Mood Disorders Practice Questions

Q: Which of the following is NOT considered a differential diagnosis of premenstrual tension?

Chronic fatigue syndrome. **Explanation:** Premenstrual Dysphoric Disorder (PMDD) or Premenstrual Tension (PMT) is characterized by significant emotional and physical symptoms that occur during the **luteal phase** of the menstrual cycle and remit shortly after the onset of menses. **Why Chronic Fatigue Syndrome (CFS) is the correct answer:** Chronic Fatigue Syndrome is characterized by persistent, unexplained exhaustion lasting at least six months that is not relieved by rest. Unlike PMT, CFS symptoms are **chronic and continuous**, lacking the cyclical, hormone-dependent pattern essential for a PMT diagnosis. While fatigue is a symptom of PMT, the lack of periodicity in CFS makes it an unlikely differential diagnosis compared to mood and anxiety disorders that can "mimic" or be exacerbated by the menstrual cycle (premenstrual magnification). **Analysis of Incorrect Options:** * **A. Psychiatric Depressive Disorder:** Major Depressive Disorder (MDD) is a primary differential. Clinicians must distinguish whether the patient has PMT or a continuous depression that worsens premenstrually. * **B. Panic Disorder:** Many women experience increased autonomic arousal and panic attacks specifically during the luteal phase, making it a common differential. * **C. Generalized Anxiety Disorder (GAD):** GAD involves persistent worry. Because PMT often presents with high levels of irritability and anxiety, GAD must be ruled out by tracking symptoms on a daily prospective calendar. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Prospective daily charting of symptoms for at least **two consecutive menstrual cycles**. * **First-line Treatment:** SSRIs (e.g., Fluoxetine, Sertraline). Unlike in MDD, SSRIs for PMT can be effective even when taken only during the luteal phase (intermittent dosing). * **Key Symptom:** Irritability is often the most prominent emotional symptom in PMT/PMDD.

Q: Which of the following is NOT a risk factor for depression?

18-year-old teenager. In psychiatry, understanding the epidemiology and risk factors of Major Depressive Disorder (MDD) is crucial for NEET-PG. **Explanation of the Correct Answer:** **Option D (18-year-old teenager)** is the correct answer because, statistically, the peak age of onset for depression is between **20 and 50 years**, with the mean age being approximately **40 years**. While adolescents can suffer from depression, being an 18-year-old is not considered a primary "risk factor" compared to the established demographic and medical vulnerabilities listed in the other options. **Analysis of Incorrect Options:** * **Option A (Middle-aged female):** Female gender is a significant risk factor; women are twice as likely to develop depression as men. The risk is highest during reproductive years and middle age due to hormonal fluctuations and psychosocial stressors. * **Option B (Hypothyroidism):** This is a classic organic cause of secondary depression. Endocrine disorders (including Cushing’s and Addison’s disease) are high-yield medical comorbidities that trigger depressive symptoms. * **Option C (Age above 70 years):** Geriatric populations are at high risk due to social isolation, bereavement, chronic physical illnesses, and neurological changes. In the elderly, depression often presents as "pseudodementia." **High-Yield Clinical Pearls for NEET-PG:** * **Gender Ratio:** Female:Male = 2:1. * **Marital Status:** Highest risk in those who are divorced or separated; lowest risk in married individuals. * **Genetics:** If one monozygotic twin has MDD, the other has a 50% chance of developing it. * **Biogenic Amine Hypothesis:** Depression is primarily linked to low levels of Serotonin (5-HT) and Norepinephrine in the synaptic cleft.

Q: What is the minimum duration of chronic mild depression to be considered dysthymia?

