Mood Disorders Practice Questions

Q: According to the ICD-10 revision, for establishing a diagnosis of mania, the symptoms should persist for at least how long?

1 week. **Explanation:** In psychiatry, the duration of symptoms is a critical diagnostic criterion for differentiating various mood disorders. According to the **ICD-10** (and similarly the DSM-5), the diagnosis of a **Manic Episode** requires symptoms to be present for at least **one week**. **1. Why Option A is correct:** The core diagnostic criteria for mania include a distinct period of abnormally elevated, expansive, or irritable mood. For this to be classified as a "Manic Episode," the symptoms must persist for at least **7 days** (1 week) and be severe enough to cause significant impairment in social or occupational functioning, or necessitate hospitalization. **2. Why other options are incorrect:** * **Option B (2 weeks):** This is the minimum duration required for a **Depressive Episode** (ICD-10/DSM-5) or Dysthymia (which requires 2 years). * **Options C & D (3 and 4 weeks):** These timeframes do not correspond to the standard diagnostic threshold for an acute manic episode in any major classification system. **High-Yield Clinical Pearls for NEET-PG:** * **Hypomania:** Requires a minimum duration of **4 days**. It is characterized by a milder elevation of mood that does *not* cause severe functional impairment or require hospitalization, and lacks psychotic features. * **Cyclothymia:** Requires persistent mood instability for at least **2 years**, involving numerous periods of hypomania and mild depression. * **Key Distinction:** If a patient requires **hospitalization** due to the severity of symptoms, the diagnosis is Mania, regardless of the duration (even if less than 7 days). * **ICD-11 Update:** While ICD-10 is the traditional reference, ICD-11 maintains the 1-week threshold for Mania but emphasizes that if hospitalization occurs, the duration requirement is waived.

Q: A 45-year-old female patient reports that over the last 3 months she has lost her appetite and interest in her usual activities, and often feels that life is not worth living. Compared with typical sleep, in this patient the percentage of REM sleep, percentage of delta sleep, and REM latency, respectively, are most likely to

increase, decrease, decrease. ### Explanation The patient presents with classic symptoms of **Major Depressive Disorder (MDD)**: anhedonia (loss of interest), anorexia, and suicidal ideation (life not worth living). In MDD, sleep architecture undergoes specific, high-yield neurobiological changes. **1. Why Option A is Correct:** The characteristic polysomnography (PSG) findings in depression include: * **Increased REM sleep percentage:** There is an overall increase in the total amount and density of REM sleep, particularly in the first half of the night. * **Decreased Delta sleep (Slow Wave Sleep):** Stages 3 and 4 of NREM sleep are significantly reduced. * **Decreased REM Latency:** This is the most specific marker. REM latency is the time from sleep onset to the first REM period. In depression, this interval shortens (often <60 minutes). **2. Why Other Options are Incorrect:** * **Option B:** Incorrect because REM latency **decreases** in depression, not increases. Increased REM latency is seen in healthy individuals or those using certain antidepressants (like SSRIs). * **Options C & D:** Incorrect because REM sleep percentage **increases** in depression due to "REM pressure," and REM latency **decreases**. **Clinical Pearls for NEET-PG:** * **Sleep Continuity:** Depressed patients also show increased sleep-onset latency (difficulty falling asleep) and increased early morning awakenings (terminal insomnia). * **REM Density:** There is an increase in the frequency of rapid eye movements during REM sleep. * **Cholinergic-Aminergic Balance:** The shift toward REM sleep in MDD is thought to be due to an imbalance between acetylcholine (which triggers REM) and monoamines (which inhibit REM). * **Treatment Effect:** Most antidepressants (SSRIs, TCAs, MAOIs) **suppress REM sleep** and **increase REM latency**, which is the opposite of the disease state.

Q: What is the treatment of choice for bipolar mood disorder?

