Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 331: A 35-year-old woman experiences periods of excessive energy, a decreased need for sleep, and increased goal-directed activity, followed by episodes of depression. What is the most likely diagnosis?

A. Major depressive disorder
B. Schizoaffective disorder
C. Bipolar disorder (Correct Answer)
D. Cyclothymic disorder

Explanation: ***Bipolar disorder*** - The combination of **manic symptoms** (excessive energy, decreased need for sleep, increased goal-directed activity) and **depressive episodes** is the hallmark of bipolar disorder. - This pattern of alternating mood states, specifically distinct episodes of **mania/hypomania** and **major depression**, distinguishes it from other mood disorders. *Major depressive disorder* - This diagnosis is characterized solely by **recurrent depressive episodes** without any history of manic or hypomanic episodes. - The presence of periods of **excessive energy** and decreased need for sleep rules out a diagnosis of unipolar major depressive disorder. *Schizoaffective disorder* - This disorder involves a concurrent presentation of a **mood episode** (manic or depressive) and **schizophrenia symptoms** (e.g., delusions, hallucinations) for at least two weeks in the absence of a prominent mood episode. - The patient's presentation primarily focuses on mood symptoms without mention of significant psychotic features independent of mood. *Cyclothymic disorder* - Cyclothymic disorder involves chronic, fluctuating mood disturbances with numerous periods of **hypomanic symptoms** and numerous periods of **depressive symptoms**, none of which meet criteria for a full manic, hypomanic, or major depressive episode. - The description of distinct periods of "excessive energy" and "episodes of depression" suggests full manic or depressive episodes, which are more severe than the symptoms seen in cyclothymia.

Question 332: A 30-year-old female with a history of bipolar disorder presents with symptoms of acute mania. She is currently on lithium with therapeutic serum levels (0.8 mEq/L). What additional medication should be considered?

A. Consider adding valproate (Correct Answer)
B. Consider switching to carbamazepine
C. Consider increasing lithium dose with monitoring
D. Consider discontinuing lithium

Explanation: ***Consider adding valproate*** - For acute mania that is not responding adequately to lithium monotherapy, **adding an antipsychotic or another mood stabilizer like valproate** is a common and effective strategy. - Valproate is particularly useful for **mixed episodes** and rapid cycling, but also effective for acute manic episodes. *Consider switching to carbamazepine* - While **carbamazepine** is an alternative mood stabilizer, switching from lithium would mean abandoning an agent that might still have some efficacy or therapeutic potential, especially if the patient previously responded well. - Adding a second agent rather than switching is generally preferred to address acute manic symptoms when monotherapy is insufficient. *Consider increasing lithium dose with monitoring* - The question implies the patient is already on lithium and experiencing breakthrough manic symptoms, suggesting the current dose or monotherapy is insufficient. **Increasing the lithium dose** might be considered, but only after checking current lithium levels to ensure they are subtherapeutic and within a safe range for upward titration. - **Lithium has a narrow therapeutic index**, and increasing the dose without careful monitoring could lead to toxicity. *Consider discontinuing lithium* - **Discontinuing lithium** would remove the existing mood stabilization and potentially worsen the manic symptoms or precipitate a more severe episode, especially given the patient's history of bipolar disorder. - Abrupt discontinuation of mood stabilizers is generally avoided due to the **risk of relapse**.

Question 333: A 19-year-old male with a history of bipolar disorder presents with elevated mood, increased energy, and decreased need for sleep for the past week. Which medication is most appropriate for acute management?

