Mood Disorders Practice Questions

Q: Which of the following conditions is ECT most useful in?

Acute Depression. **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry. While it has several indications, **Acute Depression** (specifically Major Depressive Disorder with melancholic or psychotic features) is the condition where ECT shows the highest efficacy and most rapid response. **Why Acute Depression is Correct:** ECT is considered the "gold standard" for treatment-resistant depression or when a rapid clinical response is required (e.g., severe suicidal ideation, refusal to eat, or catatonia). It works by inducing a generalized seizure, which leads to a massive release of neurotransmitters and increases BDNF (Brain-Derived Neurotrophic Factor) levels. **Analysis of Incorrect Options:** * **A. Mania (Acute):** While ECT is effective for acute mania (especially delirious mania), it is typically reserved as a second or third-line treatment after mood stabilizers (Lithium, Valproate) and antipsychotics. * **B. Chronic Schizophrenia:** ECT is generally not effective for the negative symptoms of chronic schizophrenia. It is primarily used in schizophrenia for acute exacerbations, catatonic features, or when there is a strong affective (mood) component. * **C. Panic Disorder:** ECT has no established role in the treatment of anxiety disorders like Panic Disorder. These are managed with SSRIs and Cognitive Behavioral Therapy (CBT). **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** There are **no absolute contraindications** for ECT, but increased intracranial pressure (ICP) is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde amnesia (memory loss) and post-ictal confusion. * **Mortality Rate:** Approximately 0.01 per 1,000 patients (similar to general anesthesia). * **Electrode Placement:** Bilateral (Gold standard for efficacy) vs. Unilateral (Fewer cognitive side effects).

Q: Mania is characterized by?

Loss of insight. **Explanation:** In Psychiatry, **insight** refers to a patient’s ability to understand that they have a mental illness, recognize its symptoms, and accept the need for treatment. In **Mania**, the loss of insight is a hallmark feature. Patients typically experience a state of "ego-syntonic" euphoria, believing they are functioning at their peak. This lack of awareness is why manic patients often refuse medication and require involuntary hospitalization. While high self-esteem is a symptom, the **loss of insight** is the defining clinical characteristic that complicates management. **Analysis of Options:** * **A. Paranoid Delusion:** While delusions can occur in "Mania with Psychotic Features," they are more characteristic of Schizophrenia. In mania, delusions are typically **grandiose** (inflated power/knowledge) rather than paranoid. * **B. Loss of Orientation:** Orientation (to time, place, and person) remains **intact** in mood disorders. Disorientation suggests an organic brain syndrome or Delirium. * **C. High Self-esteem:** This is a common symptom (Grandiosity), but it is not as definitive or clinically significant as the loss of insight. A person can have high self-esteem without being manic, but a manic patient almost universally lacks insight into their pathological state. **NEET-PG High-Yield Pearls:** * **DIGFAST** Mnemonic for Mania: **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressured speech). * **Insight Scale:** Often measured using the G12 item of the PANSS or the Birchwood Insight Scale. * **Key Distinction:** Hypomania is distinguished from Mania by the *absence* of psychotic features and the fact that it does *not* cause marked impairment in social or occupational functioning.

Q: ECT is mainly indicated in:

Severe depression. **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry. While it has several indications, **Severe Depression** (especially Major Depressive Disorder with psychotic features or suicidal ideation) is the primary and most common indication. **Why Severe Depression is Correct:** ECT is considered the "gold standard" for rapid symptom relief in severe depression. It is specifically indicated when: * There is a high risk of suicide (requires immediate intervention). * The patient is stuporous or refusing food/fluids (nutritional compromise). * The depression is resistant to multiple trials of antidepressants. * Psychotic features are present. **Analysis of Incorrect Options:** * **Schizophrenia:** While ECT is used in schizophrenia (specifically catatonic type or acute exacerbations resistant to antipsychotics), it is a second-line treatment. Antipsychotics remain the primary treatment. * **Somatization Disorder:** This is a chronic condition characterized by multiple physical complaints. Treatment focuses on psychotherapy (CBT) and conservative management; ECT has no role here. * **Hysteria (Dissociative/Conversion Disorder):** These are neurotic, stress-related disorders. The mainstay of treatment is psychotherapy and addressing underlying stressors. ECT is not indicated. **High-Yield Clinical Pearls for NEET-PG:** * **Most common side effect:** Retrograde amnesia (usually resolves) and post-ictal confusion. * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Mechanism:** It works by inducing a generalized tonic-clonic seizure (minimum duration: 25-30 seconds). * **Modified ECT:** Involves the use of an anesthetic (Thiopentone/Propofol) and a muscle relaxant (Succinylcholine) to prevent fractures.

Q: What is the cause of postpartum blues?

