduced later than lithium as a mood stabilizer. - It works by **enhancing GABAergic transmission** and modulating voltage-sensitive sodium channels. *Lamotrigine* - Primarily indicated for the treatment of **bipolar depression** and as a maintenance therapy to prevent depressive episodes. - It has **limited efficacy** in treating acute manic episodes. *Carbamazepine* - An **anticonvulsant** that also possesses mood-stabilizing properties, effective in some cases of acute mania and rapid cycling. - Its use in bipolar disorder followed the introduction of lithium, and it is considered a **second-line treatment**.

Q: Early morning awakening is a feature of -

Depression. ***Depression*** - **Early morning awakening** (or terminal insomnia) is a classic symptom of major depressive disorder, where patients wake up several hours before their usual time and cannot return to sleep. - This symptom is often accompanied by other features like **anhedonia**, feelings of worthlessness, fatigue, and **psychomotor retardation** or agitation. *Mania* - Patients experiencing **mania** often have a significantly reduced need for sleep but do not typically report early morning awakening as a distressful symptom. - They may go days with very little sleep, feeling energetic and not tired, which differs from the insomnia associated with depression. *Psychosis* - **Psychotic disorders** can disrupt sleep patterns due to hallucinations, delusions, or disorganized thinking, leading to various sleep disturbances. - However, **early morning awakening** is not a specific or hallmark symptom of psychosis; rather, sleep architecture can be severely fragmented and irregular. *Anxiety neurosis* - **Anxiety neurosis** (now often termed generalized anxiety disorder or panic disorder) can cause sleep initiation difficulties due to racing thoughts and worries. - While anxiety can cause **insomnia**, it more commonly manifests as difficulty falling asleep or nocturnal awakenings, rather than the characteristic early morning awakening seen in depression.

Q: The psychiatric disorder most likely to be associated with epilepsy is:

Depression. ***Depression*** - **Depression** is the most commonly recognized psychiatric comorbidity in patients with epilepsy, affecting a significant percentage of individuals. - The link is multifactorial, involving shared neurobiological pathways, the psychosocial impact of living with a chronic illness, and potential side effects of **antiepileptic drugs (AEDs)**. *Psychosis* - While **psychosis** can be associated with epilepsy (e.g., postictal psychosis, interictal psychosis), it is less common than depression. - The prevalence of psychosis in epilepsy typically ranges between 5-10%, whereas depression is much higher. *Mania* - **Mania** and bipolar disorder can occur in individuals with epilepsy, but they are less prevalent than depression. - Some AEDs, such as **topiramate** or **levetiracetam**, may rarely induce manic symptoms. *Insomnia* - **Insomnia** is a common sleep disturbance in the general population and can be more prevalent in individuals with epilepsy. - However, it is a symptom or a sleep disorder rather than a primary psychiatric disorder in the same vein as depression or psychosis.

Q: Bright light therapy is used for?

Seasonal affective disorder. ***Seasonal affective disorder*** - **Bright light therapy** is a primary treatment for **seasonal affective disorder (SAD)**, particularly **winter depression**, by simulating natural outdoor light. - Exposure to bright light can help regulate the body's **circadian rhythm** and neurotransmitter levels, which are often disrupted in SAD. *Adjustment disorder* - This disorder is a **stress-related condition** where a person has difficulty coping with a specific stressor or event. - Treatment typically involves **psychotherapy** and addresses the specific stressor, not light therapy. *Anxiety* - **Anxiety disorders** are characterized by excessive worry, fear, or apprehension. - Treatment usually involves **cognitive behavioral therapy (CBT)**, medications (e.g., SSRIs), or a combination thereof, not bright light therapy. *Schizophrenia* - **Schizophrenia** is a chronic and severe mental disorder affecting how a person thinks, feels, and behaves, involving psychosis. - Management primarily relies on **antipsychotic medications** and psychosocial interventions, with no established role for bright light therapy.

Question 1

Which of the following is false about bipolar disorder?

Accepted Answer

Unipolar mania is more common than bipolar disorder

Answer

Genetic factors play important role

Answer

Rapid cycling is more common in females

Answer

Age of onset is earlier than unipolar depression

Question 2

A 22-year-old woman presents with a complaint of low energy levels for the past 6 months. She feels as if she has no energy to do anything and has lost interest in photography, which she was previously passionate about. Feelings of hopelessness occupy her mind and she can no longer focus at work. She says she forces herself to hang out with her friends at weekends but would rather stay home. She denies any suicidal ideation. Her past medical history is significant for bulimia nervosa, which was diagnosed when she was a teen and was controlled with cognitive behavioral therapy. In addition, she has gastroesophageal reflux, which is being treated with esomeprazole. The patient has a 10-pack-year smoking history but denies any alcohol or recreational drug use. On examination, she is afebrile and vital signs are within normal limits. Her BMI is 24 kg/m2. Further physical examination is unremarkable. Which of the following aspects of this patient’s history is a contraindication to using bupropion as an antidepressant?

Accepted Answer

History of bulimia nervosa

Answer

BMI of 24 kg/m2

Answer

Smoking cessation

Answer

Age of 22 years

Question 3

A woman has mild depressive symptoms a few days after delivery that disappear within 2 weeks postpartum. The most likely cause is ______

Accepted Answer

Postpartum blues

Answer

Major depression

Answer

Mania

Answer

Postpartum psychosis

Question 4

During a manic episode, a patient typically exhibits:

Accepted Answer

Grandiosity

Answer

Delusion of persecution

Answer

Crying spells

Answer

Low self-esteem

Question 5

Double depression is seen in:

Accepted Answer

Depression with dysthymia

Answer

Depression with anxiety attack

Answer

Major depression with OCD

Answer

Major depressive disorder from 2 years

Question 6

A 72 year old lady is severely depressed. For the past 2 days she has suicidal thoughts with an actual intent to die. Which of the following is best suitable to alleviate the symptoms?

Accepted Answer

ECT

Answer

Selegiline

Answer

Haloperidol + Chlorpromazine

Answer

Amitriptyline

Question 7

First agent shown to be effective in manic phase of Bipolar Disorder -

Accepted Answer

Lithium

Answer

Valproate

Answer

Lamotrigine

Answer

Carbamazepine

Question 8

Early morning awakening is a feature of -

Accepted Answer

Depression

Answer

Mania

Answer

Psychosis

Answer

Anxiety neurosis

Question 9

The psychiatric disorder most likely to be associated with epilepsy is:

Accepted Answer

Depression

Answer

Psychosis

Answer

Mania

Answer

Insomnia

Question 10

Bright light therapy is used for?

Accepted Answer

Seasonal affective disorder

Answer

Adjustment disorder

Answer

Anxiety

Answer

Schizophrenia

Mood Disorders — MCQs

Mood Disorders — MCQs

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