More than 2 years. ### Explanation **Concept Overview:** Dysthymia, now referred to as **Persistent Depressive Disorder (PDD)** in DSM-5, is a chronic form of depression where the mood is low for most of the day, for more days than not, but the symptoms are typically less severe than those of Major Depressive Disorder (MDD). **Why Option D is Correct:** According to both ICD-10 and DSM-5 criteria, the hallmark of Dysthymia is its **chronicity**. For a diagnosis in adults, the depressive symptoms must persist for **at least 2 years**. During this period, the individual must not be symptom-free for more than 2 months at a time. This duration is essential to differentiate a chronic personality-like depressive state from an acute depressive episode. **Why Other Options are Incorrect:** * **Options A, B, and C:** These durations (3 months to 1.5 years) are insufficient for a diagnosis of Dysthymia. While a Major Depressive Episode only requires symptoms for **2 weeks**, and Adjustment Disorder typically lasts less than 6 months after a stressor, Dysthymia specifically requires the long-term 2-year threshold. **Clinical Pearls for NEET-PG:** * **Pediatric Exception:** In children and adolescents, the duration required for diagnosis is only **1 year**, and the mood may be **irritable** rather than depressed. * **"Double Depression":** This term is used when a patient with pre-existing Dysthymia experiences a superimposed Major Depressive Episode. * **Symptoms:** Look for the "Rule of 2": **2 years** duration + at least **2 symptoms** (e.g., poor appetite/overeating, insomnia/hypersomnia, low energy, low self-esteem, poor concentration, or hopelessness). * **Treatment:** A combination of Pharmacotherapy (SSRIs are first-line) and Psychotherapy (CBT or IPT) is more effective than either alone.

Q: The classical triad of symptoms of depression includes all the following except?

Distractibility. ### Explanation The **Classical Triad of Depression**, historically described by Emil Kraepelin, consists of three core clinical features that characterize a depressive episode. These are: 1. **Depressed Mood:** A pervasive and persistent feeling of sadness or "low" mood. 2. **Slowed Thinking (Poverty of Thought):** Patients often experience a decrease in the flow of ideas, difficulty concentrating, and slowed cognitive processing. 3. **Psychomotor Retardation:** A visible slowing of physical movements, speech, and emotional reactions. **Why Distractibility is the Correct Answer:** Distractibility is **not** part of the classical triad of depression. In fact, distractibility is a hallmark symptom of **Mania** (as part of the DIGFAST mnemonic). While depressed patients may struggle with concentration, their cognitive state is characterized by "slowness" rather than the rapid shifting of attention seen in distractibility. **Analysis of Incorrect Options:** * **Depressed mood:** This is the primary emotional component of the triad. * **Slowed thinking:** This represents the cognitive component of the triad. * **Psychomotor retardation:** This represents the physical/behavioral component of the triad. **High-Yield Clinical Pearls for NEET-PG:** * **ICD-10 Core Criteria:** For a diagnosis of depression, ICD-10 requires at least two of the three core symptoms: Depressed mood, Loss of interest (Anhedonia), and Fatigability. * **Beck’s Cognitive Triad:** Do not confuse the classical triad with Beck’s Triad, which consists of negative views about the **Self, the World, and the Future**. * **Psychomotor Agitation:** While retardation is classical, some patients (especially in elderly or "Agitated Depression") may show increased purposeless activity. * **Melancholic Depression:** Characterized by a complete loss of pleasure, early morning awakening, and psychomotor retardation/agitation.

Q: Which of the following is NOT considered a risk factor for suicide?

Somatization. **Explanation:** The correct answer is **Somatization**. In psychiatric epidemiology, somatization (the expression of psychological distress through physical symptoms) is generally considered a "protective" factor or, at the very least, is not associated with an increased risk of completed suicide. Patients with somatization disorder often have a high frequency of medical consultations and a focus on physical health, which contrasts with the hopelessness and self-destructive intent seen in high-risk individuals. **Analysis of Options:** * **Male sex:** While females make more suicide *attempts*, males are more likely to *complete* suicide (a ratio of approximately 3:1). This is due to the use of more lethal methods (e.g., firearms, hanging). * **Social isolation:** Living alone, being widowed, or lacking a social support system are significant risk factors. "Social integration" is a known protective factor. * **Drug dependence:** Substance use disorders (especially alcohol and opioids) significantly increase impulsivity and worsen underlying depression, making it a major risk factor for suicide. **High-Yield Clinical Pearls for NEET-PG:** * **Strongest Predictor:** A **previous suicide attempt** is the single strongest predictor of a future completed suicide. * **SAD PERSONS Scale:** A mnemonic used to assess suicide risk (Sex, Age, Depression, Previous attempt, Ethanol use, Rational thinking loss, Social supports lacking, Organized plan, No spouse, Sickness). * **Psychiatric Comorbidity:** Over 90% of individuals who commit suicide have a diagnosable psychiatric disorder, most commonly **Depression**. * **Age:** Risk increases with age; elderly males have the highest rates of completed suicide.

