Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 341: Which disorder is characterized by periods of depression and hypomania?

A. Major Depressive Disorder
B. Cyclothymic Disorder
C. Bipolar I Disorder
D. Bipolar II Disorder (Correct Answer)

Explanation: ***Bipolar II Disorder*** - This disorder is defined by the presence of at least one major depressive episode and at least one **hypomanic episode**. - **Hypomania** involves elevated mood, increased energy, and decreased need for sleep, but it is less severe than mania and does not cause significant functional impairment or psychosis. *Major Depressive Disorder* - This disorder is characterized by one or more **major depressive episodes** without any history of manic or hypomanic episodes. - While it involves periods of depression, it does not include episodes of hypomania. *Cyclothymic Disorder* - This disorder involves chronic, fluctuating mood disturbances with numerous periods of **hypomanic symptoms** and numerous periods of **depressive symptoms** for at least two years. - The symptoms are milder than those seen in major depressive or hypomanic episodes and do not meet the full criteria for either. *Bipolar I Disorder* - This disorder is defined by the occurrence of at least one **manic episode**, which may be preceded or followed by hypomanic or major depressive episodes. - While it can include depressive periods, the hallmark is the presence of full-blown **mania**, not just hypomania.

Question 342: A 50-year-old male reports feeling persistently sad, hopeless, and experiencing a loss of interest in activities he once enjoyed for over a year. What is the most likely diagnosis?

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

Explanation: ***Dysthymia (Persistent Depressive Disorder)*** - This is the most appropriate diagnosis given the **chronic duration of over a year** with persistent depressive symptoms. - **Persistent Depressive Disorder (Dysthymia)** is characterized by **depressed mood for most of the day, for more days than not, for at least 2 years** in adults (1 year in children/adolescents). - The patient exhibits core symptoms: **persistent sadness, hopelessness, and anhedonia** without mention of distinct episodes or periods of remission. - While the symptoms described could meet criteria for MDD, the **continuous nature over more than a year** without episodic presentation points toward Persistent Depressive Disorder. - The vignette does not specify severe vegetative symptoms or acute functional impairment that would more strongly suggest an acute major depressive episode. *Major depressive disorder* - **MDD** involves a **distinct episode** of depressive symptoms lasting at least 2 weeks. - While MDD episodes can last longer, the diagnosis typically implies an **episodic course** rather than the chronic, continuous presentation described here. - The vignette's emphasis on "**over a year**" of persistent symptoms suggests a **chronic depressive disorder** rather than a major depressive episode. - If the patient had MDD lasting over a year, we would expect more specific information about severity, vegetative symptoms, or functional impairment. *Bipolar disorder* - **Bipolar disorder** requires a history of **manic** or **hypomanic** episodes in addition to depressive episodes. - There is no mention of elevated mood, decreased need for sleep, increased energy, grandiosity, or risk-taking behavior. - The absence of any manic or hypomanic features rules out this diagnosis. *Schizoaffective disorder* - **Schizoaffective disorder** requires both **mood symptoms** and **psychotic symptoms** (delusions, hallucinations) meeting criteria for schizophrenia. - The patient's presentation involves only mood symptoms with **no psychotic features** mentioned. - This diagnosis is not supported by the clinical information provided.

Question 343: A patient with chronic depression and a strong family history is likely to have an imbalance in which neurotransmitter?

A. Increased Dopamine
B. Increased Norepinephrine
C. Decreased GABA
D. Decreased Serotonin (Correct Answer)

Explanation: ***Decreased Serotonin*** - Chronic depression is strongly associated with a **dysregulation of serotonin** (5-HT) pathways in the brain. Many antidepressant medications (SSRIs) work by increasing serotonin availability. - A strong **family history** suggests a genetic predisposition to these neurotransmitter imbalances, with serotonin pathways being a common target for such vulnerabilities in mood disorders. *Increased Dopamine* - While dopamine is involved in mood regulation, **increased dopamine** is more commonly linked to conditions like psychosis or mania, not typically chronic depression. - Low dopamine levels can be associated with anhedonia and lack of motivation, but a primary increase is usually not implicated in depression. *Increased Norepinephrine* - **Increased norepinephrine** is often associated with anxiety, panic attacks, or manic states, rather than chronic depression. - Although norepinephrine plays a role in mood, a primary increase is not considered the core imbalance in typical depression. *Decreased GABA* - **Decreased GABA** (gamma-aminobutyric acid) is primarily linked to anxiety disorders and seizure disorders, due to its role as the brain's main inhibitory neurotransmitter. - While GABAergic system dysfunction can contribute to emotional dysregulation, it's not considered the primary neurotransmitter imbalance in chronic depression.

