Mood Disorders Practice Questions

Q: Erotomania is seen in:

Delusional disorder. ***Delusional disorder*** - Erotomania (De Clérambault's syndrome) is **classically a subtype of delusional disorder** known as **erotomanic type** in DSM-5. - Characterized by a **non-bizarre delusion** that another person, usually of higher social status, is in love with the individual. - The delusion persists despite clear evidence to the contrary and is the **primary psychiatric diagnosis** for erotomania. - Patients may engage in behaviors like following, attempting contact, or surveillance of the object of their delusion. *Bipolar mania* - While **psychotic features can occur** in severe manic episodes, they typically involve **grandiose delusions** about one's own abilities, power, wealth, or special identity. - Erotomania is **not a characteristic or common psychotic feature** of bipolar mania. - Manic psychosis more commonly presents with mood-congruent grandiose delusions rather than erotomanic delusions. *Obsessive compulsive disorder* - Characterized by **obsessions** (intrusive, unwanted thoughts) and **compulsions** (repetitive behaviors performed to reduce anxiety). - These thoughts are **ego-dystonic** and recognized as excessive or irrational by the patient. - Erotomania is a **fixed delusional belief** without insight, fundamentally different from OCD phenomenology. *Mania without psychotic features* - By definition involves elevated mood, increased energy, and decreased need for sleep **without delusions or hallucinations**. - Erotomania is a **delusional belief**, indicating presence of psychotic features. - This diagnosis would exclude any presentation with erotomanic delusions.

Q: Which of the following conditions is characterized by intense depression and misery?

Major depressive disorder. ***Major depressive disorder*** - This condition is primarily defined by a period of at least two weeks of **depressed mood** or **loss of interest or pleasure** (anhedonia). - Patients often experience profound **feelings of sadness, hopelessness, and misery**, along with other symptoms like changes in sleep, appetite, energy, and concentration. - **MDD is the primary diagnostic category** for conditions characterized by intense depression and misery. *Schizophrenia* - Schizophrenia is characterized by **psychotic symptoms** such as hallucinations, delusions, disorganized thought, and negative symptoms. - While people with schizophrenia might experience periods of low mood, the primary defining features are not intense depression and misery, but rather a **break from reality**. *Mania* - Mania is characterized by an **elevated or irritable mood**, increased energy, and hyperactivity, which are the opposite of depression. - Symptoms include **racing thoughts, decreased need for sleep, grandiosity, and impulsive behavior**, not intense depression. *Melancholia* - Melancholia is a **specifier for major depressive disorder**, not a standalone condition in DSM-5/ICD-11. - While melancholia describes a **particularly severe form** of depression with profound despondency, it is a **subtype or qualifier** applied to MDD, not a separate diagnostic entity. - **The question asks for a "condition"** - MDD is the primary condition, while melancholic features describe characteristics within that condition.

Q: A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

Major depressive disorder plus psychosis. ***Major depressive disorder plus psychosis*** - The patient presents with classic symptoms of **major depressive disorder**, including persistent sadness, **anhedonia (loss of interest)**, **lethargy**, and **early morning awakening**. - The presence of **auditory hallucinations** (hearing voices asking her to kill herself) indicates **psychotic features** accompanying the severe depression, leading to the diagnosis of major depressive disorder with psychotic features. *Schizophrenia* - While schizophrenia involves psychosis, the primary presentation here is a prominent **depressive syndrome** rather than the typical **positive symptoms (delusions, hallucinations)**, **negative symptoms (alogia, avolition)**, and **disorganized thought** processes characteristic of schizophrenia. - The depressive symptoms are too pervasive and central to the clinical picture to be solely schizophrenia. *Schizoaffective disorder* - This disorder requires a period of **at least two weeks of psychotic symptoms** (hallucinations or delusions) **without prominent mood symptoms**, which is not described. - In this case, the **psychotic symptoms are congruent with the depressed mood** (e.g., voices urging self-harm, reflecting hopelessness), rather than independent. *Schizotypal personality disorder* - This is a pervasive pattern of **social and interpersonal deficits** marked by acute discomfort with, and reduced capacity for, close relationships, as well as by **cognitive or perceptual distortions** and eccentricities of behavior. - It does not involve persistent, severe depressive episodes with overt psychotic symptoms as described, nor significant functional impairment to the extent seen here.

