Mood Disorders Practice Questions

Q: Which of the following statements about postpartum depression is false?

Symptoms resolve in 10-12 days. ***Symptoms resolve in 10-12 days*** - This statement is false because **postpartum depression (PPD)** symptoms typically last much longer, often for **several weeks to months**, and require intervention. - The resolution of symptoms within 10-12 days is characteristic of **postpartum blues**, a much milder and self-limiting condition. *Affects both sexes* - This statement is true because while more common in mothers, **paternal postpartum depression** is also a recognized condition. - Fathers can also experience significant depressive symptoms, often related to stress, lack of sleep, and changes in relationships. *SSRIs are effective* - This statement is true because **Selective Serotonin Reuptake Inhibitors (SSRIs)** are a first-line pharmacological treatment for postpartum depression. - SSRIs help regulate **neurotransmitter imbalances** associated with depression, with efficacy shown in numerous studies. *None of the above* - This option is incorrect because there is a false statement among the given choices, which is "Symptoms resolve in 10-12 days." - Therefore, this choice would only be correct if all other statements were true.

Q: What is the condition for which lithium is considered the treatment of choice?

Bipolar Disorder prophylaxis. ***Bipolar Disorder prophylaxis*** - Lithium is a **mood stabilizer** highly effective in preventing both manic and depressive episodes in patients with **bipolar disorder**. - Its long-term use significantly reduces the frequency and severity of relapses, thereby improving the **quality of life** for these patients. *Schizophrenia* - **Antipsychotic medications** are the primary treatment for schizophrenia, targeting positive and negative symptoms. - Lithium is not considered a first-line treatment for schizophrenia and is generally not effective in managing its core symptoms like **psychosis** and **thought disorganization**. *Acute mania management* - While lithium can be used to treat **acute mania**, it often has a slower onset of action compared to other agents like **antipsychotics** or **valproate**, which are often preferred for rapid symptom control. - For immediate stabilization of acute mania, faster-acting medications are usually initiated, with lithium being added later for prophylaxis. *Unipolar Major Depressive Disorder prophylaxis* - The primary treatment for **unipolar major depressive disorder** involves **antidepressants**, psychotherapy, or a combination of both. - While lithium can be used as an augmentation strategy for refractory depression, it is not considered the treatment of choice for primary prophylaxis of unipolar depression.

Q: Which of the following is a characteristic of mania?

High self esteem. ***High self esteem*** - **Elevated self-esteem** or **grandiosity** is a core symptom of mania, where individuals may believe they possess unique talents, abilities, or even divine connections. - This symptom contributes to an overall expansive and **euphoric mood**, characteristic of a manic episode. *Paranoid delusion* - **Paranoid delusions** are more characteristic of conditions like **schizophrenia** or **delusional disorder**, where individuals experience false beliefs of being persecuted or conspired against. - While psychotic features can occur in severe mania, **grandiosity** is more typical than paranoia. *Depressed mood* - A **depressed mood** is the hallmark of a **depressive episode**. - Mania, by definition, involves a distinct period of **abnormally and persistently elevated, expansive, or irritable mood**. *Loss of orientation* - **Loss of orientation** to time, place, or person is typically seen in conditions causing **cognitive impairment**, such as **dementia**, **delirium**, or severe organic brain disorders. - While severe mania can involve disorganized thinking, true **disorientation** is less common than in organically based cognitive disorders.

Q: Which of the following drugs is not given in acute mania?

Lamotrigine. ***Lamotrigine*** - Lamotrigine is primarily used for the **maintenance treatment of bipolar disorder** and is effective in preventing depressive episodes, but it has **limited efficacy in treating acute mania**. - Its **slow titration schedule** due to the risk of Stevens-Johnson syndrome makes it impractical for rapid symptomatic control in acute manic episodes. *Lithium* - **Lithium** is a first-line mood stabilizer used effectively in the **treatment of acute mania** as well as for continuation and maintenance therapy. - It helps to **reduce manic symptoms** such as hyperactivity, grandiosity, and irritability. *Valproate* - **Valproate** (Depakote) is an **anticonvulsant** commonly used as a mood stabilizer and is highly effective in the **treatment of acute mania**, especially in patients who do not respond to or tolerate lithium. - It acts more quickly than lithium in some cases and is also used for **maintenance treatment** in bipolar disorder. *Olanzapine* - **Olanzapine** is an atypical antipsychotic that is approved for the treatment of **acute mania** as both monotherapy and in combination with lithium or valproate. - It provides rapid symptomatic relief from acute manic symptoms, including **psychosis**, **agitation**, and **insomnia**.

Q: A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?

