Mood Disorders — MCQs
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A 67-year-old lady is brought in by her six children, who say that she has become senile. Six months after her husband's death, she has become more religious and spiritual, and gives a lot of money in donation. She is occupied with too many activities and sleeps less. She now believes that she has a goal to change society. She does not like being brought to the hospital and is argumentative when questioned about her actions. The diagnosis is:
Pseudodementia is seen in:
An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
A 68-year-old lady thinks that she has committed a sin, she is not worthy to live in this world, she is also having anorexia and insomnia, she is suffering from -
Intense nihilism, somatization and agitation in old age are the hallmark symptoms of -
Nitric Oxide (NO) is a novel neurotransmitter which is considered to have an effect in the pathophysiology of which of the following psychiatric conditions?
Pseudodementia is seen in?
F00 in ICD denotes
A reduction in the CSF 5-HIAA (Hydroxyindoleacetic Acid) is associated with all the following, EXCEPT:
An elderly housewife lost her husband who died suddenly of Myocardial infarction. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. Over the past couple of years since his death, this has continued and provokes anxiety and sadness of mood when she is preoccupied with his thought. She should be treated with:
Mood Disorders Indian Medical PG Practice Questions and MCQs
Question 311: A 67-year-old lady is brought in by her six children, who say that she has become senile. Six months after her husband's death, she has become more religious and spiritual, and gives a lot of money in donation. She is occupied with too many activities and sleeps less. She now believes that she has a goal to change society. She does not like being brought to the hospital and is argumentative when questioned about her actions. The diagnosis is:
- A. Depression
- B. Impulse control disorder
- C. Mania (Correct Answer)
- D. Schizophrenia
Explanation: ***Mania*** - The patient exhibits classic symptoms of **mania**: increased religiosity, excessive donations, overactivity, reduced sleep, and a **grandiose belief** ("goal to change society"). - Her **argumentativeness** and resistance to evaluation are consistent with the **lack of insight** often seen in manic episodes. *Depression* - While the death of her husband could trigger depression, her symptoms of **increased energy**, reduced sleep, and grandiosity are **contrary to typical depression** (low mood, anhedonia, fatigue). - Depression usually involves feelings of **worthlessness and guilt**, not an inflated sense of self-importance or mission. *Impulse control disorder* - This category usually involves specific problematic behaviors (e.g., gambling, kleptomania) driven by an **irresistible urge**, often preceded by tension and followed by relief. - The patient's broader constellation of symptoms, including grandiosity and reduced sleep, points to a more pervasive mood disturbance rather than a single maladaptive impulse. *Schizophrenia* - Schizophrenia is characterized by **psychosis**, including prominent hallucinations, delusions (often bizarre), disorganization in thought and speech, and negative symptoms. - While she has a **grandiose delusion**, the overall clinical picture, especially the prominent mood and energy changes, is much more indicative of a **manic episode**.
Question 312: Pseudodementia is seen in:
- A. Depression (Correct Answer)
- B. Schizophrenia
- C. Alcoholism
- D. Mania
Explanation: ***Depression*** - **Pseudodementia** refers to cognitive deficits (e.g., memory, concentration) that mimic dementia but are caused by a psychiatric condition, most commonly **severe depression**. - These cognitive impairments often resolve with effective treatment of the underlying depressive disorder. *Schizophrenia* - While schizophrenia can present with cognitive impairments, these are typically considered integral to the disorder itself rather than a "pseudo" presentation of dementia. - The cognitive deficits in schizophrenia often involve executive function, attention, and memory, but are distinct from a primary neurodegenerative process. *Alcoholism* - Chronic alcoholism can lead to **alcohol-related dementia** or other permanent cognitive impairments, such as **Wernicke-Korsakoff syndrome**, which are true organic brain disorders, not pseudodementia. - These conditions are characterized by actual brain damage and are not typically reversible by simply treating the alcoholism. *Mania* - Mania can cause significant cognitive dysfunction, including distractibility, impaired judgment, and difficulty concentrating due to racing thoughts and heightened activity. - However, these are typically transient and directly related to the acute manic state, not a sustained pattern resembling dementia that would be termed "pseudodementia."
Question 313: An old man is diagnosed with major depressive disorder. His son reports that he always shows suicidal tendencies. What is the treatment of choice for depression with suicidal tendencies?