Decreased estrogen and progesterone. ### Explanation **Correct Answer: D. Decreased estrogen and progesterone** **Medical Concept:** Postpartum blues (maternity blues) is a transient, self-limiting condition affecting up to 50–80% of women within the first week after delivery. The primary pathophysiology is the **rapid withdrawal of placental hormones**, specifically **estrogen and progesterone**, immediately following the delivery of the placenta. This sudden drop triggers neurochemical changes in the brain, affecting neurotransmitters like serotonin, which leads to emotional lability, irritability, and tearfulness. **Analysis of Incorrect Options:** * **A & B (Decreased Estrogen or Progesterone alone):** While both hormones decrease, it is the **synergistic withdrawal** of both that is clinically significant. Singling out one hormone is incomplete as they both plummet simultaneously from high pregnancy levels to near-basal levels. * **C (Increased Prolactin):** While prolactin levels do rise postpartum to facilitate lactation, this hormone is not the primary driver of the mood disturbances seen in postpartum blues. In fact, breastfeeding (mediated by prolactin and oxytocin) is often encouraged as it can have a stabilizing effect on maternal bonding. **High-Yield Clinical Pearls for NEET-PG:** * **Timeline:** Starts within **3–5 days** postpartum and typically resolves by **day 10**. * **Management:** Reassurance and supportive care only. No pharmacological intervention is required. * **Differential Diagnosis:** If symptoms persist beyond 2 weeks or involve suicidal ideation, suspect **Postpartum Depression**. If there are hallucinations or delusions, it is **Postpartum Psychosis** (a psychiatric emergency). * **Risk Factor:** A history of Premenstrual Syndrome (PMS) is a significant risk factor for developing postpartum blues.

Q: Depression is associated with all of the following except?

Metformin. **Explanation:** The correct answer is **Metformin**. This question tests the knowledge of "Substance/Medication-Induced Depressive Disorder," a high-yield topic in NEET-PG Psychiatry. **1. Why Metformin is the correct answer:** Metformin is a biguanide used in Type 2 Diabetes Mellitus. Unlike the other options, Metformin is **not** associated with causing depression. In fact, emerging research suggests that Metformin may have potential antidepressant effects due to its role in improving insulin sensitivity and reducing neuroinflammation, though it is not currently used as a primary psychiatric treatment. **2. Analysis of Incorrect Options (Drugs that CAUSE depression):** * **Corticosteroids:** These are notorious for causing "Steroid-induced Psychosis" and mood disturbances. While they can cause mania/euphoria initially, long-term use or withdrawal is strongly linked to clinical depression. * **Methyldopa:** An older antihypertensive that acts as a centrally acting alpha-2 agonist. It depletes central catecholamines (dopamine, norepinephrine), which is a direct pharmacological mechanism for inducing depression. * **Interferon (especially IFN-alpha):** Used in treating Hepatitis C and certain cancers, Interferon is highly associated with "Interferon-induced depression." It is so common that patients are often pre-screened for psychiatric history before starting therapy. **Clinical Pearls for NEET-PG:** * **Other high-yield drugs causing depression:** Reserpine (classic example), Propranolol (beta-blockers), Oral Contraceptives, Isotretinoin, and Varenicline. * **Reserpine** is historically significant because its ability to cause depression by depleting monoamines led to the development of the **Monoamine Hypothesis of Depression**. * Always screen for thyroid dysfunction (Hypothyroidism) in patients presenting with depressive symptoms, as it is a common organic mimic.

Q: A 72-year-old male suffering from major depression is attempting suicide multiple times. What is the best treatment?

ECT. **Explanation:** The correct answer is **ECT (Electroconvulsive Therapy)**. In psychiatric emergencies, especially when there is an **imminent risk of suicide**, ECT is the treatment of choice. It provides the most rapid clinical response compared to pharmacological interventions, which typically take 2–4 weeks to show efficacy. In this 72-year-old patient with multiple suicide attempts, the priority is immediate safety and rapid stabilization. **Why the other options are incorrect:** * **Amitriptyline (TCA):** While effective for depression, TCAs have a slow onset of action. More importantly, they are highly cardiotoxic in overdose; prescribing them to a patient with active suicidal ideation is contraindicated. * **Selegiline (MAOI):** This is generally a second or third-line treatment for depression due to dietary restrictions and drug interactions. It does not address the acute suicidal crisis. * **Haloperidol:** This is an antipsychotic used for agitation or psychosis. While it may be used as an adjunct if psychotic features are present, it is not a primary treatment for major depression or suicidal ideation. **High-Yield Clinical Pearls for NEET-PG:** * **Indications for ECT:** Severe depression with suicidal risk (No. 1 indication), stuporous depression, severe mania, treatment-resistant schizophrenia, and Catatonia. * **Safety in Elderly:** ECT is considered safe and effective for geriatric patients who may not tolerate the side effects of polypharmacy. * **Absolute Contraindication:** There are no absolute contraindications for ECT, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde and anterograde amnesia (usually transient).

Q: What is true about bipolar disorder type II?