Postpartum blues. ***Postpartum blues*** - This condition presents with mild, transient symptoms like **tearfulness**, **mood swings**, and **insomnia** typically peaking around **4-5 days postpartum** and resolving within two weeks. - It is a very common, self-limiting condition impacting up to 80% of new mothers, attributed to drastic **hormonal shifts** post-delivery. *Postpartum depression* - Symptoms are similar to postpartum blues but are more **severe**, last longer (typically **beyond two weeks**), and significantly impair functioning. - It often includes feelings of **hopelessness**, pervasive sadness, loss of pleasure, and sometimes thoughts of harming oneself or the baby. *Postpartum psychosis* - This is a severe psychiatric emergency characterized by **hallucinations**, delusions, disorganized thinking, and bizarre behavior, usually within the first 2-3 weeks postpartum. - It is a rare condition requiring **urgent medical intervention** due to the high risk of harm to mother and baby. *Postpartum anxiety* - While anxiety can co-occur with postpartum blues or depression, primary postpartum anxiety specifically involves excessive and **uncontrollable worry** or fear, often about the baby's health or safety. - It does not typically present with the prominent **tearfulness** and **mood swings** characteristic of blues or depression.

Q: A patient with depressive symptoms for 6 months now presents with auditory hallucinations that started 2 weeks ago. What is the probable diagnosis of the condition?

Major depressive disorder with psychotic features. ***Major depressive disorder with psychotic features*** - The presence of **depressive symptoms for 6 months** as the predominant and longer-standing issue, followed by the emergence of **psychotic features (auditory hallucinations)** *only during the depressive episode*, aligns with this diagnosis. - In this condition, the psychotic symptoms occur exclusively in the context of a **major depressive episode**. *Schizoaffective disorder* - This disorder requires a period of **at least 2 weeks of psychotic symptoms** (like hallucinations or delusions) *in the absence of prominent mood symptoms*. - Here, the psychotic symptoms *co-occur with and are limited to the depressive episode*, so there is no separate period where only psychosis is present. *Bipolar disorder* - This diagnosis involves episodes of **mania or hypomania**, which are not described in the patient's presentation. - While psychotic features can occur during severe depressive or manic episodes in bipolar disorder, the primary mood symptoms presented are purely depressive. *Schizophrenia* - Schizophrenia is characterized by **prominent psychotic symptoms** (hallucinations, delusions, disorganized speech/behavior) for a significant portion of time, typically lasting at least 6 months, and its diagnosis requires a **lack of prominent mood episodes** existing for *most of the active phase*. - In this case, the **mood symptoms (depression) predate and are consistently present**, indicating a primary mood disorder focus.

Q: What is the term for a profound state of depression characterized by severe symptoms and a lack of identifiable cause?

Melancholia. ***Melancholia*** - **Melancholia** is the term specifically used to describe a profound, severe state of depression that arises **without an identifiable external cause** (historically called "endogenous depression"). - It is characterized by **loss of pleasure in all activities** (pervasive anhedonia), profound despondency, distinct biological features like **early morning awakening**, **psychomotor retardation**, **worse symptoms in the morning**, and **significant weight loss**. - In DSM-5, melancholia is a specifier for major depressive episodes, but the **term itself** refers to this specific severe, endogenous form of depression lacking clear precipitating factors. - This distinguishes it from reactive depression, which has identifiable life stressors or causes. *Major depressive disorder* - **Major Depressive Disorder (MDD)** is the broader diagnostic category that encompasses various forms of depression. - MDD can be **reactive** (with identifiable precipitating causes like life stressors) or **endogenous** (without clear external triggers). - While melancholic features represent a severe subtype of MDD, the question asks for the specific **term** describing profound depression **lacking identifiable cause**, which is melancholia. *Mania* - **Mania** is characterized by abnormally elevated, expansive, or irritable mood with increased energy and activity. - It is the opposite pole of depression and is a hallmark of **bipolar I disorder**, not a form of depression. *Schizophrenia* - **Schizophrenia** is a psychotic disorder characterized by **hallucinations**, **delusions**, and disorganized thinking. - While mood disturbances can occur in schizophrenia, it is not primarily a mood disorder and does not describe a profound state of depression.

Q: Which of the following is a common feature associated with mania?

Flights of ideas. ***Flights of ideas*** - A **flight of ideas** is characterized by a rapid, continuous, pressured flow of talk with abrupt changes from one topic to another, usually based on understandable associations or plays on words, which is a hallmark feature of **mania**. - This symptom reflects the accelerated thinking and heightened energy typical of a **manic episode**. *Neologism* - **Neologisms** are newly coined words or phrases, often without meaning to others, which are more commonly associated with thought disorders like **schizophrenia**. - While patients with mania can have pressured speech, the formation of nonsensical new words is not a primary or common feature of the condition. *Perseveration* - **Perseveration** involves the persistent repetition of a word, phrase, or gesture despite the absence of a stimulus or the appropriateness of the repetition, often seen in **cognitive disorders** or **schizophrenia**. - It differs from the rapidly shifting topics in a flight of ideas, where new thoughts are constantly being generated rather than a single thought being repeated. *Echolalia* - **Echolalia** is the automatic repetition of vocalizations made by another person, which is mainly observed in conditions such as **autism spectrum disorder** or **Tourette's syndrome**. - This symptom involves imitation rather than the spontaneous generation of accelerated speech and thoughts characteristic of mania.

