Mood Disorders — MCQs

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?

Q56Medium

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

Q57Medium

True about bipolar disorder is:

Q58Easy

What is the drug of choice in mixed mania?

Q59Easy

Frequent suicidal tendencies are seen in which of the following?

Q60Medium

Which of the following is NOT true regarding serotonin syndrome?

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 51: Bipolar disorder is a:

A. Mood disorder (Correct Answer)
B. Neurotic disorder
C. Behavior disorder
D. Personality disorder

Explanation: **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%).

Question 52: What is the recurrent risk for postpartum psychosis in a subsequent pregnancy?

A. 10%
B. 20%
C. 35%
D. 50% (Correct Answer)

Explanation: **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.

Question 53: 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?

A. Confusion
B. Mania (Correct Answer)
C. Hyperactivity
D. Loss of memory

Explanation: ### 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.

Question 54: Higher cortisol levels are seen in which of the following conditions?

A. Depression (Correct Answer)
B. Phobia
C. Schizophrenia
D. Parkinsonism

Explanation: **Explanation:** The correct answer is **Depression**. This association is rooted in the dysregulation of the **Hypothalamic-Pituitary-Adrenal (HPA) axis**, which is one of the most consistent biological findings in biological psychiatry. **1. Why Depression is Correct:** In patients with Major Depressive Disorder (MDD), there is often hypercortisolemia due to a failure in the negative feedback mechanism of the HPA axis. This is clinically demonstrated by the **Dexamethasone Suppression Test (DST)**; many depressed patients are "non-suppressors," meaning their cortisol levels remain high even after the administration of exogenous glucocorticoids. Chronic stress and elevated cortisol lead to hippocampal atrophy, which is frequently observed in long-term depression. **2. Why Other Options are Incorrect:** * **Phobia:** While acute anxiety can cause a transient spike in cortisol (the "fight or flight" response), phobias are not characterized by the sustained, tonic elevations of cortisol seen in MDD. * **Schizophrenia:** While some patients may show HPA axis changes during acute psychosis, it is not a hallmark diagnostic or biological feature of the disorder. Schizophrenia is primarily linked to the **Dopamine Hypothesis**. * **Parkinsonism:** This is a neurodegenerative movement disorder primarily involving the depletion of **Dopamine** in the substantia nigra. It is not fundamentally characterized by hypercortisolemia. **High-Yield Clinical Pearls for NEET-PG:** * **DST Non-suppression:** A classic board-style finding for Melancholic Depression. * **CRH Levels:** Elevated levels of Corticotropin-Releasing Hormone (CRH) are often found in the CSF of depressed patients. * **Thyroid Axis:** Roughly 5-10% of patients with depression have previously undetected secondary hypothyroidism (Blunted TSH response to TRH). * **Sleep Architecture in Depression:** Shortened REM latency, increased REM density, and decreased slow-wave (Stage 3 & 4) sleep.

Question 55: 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?

A. Somatoform pain disorder
B. Major depression (Correct Answer)
C. Somatization disorder
D. Dissociative disorder

Explanation: ### Explanation The correct diagnosis is **Major Depression**, specifically presenting as **Masked Depression**. **1. Why Major Depression is Correct:** While the patient denies "sadness," she exhibits several core and somatic symptoms of a depressive episode according to ICD-10/DSM-5 criteria: * **Anhedonia/Lack of interest:** She has lost interest in work and social withdrawal (not meeting friends). * **Biological symptoms:** Significant loss of appetite and insomnia. * **Somatic symptoms:** Chronic generalized aches, pains, and weakness. In clinical practice, many patients (especially in South Asian contexts) present with **"Masked Depression,"** where physical complaints (somatization) dominate the clinical picture, and the patient may not explicitly report a depressed mood. **2. Why Other Options are Incorrect:** * **Somatoform Pain Disorder:** This involves persistent, severe pain that cannot be explained by a physiological process. However, it does not typically include the pervasive loss of interest and biological symptoms (appetite/sleep loss) seen here. * **Somatization Disorder:** This requires a history of many physical complaints starting before age 30, involving multiple organ systems (GI, sexual, neurological). This patient’s symptoms are more localized to pain and fatigue associated with a change in interest. * **Dissociative Disorder:** This involves a disruption of identity, memory, or consciousness (e.g., amnesia, fugue, or motor deficits), which is absent in this case. **3. NEET-PG Clinical Pearls:** * **Masked Depression:** Depression where somatic symptoms (headache, backache, fatigue) "mask" the underlying low mood. * **ICD-10 Criteria for Depression:** Requires at least 2 of 3 core symptoms (depressed mood, anhedonia, decreased energy) for at least 2 weeks. * **High-Yield Fact:** In elderly or South Asian patients, somatic complaints are often the primary presenting symptom of Major Depressive Disorder. Always screen for "loss of interest" if "sadness" is denied.

