Mood Disorders Practice Questions

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 25-year-old woman complains of intense depressed mood for 6 months with inability to enjoy previously pleasurable activities. What is this symptom known as?

Anhedonia. ### Explanation **Correct Answer: A. Anhedonia** **Concept Analysis:** The patient is presenting with core symptoms of a **Major Depressive Episode**. The specific inability to experience pleasure from activities that were previously found enjoyable is the definition of **Anhedonia**. It is one of the two primary diagnostic criteria for Depression according to ICD-11 and DSM-5 (the other being depressed mood). It reflects a dysfunction in the brain's reward system, particularly involving dopaminergic pathways in the nucleus accumbens. **Analysis of Incorrect Options:** * **B. Avolition:** This refers to a total lack of motivation or "will" to initiate and persist in goal-directed activities (e.g., sitting for hours without starting a task). While common in depression, it specifically describes the lack of *drive*, not the lack of *pleasure*. * **C. Apathy:** This is a state of indifference or a lack of emotional responsiveness, enthusiasm, or interest. It is a broader term encompassing cognitive, emotional, and behavioral deficits. * **D. Amotivation:** Similar to avolition, this is a reduction in the drive to engage in activities. It is frequently used to describe the "Amotivational Syndrome" associated with chronic cannabis use. **NEET-PG High-Yield Pearls:** * **Snaith-Hamilton Pleasure Scale (SHAPS):** A clinical tool used specifically to measure the degree of anhedonia. * **Core Symptoms of Depression (ICD-10):** 1. Depressed mood, 2. Anhedonia, 3. Increased fatigability/Energy loss. * **Melancholic Depression:** Anhedonia is the hallmark feature of this subtype, often accompanied by early morning awakening and psychomotor agitation/retardation. * **Neurobiology:** Anhedonia is often linked to the **Mesolimbic pathway** (Reward pathway).

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: Which of the following is NOT a predisposing factor for suicide?

Female sex. ### Explanation In psychiatry, understanding the risk factors for suicide is crucial for both clinical practice and competitive exams like NEET-PG. While suicide is a complex phenomenon, epidemiological data consistently identifies specific demographic and clinical predictors. **Why "Female sex" is the correct answer:** While women are significantly more likely to **attempt** suicide (3 times more often than men), men are more likely to **complete** suicide (3–4 times more often than women). This is often referred to as the "gender paradox" of suicide. Therefore, being female is considered a risk factor for suicidal *gestures/attempts*, but **male sex** is the established predisposing factor for *completed* suicide. **Analysis of Incorrect Options:** * **Depression:** This is the strongest clinical predictor. Approximately 50–70% of individuals who commit suicide have a primary diagnosis of a mood disorder. * **Drug abuse:** Substance use disorders (especially alcoholism) significantly increase impulsivity and lower the threshold for self-harm, making it a major risk factor. * **Living alone:** Social isolation, being single, divorced, or widowed are well-documented sociological risk factors. Integration into a social or family unit acts as a protective factor. **High-Yield Clinical Pearls for NEET-PG:** * **Most common method of suicide:** In India, it is **hanging** (globally, firearms are common where legal). * **Best predictor of future suicide:** A **previous history** of suicide attempts. * **Protective factors:** Marriage, pregnancy, and strong religious/social beliefs. * **SAD PERSONS Scale:** A mnemonic used to assess risk (Sex-Male, Age, Depression, Previous attempt, Ethanol, Rational thinking loss, Social support lacking, Organized plan, No spouse, Sickness).

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

Depression is associated with all of the following except?

Accepted Answer

Metformin

Answer

Corticosteroids

Answer

Methyldopa

Answer

Interferon

Question 2

A 25-year-old woman complains of intense depressed mood for 6 months with inability to enjoy previously pleasurable activities. What is this symptom known as?

Accepted Answer

Anhedonia

Answer

Avolition

Answer

Apathy

Answer

Amotivation

Question 3

Suicidal tendencies are most common in which of the following conditions?

Accepted Answer

Childhood depression

Answer

Involutional depression

Answer

Reactive depression

Answer

Psychotic depression

Question 4

A patient with a history of depression is prescribed Imipramine. One week later, bystanders complain that she is experiencing hallucinations and excessive talking. What would be your advice on follow-up?

Accepted Answer

Add sodium valproate to antidepressants

Answer

Stop the current antidepressant

Answer

Mood stabilizers

Answer

Add antipsychotics

Question 5

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 6

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 7

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 8

Which of the following is NOT a predisposing factor for suicide?

Accepted Answer

Female sex

Answer

Depression

Answer

Drug abuse

Answer

Living alone

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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