Q: What is the core feature required for diagnosing a manic episode?

Elevated mood. ***Elevated mood*** - The **DSM-5 criteria** for a manic episode explicitly state that an abnormally and persistently **elevated, expansive, or irritable mood** must be present for at least one week. - This core mood disturbance is what differentiates mania from other psychiatric conditions and is a prerequisite for diagnosis. *Grandiosity* - While **grandiosity** (inflated self-esteem or sense of importance) is a common associated symptom of a manic episode, it is not the sole diagnostic requirement. - It is one of several symptom criteria that must be present in addition to the mood disturbance for a diagnosis of mania. *Decreased appetite* - **Decreased appetite** is generally not a feature of a manic episode; in fact, individuals in a manic state often have an **increased appetite** or engage in impulsive eating due to lack of inhibition. - A decreased appetite is more commonly associated with depressive episodes. *Increased sleep* - **Increased sleep** is contrary to the typical presentation of a manic episode, where individuals often experience a **decreased need for sleep** and can function on very little sleep, feeling energized. - A significant reduction in the need for sleep is a characteristic symptom of mania, not an increase.

Q: Cyclothymia is classified as which type of mood disorder?

Bipolar mood disorder. ***Bipolar mood disorder*** - **Cyclothymia (Cyclothymic Disorder)** is classified under **Bipolar and Related Disorders** in both DSM-5 and ICD-11, making it part of the bipolar spectrum. - It is characterized by **chronic, fluctuating mood disturbances** lasting at least 2 years (1 year in children/adolescents) with numerous periods of hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes. - The alternating, less severe mood swings share the fundamental **bipolar pattern** of mood elevation and depression, hence its classification under bipolar mood disorders. *Major depression* - **Major depressive disorder** is a unipolar mood disorder involving persistent feelings of sadness, loss of interest, and other depressive symptoms that significantly impair daily functioning, **without any episodes of mania or hypomania**. - Cyclothymia involves **mood instability with both elevated and depressed periods**, which distinguishes it from unipolar major depression. *Dysthymia* - **Dysthymia** (now termed **Persistent Depressive Disorder** in DSM-5) is characterized by chronic, low-grade depressive symptoms lasting at least 2 years, **without manic or hypomanic episodes**. - While both involve sub-threshold symptoms, cyclothymia includes periods of **hypomanic symptoms** (elevated mood, increased energy), which are absent in dysthymia. *Persistent mood disorder* - This is a broad, non-specific descriptive term rather than a formal diagnostic category in DSM-5 or ICD-11. - While cyclothymia is indeed a persistent condition, it is **specifically categorized under Bipolar and Related Disorders** due to the presence of both elevated (hypomanic) and depressed mood states.

Question 1

Which of the following statements about postpartum depression is false?

Accepted Answer

Symptoms resolve in 10-12 days

Answer

SSRIs are effective

Answer

Affects both sexes

Answer

None of the above

Question 2

What is the condition for which lithium is considered the treatment of choice?

Accepted Answer

Bipolar Disorder prophylaxis

Answer

Schizophrenia

Answer

Acute mania management

Answer

Unipolar Major Depressive Disorder prophylaxis

Question 3

Which of the following is a characteristic of mania?

Accepted Answer

High self esteem

Answer

Depressed mood

Answer

Paranoid delusion

Answer

Loss of orientation

Question 4

Which of the following drugs is not given in acute mania?

Accepted Answer

Lamotrigine

Answer

Valproate

Answer

Olanzapine

Answer

Lithium

Question 5

A woman, who is 4 days postpartum, presented with tearfulness, mood swings, and occasional insomnia. What is the likely diagnosis?

Accepted Answer

Postpartum blues

Answer

Postpartum depression

Answer

Postpartum psychosis

Answer

Postpartum anxiety

Question 6

A patient with depressive symptoms for 6 months now presents with auditory hallucinations that started 2 weeks ago. What is the probable diagnosis of the condition?

Accepted Answer

Major depressive disorder with psychotic features

Answer

Schizoaffective disorder

Answer

Bipolar disorder

Answer

Schizophrenia

Question 7

What is the term for a profound state of depression characterized by severe symptoms and a lack of identifiable cause?

Accepted Answer

Melancholia

Answer

Mania

Answer

Schizophrenia

Answer

Major depressive disorder

Question 8

Which of the following is a common feature associated with mania?

Accepted Answer

Flights of ideas

Answer

Neologism

Answer

Perseveration

Answer

Echolalia

Question 9

What is the core feature required for diagnosing a manic episode?

Accepted Answer

Elevated mood

Answer

Decreased appetite

Answer

Increased sleep

Answer

Grandiosity

Question 10

Cyclothymia is classified as which type of mood disorder?

Accepted Answer

Bipolar mood disorder

Answer

Major depression

Answer

Dysthymia

Answer

Persistent mood disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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