Question 56: Which of the following is NOT a somatic therapy used in depression?

A. Electroconvulsive therapy
B. Deep brain stimulation
C. Transcranial magnetic stimulation
D. Ultrasound brain stem stimulation (Correct Answer)

Explanation: **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.

Question 57: True about bipolar disorder is:

A. Personality deterioration is common.
B. The patient primarily suffers from mania or depression.
C. Unipolar depression is uncommon.
D. The patient often experiences complete remission between episodes. (Correct Answer)

Explanation: ### Explanation **Correct Option: D. The patient often experiences complete remission between episodes.** The hallmark of Bipolar Disorder (BD) is its **episodic nature**. Unlike Schizophrenia, where there is often a progressive decline in baseline functioning, Bipolar Disorder is characterized by distinct episodes of mania, hypomania, or depression interspersed with periods of **euthymia** (normal mood). During these inter-episodic intervals, most patients achieve **complete clinical remission**, returning to their premorbid level of functioning. #### Why other options are incorrect: * **A. Personality deterioration is common:** This is incorrect. Personality deterioration and "downward drift" are characteristic of Schizophrenia. In Bipolar Disorder, the personality usually remains intact between episodes. * **B. The patient primarily suffers from mania or depression:** While these are the core symptoms, this is a vague description. The defining feature of BD is the *cycling* or *alternation* between these states (or the presence of at least one manic/hypomanic episode), not just suffering from them in isolation. * **C. Unipolar depression is uncommon:** This is factually incorrect in a clinical context. Unipolar depression (Major Depressive Disorder) is significantly **more common** in the general population than Bipolar Disorder. #### NEET-PG High-Yield Pearls: * **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode PLUS a Major Depressive episode. * **Prognosis:** Bipolar disorder generally has a **better prognosis** than Schizophrenia but a worse prognosis than Unipolar Depression. * **Lithium:** The gold standard for prophylaxis and treatment of mania. It is known to reduce the risk of suicide in BD patients. * **Rapid Cycling:** Defined as **≥4 mood episodes** (mania, hypomania, or depression) within a 12-month period.

Question 58: What is the drug of choice in mixed mania?

A. Lithium (Correct Answer)
B. Lamotrigine
C. Sodium Valproate
D. Carbamezepine

Explanation: **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).

Question 59: Frequent suicidal tendencies are seen in which of the following?

A. Schizophrenia
B. Severe depression
C. Borderline personality disorder
D. All of the above (Correct Answer)

Explanation: **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 60: Which of the following is NOT true regarding serotonin syndrome?

A. It is predictable and not idiosyncratic.
B. SSRIs and MAOIs can cause it.
C. IV dantrolene is the treatment of choice. (Correct Answer)
D. Hypertension, hyperthermia, and hyperreflexia are characteristic signs.

Explanation: **Explanation:** **Serotonin Syndrome (SS)** is a potentially life-threatening condition caused by excessive serotonergic activity in the central and peripheral nervous systems. 1. **Why Option C is the correct answer (False statement):** The treatment of choice for Serotonin Syndrome is **supportive care** and the administration of **Cyproheptadine** (a 5-HT2A antagonist). **IV Dantrolene** is the specific treatment for **Malignant Hyperthermia**, not Serotonin Syndrome. While Dantrolene is sometimes used off-label for hyperthermia in Neuroleptic Malignant Syndrome (NMS), it has no direct role in reversing the serotonergic toxidrome. 2. **Analysis of Incorrect Options (True statements):** * **Option A:** Unlike Neuroleptic Malignant Syndrome (which is idiosyncratic), Serotonin Syndrome is **predictable**. It is a dose-dependent spectrum of toxicity that occurs when serotonergic drugs are overdosed or combined. * **Option B:** The most common cause is the co-administration of two serotonergic agents, such as **SSRIs and MAOIs**. This combination is particularly dangerous due to the irreversible inhibition of serotonin metabolism. * **Option C:** The clinical triad of SS includes **Autonomic instability** (Hypertension, Tachycardia, Hyperthermia), **Altered mental status**, and **Neuromuscular hyperactivity** (Hyperreflexia, Myoclonus, Tremor). **High-Yield Clinical Pearls for NEET-PG:** * **Hunter’s Criteria:** Used for diagnosing Serotonin Syndrome; **Clonus** (spontaneous, inducible, or ocular) is the most important diagnostic sign. * **SS vs. NMS:** * **SS:** Rapid onset (<24 hours), **Hyperreflexia/Myoclonus**, caused by Serotonergic drugs. * **NMS:** Slow onset (days/weeks), **"Lead-pipe" Rigidity**, caused by Dopamine antagonists (Antipsychotics). * **Washout Period:** When switching from an SSRI (especially Fluoxetine) to an MAOI, a 5-week washout period is required 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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