A. Lithium
B. Fluoxetine
C. Olanzapine (Correct Answer)
D. Valproate

Explanation: ***Olanzapine*** - **Second-generation antipsychotics** (SGAs) like olanzapine are **first-line agents** for the **acute management of manic episodes**, particularly when there is severe agitation or psychotic features. - Olanzapine provides **rapid control of agitation and behavioral symptoms**, often showing improvement within 24-48 hours, which is crucial in an acute setting. - SGAs are particularly useful when **immediate sedation** and symptom control are needed. *Lithium* - **Lithium** is a highly effective **mood stabilizer** for bipolar disorder and is considered a first-line maintenance agent. - However, its therapeutic effects for acute mania take **1-2 weeks** to fully manifest, making it less ideal for immediate acute symptom control. - It also requires careful **monitoring of blood levels** due to a narrow therapeutic window and potential for toxicity. *Fluoxetine* - **Fluoxetine** is an **antidepressant (SSRI)** and is **contraindicated as monotherapy** in acute mania due to the high risk of **inducing or worsening manic symptoms**. - While it can be used cautiously in combination with a mood stabilizer for bipolar depression, it is inappropriate and potentially harmful for acute mania. *Valproate* - **Valproate** is also a **first-line agent** for acute mania and is equally effective as SGAs in many cases, with onset of antimanic effects typically within **4-5 days**. - In this clinical scenario, **olanzapine may be slightly preferred** due to more rapid initial control of agitation and behavioral symptoms in the first 24-48 hours, which is important for acute management. - Valproate is an excellent choice, particularly for less severe mania or when antipsychotic side effects are a concern.

Question 334: A 30-year-old male is brought to the emergency department after an episode of violent behavior. He reports feeling euphoric, experiencing racing thoughts, and having a decreased need for sleep over the past week. What is the most likely diagnosis?

A. Major depressive disorder
B. Schizophrenia
C. Bipolar disorder (Correct Answer)
D. Generalized anxiety disorder

Explanation: ***Bipolar disorder*** - The combination of **euphoria**, **racing thoughts**, **decreased need for sleep**, and **violent behavior** is characteristic of a manic episode, which is central to **bipolar disorder**. - **Manic episodes** involve a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy. *Major depressive disorder* - This disorder is characterized by a persistent feeling of **sadness** and **loss of interest** or pleasure in daily activities. - While it can involve **irritability**, it does not typically present with **euphoria**, **racing thoughts**, or **decreased need for sleep** as primary or prominent symptoms. *Schizophrenia* - Schizophrenia is characterized by **psychotic symptoms** such as **hallucinations**, **delusions**, **disorganized speech**, and **negative symptoms** like avolition or alogia. - Although there can be a **mood component**, the primary presentation of **euphoria** and **racing thoughts** along with reduced sleep specifically points away from schizophrenia as the most likely diagnosis. *Generalized anxiety disorder* - This disorder is characterized by **excessive worry** and **anxiety** about various events or activities, often accompanied by physical symptoms like restlessness and muscle tension. - It does not typically involve **euphoria**, **racing thoughts**, or significant **decreased need for sleep** as prominent features.

Question 335: A 35-year-old woman with a history of depressive episodes presents with hyperactivity, rapid speech, and a decreased need for sleep lasting for one week. What is the diagnosis?

A. Major depressive disorder
B. Bipolar I disorder (Correct Answer)
C. Bipolar II disorder
D. Cyclothymia

Explanation: ***Bipolar I disorder*** - The presence of a **manic episode**, characterized by hyperactivity, rapid speech, and decreased need for sleep lasting for at least one week, is diagnostic of **Bipolar I Disorder**. - A history of depressive episodes, along with the current manic symptoms, further supports this diagnosis, fitting the criteria for Bipolar I. *Major depressive disorder* - This disorder is characterized by persistent **depressed mood** and/or loss of interest or pleasure, along with other symptoms like changes in sleep, appetite, or energy. - It does not involve the presence of **manic or hypomanic episodes**, which are key features in the presented case. *Bipolar II disorder* - Bipolar II disorder involves at least one **hypomanic episode** (less severe and shorter duration than a manic episode) and at least one major depressive episode. - The symptoms described (hyperactivity, rapid speech, decreased need for sleep) are suggestive of a **full manic episode** due to their intensity and one-week duration, thus ruling out hypomania. *Cyclothymia* - Cyclothymia is characterized by numerous periods of **hypomanic symptoms** and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode. - The described symptoms meet the criteria for a **manic episode**, which is more severe than hypomanic symptoms and is not seen in cyclothymia.

