Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 41: Suicidal risk is common with which type of depression?

A. Reactive depression
B. Endogenous depression
C. Childhood depression (Correct Answer)
D. Depression in involution

Explanation: ### Explanation **Correct Answer: C. Childhood depression** In the context of psychiatric examinations like NEET-PG, **Childhood depression** is associated with a high risk of suicide, often presenting with "masked" symptoms. Unlike adults, children and adolescents may not express sadness directly; instead, they manifest **irritability, behavioral outbursts, and agitation**. This impulsivity, combined with a lack of mature coping mechanisms and a tendency toward "acting out," significantly elevates the immediate risk of suicidal gestures or completed suicide. **Analysis of Incorrect Options:** * **A. Reactive depression:** This occurs in response to an external stressful life event (e.g., loss of a job). While suicidal ideation can occur, the risk is generally considered lower than in endogenous or childhood forms because the cause is external and often time-limited. * **B. Endogenous depression:** This is a biological depression arising from internal neurochemical imbalances (e.g., Melancholic depression). While it carries a significant suicide risk due to profound hopelessness and psychomotor retardation, childhood depression is often highlighted in exams for its unpredictable and impulsive suicidal nature. * **D. Depression in involution (Involutional Melancholia):** This refers to depression occurring in late adulthood (40–60 years). While it involves high anxiety and agitation, it is statistically less emphasized as the "most common" or "highest risk" compared to the impulsive vulnerability seen in younger populations in this specific question context. **Clinical Pearls for NEET-PG:** * **Highest Risk Period:** The risk of suicide in depression is highest when the patient **starts to recover** (the "energy paradox"). As psychomotor retardation improves, the patient gains the physical energy to act on suicidal ideations. * **Strongest Predictor:** The single best predictor of a future suicide attempt is a **previous history of suicide attempts**. * **Gender Paradox:** Females attempt suicide more frequently, but males complete suicide more often (due to more lethal methods).

Question 42: In which condition is the maximum benefit from Electroconvulsive Therapy (ECT) typically observed?

A. Hysteria
B. Depression with suicidal tendency (Correct Answer)
C. Chronic schizophrenia
D. Mania

Explanation: **Explanation:** The primary indication for **Electroconvulsive Therapy (ECT)** is Severe Depression, particularly when it is life-threatening or refractory to medications. **Why Option B is Correct:** ECT is considered the "gold standard" for rapid symptom relief in psychiatry. In **Depression with suicidal tendency**, the risk of self-harm is immediate. ECT works faster than antidepressants (which take 2–4 weeks to show effect), making it the treatment of choice to rapidly stabilize a patient and prevent suicide. Other high-priority indications include depressive stupor and psychotic depression. **Analysis of Incorrect Options:** * **A. Hysteria (Dissociative Disorders):** ECT has no therapeutic role here. Management involves psychotherapy and addressing underlying stressors. * **C. Chronic Schizophrenia:** While ECT is used in acute schizophrenia (especially catatonic or paranoid types), it is significantly less effective in chronic cases with negative symptoms or long-standing cognitive decline. * **D. Mania:** ECT is effective for acute mania (especially if delirious or treatment-resistant), but it is generally a second-line treatment after mood stabilizers and antipsychotics. **High-Yield Clinical Pearls for NEET-PG:** * **Most common indication:** Major Depressive Disorder (MDD). * **Most effective indication:** Catatonia (shows the fastest and most dramatic response). * **Absolute Contraindication:** Increased Intracranial Pressure (ICP) due to risk of brain herniation. * **Common Side Effect:** Retrograde amnesia (usually transient). * **Mechanism:** It is believed to work by increasing the seizure threshold and modulating neurotransmitter sensitivity (upregulation of serotonin and downregulation of β-receptors).

Question 43: A depressed patient does not want to take medication on a daily basis. Which selective serotonin reuptake inhibitor (SSRI) is most suitable for this patient?

