Mood Disorders — MCQs

A 50-year-old man has presented with a 2-month history of back pain, lack of interest in recreational activities, low mood, lethargy, decreased sleep, and appetite. There is no evidence of delusions or hallucinations, and he has no chronic medical illness or family history of psychiatric illness. Routine investigations, including hemogram, renal function tests, liver function tests, and electrocardiogram, did not reveal any abnormalities. This patient should be treated with:

Q377

Which of the following mental health disorders is most commonly associated with suicidal tendencies?

Q378

Which of the following is NOT true about major depressive disorder?

Q379

A 30-year-old male was brought for evaluation, with a history of his 3-year-old son's death, 5 months prior, following a car accident. At the time of the accident, the patient was a witness. Since then, he has experienced symptoms of sadness, crying spells, feelings of hopelessness, poor sleep, and poor appetite. He has had suicidal thoughts on two occasions, but has not acted on them. He has not been attending work for the past 5 months. What is the likely diagnosis?

Q380

A 30-year-old female with depressed mood, decreased appetite, and no interest for one year. What is the diagnosis?

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 371: Which of the following is not a common symptom of depression?

A. Hopelessness
B. Delusion of nihilism
C. Complete anhedonia
D. Delusion of persecution (Correct Answer)

Explanation: ***Delusion of persecution*** - While psychotic features can occur in severe depression, **delusions of persecution** are more commonly associated with **schizophrenia** or **paranoid disorders**. - Depression-related delusions are often **mood-congruent**, such as worthlessness, guilt, or nihilism, rather than being targeted or persecutory. *Hopelessness* - **Hopelessness** about the future is a classic and core symptom of major depressive disorder, often impacting motivation and increasing suicide risk. - It reflects a pervasive negative outlook and belief that things will not improve. *Delusion of nihilism* - **Delusions of nihilism**, such as believing one's body is decaying or that the world no longer exists, are **mood-congruent psychotic features** that can occur in severe depression. - This symptom is particularly seen in conditions like **Cotard's syndrome**, a rare depressive manifestation. *Complete anhedonia* - **Anhedonia**, the inability to experience pleasure, is a cardinal symptom of depression and can be pervasive across all activities. - While complete anhedonia is severe, it is a recognized and common feature, indicating a profound loss of interest and enjoyment.

Question 372: Disturbances in sleep due to depression are associated with which of the following?

A. Occasional vivid dreams
B. Changes in REM sleep architecture
C. Decreased REM (rapid eye movement) latency (Correct Answer)
D. Insomnia and fragmented sleep

Explanation: ***Decreased REM (rapid eye movement) latency*** - **Decreased REM latency** (shortened time from sleep onset to first REM period, typically <60 minutes vs normal ~90 minutes) is the **most specific and well-established polysomnographic finding** in major depressive disorder. - This neurobiological marker reflects dysregulation of sleep architecture and is used as a **biological marker** in depression research. - Other REM changes include **increased REM density** (more rapid eye movements per REM period) and **prolonged first REM period**. *Changes in REM sleep architecture* - While this statement is technically correct (decreased REM latency is a change in REM architecture), it is **too broad and non-specific**. - This option lacks the precision needed for a clinical diagnosis, as many psychiatric and medical conditions alter REM architecture. - The question asks for the specific disturbance most associated with depression, making **decreased REM latency** the superior answer. *Occasional vivid dreams* - Vivid dreams are **not a characteristic or diagnostic feature** of depression-related sleep disturbance. - More commonly associated with **REM rebound** (after REM suppression), **narcolepsy**, **PTSD**, or certain medications (e.g., beta-blockers, antidepressants). *Insomnia and fragmented sleep* - While **early morning awakening** (terminal insomnia), difficulty maintaining sleep, and fragmented sleep are common clinical symptoms of depression, they are **non-specific**. - These symptoms occur in many conditions and describe subjective sleep quality rather than the **objective neurophysiological marker** that decreased REM latency represents.

Question 373: Which of the following is not a typical feature of depression?

A. Loss of interest in activities
B. Increased energy (Correct Answer)
C. Suicidal thoughts
D. Persistent sadness

Explanation: ***Increased energy*** - **Increased energy** is not a typical symptom of depression; rather, individuals with depression commonly experience **fatigue** and **loss of energy**. - This symptom is more characteristic of conditions like **mania** or **hypomania**, which are phases of bipolar disorder. *Loss of interest in activities* - **Anhedonia**, or the loss of interest or pleasure in nearly all activities, is a **core diagnostic criterion** for depression. - Patients often report that things they once enjoyed no longer bring them joy or satisfaction. *Suicidal thoughts* - **Suicidal ideation**, ranging from thoughts of death to specific plans, is a serious and common symptom of depression. - It reflects the intense emotional pain and hopelessness experienced by individuals with severe depression. *Persistent sadness* - **Persistent sadness** or a depressed mood is another **core diagnostic feature** of major depressive disorder. - This sadness is often pervasive and may not lift even with positive life events.

Question 374: Which of the following is a characteristic of Bipolar II disorder?