Question 344: What is the key difference between Bipolar I Disorder and Bipolar II Disorder?

A. Bipolar I involves full manic episodes, Bipolar II involves hypomanic episodes. (Correct Answer)
B. Bipolar I is characterized by more severe manic episodes than Bipolar II.
C. Bipolar II always includes more severe depressive episodes than Bipolar I.
D. Bipolar I requires manic episodes lasting at least 7 days, while Bipolar II requires hypomanic episodes lasting at least 4 days

Explanation: ***Bipolar I involves full manic episodes, Bipolar II involves hypomanic episodes.*** - Bipolar I Disorder is diagnosed when an individual experiences at least one episode of **full mania**, which can be severe, cause significant impairment, and may involve psychotic features. - Bipolar II Disorder is diagnosed when an individual experiences at least one **hypomanic episode** and at least one major depressive episode; hypomanic episodes are less severe than manic episodes and do not typically cause significant functional impairment or psychotic features. - This represents the **key diagnostic distinction** between the two disorders. *Bipolar I is characterized by more severe manic episodes than Bipolar II.* - This option is **misleading** because it incorrectly suggests that Bipolar II involves manic episodes (just milder ones). - Bipolar II does **not** involve manic episodes at all; it is characterized by **hypomanic episodes**, which are a distinct type of affective episode. - The difference is not just severity but the **qualitative nature** of the elevated mood episode. *Bipolar II always includes more severe depressive episodes than Bipolar I.* - This is a common misconception; while individuals with Bipolar II often experience significant and frequent depressive episodes, the severity of depression can vary widely in both disorders. - The defining difference lies in the **severity and type of the elevated mood episodes** (mania vs. hypomania), not necessarily the depressive episodes. - Depression severity is **not a reliable distinguishing feature** between these disorders. *Bipolar I requires manic episodes lasting at least 7 days, while Bipolar II requires hypomanic episodes lasting at least 4 days* - While this statement correctly describes the **duration criteria** per DSM-5 (mania ≥7 days, hypomania ≥4 days), it does not capture the **key difference** between the two disorders. - The crucial distinction is the **qualitative difference**: full mania involves severe impairment, possible hospitalization, and potential psychotic features, whereas hypomania is less severe without these features. - Duration alone is insufficient to distinguish the disorders; the **severity, impairment, and clinical features** are paramount.

Question 345: A 35-year-old male presents with episodes of intense euphoria, increased energy, and decreased need for sleep, followed by periods of severe depression. What is the most likely diagnosis?

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

Explanation: ***Bipolar disorder*** - The alternating episodes of **intense euphoria, increased energy, and decreased need for sleep** (manic or hypomanic symptoms) and **severe depression** are characteristic features of bipolar disorder. - This condition is defined by the presence of at least one manic or hypomanic episode, often accompanied by depressive episodes. *Major depressive disorder* - This disorder is characterized by **persistent sadness and anhedonia** but does not include episodes of elevated mood, increased energy, or decreased need for sleep. - While periods of severe depression are mentioned, the presence of euphoric and high-energy phases rules out major depressive disorder as the sole diagnosis. *Cyclothymic disorder* - Cyclothymia involves **chronic, fluctuating mood disturbances** with numerous periods of hypomanic and depressive symptoms, but these symptoms are less severe and do not meet the full criteria for manic, hypomanic, or major depressive episodes. - The description of "intense euphoria" and "severe depression" suggests a more pronounced presentation than typically seen in cyclothymic disorder. *Schizophrenia* - Schizophrenia is primarily characterized by **psychotic symptoms** such as hallucinations, delusions, disorganized thinking, and negative symptoms. - While mood disturbances can occur, they are not the primary feature, and the recurring pattern of distinct manic/hypomanic and depressive episodes is not characteristic of schizophrenia.