A. Escitalopram
B. Fluoxetine (Correct Answer)
C. Fluvoxamine
D. Paroxetine

Explanation: **Explanation:** The correct answer is **Fluoxetine**. The primary pharmacological factor determining the suitability of an SSRI for a patient who struggles with daily adherence is the **elimination half-life**. 1. **Why Fluoxetine is correct:** Fluoxetine has the longest half-life of all SSRIs (approximately 2–4 days), and its active metabolite, **norfluoxetine**, has an even longer half-life of **7–15 days**. This long duration of action provides a "built-in" buffer; if a patient misses a dose, the plasma levels remain therapeutic for a longer period. It is also available as a once-weekly formulation in some regions, making it the drug of choice for patients with poor daily compliance. 2. **Why other options are incorrect:** * **Escitalopram:** Has a half-life of about 27–32 hours. It requires daily dosing to maintain steady-state levels. * **Fluvoxamine:** Has one of the shortest half-lives among SSRIs (approx. 15 hours) and often requires twice-daily dosing. * **Paroxetine:** Has a short half-life (approx. 21 hours) and no active metabolites. It is notorious for causing severe **discontinuation syndrome** if even a single dose is missed. **High-Yield Clinical Pearls for NEET-PG:** * **Discontinuation Syndrome:** Least common with Fluoxetine (due to long half-life) and most common with Paroxetine (due to short half-life and lack of metabolites). * **Drug Interactions:** Fluoxetine is a potent inhibitor of **CYP2D6**, which can lead to significant drug-drug interactions. * **Activating Effect:** Fluoxetine is the most "activating" SSRI; it is often taken in the morning to avoid insomnia. * **Weight Neutrality:** Fluoxetine is generally considered the most weight-neutral SSRI in the short term.

Question 44: Which of the following drugs is NOT used in the management of bipolar mood disorder?

A. Sodium valproate
B. Oxcarbazepine
C. Pregabalin (Correct Answer)
D. Lamotrigine

Explanation: **Explanation:** The management of Bipolar Mood Disorder (BMD) primarily involves **Mood Stabilizers** and certain atypical antipsychotics. Mood stabilizers are drugs that treat mania or depression without inducing the opposite pole and prevent future episodes. **Why Pregabalin is the correct answer:** Pregabalin (and its predecessor Gabapentin) acts on the $\alpha_2\delta$ subunit of voltage-gated calcium channels. While it is an effective anticonvulsant and anxiolytic (used in Generalised Anxiety Disorder and neuropathic pain), clinical trials have consistently shown it has **no efficacy as a mood stabilizer** in the treatment of bipolar disorder. Therefore, it is not indicated for BMD. **Analysis of other options:** * **Sodium Valproate:** A first-line mood stabilizer particularly effective for **Rapid Cycling** bipolar disorder and Mixed episodes. It works by increasing GABA levels and blocking sodium channels. * **Oxcarbazepine:** A derivative of Carbamazepine with a better side-effect profile (less induction of hepatic enzymes). It is used as a second-line mood stabilizer for acute mania. * **Lamotrigine:** A unique mood stabilizer that is highly effective in the **prevention of Bipolar Depression**. It is not effective for acute mania. **High-Yield Clinical Pearls for NEET-PG:** * **Lithium** remains the "Gold Standard" for BMD and is the only drug proven to reduce **suicidal risk**. * **Drug of choice for Bipolar Depression:** Quetiapine, Lurasidone, or Lamotrigine. * **Teratogenicity:** Valproate is associated with Neural Tube Defects (highest risk), while Lithium is associated with Ebstein’s Anomaly. * **Lamotrigine Warning:** Always monitor for **Stevens-Johnson Syndrome (SJS)**; the dose must be titrated slowly.

Question 45: Who proposed the cognitive model of depression?

A. Beck (Correct Answer)
B. Skinner
C. Cerletti
D. Freud

Explanation: **Explanation:** The correct answer is **Aaron T. Beck**, who is widely regarded as the father of Cognitive Therapy. **1. Why Beck is correct:** Beck proposed the **Cognitive Model of Depression**, which suggests that depression is maintained by distorted thinking patterns. He introduced the concept of the **Cognitive Triad**, consisting of negative views about: * **The Self** (e.g., "I am worthless") * **The World/Environment** (e.g., "Everything is unfair") * **The Future** (e.g., "Things will never get better") According to Beck, these negative schemas lead to "cognitive distortions" (like overgeneralization or catastrophic thinking), which result in the emotional and behavioral symptoms of depression. **2. Why the other options are incorrect:** * **B. Skinner:** B.F. Skinner was a behaviorist known for **Operant Conditioning**. While behavioral activation is used in depression, the cognitive model specifically belongs to Beck. * **C. Cerletti:** Ugo Cerletti (along with Lucio Bini) developed **Electroconvulsive Therapy (ECT)** in 1938. He contributed to biological treatment, not psychological modeling. * **D. Freud:** Sigmund Freud proposed the **Psychoanalytic theory**. In his work *"Mourning and Melancholia,"* he viewed depression as "anger turned inward" resulting from the loss of an ambivalent object. **Clinical Pearls for NEET-PG:** * **Cognitive Behavioral Therapy (CBT):** The gold-standard psychotherapy for mild-to-moderate depression, based on Beck’s model. * **Learned Helplessness:** Another high-yield psychological model of depression proposed by **Martin Seligman**. * **Arbitrary Inference:** A common cognitive distortion where one draws a negative conclusion without supporting evidence.