Q: A patient with bipolar disorder shows poor response to lithium. Which feature best explains this?

Mixed episodes. ***Mixed episodes*** - The presence of **mixed episodes** (simultaneous manic and depressive symptoms) in bipolar disorder predicts a poorer response to **lithium** monotherapy. - Patients experiencing mixed features often require **antipsychotics** or **mood stabilizers** like valproate or carbamazepine in addition to or instead of lithium. *Early age of onset* - While an early age of onset can indicate a more severe course of bipolar disorder, it doesn't specifically predict **poor response to lithium**. - In fact, lithium can be effective in reducing the frequency of episodes for many patients with early-onset bipolar disorder. *Classical mania* - **Classical mania** (euphoric, agitated, pressured speech) is generally associated with a **good response to lithium**. - Lithium is considered a first-line treatment for classic euphoric mania. *Family history of bipolar* - A **family history of bipolar disorder** suggests a genetic predisposition but does not inherently predict a poor response to lithium. - Genetic factors can influence treatment response, but a positive family history alone is not a contraindication or predictor of lithium failure.

Q: Which neurotransmitter deficit is MOST consistently implicated as the primary mechanism in the pathophysiology of depression?

Serotonin. ***Serotonin (decreased levels)*** - The **monoamine hypothesis** of depression suggests that a functional deficit of neurotransmitters is central to its pathophysiology, with **serotonin (5-HT) most consistently highlighted as the primary driver**. - Reduced levels of serotonin in the synaptic cleft lead to impaired neurotransmission, affecting **mood**, **sleep**, **appetite**, and **cognitive functions**. - Most **selective serotonergic antidepressants (SSRIs)** target this pathway as first-line treatment, underscoring serotonin's central role. *Norepinephrine (decreased levels)* - **Norepinephrine** is another monoamine neurotransmitter implicated in depression, and its deficiency contributes to depressive symptoms. - Low norepinephrine levels are linked to symptoms like **fatigue**, **difficulty concentrating**, and **anhedonia**. - However, while important, **decreased serotonin is more consistently emphasized as the primary pathophysiological mechanism** in most contemporary models of depression. *GABA (reduced levels)* - **GABA (gamma-aminobutyric acid)** is the primary inhibitory neurotransmitter in the brain; reduced levels are associated more strongly with **anxiety disorders** and seizure disorders. - While GABAergic system dysfunction can contribute to certain depressive symptoms, it is not considered a primary mechanism for the core pathophysiology of depression. *Dopamine (increased levels)* - **Increased dopamine levels** are more commonly associated with conditions like **schizophrenia** (mesolimbic pathway) and **mania**, not depression. - Conversely, **decreased** dopamine levels (particularly in the mesocortical pathway) are linked to anhedonia and lack of motivation in depression, making this option factually incorrect.

Q: All of the following are true about bipolar disorder rapid cycling EXCEPT:

More common in males. ***More common in males*** - **Rapid cycling** in bipolar disorder is actually **more common in females** than in males. - While overall prevalence of bipolar disorder is similar between sexes, rapid cycling and mixed features tend to be more frequent in women. *Defined by ≥4 mood episodes per year* - This is the correct definition of **rapid cycling** in bipolar disorder according to diagnostic criteria (DSM-5). - These episodes can be of major depressive, manic, hypomanic, or mixed types. *Often worsened by antidepressants* - **Antidepressants** can sometimes **induce mania** or **accelerate cycling** in vulnerable individuals with bipolar disorder. - This risk is particularly elevated in rapid cycling presentations, leading to caution in their use. *Associated with hypothyroidism* - There is a recognized association between **hypothyroidism** and **rapid cycling** in bipolar disorder. - Treating underlying thyroid dysfunction can sometimes help stabilize mood in these patients.

Q: Which of the following is the core component of Beck's cognitive theory of depression?