- A. Olanzapine
- B. ECT (Correct Answer)
- C. Mirtazapine
- D. Clozapine
Explanation: ***ECT*** - **Electroconvulsive therapy (ECT)** is the **treatment of choice** for severe depression with **suicidal ideation** due to its rapid onset of action and high efficacy. - It is particularly indicated when there is an urgent need for symptom remission to prevent self-harm, as verbal therapies and medications take longer to exert their full effects. *Olanzapine* - **Olanzapine** is an **antipsychotic medication** with some antidepressant properties, but it is not the first-line treatment for severe depression with suicidal tendencies. - It is often used as an **adjunctive treatment** in treatment-resistant depression or in psychotic depression with delusions. *Mirtazapine* - **Mirtazapine** is an **antidepressant** that can be very effective in cases of major depressive disorder, especially when insomnia and appetite loss are prominent. - However, its onset of action is not as rapid as ECT, making it less suitable for situations requiring immediate intervention for **severe suicidal risk**. *Clozapine* - **Clozapine** is an **antipsychotic medication** primarily used for **treatment-resistant schizophrenia** and reducing suicidal behavior in schizophrenia. - It is highly effective but has significant side effects, including **agranulocytosis**, and is not a first-line treatment for major depressive disorder with suicidal tendencies.
Question 314: A 68-year-old lady thinks that she has committed a sin, she is not worthy to live in this world, she is also having anorexia and insomnia, she is suffering from -
- A. Endogenous depression (Correct Answer)
- B. Dissociative disorder
- C. Exogenous depression
- D. Neurotic depression
Explanation: ***Endogenous depression*** - This older classification term describes **severe depressive symptoms** that arise without a clear external precipitating factor and are characterized by **melancholic/biological features**. - The patient presents with classic features: profound guilt (\"committed a sin\"), worthlessness (\"not worthy to live\"), and significant **vegetative symptoms** including **anorexia** and **insomnia**. - These symptoms align with what is now termed **Major Depressive Disorder with Melancholic Features** in modern classification (DSM-5/ICD-11). - The endogenous nature suggests a **biological/biochemical basis** rather than purely reactive symptoms. *Dissociative disorder* - This disorder involves disruption of **consciousness, memory, identity, or perception** (e.g., dissociative amnesia, depersonalization). - The core features presented—guilt, worthlessness, anorexia, insomnia—are **mood and vegetative symptoms**, not dissociative phenomena. - While depression and dissociation can co-occur, this presentation is primarily a **mood disorder**. *Exogenous depression* - Also called **reactive depression**, this type is triggered by an **identifiable external stressor** (e.g., bereavement, job loss, trauma). - The question provides **no history of external precipitant**, and the severity of guilt and biological symptoms suggests an endogenous process. - Modern equivalent would be depression clearly linked to a psychosocial stressor. *Neurotic depression* - This outdated term historically referred to **milder depression** with prominent **anxiety features** and thought to be related to personality factors. - The patient's presentation is **too severe**—profound guilt, worthlessness, and marked vegetative symptoms indicate a more severe depressive episode. - This better fits **melancholic/endogenous depression** rather than a neurotic-level disorder.
Question 315: Intense nihilism, somatization and agitation in old age are the hallmark symptoms of -
- A. Depressive stupor
- B. Atypical depression
- C. Involutional melancholia (Correct Answer)
- D. Somatized depression
Explanation: ***Involutional melancholia*** - This **historical term** (now obsolete in DSM-5 and ICD-11) described a severe depressive episode occurring in late life, characterized by **intense nihilism**, **somatization**, and **agitation**. - In modern psychiatry, this presentation would be diagnosed as **Major Depressive Disorder with melancholic features** or **with psychotic features** (if nihilistic delusions are present). - Though no longer used as a formal diagnosis, this term may still appear in older psychiatric literature and some textbook references, particularly describing the classical triad in elderly patients. - Key features included: severe guilt, nihilistic themes, marked psychomotor agitation (not retardation), and somatic preoccupations in older adults. *Depressive stupor* - This is a rare and severe form of depression characterized by extreme **psychomotor retardation**, where the individual is almost entirely unresponsive, withdrawn, and has minimal or no movement or speech. - The key differentiating feature is **marked retardation** rather than **agitation** - these are opposite psychomotor presentations. - While it involves severe depression, the primary features of **agitation** and active **somatization** as described in the question are not characteristic of depressive stupor. *Atypical depression* - This type of depression is characterized by **mood reactivity** (mood improves in response to positive events), increased appetite or weight gain, hypersomnia, leaden paralysis, and interpersonal rejection sensitivity. - Features **reversed neurovegetative symptoms** (hypersomnia and hyperphagia rather than insomnia and anorexia). - The symptoms of **nihilism**, **somatization**, and **agitation** are not typical features; atypical depression often involves anergic features and is more common in younger patients. *Somatized depression* - This refers to depression where psychological distress is primarily expressed through **physical symptoms** such as pain, fatigue, or gastrointestinal issues, often leading to medical consultations. - While **somatization** is the predominant feature, it lacks the specific constellation of **intense nihilism** and severe **agitation in elderly patients** that characterizes the classical involutional presentation. - More commonly seen in cultures where psychological expression of distress is stigmatized.