Question 336: A 22-year-old woman presents with a 2-week history of low mood, anhedonia, and suicidal ideation. She has a history of major depressive disorder. What is the most appropriate initial treatment?

A. Start an SSRI
B. Start a benzodiazepine
C. Admit to the hospital (Correct Answer)
D. Start cognitive-behavioral therapy

Explanation: ***Admit to the hospital*** - The presence of **suicidal ideation** in a patient with a history of major depressive disorder is a critical indicator for **immediate hospitalization** to ensure safety and prevent self-harm. - Inpatient care allows for close monitoring, a structured environment, and urgent initiation of treatment in a crisis situation. *Start an SSRI* - While **SSRIs (Selective Serotonin Reuptake Inhibitors)** are a first-line treatment for major depressive disorder, starting them initially without addressing the immediate danger of **suicidal ideation** is inappropriate due to the delayed onset of action and potential initial worsening of symptoms. - The patient's safety must be secured before outpatient pharmacological management is initiated, as SSRIs can take several weeks to show full therapeutic effects. *Start a benzodiazepine* - **Benzodiazepines** can reduce anxiety and agitation, but they do not treat the underlying depressive disorder or the risk of **suicidal ideation**. - Their use for depression and suicidality is limited due to the potential for dependence, abuse, and masking of underlying symptoms, and they are not a primary treatment for severe depression with suicidal ideation. *Start cognitive-behavioral therapy* - **Cognitive-behavioral therapy (CBT)** is an effective psychotherapy for major depressive disorder, but it is not an appropriate initial intervention when **suicidal ideation** is present due to the urgent need for safety and stabilization. - CBT requires active participation and consistent engagement over time, which may not be feasible or safe for a patient in acute crisis with high suicidal risk.

Question 337: A 40-year-old woman with a history of bipolar disorder presents with increased energy, decreased need for sleep, and grandiose ideas. She has been taking lithium for several years. What is the most appropriate management?

A. Add an atypical antipsychotic (Correct Answer)
B. Increase the lithium dose
C. Switch to valproate
D. Discontinue lithium

Explanation: ***Add an atypical antipsychotic*** - The patient is experiencing a **manic episode** despite being on long-term lithium, indicating **breakthrough symptoms**. - Adding an **atypical antipsychotic** like olanzapine, quetiapine, or risperidone is an effective strategy for acute mania in patients already on a mood stabilizer. *Increase the lithium dose* - While adjusting lithium levels might be considered, simply increasing the dose may not be sufficient for an acute manic episode, especially if the patient is already at a therapeutic or near-therapeutic level. - Higher doses also carry an increased risk of **lithium toxicity**. *Switch to valproate* - Switching medications abruptly can destabilize the patient further, especially if lithium has been partially effective for a long period. - Adding an additional agent rather than switching is generally preferred for breakthrough symptoms to avoid a period of being unmedicated or inadequately medicated. *Discontinue lithium* - Discontinuing lithium can lead to a **rebound manic episode** or worsening of current symptoms, as it is an effective mood stabilizer. - It would be inappropriate to remove a medication that has been part of a long-term maintenance regimen during an acute exacerbation.

Question 338: A 60-year-old woman complains of sadness, lack of interest in activities, and feelings of worthlessness. She also experiences difficulty concentrating, as well as changes in appetite and sleep patterns. What is the most likely diagnosis?

