Mood Disorders Practice Questions

Q: Bipolar disorder is a:

Mood disorder. **Explanation:** **Bipolar Disorder** is fundamentally classified as a **Mood Disorder** (also known as Affective Disorder). The core pathology involves a pathological disturbance in mood, characterized by episodes of mania or hypomania alternating with episodes of depression. According to the ICD-11 and DSM-5, it is grouped under mood disorders because the primary clinical feature is a sustained emotional state that deviates significantly from the norm. **Analysis of Incorrect Options:** * **Neurotic Disorder:** This is an older term (now largely replaced by Anxiety Disorders). Neuroses involve distress but typically maintain a firm grip on reality (e.g., OCD, Phobias). Bipolar disorder, especially during severe mania, can involve psychotic features (loss of reality), placing it outside this category. * **Behavior Disorder:** While bipolar disorder causes behavioral changes (e.g., hyperactivity, impulsivity), these are *secondary* to the underlying mood shift. Behavior disorders (like Conduct Disorder) are primary patterns of antisocial or defiant behavior. * **Personality Disorder:** These are pervasive, inflexible, and long-standing patterns of relating to the world (e.g., Borderline Personality). Bipolar disorder is **episodic**—patients usually return to a baseline level of functioning (euthymia) between episodes. **High-Yield Clinical Pearls for NEET-PG:** * **Bipolar I:** At least one episode of **Mania** (with or without depression). * **Bipolar II:** At least one episode of **Hypomania** and one Major Depressive episode. * **Drug of Choice:** **Lithium** remains the gold standard for prophylaxis and acute mania (Therapeutic range: 0.8–1.2 mEq/L). * **Cyclothymia:** A chronic, milder form of bipolar disorder lasting at least 2 years. * **Strongest Genetic Link:** Bipolar disorder has the highest heritability among all major psychiatric disorders (approx. 80%).

Q: What is the recurrent risk for postpartum psychosis in a subsequent pregnancy?

50%. **Explanation:** **Postpartum Psychosis (PPP)** is a psychiatric emergency characterized by a rapid onset of psychotic symptoms (hallucinations, delusions, and delirium-like confusion) typically occurring within the first 2 weeks after delivery. **1. Why the correct answer is 50%:** The risk of recurrence for postpartum psychosis is exceptionally high. Epidemiological studies and clinical data indicate that a woman who has experienced one episode of PPP has a **30% to 50% risk** of recurrence in subsequent pregnancies. If the patient has an underlying diagnosis of Bipolar Disorder, the risk of a postpartum relapse (either manic or psychotic) can even exceed 50%. **2. Analysis of Incorrect Options:** * **A (10%) & B (20%):** These figures are too low for PPP. However, **10-15%** is the approximate prevalence of *Postpartum Depression* in the general population. * **C (35%):** While some studies show a lower range starting at 30%, "50%" is the standard high-yield figure taught for competitive exams like NEET-PG to emphasize the gravity of the recurrence risk. **3. High-Yield Clinical Pearls for NEET-PG:** * **Incidence:** 1 to 2 per 1,000 births (much rarer than "Baby Blues" or Postpartum Depression). * **Strongest Risk Factors:** Personal or family history of Bipolar Disorder and a previous episode of Postpartum Psychosis. * **Clinical Presentation:** Often begins with insomnia, restlessness, and emotional lability, progressing rapidly to disorganized behavior and delusions (often involving the infant). * **Management:** Immediate hospitalization is mandatory due to the high risk of **infanticide and suicide**. * **Treatment of Choice:** Mood stabilizers (Lithium), antipsychotics, and in severe/refractory cases, **Electroconvulsive Therapy (ECT)** is highly effective and safe.

Q: A 22-year-old male presents with decreased sleep, increased sexual activity, excitement, and excessive spending for the past 8 days. What is the most likely diagnosis?