Question 316: Nitric Oxide (NO) is a novel neurotransmitter which is considered to have an effect in the pathophysiology of which of the following psychiatric conditions?
- A. Schizophrenia
- B. Substance Misuse
- C. OCD
- D. Mood Disorders (Correct Answer)
Explanation: ***Mood Disorders*** - **Nitric oxide (NO)** has been implicated in the pathophysiology of **mood disorders**, such as major depressive disorder and bipolar disorder, due to its role in **neurotransmission** and **neuronal plasticity**. - NO can modulate the activity of various neurotransmitter systems (e.g., serotonergic, dopaminergic) that are known to be dysregulated in mood disorders, influencing **affect** and **emotional regulation**. *Schizophrenia* - While **NO dysfunction** has been investigated in schizophrenia, its role is less clearly established as a primary effector compared to neurotransmitters like **dopamine** and **glutamate**. - Research in schizophrenia often focuses on the **dopamine hypothesis** or **glutamate hypofunction**, with NO having a more modulatory role. *Substance Misuse* - NO is known to be involved in pathways related to **reward** and **addiction**, but it is generally considered a **modulator** of neurotransmission rather than a primary neurotransmitter in the development of substance misuse. - The pathophysiology of substance misuse is highly complex, involving multiple neurotransmitter systems and circuits, including **dopamine** and the mesolimbic reward system. *OCD* - The primary neurotransmitter theories for **Obsessive-Compulsive Disorder (OCD)** largely focus on **serotonin dysregulation**, with treatments like SSRIs being highly effective. - While NO may have some modulatory effects on brain circuits involved in OCD, it is not considered a central player in its pathophysiology compared to other conditions.
Question 317: Pseudodementia is seen in?
- A. Dissociative disorder
- B. Schizophrenia
- C. Depression (Correct Answer)
- D. Parkinson's disease
Explanation: ***Depression*** - **Pseudodementia** is a syndrome in which a patient exhibits **cognitive impairment** that mimics **dementia** but is actually caused by a **psychiatric condition**, most commonly **depression**. - Patients with depression may experience **memory loss**, **difficulty concentrating**, and **slowed thinking** that can be mistaken for dementia. *Dissociative disorder* - Dissociative disorders involve disruptions of **memory**, **consciousness**, **identity**, and **perception**, but they typically do not manifest as a global cognitive decline resembling dementia. - While extreme stress or trauma can cause **dissociative amnesia**, it's usually specific to certain events or periods, not a generalized cognitive impairment. *Schizophrenia* - Schizophrenia is characterized by **psychosis**, **disorganized thinking**, **hallucinations**, and **delusions**, which are distinct from the cognitive symptoms of dementia. - While some cognitive deficits can be present in schizophrenia, they are typically not the primary feature and do not present as a pervasive "dementia-like" picture. *Parkinson's disease* - Parkinson's disease is a **neurodegenerative disorder** primarily affecting **motor function**, causing **tremors**, **rigidity**, and **bradykinesia**. - While **dementia** can occur in the later stages of Parkinson's disease (**Parkinson's disease dementia**), it is true dementia and not a "pseudo" condition caused by a psychiatric disorder.