Question 46: Maintaining the sick role by any means is a characteristic feature of which of the following conditions?

A. Hypochondriasis
B. Somatization disorder
C. Conversion disorder
D. Factitious disorder (Correct Answer)

Explanation: **Explanation:** The core feature of **Factitious Disorder** (formerly known as Munchausen syndrome) is the intentional production or feigning of physical or psychological signs or symptoms. The primary motivation is to assume the **"sick role"** to gain attention, sympathy, or care from medical personnel. Unlike malingering, there are no external incentives (like financial gain or avoiding work). **Analysis of Options:** * **Factitious Disorder (Correct):** The patient consciously creates symptoms (e.g., injecting insulin to cause hypoglycemia) solely to be a patient. The goal is internal/psychological. * **Hypochondriasis (Illness Anxiety Disorder):** Patients are preoccupied with the *fear* of having a serious disease based on misinterpretation of bodily sensations. They do not intentionally produce symptoms; they genuinely believe they are ill. * **Somatization Disorder:** Characterized by multiple, recurring physical complaints (pain, GI, sexual, neurological) that have no organic cause. The symptoms are **unconscious** and not intentionally produced. * **Conversion Disorder (Functional Neurological Symptom Disorder):** Involves unexplained loss of sensory or motor function (e.g., sudden blindness or paralysis) following a psychological stressor. The symptoms are **involuntary** and not faked. **Clinical Pearls for NEET-PG:** * **Factitious Disorder vs. Malingering:** In Factitious disorder, the motivation is **internal** (the sick role). In Malingering, the motivation is **external** (money, drugs, avoiding jail). * **Munchausen by Proxy:** A form of child abuse where a caregiver (usually the mother) induces illness in a child to assume the sick role by proxy. * **La Belle Indifference:** Classically associated with Conversion Disorder, where the patient shows a surprising lack of concern regarding their severe disability.

Question 47: What is the treatment of acute manic episodes?

A. Electroconvulsive Therapy (ECT)
B. Lithium
C. Diazepam
D. Sodium valproate (Correct Answer)

Explanation: **Explanation:** The management of an **acute manic episode** focuses on rapid stabilization of mood and control of agitation. **Why Sodium Valproate is the correct answer:** Sodium Valproate is a first-line mood stabilizer for acute mania. It is often preferred over Lithium in clinical practice for acute episodes because it has a **faster onset of action** (usually within 3–5 days) and is highly effective for "mixed episodes" and "rapid cycling" bipolar disorder. In the context of this question, it represents the pharmacological gold standard for acute stabilization. **Analysis of Incorrect Options:** * **Lithium (Option B):** While Lithium is the "Gold Standard" for long-term maintenance and prophylaxis of Bipolar Disorder, it has a slower onset of action (5–7 days) compared to Valproate and a narrow therapeutic index, making it slightly less ideal for immediate acute control in some settings. * **Electroconvulsive Therapy (Option A):** ECT is highly effective for mania but is reserved as a **second-line** treatment. It is indicated only when pharmacological treatments fail, in cases of severe exhaustion, or during pregnancy. * **Diazepam (Option C):** Benzodiazepines like Diazepam or Lorazepam are used only as **adjuncts** to control agitation and sleep disturbance. They do not treat the underlying manic pathology. **High-Yield Clinical Pearls for NEET-PG:** * **First-line drugs for Acute Mania:** Lithium, Sodium Valproate, or Atypical Antipsychotics (e.g., Haloperidol, Risperidone, Olanzapine). * **Drug of Choice for Rapid Cyclers:** Sodium Valproate. * **Therapeutic Range for Lithium (Acute Mania):** 0.8 to 1.2 mEq/L. * **Teratogenicity:** Avoid Valproate in pregnancy (Neural Tube Defects); Lithium is associated with Ebstein’s Anomaly.

Question 48: All of the following are features of depression except?