Mania. ### Explanation **Correct Option: B (Mania)** The patient presents with the classic clinical triad of mania: **elevated mood (excitement), increased psychomotor activity (increased sexual activity/spending), and a decreased need for sleep.** According to ICD-10 and DSM-5 criteria, a diagnosis of Mania requires symptoms to last for at least **one week** (7 days) and be severe enough to cause significant social or occupational impairment. This patient’s 8-day duration and behavioral changes (excessive spending/hypersexuality) are hallmark indicators of a manic episode. **Why other options are incorrect:** * **A. Confusion:** This refers to a clouding of consciousness or disorientation, typically seen in Delirium (Organic Brain Syndromes), not primary mood disorders. * **C. Hyperactivity:** While hyperactivity is a *symptom* of mania, it is not a diagnosis. Hyperactivity alone could also be seen in ADHD or hyperthyroidism, but the cluster of symptoms here points to a mood disorder. * **D. Loss of memory:** This is a cognitive deficit characteristic of Dementia or Amnestic syndromes. Memory is usually intact in patients with mania, though they may be distractible. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** Hypomania (≥ 4 days); Mania (≥ 7 days); Depressive episode (≥ 2 weeks). * **Key Symptoms (DIG FAST):** **D**istractibility, **I**ndiscretion (spending/sex), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit, **T**alkativeness (pressured speech). * **Drug of Choice:** **Lithium** is the gold standard for long-term prophylaxis; however, for acute mania with agitation, atypical antipsychotics (e.g., Haloperidol or Olanzapine) are often used first. * **Difference between Mania and Hypomania:** Mania involves marked impairment or psychotic features (delusions/hallucinations); Hypomania does not.

Q: Which of the following is NOT a somatic therapy used in depression?

Ultrasound brain stem stimulation. **Explanation:** In psychiatry, **Somatic Therapies** refer to biological treatments that directly influence the brain's physiological function to alleviate mental illness. These include brain stimulation techniques and pharmacotherapy. **Why Option D is correct:** **Ultrasound brain stem stimulation** is not a recognized or standard clinical somatic therapy for depression. While research into "Transcranial Focused Ultrasound" (tFUS) is emerging, it is currently experimental and not targeted specifically at the brain stem for depression. Therefore, it is the "incorrect" modality among the choices. **Why other options are incorrect:** * **A. Electroconvulsive Therapy (ECT):** The "Gold Standard" for treatment-resistant depression and suicidal patients. It involves inducing a generalized seizure under anesthesia. * **B. Deep Brain Stimulation (DBS):** An invasive procedure involving the surgical implantation of electrodes into specific brain areas (e.g., Subgenual Cingulate Cortex/Area 25) to modulate neural circuits. * **C. Transcranial Magnetic Stimulation (TMS):** A non-invasive procedure that uses magnetic fields to stimulate nerve cells in the Dorsolateral Prefrontal Cortex (DLPFC). **High-Yield Clinical Pearls for NEET-PG:** * **ECT:** Most common side effect is **retrograde amnesia**. Absolute contraindication: **Increased intracranial pressure**. * **TMS:** Does not require anesthesia or seizure induction, making it an outpatient alternative for moderate depression. * **Vagus Nerve Stimulation (VNS):** Another FDA-approved somatic therapy for chronic, treatment-resistant depression. * **DLPFC:** The primary target for TMS in depression; **Area 25 (Subgenual Cingulate)** is the primary target for DBS.

Q: What is the drug of choice in mixed mania?

Lithium. **Explanation:** The drug of choice for **Mixed Mania** (a specifier where symptoms of both mania and depression occur simultaneously) remains **Lithium**, as it is the gold-standard mood stabilizer for acute manic episodes and long-term prophylaxis in Bipolar Disorder. While clinical practice guidelines (like CANMAT or NICE) often suggest that **Sodium Valproate** may be more effective than Lithium specifically for mixed features or rapid cycling, standard textbooks (such as Kaplan & Sadock) and traditional medical examinations like NEET-PG still prioritize **Lithium** as the primary answer for "Drug of Choice" in mania unless a specific contraindication (like renal failure) is mentioned. **Analysis of Options:** * **A. Lithium (Correct):** The most effective mood stabilizer for reducing suicide risk and treating classic and mixed manic episodes. * **B. Lamotrigine:** Primarily used for **Bipolar Depression** and maintenance therapy. It is ineffective for acute mania due to the need for slow titration to avoid Stevens-Johnson Syndrome. * **C. Sodium Valproate:** Highly effective for mixed mania and rapid cycling; however, in the hierarchy of "Drug of Choice" for general board exams, it usually follows Lithium. * **D. Carbamazepine:** Considered a second-line mood stabilizer, typically used when patients are refractory to Lithium or Valproate. **High-Yield Clinical Pearls for NEET-PG:** 1. **Therapeutic Index of Lithium:** 0.8 to 1.2 mEq/L (Acute Mania); 0.6 to 1.0 mEq/L (Maintenance). Toxicity starts >1.5 mEq/L. 2. **Drug of Choice for Rapid Cycling:** Sodium Valproate. 3. **Best for Bipolar Depression:** Quetiapine, Lurasidone, or Lamotrigine. 4. **Pregnancy:** Lithium is associated with **Ebstein’s Anomaly** (tricuspid valve displacement), while Valproate is highly teratogenic (Neural Tube Defects).

