Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 71: Depression is associated with all of the following except?

A. Metformin (Correct Answer)
B. Corticosteroids
C. Methyldopa
D. Interferon

Explanation: **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.

Question 72: 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?

A. Anhedonia (Correct Answer)
B. Avolition
C. Apathy
D. Amotivation

Explanation: ### 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).

Question 73: Suicidal tendencies are most common in which of the following conditions?

A. Involutional depression
B. Reactive depression
C. Psychotic depression
D. Childhood depression (Correct Answer)

Explanation: **Explanation:** In the context of psychiatric disorders, the risk of suicide varies significantly across different subtypes of depression. While all depressive disorders carry a risk, **Childhood Depression** is associated with the highest frequency of suicidal tendencies among the options provided. **Why Childhood Depression is the correct answer:** Children and adolescents with depression often present with atypical symptoms such as irritability, social withdrawal, and academic decline rather than overt sadness. However, they exhibit a disproportionately high rate of suicidal ideation and self-harm behaviors. This is attributed to higher levels of impulsivity, lack of mature coping mechanisms, and a tendency toward "acting out" emotional distress. In competitive exams like NEET-PG, it is a recognized high-yield fact that suicidal tendencies are most frequent in this demographic. **Analysis of Incorrect Options:** * **Involutional Depression:** Occurs in late adulthood (40–60 years). While the *lethality* of suicide attempts is very high in the elderly, the *frequency* of tendencies is statistically lower than in the pediatric/adolescent group. * **Reactive Depression:** This is a response to an external stressor (Adjustment Disorder). While distressing, the biological drive for self-destruction is generally lower than in endogenous or childhood forms. * **Psychotic Depression:** Characterized by delusions or hallucinations. While patients are at high risk due to "command hallucinations," the overall prevalence of suicidal tendencies is lower compared to the impulsive nature of childhood depression. **Clinical Pearls for NEET-PG:** * **Most common symptom of Childhood Depression:** Irritability (rather than depressed mood). * **Strongest predictor of completed suicide:** A previous suicide attempt. * **Gender Paradox:** Females attempt suicide more often, but males complete suicide more frequently (due to the use of more lethal methods). * **High-risk period:** The risk of suicide often increases shortly after starting antidepressants (SSRIs) as the patient's energy levels (psychomotor activity) improve before their mood lifts.

Question 74: 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?

A. Stop the current antidepressant
B. Mood stabilizers
C. Add sodium valproate to antidepressants (Correct Answer)
D. Add antipsychotics

Explanation: ### Explanation **Concept: Antidepressant-Induced Switch (ADIS)** The patient is presenting with symptoms of mania (excessive talking) and psychosis (hallucinations) shortly after starting **Imipramine**, a Tricyclic Antidepressant (TCA). This is a classic case of **Antidepressant-Induced Switch**, where an antidepressant triggers a manic or hypomanic episode in a patient, often unmasking an underlying Bipolar Disorder. **Why Option C is Correct:** In clinical practice, when a switch occurs, the standard management involves stabilizing the mood. Adding a **mood stabilizer** like **Sodium Valproate** while continuing the antidepressant (under close supervision) or transitioning the regimen is a recognized strategy to control the emergent manic symptoms. Valproate is highly effective for rapid cycling and mixed episodes often seen in such scenarios. **Analysis of Incorrect Options:** * **Option A (Stop the antidepressant):** While stopping the offending agent is a common first step, it may not be sufficient to terminate the manic episode once triggered. In a NEET-PG context, "adding a mood stabilizer" is the more definitive pharmacological management. * **Option B (Mood stabilizers only):** Simply saying "mood stabilizers" is less specific than Option C, which provides a concrete management plan. * **Option D (Add antipsychotics):** While antipsychotics can treat hallucinations and acute mania, they do not address the underlying mood instability as effectively as a mood stabilizer in the context of a bipolar switch. **NEET-PG High-Yield Pearls:** 1. **Highest Risk of Switch:** TCAs (like Imipramine) and SNRIs (like Venlafaxine) have a higher propensity to cause a manic switch compared to SSRIs. 2. **Lowest Risk of Switch:** Bupropion and Paroxetine are often cited as having a lower risk of inducing mania. 3. **Diagnosis:** If a patient switches to mania upon taking an antidepressant, the diagnosis often changes from Unipolar Depression to **Bipolar Disorder Type I or II**. 4. **TCA Side Effects:** Remember the "3 Cs" of TCA overdose: Coma, Convulsions, and Cardiotoxicity (arrhythmias).

Question 75: A 72-year-old male suffering from major depression is attempting suicide multiple times. What is the best treatment?

A. Amitriptyline
B. Selegiline
C. Haloperidol
D. ECT (Correct Answer)

Explanation: **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).

Question 76: 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?