Question 346: A 28-year-old woman experiences persistent depressive symptoms, including low energy and feelings of hopelessness, for over 2 years. What is the most likely diagnosis?

A. Major depressive disorder
B. Persistent Depressive Disorder (Dysthymia) (Correct Answer)
C. Cyclothymia
D. Bipolar disorder

Explanation: ***Persistent Depressive Disorder (Dysthymia)*** - Also known as **persistent depressive disorder**, dysthymia is characterized by **chronic depressive symptoms** lasting for at least **two years** in adults. - The symptoms are persistent but generally **less severe** than those seen in major depressive disorder. - This is the correct diagnosis given the presentation of depressive symptoms persisting for over 2 years. *Major depressive disorder* - Requires symptoms to be present for a minimum of **two weeks**. - The symptoms are typically more **severe** and debilitating, often including vegetative symptoms (e.g., significant weight change, insomnia/hypersomnia). - While this patient has depressive symptoms, the chronic nature over 2 years without mention of distinct episodes suggests persistent depressive disorder rather than MDD. *Cyclothymia* - Characterized by **numerous periods of hypomanic symptoms** and **numerous periods of depressive symptoms** that do not meet criteria for a major depressive episode, lasting for at least two years. - This patient's symptoms are consistently depressive without any mention of hypomanic episodes. *Bipolar disorder* - Involves alternating episodes of **major depression** and **mania** or **hypomania**. - The patient's presentation of persistent depressive symptoms over an extended period without any mention of elevated or irritable moods makes bipolar disorder unlikely.

Question 347: A 30-year-old woman presents with episodes of extreme euphoria, decreased need for sleep, and hyperactivity lasting for at least one week. What is the most likely diagnosis?

A. Major Depressive Disorder
B. Bipolar I Disorder (Correct Answer)
C. Bipolar II Disorder
D. Cyclothymic Disorder

Explanation: ***Bipolar I Disorder*** - The patient's presentation with episodes of extreme **euphoria**, **decreased need for sleep**, and **hyperactivity** lasting for at least one week are classic features of a **manic episode**. - According to DSM-5 criteria, the presence of at least one **manic episode** is sufficient for a diagnosis of Bipolar I Disorder. *Major Depressive Disorder* - This diagnosis involves persistent **depressed mood** or **loss of pleasure**, with symptoms lasting at least two weeks. - It does not involve episodes of **euphoria** or **manic symptoms**. *Bipolar II Disorder* - This disorder is characterized by at least one episode of **hypomania** and at least one **major depressive episode**. - **Hypomanic episodes** are less severe than manic episodes, do not cause significant functional impairment, and typically last for a shorter duration (at least 4 consecutive days, but less than a week). The described symptoms are of extreme euphoria and hyperactivity, pointing to mania. *Cyclothymic Disorder* - This disorder involves chronic, fluctuating moods with numerous periods of **hypomanic symptoms** and numerous periods of **depressive symptoms** for at least 2 years. - The symptoms are less severe and do not meet the full criteria for either a hypomanic or a major depressive episode.

Question 348: A 50-year-old female with bipolar disorder presents with severe euphoric mania. What is the first-line treatment?

A. Lithium (Correct Answer)
B. Carbamazepine
C. Valproate
D. Lamotrigine

Explanation: ***Lithium*** - **Lithium** is considered **first-line** for the treatment of **acute mania** and for **long-term maintenance** in bipolar disorder, especially for classic euphoric mania. - Its efficacy in stabilizing mood, reducing the frequency and severity of episodes, and decreasing suicidality is well-established. *Carbamazepine* - While effective in treating acute mania, **carbamazepine** is generally considered a **second-line agent** or an alternative for rapid cycling or mixed features rather than first-line. - It carries risks of side effects such as **aplastic anemia** and **agranulocytosis**, requiring close monitoring. *Valproate* - **Valproate (valproic acid)** is a widely used and effective treatment for acute mania, especially in patients with **rapid cycling**, mixed states, or who are unable to tolerate lithium. - However, **lithium** is often preferred as a first-line agent particularly for classic euphoric mania due to its comprehensive efficacy profile and established safety for long-term use with appropriate monitoring. *Lamotrigine* - **Lamotrigine** is primarily used for the **maintenance treatment of bipolar depression** and is **not effective for acute manic episodes**. - Initiating lamotrigine requires a **slow titration** due to the risk of **Stevens-Johnson syndrome**, making it unsuitable for acute management of severe mania.

