Mood Disorders Practice Questions

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

Major Depressive Disorder. ***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.

Q: 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.

Chlorpromazine. ***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.

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

Depression. ***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.

Q: What neurotransmitter is found in increased quantities in mania?

Dopamine. ***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.

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

Depression superimposed on dysthymia. ***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"

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

Serotonin. ***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.

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

Disorientation. ***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.

Question 1

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

Accepted Answer

Major Depressive Disorder

Answer

None of the options

Answer

Dysthymia

Answer

Anxiety

Question 2

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.

Accepted Answer

Chlorpromazine

Answer

Sodium Valproate

Answer

Carbamazepine

Answer

Lithium

Question 3

Among which of the following conditions is suicide risk highest?

Accepted Answer

Depression

Answer

Alcohol dependence

Answer

Dementia

Answer

Schizophrenia

Question 4

What neurotransmitter is found in increased quantities in mania?

Accepted Answer

Dopamine

Answer

Noradrenaline

Answer

Serotonin

Answer

GABA

Question 5

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

Accepted Answer

Depression superimposed on dysthymia

Answer

Recurrent major depressive episodes without chronic low mood

Answer

Major depressive disorder occurring alongside cognitive decline

Answer

Chronic low-grade depression without major depressive episodes

Question 6

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

Accepted Answer

Serotonin

Answer

Acetylcholine

Answer

Dopamine

Answer

GABA

Question 7

Which of the following is least characteristic of mania?

Accepted Answer

Disorientation

Answer

Pressure of speech

Answer

Decreased need for sleep

Answer

Grandiose delusions

Mood Disorders — MCQs

Mood Disorders — MCQs

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