A. Dysthymia
B. Major depression and hypomania (Correct Answer)
C. Single manic episode
D. Cyclothymic disorder

Explanation: ***Major depression and hypomania*** - Bipolar II disorder is characterized by the occurrence of at least one **major depressive episode** and at least one **hypomanic episode**. - Crucially, it does not involve full-blown **manic or mixed episodes**. *Dysthymia* - **Dysthymia**, or persistent depressive disorder, involves chronic low-grade depression lasting at least two years, but without manic or hypomanic symptoms. - It is a form of depression and does not include the characteristic mood elevations seen in bipolar disorders. *Single manic episode* - A single manic episode is characteristic of **Bipolar I disorder**, which involves at least one manic episode, with or without previous depressive or hypomanic episodes. - Bipolar II disorder specifically excludes the presence of a **manic episode**. *Cyclothymic disorder* - **Cyclothymic disorder** involves numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode. - It is a milder but chronic form of bipolar spectrum disorder, distinct from the full major depressive and hypomanic episodes of Bipolar II.

Question 375: What deficiency may contribute to relapse in a patient who has experienced remission with selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants (TCAs)?

A. Pyridoxine
B. Cobalamin
C. Ascorbate
D. Folate (Correct Answer)

Explanation: ***Folate*** - **Folate (vitamin B9) deficiency** is strongly linked to depression and is a well-established cause of relapse in patients treated with antidepressants. - Folate plays a crucial role in the **one-carbon metabolism pathway**, which is essential for the synthesis of monoamine neurotransmitters including **serotonin, norepinephrine, and dopamine**. - Studies show that **low folate levels** are associated with poor response to SSRIs and TCAs, and folate supplementation can improve antidepressant efficacy. - Approximately **30% of depressed patients** have folate deficiency, making it a clinically significant factor in treatment resistance and relapse. *Cobalamin* - **Cobalamin (vitamin B12)** deficiency can cause neuropsychiatric symptoms including depression and cognitive impairment. - While B12 is important for myelin formation and neurotransmitter synthesis, it is less specifically implicated in antidepressant relapse compared to folate. - B12 deficiency more commonly presents with **cognitive and neurological symptoms** rather than pure mood symptoms. *Pyridoxine* - **Pyridoxine (vitamin B6)** is a cofactor in neurotransmitter synthesis, including serotonin and dopamine. - While B6 deficiency can contribute to mood disturbances, it is not commonly implicated as a primary cause of relapse in antidepressant-treated depression. *Ascorbate* - **Ascorbate (vitamin C)** is an antioxidant with some role in neurotransmitter metabolism. - Severe vitamin C deficiency (scurvy) can have psychiatric manifestations, but it is not typically associated with relapse in patients treated with SSRIs or TCAs.

Question 376: A 50-year-old man has presented with a 2-month history of back pain, lack of interest in recreational activities, low mood, lethargy, decreased sleep, and appetite. There is no evidence of delusions or hallucinations, and he has no chronic medical illness or family history of psychiatric illness. Routine investigations, including hemogram, renal function tests, liver function tests, and electrocardiogram, did not reveal any abnormalities. This patient should be treated with:

A. Sertraline (Correct Answer)
B. Alprazolam
C. Olanzapine
D. Haloperidol

Explanation: ***Sertraline*** - The patient's symptoms (back pain, anhedonia, low mood, lethargy, decreased sleep, decreased appetite) are highly suggestive of **major depressive disorder**. - **Sertraline** is a **selective serotonin reuptake inhibitor (SSRI)**, which is a first-line treatment for major depressive disorder due to its efficacy and relatively favorable side-effect profile. *Alprazolam* - **Alprazolam** is a **benzodiazepine** primarily used for short-term treatment of anxiety and panic disorders. - It is not indicated as a primary treatment for depression and carries a significant risk of **dependence and withdrawal symptoms**. *Olanzapine* - **Olanzapine** is an **atypical antipsychotic** used to treat schizophrenia and bipolar disorder, and sometimes as an adjunct for treatment-resistant depression. - It is not a first-line monotherapy for major depressive disorder, especially in a patient with no evidence of psychosis or bipolar symptoms. *Haloperidol* - **Haloperidol** is a **typical antipsychotic** primarily used to treat psychotic disorders like schizophrenia and acute delirium. - It is not indicated for the treatment of depression and would likely worsen symptoms or cause significant side effects like **extrapyramidal symptoms**.

Question 377: Which of the following mental health disorders is most commonly associated with suicidal tendencies?

A. Depression (Correct Answer)
B. Post-Traumatic Stress Disorder (PTSD)
C. Obsessive-Compulsive Disorder (OCD)
D. Schizophrenia

Explanation: ***Depression*** - **Clinical depression**, especially severe or recurrent episodes, is a primary risk factor for **suicidal ideation** and attempts. - The symptoms of profound sadness, anhedonia, hopelessness, and worthlessness significantly increase the likelihood of **suicidal tendencies**. *Post-Traumatic Stress Disorder (PTSD)* - While **PTSD** is associated with an increased risk of suicide, particularly due to high rates of comorbidity with depression and substance abuse, it is not the most common standalone diagnosis linked to suicidal tendencies. - **Flashbacks**, nightmares, and hypervigilance are core symptoms, but direct suicidal intent is often mediated by co-occurring conditions. *Schizophrenia* - Individuals with **schizophrenia** have a significantly elevated risk of suicide, particularly during early stages of the illness or during psychotic exacerbations. - However, the overall prevalence of schizophrenia is lower than that of depression, making **depression** a more common underlying factor in the general population presenting with suicidal tendencies. *Obsessive-Compulsive Disorder (OCD)* - **OCD** can cause significant distress and impairment, and some individuals may experience suicidal ideation due to the chronicity and intrusiveness of their obsessions and compulsions. - However, **OCD** is generally considered to have a lower direct association with suicide compared to major depressive disorder, though comorbid depression can heighten the risk.