Question 349: A 25-year-old woman has a 5-year history of cyclic mood changes, with periods of mild depression and hypomania. These symptoms do not meet the criteria for major depressive or manic episodes. What is the most likely diagnosis?

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

Explanation: ***Cyclothymic disorder*** - This disorder is characterized by a **chronic course of cyclic mood disturbances** that involve numerous periods of both hypomanic and depressive symptoms, which are not severe enough to meet the criteria for a full manic episode or a major depressive episode. - The duration of 5 years in this 25-year-old woman, coupled with the description of **mild depression and hypomania** that do not fully meet criteria for major episodes, aligns perfectly with the diagnostic criteria for cyclothymic disorder (at least two years in adults, with symptoms present for at least half the time and no more than two consecutive symptom-free months). *Major depressive disorder* - This diagnosis requires the presence of **one or more major depressive episodes**, characterized by at least two weeks of significantly depressed mood or anhedonia along with other specified symptoms causing significant distress or impairment. - While periods of mild depression are mentioned, the patient also experiences hypomania, and the depressive symptoms are specifically stated as not meeting criteria for a major depressive episode, ruling out MDD as the primary diagnosis. *Bipolar I disorder* - Bipolar I disorder is defined by the occurrence of **at least one manic episode**, which is a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy, lasting at least one week. - The patient's symptoms are described as **hypomania**, which is a less severe form of mania and does not meet the full criteria for a manic episode, thereby ruling out Bipolar I disorder. *Persistent depressive disorder* - Previously known as dysthymia, this disorder involves a **chronic depressed mood** that has lasted for at least two years, along with at least two other depressive symptoms, but often lacks the severity and pervasive nature of a major depressive episode. - This diagnosis does not account for the **periods of hypomania** that the patient experiences, which are a key feature of her cyclic mood changes.

Question 350: A 50-year-old female presents with persistent depressive disorder and has not responded to SSRIs. What is the next best treatment option?

A. Switch to a tricyclic antidepressant as the next treatment option (Correct Answer)
B. Add an antipsychotic medication to the treatment
C. Start electroconvulsive therapy for treatment
D. Switch to a monoamine oxidase inhibitor for treatment

Explanation: ***Switch to a tricyclic antidepressant as the next treatment option*** - This patient has **persistent depressive disorder (PDD/dysthymia)** that has **not responded to SSRIs**, requiring a change in medication strategy. - After failure of one SSRI in PDD, the **next appropriate step** is to switch to a different antidepressant class rather than immediately adding augmentation agents. - **Tricyclic antidepressants (TCAs)** such as imipramine or amitriptyline have **good efficacy in PDD** and are evidence-based options after SSRI failure. - While TCAs have more side effects than SSRIs, they are **appropriate second-line agents** and can be effective when SSRIs have failed. *Add an antipsychotic medication to the treatment* - **Antipsychotic augmentation** (with aripiprazole or quetiapine) is used in treatment-resistant **major depressive disorder**, typically after failure of **multiple antidepressant trials** (not just one SSRI). - This strategy is **premature** as a next step after single SSRI failure in PDD - switching to another antidepressant class should be tried first. - Augmentation with antipsychotics is more appropriate for MDD with inadequate response to adequate trials of 2-3 antidepressants, or when psychotic features are present. *Start electroconvulsive therapy for treatment* - **ECT** is a highly effective treatment for severe depression, especially in cases with **psychotic features**, severe suicidality, or when rapid response is needed. - It is typically reserved for cases that have failed **multiple pharmacotherapy trials** and augmentation strategies, or where the patient's condition is life-threatening. - Starting ECT after failure of just one SSRI would be **premature and excessive** for PDD without life-threatening features. *Switch to a monoamine oxidase inhibitor for treatment* - **MAOIs** are effective antidepressants but require strict **dietary restrictions** (tyramine-free diet) to prevent hypertensive crises and have numerous drug-drug interactions. - Due to these complications and safety concerns, they are usually **reserved for cases** that have failed several other antidepressant classes. - While effective, MAOIs are not the preferred next step after single SSRI failure when other safer options (TCAs, SNRIs, bupropion) are available.

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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