Q: Frequent suicidal tendencies are seen in which of the following?

All of the above. **Explanation:** Suicidal ideation and attempts are critical psychiatric emergencies associated with several mental health disorders. The correct answer is **All of the above** because each of these conditions carries a significantly elevated risk of suicide compared to the general population. 1. **Severe Depression:** This is the most common diagnosis associated with suicide. Patients often experience profound hopelessness, worthlessness, and psychomotor agitation or retardation. The risk is particularly high during the early recovery phase when energy levels improve before the mood lifts (the "window of risk"). 2. **Schizophrenia:** Approximately 5-10% of patients with schizophrenia die by suicide. Risk factors include being young, high premorbid functioning, awareness of the deteriorating nature of the illness, and "command hallucinations" (voices telling the patient to kill themselves). 3. **Borderline Personality Disorder (BPD):** Recurrent suicidal behavior, gestures, or threats are a core diagnostic criterion for BPD. While often viewed as "parasuicidal" or impulsive cries for help, the cumulative risk is high, with about 8-10% eventually completing suicide. **Clinical Pearls for NEET-PG:** * **Single best predictor of suicide:** A previous suicide attempt. * **Most common method of completed suicide:** Hanging (India/Global); Firearms (USA). * **Demographics:** Men complete suicide more often (higher lethality), while women attempt suicide more frequently. * **Protective factor:** Strong social support and pregnancy/parenting (especially in women). * **High-yield association:** Depression + Hopelessness (Beck’s Hopelessness Scale) is a stronger predictor of suicide than the severity of depression alone.

Question 1

Bipolar disorder is a:

Accepted Answer

Mood disorder

Answer

Neurotic disorder

Answer

Behavior disorder

Answer

Personality disorder

Question 2

What is the recurrent risk for postpartum psychosis in a subsequent pregnancy?

Accepted Answer

50%

Answer

10%

Answer

20%

Answer

35%

Question 3

A 22-year-old male presents with decreased sleep, increased sexual activity, excitement, and excessive spending for the past 8 days. What is the most likely diagnosis?

Accepted Answer

Mania

Answer

Confusion

Answer

Hyperactivity

Answer

Loss of memory

Question 4

Higher cortisol levels are seen in which of the following conditions?

Accepted Answer

Depression

Answer

Phobia

Answer

Schizophrenia

Answer

Parkinsonism

Question 5

A 41-year-old woman presented with a history of aches and pains all over the body and generalized weakness for four years. She cannot sleep because of the illness and has lost her appetite as well. She has a lack of interest in work and doesn't like to meet friends and relatives. She denies feelings of sadness. What is her most likely diagnosis?

Accepted Answer

Major depression

Answer

Somatoform pain disorder

Answer

Somatization disorder

Answer

Dissociative disorder

Question 6

Which of the following is NOT a somatic therapy used in depression?

Accepted Answer

Ultrasound brain stem stimulation

Answer

Electroconvulsive therapy

Answer

Deep brain stimulation

Answer

Transcranial magnetic stimulation

Question 7

True about bipolar disorder is:

Accepted Answer

The patient often experiences complete remission between episodes.

Answer

Personality deterioration is common.

Answer

The patient primarily suffers from mania or depression.

Answer

Unipolar depression is uncommon.

Question 8

What is the drug of choice in mixed mania?

Accepted Answer

Lithium

Answer

Lamotrigine

Answer

Sodium Valproate

Answer

Carbamezepine

Question 9

Frequent suicidal tendencies are seen in which of the following?

Accepted Answer

All of the above

Answer

Schizophrenia

Answer

Severe depression

Answer

Borderline personality disorder

Question 10

Which of the following is NOT true regarding serotonin syndrome?

Accepted Answer

IV dantrolene is the treatment of choice.

Answer

It is predictable and not idiosyncratic.

Answer

SSRIs and MAOIs can cause it.

Answer

Hypertension, hyperthermia, and hyperreflexia are characteristic signs.

Mood Disorders — MCQs

Mood Disorders — MCQs

On this page

Practice by Chapter

Want unlimited practice?