Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 381: 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?

A. Schizophrenia
B. Mania (Correct Answer)
C. Hypomania
D. Depression

Explanation: ***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 382: Which of the following medications is primarily an antipsychotic rather than a mood stabilizer and is NOT typically used for long-term prophylaxis in bipolar disorder? Chlorpromazine, Lithium, Carbamazepine, Sodium Valproate.

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

Explanation: ***Chlorpromazine*** - **Chlorpromazine** is a **first-generation antipsychotic** primarily used to treat **psychotic symptoms** like hallucinations and delusions. - While it can be used for acute agitation in bipolar disorder, it's generally **not considered a first-line agent** for **long-term mood stabilization** or prophylaxis due to its side effect profile and limited efficacy in preventing mood episodes compared to true mood stabilizers. *Carbamazepine* - **Carbamazepine** is an **anticonvulsant medication** well-established as a **mood stabilizer** for the long-term prophylaxis and treatment of bipolar disorder. - It is particularly effective for **rapid cycling** and **mixed features**, distinguishing it from an antipsychotic. *Sodium Valproate* - **Sodium valproate** (Valproic acid) is a widely used **mood stabilizer** for both acute mania and long-term prophylaxis in bipolar disorder. - It is effective in treating or preventing both manic and depressive episodes, and is **not primarily an antipsychotic**. *Lithium* - **Lithium** is considered the **gold standard mood stabilizer** for the long-term prophylaxis of bipolar disorder, significantly reducing the risk of both manic and depressive episodes. - It is primarily a **mood stabilizer** and does not possess significant antipsychotic effects on its own.

Question 383: What neurotransmitter is found in increased quantities in mania?

A. Noradrenaline
B. Serotonin
C. GABA
D. Dopamine (Correct Answer)

Explanation: ***Dopamine*** - **Dopamine levels are consistently elevated during manic episodes**, representing one of the most robust neurobiological findings in mania. - Increased dopaminergic activity contributes to **psychomotor agitation**, **goal-directed behavior**, **reward-seeking**, **decreased need for sleep**, and **psychotic features** (delusions, hallucinations). - **Dopamine antagonists** (antipsychotics like haloperidol, olanzapine) are **first-line treatments** for acute mania, supporting the dopamine hypothesis. - The dopamine hypothesis of mania is well-established in psychiatric literature and supported by neuroimaging studies. *Noradrenaline* - Noradrenergic hyperactivity is also implicated in mania, contributing to increased arousal, energy, and reduced sleep. - However, while elevated, the evidence is less consistent than for dopamine, and noradrenaline's role appears more modulatory. - The question asks for the neurotransmitter "found in increased quantities" - both are elevated, but dopamine has stronger evidence. *Serotonin* - Serotonin dysfunction is implicated in mood disorders, but manic episodes are generally associated with **reduced or dysregulated serotonin activity**, not an increase. - Low serotonin may contribute to impulsivity and mood instability in bipolar disorder. *GABA* - **GABA** (gamma-aminobutyric acid) is the primary **inhibitory neurotransmitter** in the CNS. - **Reduced GABAergic activity** has been reported in mania (not increased), which may contribute to disinhibition and hyperexcitability. - GABAergic drugs (e.g., benzodiazepines, valproate) are used as adjuncts in mania, supporting reduced GABA activity.

Question 384: Among which of the following conditions is suicide risk highest?

A. Depression (Correct Answer)
B. Alcohol dependence
C. Dementia
D. Schizophrenia

Explanation: ***Depression*** - **Major depressive disorder** is the psychiatric condition most frequently associated with **suicide**, accounting for a large percentage of completed suicides. - The presence of severe depression, especially with features like **hopelessness**, **agitation**, and **prior suicide attempts**, significantly elevate the risk. *Alcohol dependence* - While **alcohol dependence** is a significant risk factor for suicide, it often co-occurs with mood disorders like depression; alcohol can exacerbate suicidal ideation and impulsivity. - It is an important comorbidity, but **major depression** alone has a higher prevalence in suicide statistics than alcohol dependence as a primary factor. *Dementia* - **Dementia** generally poses a lower risk of completed suicide compared to mood disorders, as cognitive decline can impair the ability to plan and execute such acts. - Early stages of dementia, particularly when insight into cognitive decline is preserved, may carry some risk, but it is not the highest risk condition overall. *Schizophrenia* - Individuals with **schizophrenia** have a significantly elevated risk of suicide compared to the general population, often due to factors like **command hallucinations**, hopelessness, and adverse effects of medication. - However, **depression** remains the leading psychiatric diagnosis associated with suicide completions.

Question 385: What is the definition of "double depression" in the context of mental health?