A. Nihilistic delusions
B. Diurnal variation in mood
C. Suicidal tendency
D. Elation (Correct Answer)

Explanation: **Explanation:** The core clinical feature of **Depression (Major Depressive Disorder)** is a persistent low mood, loss of interest (anhedonia), and decreased energy. **Elation** (Option D) is the correct answer because it is the hallmark of **Mania**, not depression. Elation refers to a state of extreme happiness, euphoria, and confidence, which is diametrically opposed to the depressive state. **Analysis of Options:** * **Nihilistic Delusions (Cotard’s Syndrome):** These are common in severe psychotic depression. Patients believe they are dead, their internal organs are rotting, or that the world no longer exists. * **Diurnal Variation:** This is a classic "biological" symptom of melancholic depression. Typically, the mood is **worst in the morning** and improves slightly as the day progresses. * **Suicidal Tendency:** This is the most serious complication of depression. It stems from feelings of hopelessness, worthlessness, and helplessness. **NEET-PG High-Yield Pearls:** 1. **ICD-11/DSM-5 Criteria:** Symptoms must last for at least **2 weeks** for a diagnosis of a depressive episode. 2. **Beck’s Cognitive Triad:** Includes negative views about the **Self, the World, and the Future**. 3. **Biological Markers:** Depression is associated with decreased levels of Serotonin, Norepinephrine, and Dopamine, and increased levels of **Cortisol** (Dexamethasone Suppression Test failure). 4. **Treatment:** SSRIs are the first-line treatment; ECT is the most effective treatment for severe depression with high suicidal risk or nihilistic delusions.

Question 49: Which cognitive model of depression is widely recognized?

A. Ellis
B. Beck (Correct Answer)
C. Godfrey
D. Meichenbaum

Explanation: **Explanation:** The correct answer is **Beck (Option B)**. Aaron Beck is the pioneer of the **Cognitive Theory of Depression**, which posits that depression is maintained by distorted information processing. According to Beck, individuals with depression possess negative schemas (deep-seated beliefs) that lead to a **"Cognitive Triad"** consisting of negative views about: 1. **The Self** (e.g., "I am worthless") 2. **The World/Environment** (e.g., "Everything is unfair") 3. **The Future** (e.g., "Things will never get better") **Analysis of Incorrect Options:** * **A. Ellis:** Albert Ellis developed **Rational Emotive Behavior Therapy (REBT)**. While also a cognitive-behavioral approach, it focuses on the "ABC" model (Activating event, Beliefs, Consequences) and challenging "irrational beliefs" rather than the specific cognitive triad of depression. * **C. Godfrey:** This is a distractor and is not associated with a major recognized cognitive model in psychiatry. * **D. Meichenbaum:** Donald Meichenbaum is known for **Self-Instructional Training** and **Stress Inoculation Training (SIT)**, focusing on "cognitive-behavior modification" rather than a primary model of depression. **High-Yield Clinical Pearls for NEET-PG:** * **Cognitive Distortions:** Beck identified specific errors in logic used by depressed patients, such as **Arbitrary Inference** (jumping to conclusions) and **Selective Abstraction** (focusing only on negative details). * **Treatment:** Beck’s model forms the basis of **Cognitive Behavioral Therapy (CBT)**, which is as effective as antidepressants for mild-to-moderate depression. * **Learned Helplessness:** Another high-yield model of depression is **Martin Seligman’s** theory, which suggests depression arises when individuals feel they have no control over repeated stressful events.

Question 50: A patient on antidepressant therapy developed sudden hypertension on consuming cheese. The antidepressant is possibly:

A. Amitriptyline
B. Tranylcypromine (Correct Answer)
C. Fluoxetine
D. Sertraline

Explanation: **Explanation:** The clinical scenario describes a **"Cheese Reaction"** (Hypertensive Crisis), a classic adverse interaction associated with **Non-selective Monoamine Oxidase Inhibitors (MAOIs)**. **1. Why Tranylcypromine is Correct:** Tranylcypromine is an irreversible, non-selective MAO inhibitor. MAO enzymes (specifically MAO-A) are responsible for breaking down **Tyramine** in the gut. When a patient on MAOIs consumes tyramine-rich foods (like aged cheese, red wine, or smoked meats), tyramine escapes degradation, enters the systemic circulation, and acts as an indirect sympathomimetic. It displaces stored norepinephrine from synaptic vesicles, leading to a massive release of catecholamines, resulting in sudden, severe hypertension, headache, and potential stroke. **2. Why Other Options are Incorrect:** * **Amitriptyline:** A Tricyclic Antidepressant (TCA). While it has side effects like anticholinergic symptoms and arrhythmias, it does not cause a hypertensive crisis with tyramine. * **Fluoxetine & Sertraline:** These are Selective Serotonin Reuptake Inhibitors (SSRIs). Their main risk is "Serotonin Syndrome" if combined with other serotonergic drugs, but they do not interact with dietary tyramine. **Clinical Pearls for NEET-PG:** * **Antidote for Cheese Reaction:** Phentolamine (an alpha-blocker) is the drug of choice. * **MAOI Examples:** Phenelzine, Isocarboxazid, and Tranylcypromine (Non-selective); Selegiline (MAO-B selective at low doses); Moclobemide (RIMA - Reversible Inhibitor of MAO-A). * **Washout Period:** When switching from an MAOI to an SSRI (or vice versa), a **2-week washout period** is required (5 weeks for Fluoxetine due to its long half-life) to prevent Serotonin Syndrome.

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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