Question 318: F00 in ICD denotes
- A. mood disorders
- B. organic disorders (Correct Answer)
- C. substance use
- D. psychosis
Explanation: ***Organic disorders - CORRECT*** - **F00-F09** in the **International Classification of Diseases (ICD-10)** Chapter V (Mental and behavioural disorders) specifically denotes **organic, including symptomatic, mental disorders** - These disorders are characterized by brain disease, brain injury, or other insult leading to **cerebral dysfunction** - **F00** specifically refers to **Dementia in Alzheimer's disease** *Mood disorders - Incorrect* - Mood disorders are classified under codes **F30-F39** in ICD-10 - This category includes conditions like bipolar affective disorder, depressive episodes, and recurrent depressive disorders *Substance use - Incorrect* - Mental and behavioral disorders due to psychoactive substance use are classified under codes **F10-F19** in ICD-10 - This section covers disorders resulting from the use of alcohol, opioids, cannabis, sedatives, hypnotics, and other substances *Psychosis - Incorrect* - Specific psychotic disorders like schizophrenia are classified under codes **F20-F29** in ICD-10 - Psychosis can be a symptom of various mental disorders, including some organic conditions
Question 319: A reduction in the CSF 5-HIAA (Hydroxyindoleacetic Acid) is associated with all the following, EXCEPT:
- A. OCD (Correct Answer)
- B. Depression
- C. Suicide
- D. Violence
Explanation: ***OCD*** - **Obsessive-Compulsive Disorder (OCD)** has been linked to *increased* serotonin activity or hypersensitivity, rather than reduced 5-HIAA. - A *reduction* in CSF 5-HIAA is typically associated with conditions linked to *decreased* serotonin function. *Depression* - **Reduced CSF 5-HIAA** is consistently observed in many forms of **depression**, consistent with the serotonin hypothesis of mood disorders. - Decreased serotonin metabolites suggest lower serotonin turnover or activity in the central nervous system. *Suicide* - Low CSF 5-HIAA levels are a well-established biological marker associated with an **increased risk of suicide** and suicidal behavior, regardless of diagnosis. - This finding points to impaired serotonin function contributing to impulsivity and aggression often seen in suicide attempts. *Violence* - **Aggressive and violent behaviors**, particularly impulsive aggression, have been correlated with **reduced CSF 5-HIAA** levels. - This suggests a role for dysfunctional serotonin pathways in regulating inhibitions and behavioral control.
Question 320: An elderly housewife lost her husband who died suddenly of Myocardial infarction. They had been staying alone for almost a decade with infrequent visits from her son and grandchildren. About a week after the death she heard his voice clearly talking to her as he would in a routine manner from the next room. She went to check but saw nothing. Subsequently she often heard his voice conversing with her and she would also discuss her daily matters with him. Over the past couple of years since his death, this has continued and provokes anxiety and sadness of mood when she is preoccupied with his thought. She should be treated with:
- A. Benztropine
- B. Risperidone
- C. Sertraline (Correct Answer)
- D. Lorazepam
Explanation: ***Sertraline*** - The patient exhibits symptoms consistent with **prolonged grief disorder**, characterized by persistent longing for the deceased, intense emotional pain, and clinically significant distress or functional impairment following bereavement. Sertraline, an **SSRI antidepressant**, is effective in treating symptoms of grief, anxiety, and depression. - The auditory hallucinations of her deceased husband's voice, while concerning, are described as routine and conversational, suggesting a **psychotic feature secondary to severe depression or complicated grief**, rather than a primary psychotic disorder. Treating the underlying mood and anxiety component with an antidepressant is the priority. *Benztropine* - **Benztropine is an anticholinergic medication** primarily used to treat **extrapyramidal symptoms** (EPS) associated with antipsychotic use or Parkinson's disease. - There is no indication of EPS or Parkinson's disease in this patient, making benztropine an inappropriate choice for her symptoms of grief, anxiety, and auditory phenomena. *Risperidone* - **Risperidone is an atypical antipsychotic** primarily used to treat schizophrenia, bipolar disorder, and agitation. While it can address psychotic symptoms, the auditory hallucinations described here ("heard his voice clearly talking to her as he would in a routine manner") are likely **grief-related pseudohallucinations** or a reflection of the intense emotional bond, rather than frank psychosis requiring antipsychotic medication. - Administering an antipsychotic without first addressing the underlying grief and mood disorder could result in unnecessary side effects and may not effectively resolve her primary distress. The anxiety and sadness following preoccupation with his thought suggest a **depressive component** rather than a primary thought disorder. *Lorazepam* - **Lorazepam is a benzodiazepine** used for short-term management of anxiety, insomnia, and seizures. - While the patient experiences anxiety, lorazepam would only provide **symptomatic relief** for acute anxiety and does not address the underlying prolonged grief, sadness, or the grief-related auditory experiences. Long-term use of benzodiazepines can lead to dependence and withdrawal issues.
Practice by Chapter
Major Depressive Disorder
Practice Questions
Bipolar Disorder: Manic Episodes
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Bipolar Disorder: Depressive and Mixed Episodes
Practice Questions
Persistent Depressive Disorder (Dysthymia)
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Cyclothymic Disorder
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Seasonal Affective Disorder
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Suicide and Suicidal Behavior
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Pharmacotherapy of Mood Disorders
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Psychotherapy for Mood Disorders
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Brain Stimulation Therapies
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Treatment-Resistant Depression
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Mood Disorders in Special Populations
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