C. Dysfunctional belief. ***Dysfunctional belief*** - **Dysfunctional beliefs**, or **core beliefs**, are the central component of Beck's cognitive theory, acting as underlying assumptions that shape an individual's interpretation of events. - These deep-seated beliefs are often rigid, extreme, and influence the development of maladaptive thoughts and behaviors in depression. *Cognitive distortions* - **Cognitive distortions** are systematic errors in thinking that arise from dysfunctional beliefs but are not the fundamental cause themselves. - They are the *patterned ways* in which individuals misconstrue reality, such as **catastrophizing** or **all-or-nothing thinking**. *Automated thoughts* - **Automatic thoughts** are spontaneous, fleeting thoughts that occur in response to specific situations. - While they are a key symptom and target of therapy in Beck's model, they stem from underlying dysfunctional beliefs and cognitive distortions, rather than being the core component. *Introjection* - **Introjection** is a psychoanalytic concept referring to the unconscious absorption of attitudes, ideas, and behaviors from external sources into one's own personality. - This concept is primarily associated with **psychodynamic theories** and is not part of Beck's cognitive model of depression.

Q: Rapid cycling is characterized by all of the following except?

Occurs commonly in men. ***A. Occurs commonly in men*** - **Rapid cycling** is more common in **women** (approximately 70-90% of rapid cyclers are female) and is associated with comorbid conditions like **hypothyroidism**. - This is the **EXCEPT** answer because rapid cycling does NOT commonly occur in men—it predominantly affects women. *B. Commonly associated with concomitant hypothyroidism* - **Hypothyroidism** is a frequently noted comorbidity in individuals with **rapid-cycling bipolar disorder** (seen in 20-30% of cases). - Thyroid dysfunction can affect mood regulation and contribute to the instability characteristic of rapid cycling. - This IS a true characteristic of rapid cycling. *C. Antidepressants increase likelihood* - **Antidepressants** can sometimes **induce or worsen rapid cycling** in individuals with bipolar disorder, especially when used without a mood stabilizer. - This is why great care is taken when prescribing antidepressants in bipolar disorder to monitor for mood shifts. - This IS a true characteristic of rapid cycling. *D. At least 4 distinct episodes per year* - This is the **DSM-5 diagnostic criterion** for rapid cycling, meaning an individual experiences four or more mood episodes (depressive, manic, mixed, or hypomanic) within a 12-month period. - These episodes must be distinct and separated by either a full remission or a switch to an episode of opposite polarity. - This IS a true characteristic of rapid cycling.

Q: A 70-year-old woman with severe depression has not responded to multiple trials of antidepressants. What is the most appropriate next step?

Start electroconvulsive therapy. ***Start electroconvulsive therapy*** - For **severe depression** that has not responded to **multiple adequate trials of antidepressants** in an elderly patient, **electroconvulsive therapy (ECT)** is often the most effective next step due to its rapid and robust response rates. - ECT is particularly effective in severe forms of depression, including **melancholic features**, **psychotic features**, and in cases where rapid response is critical, such as severe suicidality or catatonia. *Increase the dose of the current antidepressant* - The patient has already failed **multiple trials of antidepressants**, suggesting that simply increasing the dose of an already ineffective medication is unlikely to yield a significant response. - Dose increases are usually considered if the patient has only failed one or two medications and has not reached optimal therapeutic levels. *Add an antipsychotic medication* - While atypical antipsychotics can be used as **adjunctive therapy** for treatment-resistant depression, they are typically considered after optimizing antidepressant regimens or when there are **psychotic features**. - In a 70-year-old with severe, treatment-resistant depression without mention of psychosis, ECT would generally be a more potent and effective intervention before adding an antipsychotic. *Switch to a different class of antidepressant* - The patient has "not responded to **multiple trials of antidepressants**," implying that switches to different classes have likely already been attempted or that the current situation requires a more aggressive approach. - While switching is a common strategy, it is less likely to be the "most appropriate next step" compared to ECT in a case of severe, refractory depression in an elderly individual.

Q: A 55-year-old female with major depressive disorder who has not responded to multiple antidepressant trials presents with significant cognitive impairment and vegetative symptoms. What is the next best treatment?

