Mood Disorders Practice Questions

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

Bipolar II Disorder. ***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.

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

Decreased Serotonin. ***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.

Q: 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?

Persistent Depressive Disorder (Dysthymia). ***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.

Q: 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?

Bipolar I Disorder. ***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.

Q: 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?

Bipolar disorder. ***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.

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

Lithium. ***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 1

Which disorder is characterized by periods of depression and hypomania?

Accepted Answer

Bipolar II Disorder

Answer

Major Depressive Disorder

Answer

Cyclothymic Disorder

Answer

Bipolar I Disorder

Question 2

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?

Accepted Answer

Dysthymia

Answer

Bipolar disorder

Answer

Major depressive disorder

Answer

Schizoaffective disorder

Question 3

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

Accepted Answer

Decreased Serotonin

Answer

Increased Dopamine

Answer

Increased Norepinephrine

Answer

Decreased GABA

Question 4

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

Accepted Answer

Bipolar I involves full manic episodes, Bipolar II involves hypomanic episodes.

Answer

Bipolar I is characterized by more severe manic episodes than Bipolar II.

Answer

Bipolar II always includes more severe depressive episodes than Bipolar I.

Answer

Bipolar I requires manic episodes lasting at least 7 days, while Bipolar II requires hypomanic episodes lasting at least 4 days

Question 5

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?

Accepted Answer

Persistent Depressive Disorder (Dysthymia)

Answer

Major depressive disorder

Answer

Cyclothymia

Answer

Bipolar disorder

Question 6

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?

Accepted Answer

Bipolar I Disorder

Answer

Major Depressive Disorder

Answer

Bipolar II Disorder

Answer

Cyclothymic Disorder

Question 7

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?

Accepted Answer

Bipolar disorder

Answer

Major depressive disorder

Answer

Cyclothymic disorder

Answer

Schizophrenia

Question 8

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

Accepted Answer

Lithium

Answer

Carbamazepine

Answer

Valproate

Answer

Lamotrigine

Question 9

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?

Accepted Answer

Cyclothymic disorder

Answer

Major depressive disorder

Answer

Bipolar I disorder

Answer

Persistent depressive disorder

Question 10

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

Accepted Answer

Switch to a tricyclic antidepressant as the next treatment option

Answer

Add an antipsychotic medication to the treatment

Answer

Start electroconvulsive therapy for treatment

Answer

Switch to a monoamine oxidase inhibitor for treatment

Mood Disorders — MCQs

Mood Disorders — MCQs

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