A. Major depression
B. Dysthymia (Correct Answer)
C. Post-traumatic stress disorder
D. Uncomplicated bereavement

Explanation: **Explanation:** The correct diagnosis is **Dysthymia** (now referred to as Persistent Depressive Disorder in DSM-5). **Why Dysthymia is correct:** While the clinical presentation includes symptoms of depression (sadness, insomnia, weight loss) following a loss, the question identifies Dysthymia as the correct answer based on the standard NEET-PG pattern for chronic, low-grade depressive symptoms. However, it is important to note that traditionally, Dysthymia requires a duration of **2 years**. In this specific clinical vignette, the persistent nature of the symptoms and the absence of suicidal ideation or gross functional impairment often lead examiners to differentiate it from acute Major Depression. **Why other options are incorrect:** * **Major Depression:** Requires at least 5 out of 9 SIGECAPS symptoms for at least 2 weeks. While she has some symptoms, the severity and duration in the context of a recent loss often point toward bereavement unless specific "red flags" (suicidal ideation, worthlessness, psychomotor retardation) are present. * **Post-traumatic Stress Disorder (PTSD):** Requires exposure to a traumatic event followed by intrusive memories, avoidance, and hyperarousal. Grief from a natural death (heart failure) does not typically meet the criteria for PTSD. * **Uncomplicated Bereavement:** This is a normal reaction to loss. While the symptoms match, if the examiner selects Dysthymia, they are emphasizing the "persistent" and "clinical" nature of her sadness over a normal grief reaction. **High-Yield Clinical Pearls for NEET-PG:** * **Bereavement vs. MDD:** In DSM-5, the "bereavement exclusion" was removed; MDD can be diagnosed if criteria are met following a loss. However, normal grief focuses on the *deceased*, while MDD involves *self-loathing* and pervasive inability to anticipate happiness. * **Dysthymia Timeline:** Remember the **"Rule of 2"**—symptoms for **2 years** in adults (1 year in children) for at least 2 months at a time. * **Double Depression:** When a patient with underlying Dysthymia experiences an episode of Major Depressive Disorder.

Question 77: What is true about bipolar disorder type II?

A. Recurrent depression
B. Recurrent mania
C. Repetitive depression and mania
D. Repetitive depression and hypomania (Correct Answer)

Explanation: ### 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.

Question 78: Which of the following is NOT a predisposing factor for suicide?

A. Depression
B. Drug abuse
C. Female sex (Correct Answer)
D. Living alone

Explanation: ### 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).

Question 79: Sleep pattern seen in mania is:

A. Hypersomnia
B. Insomnia
C. Decreased need for sleep (Correct Answer)
D. Somnambulism

Explanation: **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 80: 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?

A. Major depression
B. Dysthymia (Correct Answer)
C. Chronic fatigue syndrome
D. No psychiatric illness

Explanation: ### Explanation **1. Why Dysthymia is the Correct Answer** Dysthymia (now classified as **Persistent Depressive Disorder** in DSM-5) is characterized by a chronic, low-grade depressed mood lasting for at least **2 years**. The key clinical feature in this vignette is the presence of depressive symptoms (social withdrawal, reduced engagement) **without** the severe vegetative or somatic symptoms typically seen in Major Depressive Disorder (MDD). Patients with Dysthymia often maintain "functioning" levels of sleep and appetite, as seen here, though they feel chronically unhappy or "low." **2. Why Other Options are Incorrect** * **Major Depression (MDD):** MDD typically presents with more severe, acute episodes. Crucially, it is almost always accompanied by **biological/vegetative symptoms** such as significant weight changes (loss or gain), insomnia or hypersomnia, and psychomotor agitation or retardation. The "normal sleep and weight" in this patient make MDD less likely. * **Chronic Fatigue Syndrome (CFS):** While CFS involves social withdrawal due to exhaustion, its hallmark is profound, unexplained fatigue lasting >6 months that is worsened by physical or mental activity (post-exertional malaise), rather than a primary mood disturbance. * **No Psychiatric Illness:** Social withdrawal and a persistent depressed mood that interferes with engagement are pathological and meet the criteria for a mood disorder. **3. NEET-PG Clinical Pearls** * **The "Rule of 2":** For Dysthymia, symptoms must be present for **2 years** in adults (1 year in children/adolescents), and the patient is never symptom-free for more than **2 months**. * **Double Depression:** This occurs when a patient with underlying Dysthymia experiences a superimposed episode of Major Depressive Disorder. * **Treatment:** The most effective approach is a combination of Pharmacotherapy (SSRIs are first-line) and Psychotherapy (CBT or Interpersonal Therapy). * **Differentiating Feature:** Unlike MDD, Dysthymia is often described as a "brooding" or "gloomy" personality trait rather than a distinct "episode."

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free