Repetitive depression and hypomania. ### Explanation **Bipolar II Disorder** is characterized by a clinical course of one or more **Major Depressive Episodes** accompanied by at least one **Hypomanic Episode**. According to DSM-5 criteria, the presence of even a single manic episode precludes a diagnosis of Bipolar II. #### Analysis of Options: * **D (Correct): Repetitive depression and hypomania.** This is the hallmark of Bipolar II. Patients spend significantly more time in the depressive phase than the hypomanic phase, often leading to a high risk of suicide and functional impairment. * **A (Incorrect): Recurrent depression.** This describes **Unipolar Depression** (Recurrent Depressive Disorder). While Bipolar II involves depression, the presence of hypomania distinguishes it from unipolar disorders. * **B & C (Incorrect): Recurrent mania / Repetitive depression and mania.** These describe **Bipolar I Disorder**. Bipolar I requires at least one **Manic Episode** (which involves marked impairment, hospitalization, or psychotic features). In Bipolar II, the "up" periods are strictly hypomanic (milder, lasting at least 4 days, and no psychosis). #### NEET-PG High-Yield Pearls: * **Bipolar I vs. II:** Bipolar I = Mania (with or without depression); Bipolar II = Hypomania + Major Depression. * **Cyclothymia:** A chronic mood disturbance (at least 2 years) involving periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for a Major Depressive Episode. * **Rapid Cycling:** Defined as **4 or more** mood episodes (Depression, Mania, or Hypomania) within a 12-month period. * **Treatment:** Lithium remains the gold standard for maintenance. However, in Bipolar II, treating the depressive phase is often the primary clinical challenge. Avoid antidepressant monotherapy as it may trigger a "switch" into hypomania.

Q: Sleep pattern seen in mania is:

Decreased need for sleep. **Explanation:** The hallmark of a manic episode in Bipolar Disorder is a **decreased need for sleep**, which is distinct from insomnia. **1. Why "Decreased need for sleep" is correct:** In mania, patients experience a state of hyperarousal and increased psychomotor energy. Unlike someone with insomnia who wants to sleep but cannot, a patient in mania feels **fully rested and energetic** after only 2–3 hours of sleep, or sometimes no sleep at all. This is a key diagnostic criterion under the DSM-5 and ICD-11 for a manic or hypomanic episode. **2. Why other options are incorrect:** * **Hypersomnia (A):** This is excessive daytime sleepiness or prolonged nighttime sleep. It is typically associated with **Atypical Depression** or the depressive phase of Bipolar Disorder, not mania. * **Insomnia (B):** Insomnia is the *inability* to sleep despite the desire to do so, often leading to daytime fatigue. In mania, the patient lacks the *desire* or *need* to sleep. * **Somnambulism (D):** Also known as sleepwalking, this is a parasomnia occurring during NREM stage 3 sleep. It has no direct diagnostic correlation with the core symptoms of mania. **Clinical Pearls for NEET-PG:** * **Early Sign:** A decreased need for sleep is often the **earliest prodromal sign** of an impending manic relapse. * **Depression vs. Mania:** While mania features a "decreased need" for sleep, **Melancholic Depression** is characterized by **Early Morning Awakening** (terminal insomnia), where the patient wakes up 2+ hours before the usual time and cannot fall back asleep. * **Sleep Architecture:** In mania, there is often a reduction in total sleep time and a **reduction in REM latency** (REM sleep occurs sooner).

Question 1

Which of the following conditions is ECT most useful in?

Accepted Answer

Acute Depression

Answer

Mania (Acute)

Answer

Chronic Schizophrenia

Answer

Panic Disorder

Question 2

Mania is characterized by?

Accepted Answer

Loss of insight

Answer

Paranoid delusion

Answer

Loss of orientation

Answer

High self-esteem

Question 3

ECT is mainly indicated in:

Accepted Answer

Severe depression

Answer

Schizophrenia

Answer

Somatization disorder

Answer

Hysteria

Question 4

What is the cause of postpartum blues?

Accepted Answer

Decreased estrogen and progesterone

Answer

Decreased estrogen

Answer

Decreased progesterone

Answer

Increased prolactin

Question 5

Depression is associated with all of the following except?

Accepted Answer

Metformin

Answer

Corticosteroids

Answer

Methyldopa

Answer

Interferon

Question 6

A 72-year-old male suffering from major depression is attempting suicide multiple times. What is the best treatment?

Accepted Answer

ECT

Answer

Amitriptyline

Answer

Selegiline

Answer

Haloperidol

Question 7

A 25-year-old woman, whose mother recently died from heart failure, presents one month later with persistent sadness, tearfulness, difficulty concentrating, insomnia, and a three-pound weight loss. She has no prior psychiatric history. What is the most likely diagnosis?

Accepted Answer

Dysthymia

Answer

Major depression

Answer

Post-traumatic stress disorder

Answer

Uncomplicated bereavement

Question 8

What is true about bipolar disorder type II?

Accepted Answer

Repetitive depression and hypomania

Answer

Recurrent depression

Answer

Recurrent mania

Answer

Repetitive depression and mania

Question 9

Sleep pattern seen in mania is:

Accepted Answer

Decreased need for sleep

Answer

Hypersomnia

Answer

Insomnia

Answer

Somnambulism

Question 10

A patient presents with a depressed mood, social withdrawal, and reduced engagement with the outside world. The patient reports normal sleep patterns and maintained body weight. What is the most probable diagnosis?

Accepted Answer

Dysthymia

Answer

Major depression

Answer

Chronic fatigue syndrome

Answer

No psychiatric illness

Mood Disorders — MCQs

Mood Disorders — MCQs

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