A. Major depressive disorder (Correct Answer)
B. Schizophrenia
C. Generalized anxiety disorder
D. Bipolar disorder

Explanation: ***Major depressive disorder*** - The patient exhibits classic symptoms of **major depressive disorder**, including **sadness**, **anhedonia** (lack of interest), feelings of **worthlessness**, difficulties with **concentration**, and significant changes in **appetite and sleep patterns**. These symptoms collectively meet the diagnostic criteria. - The duration and pervasiveness of these symptoms, coupled with their impact on functioning, are characteristic of a depressive episode. *Bipolar disorder* - While depression can be a feature of bipolar disorder, there is no mention of **manic or hypomanic episodes**, which are essential for this diagnosis. - The clinical picture provided exclusively details depressive symptoms, without the alternating mood states indicative of bipolar disorder. *Schizophrenia* - **Schizophrenia** is characterized by **psychotic symptoms** such as **hallucinations, delusions, disorganized thought, and negative symptoms**, none of which are described in this patient's presentation. - The patient's symptoms are primarily mood-related, rather than reflecting a thought disorder. *Generalized anxiety disorder* - **Generalized anxiety disorder (GAD)** involves **excessive, uncontrollable worry** about multiple events or activities, often accompanied by physical symptoms like muscle tension and restlessness. - While anxiety can co-occur with depression, the primary and most prominent symptoms described here are those of depression, such as anhedonia and feelings of worthlessness, rather than overwhelming worry.

Question 339: A 65-year-old man with a history of depression presents with memory loss, weight loss, and sleep disturbances. He believes he is responsible for a tragic accident that occurred years ago. What is the most likely diagnosis?

A. Schizophrenia
B. Delusional disorder
C. Major depressive disorder with psychotic features (Correct Answer)
D. Bipolar disorder

Explanation: ***Major depressive disorder with psychotic features*** - This diagnosis is indicated by the patient's **depression history**, **memory loss**, **weight loss**, and **sleep disturbances**, combined with a **delusion of guilt** (belief in being responsible for an accident). - The presence of **psychotic features**, specifically delusions congruent with the depressive mood, points to this particular subtype of major depressive disorder. *Schizophrenia* - Schizophrenia typically involves **disorganized thought processes**, **hallucinations**, and negative symptoms, which are not explicitly described here. - While delusions are present, they are focused on guilt and align with depressive themes, rather than the often bizarre or non-mood-congruent delusions seen in schizophrenia. *Delusional disorder* - Delusional disorder is characterized by **non-bizarre delusions** that persist for at least one month, without other prominent psychotic symptoms or significant impairment in functioning. - The patient's presentation includes significant depressive symptoms, weight loss, and memory loss, which are not typical for delusional disorder, where functioning is relatively preserved outside of the delusion. *Bipolar disorder* - Bipolar disorder involves distinct periods of **mania or hypomania** alternating with depressive episodes. - While the patient exhibits depressive symptoms, there is no mention of manic or hypomanic episodes, which are essential for a bipolar diagnosis.

Question 340: What is the long-term treatment for a patient with Bipolar I disorder who experiences both mania and depression?

A. CBT
B. Lithium (Correct Answer)
C. Benzodiazepines (BZDs)
D. Selective Serotonin Reuptake Inhibitors (SSRIs)

Explanation: ***Lithium*** - **Lithium** is a **mood stabilizer** and is considered a first-line long-term treatment for **Bipolar I disorder**, effectively managing both manic and depressive episodes. - It helps in preventing the recurrence of episodes and reducing their severity, thereby maintaining **mood stability**. *Selective Serotonin Reuptake Inhibitors (SSRIs)* - While SSRIs are used for depression, their use in bipolar disorder, especially as monotherapy, can induce **mania** or **rapid cycling**. - They are generally avoided for long-term treatment in bipolar disorder unless carefully combined with a **mood stabilizer**. *CBT* - **Cognitive Behavioral Therapy (CBT)** is an important **adjunctive therapy** for bipolar disorder, helping patients develop coping strategies and improve functional outcomes. - However, CBT alone is not sufficient as a primary long-term treatment to manage the biological and cyclical nature of **mood episodes** in Bipolar I disorder. *Benzodiazepines (BZDs)* - **Benzodiazepines** are generally used for short-term management of acute symptoms, such as severe **agitation**, **insomnia**, or **anxiety**, during a manic episode. - They are not suitable for **long-term treatment** due to risks of tolerance, dependence, and potential for withdrawal symptoms.

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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