Q: All of the following are good prognostic factors for bipolar disorder EXCEPT:

Early age of onset. **Explanation:** In Bipolar Disorder (BD), the prognosis is influenced by the clinical presentation and the timing of interventions. **Why "Early age of onset" is the correct answer:** An early age of onset (typically defined as childhood or adolescence) is a **poor prognostic factor**. It is clinically associated with a higher frequency of rapid cycling, increased comorbidity with substance abuse and anxiety disorders, a higher risk of suicide attempts, and a greater likelihood of a chronic, refractory course. In contrast, a later onset usually suggests a more stable course with better treatment response. **Analysis of Incorrect Options:** * **Acute onset:** A sudden, rapid onset of symptoms is generally associated with a better prognosis compared to an insidious onset, as it often responds more robustly to acute stabilization. * **Early responsive treatment:** Prompt initiation of mood stabilizers (like Lithium) and adherence to treatment significantly reduce the risk of neuroprogression, cognitive decline, and future relapses. * **Associated depression:** While counterintuitive, the presence of depressive symptoms (or a "depressive-manic-euthymic" sequence) is often considered a better prognostic indicator for long-term Lithium response compared to mixed states or rapid cycling. **High-Yield Clinical Pearls for NEET-PG:** * **Best Prognostic Factor:** Good inter-episodic functioning and late onset. * **Worst Prognostic Factor:** Mixed episodes, rapid cycling (≥4 episodes/year), and comorbid substance abuse. * **Gender:** Males often present with more manic episodes; females present with more depressive episodes and have a higher risk of rapid cycling. * **Lithium:** Remains the gold standard for prophylaxis; it is most effective in patients with a family history of Lithium response and a "Manic-Depressive-Interval" pattern.

Q: What is the most common age group affected by depression?

Middle-aged women. **Explanation:** The correct answer is **Middle-aged women**. Epidemiological studies consistently show that Major Depressive Disorder (MDD) is most prevalent among women, particularly those in the **35 to 45-year age group**. **1. Why Middle-aged Women?** The gender gap in depression begins at puberty and persists through adulthood, with women being roughly **twice as likely** to experience depression as men (2:1 ratio). This peak in middle age is attributed to a combination of biological factors (fluctuating estrogen/progesterone levels, perimenopause), psychological stressors (the "sandwich generation" burden of caring for both children and aging parents), and socio-cultural factors. **2. Analysis of Incorrect Options:** * **Middle-aged men:** While men do suffer from depression, the prevalence is significantly lower than in women. However, it is a high-yield fact that men have a higher rate of **completed suicide** despite lower rates of diagnosed depression. * **Young girls:** Before puberty, the incidence of depression is roughly equal between boys and girls. The divergence only occurs post-puberty. * **Children:** Depression is relatively rare in childhood compared to adulthood. When it does occur, it often presents atypically with **irritability** rather than low mood. **Clinical Pearls for NEET-PG:** * **Gender Ratio:** 2:1 (Female:Male) for Depression; 1:1 for Bipolar Disorder. * **Mean Age of Onset:** Approximately 40 years (though it can occur at any age). * **Most Common Symptom:** While "depressed mood" is core, **Anhedonia** (loss of interest) is a key diagnostic criterion. * **Genetic Risk:** If one parent has MDD, the risk to the child is 10-25%; if both parents are affected, the risk doubles.

Q: All of the following about depression are true except?

Insomnia is often seen in the early part of sleep.. ### Explanation **1. Why Option B is the Correct Answer (The "Except" Statement):** In Major Depressive Disorder (MDD), the most characteristic sleep disturbance is **Terminal Insomnia** (Early Morning Awakening), where the patient wakes up 2–3 hours before their usual time and cannot fall back asleep. While initial insomnia (difficulty falling asleep) can occur, **Early Morning Awakening** is a classic biological marker of melancholic depression. Additionally, sleep studies in depressed patients typically show **reduced REM latency** (entering REM sleep faster) and increased REM density. **2. Analysis of Other Options:** * **Option A:** **Aaron T. Beck** proposed the **Cognitive Triad**, which consists of negative views about the **Self, the World, and the Future**. This is a high-yield concept in cognitive behavioral therapy (CBT). * **Option C:** The **Monoamine Hypothesis** suggests that depression is associated with a deficiency of neurotransmitters, primarily **Serotonin (5-HT)** and Norepinephrine. Most antidepressants (like SSRIs) work by increasing these levels in the synaptic cleft. * **Option D:** **Nihilistic delusions** (Cotard’s syndrome), where a patient believes they are dead, rotting, or do not exist, are a severe feature of psychotic depression, particularly in the elderly. **3. NEET-PG High-Yield Clinical Pearls:** * **Most common sleep abnormality:** Reduced REM latency (High Yield). * **Diurnal variation:** Symptoms are often worse in the morning and improve as the day progresses. * **Pseudodementia:** Depression in the elderly can mimic dementia (cognitive impairment that reverses with antidepressants). * **Masked Depression:** Physical complaints (somatization) dominate the clinical picture instead of reported low mood.

