Mood Disorders Practice Questions

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

Delusion of persecution. ***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.

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

Decreased REM (rapid eye movement) latency. ***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.

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

Increased energy. ***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.

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

Major depression and hypomania. ***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.

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

Folate. ***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.

Q: 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:

Sertraline. ***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**.

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

Recovery is complete after treatment. ***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.

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

Depression. ***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.

Q: 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?

Major depressive disorder. ***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.

Q: A 40-year-old man presents with persistently elevated mood, increased energy, and decreased need for sleep for the past week. What is the most likely diagnosis?

Mania. ***Mania*** - **Elevated mood**, **increased energy**, and **decreased need for sleep** are classic symptoms of a manic episode. - This presentation, lasting for **at least a week**, meets the **diagnostic criteria for mania** (DSM-5 requires ≥7 days or any duration if hospitalization needed). - The distinct period of persistently elevated, expansive, or irritable mood with increased goal-directed activity distinguishes this from other conditions. *Schizophrenia* - Characterized primarily by **psychotic symptoms** such as hallucinations, delusions, and disorganized thought/speech, which are not described here. - While agitation can occur, the core symptoms of elevated mood and increased energy are not typical of an acute schizophrenic episode. *Hypomania* - Hypomania presents with similar symptoms (elevated mood, increased energy, decreased sleep) but is **less severe** and of **shorter duration** (requires only 4 consecutive days). - Hypomanic episodes do **not cause marked impairment** in social or occupational functioning and do not require hospitalization. - The question states symptoms have lasted "for the past week" which, if causing significant functional impairment, would suggest mania rather than hypomania. *Depression* - Depression is characterized by a **depressed mood**, **loss of interest or pleasure (anhedonia)**, **low energy**, and often **increased need for sleep** or insomnia with early morning awakening. - The patient's symptoms of elevated mood and increased energy are the opposite of what is seen in depression.

Question 1

Which of the following is not a common symptom of depression?

Accepted Answer

Delusion of persecution

Answer

Hopelessness

Answer

Delusion of nihilism

Answer

Complete anhedonia

Question 2

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

Accepted Answer

Decreased REM (rapid eye movement) latency

Answer

Occasional vivid dreams

Answer

Changes in REM sleep architecture

Answer

Insomnia and fragmented sleep

Question 3

Which of the following is not a typical feature of depression?

Accepted Answer

Increased energy

Answer

Loss of interest in activities

Answer

Suicidal thoughts

Answer

Persistent sadness

Question 4

Which of the following is a characteristic of Bipolar II disorder?

Accepted Answer

Major depression and hypomania

Answer

Dysthymia

Answer

Single manic episode

Answer

Cyclothymic disorder

Question 5

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

Accepted Answer

Folate

Answer

Pyridoxine

Answer

Cobalamin

Answer

Ascorbate

Question 6

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:

Accepted Answer

Sertraline

Answer

Alprazolam

Answer

Olanzapine

Answer

Haloperidol

Question 7

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

Accepted Answer

Recovery is complete after treatment

Answer

Associated with hypothyroidism

Answer

Commonly seen in females

Answer

Family history of major depression is a risk factor

Question 8

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

Accepted Answer

Depression

Answer

Post-Traumatic Stress Disorder (PTSD)

Answer

Obsessive-Compulsive Disorder (OCD)

Answer

Schizophrenia

Question 9

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?

Accepted Answer

Major depressive disorder

Answer

Post-traumatic stress disorder (PTSD)

Answer

Normal grief reaction

Answer

Adjustment disorder with depressed mood

Question 10

A 40-year-old man presents with persistently elevated mood, increased energy, and decreased need for sleep for the past week. What is the most likely diagnosis?

Accepted Answer

Mania

Answer

Schizophrenia

Answer

Hypomania

Answer

Depression

Mood Disorders — MCQs

Mood Disorders — MCQs

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