A. Depression superimposed on dysthymia (Correct Answer)
B. Recurrent major depressive episodes without chronic low mood
C. Major depressive disorder occurring alongside cognitive decline
D. Chronic low-grade depression without major depressive episodes

Explanation: ***Depression superimposed on dysthymia*** - **Double depression** refers to the co-occurrence of a major depressive episode in an individual who already suffers from **dysthymia** (persistent depressive disorder) - This means the person experiences periods of more severe depression on top of their chronic, milder low mood - This combination results in a more severe clinical presentation and worse prognosis *Recurrent major depressive episodes without chronic low mood* - This describes **recurrent major depressive disorder**, where distinct episodes of severe depression occur without a persistent background of mild depression - It does not involve the chronic, low-grade depressive state characteristic of dysthymia *Major depressive disorder occurring alongside cognitive decline* - While depression can be associated with cognitive symptoms, this is not the standard definition of "double depression" in psychiatric diagnostic criteria - This would represent a comorbidity rather than the specific term "double depression" *Chronic low-grade depression without major depressive episodes* - This describes **dysthymia** (persistent depressive disorder), characterized by chronic, low-grade depressed mood lasting at least two years - This definition specifically excludes major depressive episodes, which is the key component that differentiates "double depression"

Question 386: According to the classical monoamine hypothesis of depression, deficiency of which of the following neurotransmitters is MOST commonly emphasized in modern antidepressant therapy?

A. Serotonin (Correct Answer)
B. Acetylcholine
C. Dopamine
D. GABA

Explanation: ***Serotonin*** - The **classical monoamine hypothesis** of depression posits deficiencies in monoamine neurotransmitters including **serotonin (5-HT), norepinephrine, and dopamine**. - Among these, **serotonin** is the **most commonly emphasized** in modern antidepressant therapy, given its central role in mood regulation, sleep, appetite, and cognition. - The majority of first-line antidepressants, such as **SSRIs (Selective Serotonin Reuptake Inhibitors)** and **SNRIs**, primarily target serotonergic pathways, reflecting its clinical importance. - **Clinical relevance**: Serotonin deficiency is associated with depressed mood, anxiety, sleep disturbances, and appetite changes. *Acetylcholine* - **Acetylcholine** is a neurotransmitter involved in cognitive function, memory, and muscle contraction. - It is **not a monoamine** and is not part of the classical monoamine hypothesis of depression. - Acetylcholine deficiency is primarily implicated in **Alzheimer's disease** and other cognitive disorders, not depression. *Dopamine* - **Dopamine** is one of the three monoamines implicated in the classical hypothesis and plays a role in pleasure, reward, motivation, and motor control. - Dopamine deficiency can contribute to symptoms of **anhedonia** (inability to feel pleasure) and lack of motivation in depression. - However, dopamine-targeting antidepressants (like bupropion) are less commonly used as first-line therapy compared to serotonergic agents, making serotonin the most emphasized in clinical practice. *GABA* - **GABA (gamma-aminobutyric acid)** is the primary **inhibitory neurotransmitter** in the central nervous system. - It is **not a monoamine** and is not part of the classical monoamine hypothesis of depression. - GABA dysfunction is primarily associated with **anxiety disorders, seizures, and insomnia**, not depression as per the classical hypothesis.

Question 387: Which of the following is least characteristic of mania?

A. Disorientation (Correct Answer)
B. Pressure of speech
C. Decreased need for sleep
D. Grandiose delusions

Explanation: ***Disorientation*** - While psychotic features can occur in severe mania, **disorientation** (confusion about time, place, or person) is not a typical or primary symptom. - It suggests a more profound cognitive disturbance or an organic cause (such as delirium), which is less characteristic of an uncomplicated manic episode. - The presence of disorientation should prompt evaluation for medical causes. *Decreased need for sleep* - **Decreased need for sleep** is a hallmark symptom of a manic episode and one of the core diagnostic criteria. - Individuals with mania feel energetic and rested despite sleeping very little (often 2-3 hours or less). - This is distinct from insomnia—patients don't feel tired or have difficulty sleeping; rather, they simply don't need much sleep. *Pressure of speech* - **Pressure of speech**, characterized by rapid, loud, and difficult-to-interrupt speech, is a core diagnostic feature of mania. - It reflects the underlying racing thoughts (flight of ideas) and increased psychomotor activity typical of manic episodes. - Speech may be tangential, circumstantial, or filled with puns, jokes, and theatrical references. *Grandiose delusions* - **Grandiose delusions** (delusions of grandeur), such as believing one has special powers, extraordinary wealth, or a special relationship with famous figures, are common psychotic features in severe mania. - These delusions are mood-congruent and consistent with the elevated mood, inflated self-esteem, and impaired judgment seen in manic episodes.

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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