Q: Nihilistic ideas are typically seen in which of the following psychiatric conditions?

Depression. **Explanation:** **Nihilistic delusions** (the belief that oneself, others, or the world no longer exists or is coming to an end) are a hallmark feature of **Severe Depression with Psychotic Features**. In the context of depression, these are considered **mood-congruent delusions**, as the theme of non-existence aligns with the patient’s profound feelings of hopelessness and worthlessness. When these nihilistic ideas become extreme—such as the patient claiming their internal organs are rotting or that they are actually dead—it is referred to as **Cotard’s Syndrome** (the "Walking Corpse" syndrome). **Analysis of Incorrect Options:** * **B. Schizophrenia:** While delusions are common, they are typically persecutory, bizarre, or involve delusions of control/passivity. Nihilistic delusions are less characteristic than in mood disorders. * **C. Mania:** Patients in a manic state exhibit **grandiose delusions** (inflated power, wealth, or identity), which is the polar opposite of nihilistic ideation. * **D. Obsessive-Compulsive Disorder (OCD):** This involves ego-dystonic obsessions (intrusive thoughts) and compulsions, not fixed false beliefs (delusions). **Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome:** Most commonly associated with severe agitated depression in the elderly. * **Mood-Congruent vs. Incongruent:** Delusions in depression (guilt, poverty, nihilism) match the low mood, whereas "mood-incongruent" features in depression suggest a poorer prognosis. * **Treatment:** Severe depression with nihilistic delusions often requires **Electroconvulsive Therapy (ECT)** as it is considered a psychiatric emergency due to the high risk of self-neglect and suicide.

Question 1

Which of the following is NOT considered a differential diagnosis of premenstrual tension?

Accepted Answer

Chronic fatigue syndrome

Answer

Psychiatric depressive disorder

Answer

Panic disorder

Answer

Generalized anxiety disorder

Question 2

Which of the following is NOT a risk factor for depression?

Accepted Answer

18-year-old teenager

Answer

Middle-aged female

Answer

Hypothyroidism

Answer

Age above 70 years, either sex

Question 3

What is the minimum duration of chronic mild depression to be considered dysthymia?

Accepted Answer

More than 2 years

Answer

3 to 6 months

Answer

6 months to 1 year

Answer

1 to 1.5 years

Question 4

The classical triad of symptoms of depression includes all the following except?

Accepted Answer

Distractibility

Answer

Depressed mood

Answer

Slowed thinking

Answer

Psychomotor retardation

Question 5

A 17-year-old girl presents with decreased sleep, irritability, and a 4-5 kg weight loss over the past two months, accompanied by a subjective feeling of increased energy. Physical examination reveals a thin build, normal BMI, nasal mucosal erythema, and mild facial acne. What is the most likely diagnosis?

Accepted Answer

Cocaine use disorder

Answer

Anorexia nervosa

Answer

Avoidant food intake disorder

Answer

Bulimia nervosa

Question 6

Which of the following is NOT considered a risk factor for suicide?

Accepted Answer

Somatization

Answer

Social isolation

Answer

Male sex

Answer

Drug dependence

Question 7

All of the following are good prognostic factors for bipolar disorder EXCEPT:

Accepted Answer

Early age of onset

Answer

Acute onset

Answer

Early responsive treatment

Answer

Associated depression

Question 8

What is the most common age group affected by depression?

Accepted Answer

Middle-aged women

Answer

Middle-aged men

Answer

Young girls

Answer

Children

Question 9

All of the following about depression are true except?

Accepted Answer

Insomnia is often seen in the early part of sleep.

Answer

Aaron T. Beck described the cognitive triad of depression.

Answer

Serotonin levels are typically decreased in depression.

Answer

Delusions of nihilism can be a symptom of depression.

Question 10

Nihilistic ideas are typically seen in which of the following psychiatric conditions?

Accepted Answer

Depression

Answer

Schizophrenia

Answer

Mania

Answer

Obsessive-Compulsive Disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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