Start electroconvulsive therapy. ***Start electroconvulsive therapy*** - **Electroconvulsive therapy (ECT)** is a highly effective treatment for **severe major depressive disorder** that is **treatment-resistant**, especially when accompanied by severe vegetative symptoms or cognitive impairment. - Given the patient's long history of **treatment failure** with multiple antidepressants and significant functional impairment, ECT is the most appropriate next step. *Switch to an atypical antipsychotic* - While atypical antipsychotics can augment antidepressant treatment for severe or treatment-resistant depression, they are generally considered **add-on therapies** rather than a primary switch after multiple antidepressant failures, especially with significant cognitive and vegetative symptoms. - Without psychosis, starting an antipsychotic as a monotherapy or direct switch might not address the core issue as effectively as ECT. *Add a benzodiazepine* - Benzodiazepines are primarily used for **short-term anxiety relief** and can sometimes help with insomnia associated with depression. - They do not treat the underlying depressive illness, can cause **cognitive impairment** themselves, and are associated with dependence, making them unsuitable as a primary treatment for severe, treatment-resistant depression. *Increase the dose of current antidepressant* - The patient has already demonstrated a lack of response to "multiple antidepressant trials," suggesting that simply increasing the dose of a current, likely ineffective, antidepressant is unlikely to yield significant improvement. - This approach is generally considered before escalating to more intensive treatments like ECT, but in this specific scenario, a more robust intervention is warranted due to the **treatment resistance**.

Question 1

Erotomania is seen in:

Accepted Answer

Delusional disorder

Answer

Obsessive compulsive disorder

Answer

Bipolar mania

Answer

Mania without psychotic features

Question 2

Which of the following conditions is characterized by intense depression and misery?

Accepted Answer

Major depressive disorder

Answer

Schizophrenia

Answer

Mania

Answer

Melancholia

Question 3

A patient complains of sadness of mood, increased lethargy, early morning awakening, loss of interest and reports no will to live and hears voices asking her to kill self. What is the diagnosis?

Accepted Answer

Major depressive disorder plus psychosis

Answer

Schizophrenia

Answer

Schizoaffective disorder

Answer

Schizotypal personality disorder

Question 4

A patient with bipolar disorder shows poor response to lithium. Which feature best explains this?

Accepted Answer

Mixed episodes

Answer

Early age of onset

Answer

Classical mania

Answer

Family history of bipolar

Question 5

Which neurotransmitter deficit is MOST consistently implicated as the primary mechanism in the pathophysiology of depression?

Accepted Answer

Serotonin

Answer

Norepinephrine

Answer

GABA

Answer

Dopamine

Question 6

All of the following are true about bipolar disorder rapid cycling EXCEPT:

Accepted Answer

More common in males

Answer

Associated with hypothyroidism

Answer

Often worsened by antidepressants

Answer

Defined by ≥4 mood episodes per year

Question 7

Which of the following is the core component of Beck's cognitive theory of depression?

Accepted Answer

C. Dysfunctional belief

Answer

A. Cognitive distortions

Answer

B. Automatic thoughts

Answer

D. Introjection

Question 8

Rapid cycling is characterized by all of the following except?

Accepted Answer

Occurs commonly in men

Answer

Commonly associated with concomitant hypothyroidism

Answer

Antidepressants increase likelihood

Answer

At least 4 distinct episodes per year

Question 9

A 70-year-old woman with severe depression has not responded to multiple trials of antidepressants. What is the most appropriate next step?

Accepted Answer

Start electroconvulsive therapy

Answer

Increase the dose of the current antidepressant

Answer

Add an antipsychotic medication

Answer

Switch to a different class of antidepressant

Question 10

A 55-year-old female with major depressive disorder who has not responded to multiple antidepressant trials presents with significant cognitive impairment and vegetative symptoms. What is the next best treatment?

Accepted Answer

Start electroconvulsive therapy

Answer

Switch to an atypical antipsychotic

Answer

Add a benzodiazepine

Answer

Increase the dose of current antidepressant

Mood Disorders — MCQs

Mood Disorders — MCQs

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