Question 378: Which of the following is NOT true about major depressive disorder?

A. Associated with hypothyroidism
B. Commonly seen in females
C. Recovery is complete after treatment (Correct Answer)
D. Family history of major depression is a risk factor

Explanation: ***Recovery is complete after treatment*** - While treatment can significantly improve symptoms and lead to remission, **major depressive disorder** often has a relapsing and remitting course. - Complete, lifelong recovery after just one episode of treatment is not guaranteed, and **recurrence** is common. *Commonly seen in females* - This statement is **true**; major depressive disorder is significantly more prevalent in **females** than in males. - The lifetime prevalence is approximately twice as high in women compared to men. *Associated with hypothyroidism* - This statement is **true**; **hypothyroidism** can present with symptoms that mimic or exacerbate depression, such as fatigue, low mood, and anhedonia. - Thyroid hormone levels should always be checked in patients presenting with depressive symptoms. *Family history of major depression is a risk factor* - This statement is **true**; a **family history** of major depression is a well-established and significant risk factor. - Genetic predisposition plays a substantial role in vulnerability to the disorder.

Question 379: A 30-year-old male was brought for evaluation, with a history of his 3-year-old son's death, 5 months prior, following a car accident. At the time of the accident, the patient was a witness. Since then, he has experienced symptoms of sadness, crying spells, feelings of hopelessness, poor sleep, and poor appetite. He has had suicidal thoughts on two occasions, but has not acted on them. He has not been attending work for the past 5 months. What is the likely diagnosis?

A. Post-traumatic stress disorder (PTSD)
B. Normal grief reaction
C. Adjustment disorder with depressed mood
D. Major depressive disorder (Correct Answer)

Explanation: ***Major depressive disorder*** - The duration of symptoms (5 months) and severity, including **suicidal ideation** and significant occupational impairment, exceed what is typically expected for **normal grief** or **adjustment disorder**. - Symptoms like **sadness**, crying spells, feelings of hopelessness, **poor sleep**, and poor appetite are classic for **major depressive disorder**, especially when persistent and functionally debilitating. *Post-traumatic stress disorder (PTSD)* - While experiencing a traumatic event (witnessing his son's death) is a prerequisite for PTSD, the patient's primary symptoms are **depressive** rather than the characteristic re-experiencing, avoidance, negative alterations in cognitions and mood, or hyperarousal associated with PTSD. - There is no mention of **flashbacks**, nightmares, or significant **avoidance behaviors** directly linked to the trauma beyond general withdrawal. *Normal grief reaction* - While grief is expected after the death of a child, the severity (suicidal ideation) and significant functional impairment (not attending work for 5 months) suggest a reaction beyond **normal grief**. - **Normal grief** typically doesn't involve persistent, severe functional impairment or recurrent suicidal thoughts over such a prolonged period without additional significant depressive symptoms. *Adjustment disorder with depressed mood* - **Adjustment disorder** usually resolves within 6 months of the stressor or its consequences ceasing, and symptoms are generally less severe than those seen in major depression. - The presence of **suicidal ideation** and profound, persistent functional impairment for 5 months makes **major depressive disorder** a more fitting diagnosis.

Question 380: A 30-year-old female with depressed mood, decreased appetite, and no interest for one year. What is the diagnosis?

A. None of the options
B. Dysthymia
C. Anxiety
D. Major Depressive Disorder (Correct Answer)

Explanation: ***Major Depressive Disorder*** - The patient presents with classic symptoms of **depressed mood**, **decreased appetite**, and **anhedonia** (no interest) which are core criteria for **Major Depressive Disorder**. - The duration of one year indicates a chronic and significant impact on daily functioning, consistent with a major depressive episode. *Dysthymia* - While dysthymia also involves chronic depressed mood, it typically presents with **less severe** symptoms than major depressive disorder. - The patient's symptoms of significant anhedonia and appetite changes are more indicative of the severity seen in a major depressive episode. *Anxiety* - Anxiety disorders are characterized primarily by **excessive worry, fear, or apprehension**, often accompanied by physical symptoms like palpitations or shortness of breath. - Although anxiety can co-occur with depression, the primary symptoms described (depressed mood, anhedonia, appetite changes) are classic for a depressive diagnosis. *None of the options* - The patient's symptoms clearly align with **Major Depressive Disorder**, meeting the diagnostic criteria based on severity and duration. - There is a suitable diagnosis among the given options; therefore, this option is incorrect.

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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