Lithium. **Explanation:** **Lithium (Option B)** is the gold standard and treatment of choice for Bipolar Mood Disorder (BMD). It is a classic mood stabilizer that is effective in treating acute manic episodes and is the most proven agent for the long-term prophylaxis of both manic and depressive relapses. Its unique clinical value lies in its significant **anti-suicidal properties**, a high-yield fact for NEET-PG. **Analysis of Incorrect Options:** * **Imipramine (Option A):** A Tricyclic Antidepressant (TCA). While it treats depression, using antidepressants as monotherapy in BMD is contraindicated as they can trigger a "manic switch" or cause rapid cycling. * **Chlorpromazine (Option C):** A typical antipsychotic. While it may be used to control acute agitation in severe mania, it is not a mood stabilizer and does not prevent future episodes. * **Fluoxetine (Option D):** An SSRI. Similar to Imipramine, it is not used alone in BMD. If used for bipolar depression, it must be combined with a mood stabilizer (e.g., the Olanzapine-Fluoxetine combination). **High-Yield Clinical Pearls for NEET-PG:** * **Therapeutic Index:** Lithium has a narrow therapeutic index. Target serum levels are **0.8–1.2 mEq/L** for acute mania and **0.6–1.0 mEq/L** for maintenance. * **Teratogenicity:** Use in pregnancy is associated with **Ebstein’s Anomaly** (atrialization of the right ventricle). * **Side Effects:** Common issues include fine tremors, polyuria (nephrogenic diabetes insipidus), hypothyroidism, and weight gain. * **Drug Interactions:** Thiazides, NSAIDs, and ACE inhibitors can increase Lithium levels, leading to toxicity.

Q: ECT is indicated in which of the following conditions?

Severe depression. **Explanation:** **Electroconvulsive Therapy (ECT)** is a highly effective psychiatric intervention involving the induction of a generalized seizure through electrical stimulation of the brain under anesthesia. **Why Severe Depression is Correct:** Severe depression, particularly when accompanied by **psychotic features, catatonia, or high suicidal risk**, is the primary indication for ECT. It is often the treatment of choice when a rapid clinical response is required or when the patient is refractory to pharmacological treatments. In cases of "Depressive Stupor," ECT is considered life-saving. **Why Other Options are Incorrect:** * **Thyrotoxicosis Crisis (Thyroid Storm):** This is a hypermetabolic medical emergency. ECT is generally **avoided** here as tachycardia and hypertension (common side effects of ECT) could exacerbate the cardiac strain inherent in thyrotoxicosis. * **Alcohol Withdrawal & Delirium Tremens:** These are medical emergencies managed primarily with **Benzodiazepines** (e.g., Diazepam, Lorazepam) and supportive care (Thiamine, hydration). ECT has no role in treating withdrawal states and could potentially lower the seizure threshold further in a vulnerable brain. **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** There are **no absolute contraindications** to ECT, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication (risk of brain herniation). * **Most Common Side Effect:** Retrograde and anterograde amnesia (transient). * **Mortality Rate:** Approximately 0.01 per 1,000 patients (similar to general anesthesia). * **Electrode Placement:** Bilateral (more effective) vs. Unilateral (fewer cognitive side effects). * **Other Indications:** Acute Mania, Schizophrenia (especially catatonic type), and Neuroleptic Malignant Syndrome (NMS).

Q: A clinical sign of mania is?

Flight of ideas. ### Explanation **Flight of Ideas** is a hallmark formal thought disorder characteristic of **Mania**. It is defined as a rapid succession of thoughts where the connection between ideas is based on chance associations, such as **rhyming (clanging)** or **punning**, rather than logical progression. While the flow is extremely fast (pressured speech), a listener can usually follow the train of thought, unlike in schizophrenia where associations are completely lost. #### Analysis of Options: * **A. Neologism:** This refers to the coining of new words that have no meaning to others. It is a classic feature of **Schizophrenia**, not mood disorders. * **B. Perseveration:** This is the persistent repetition of a specific response (word, phrase, or gesture) despite the absence or cessation of a stimulus. It is most commonly associated with **Organic Brain Disorders** (like Dementia) or Frontal Lobe lesions. * **C. Echolalia:** This is the involuntary, parrot-like repetition of words spoken by another person. It is typically seen in **Catatonic Schizophrenia**, Autism, or certain neurological conditions. #### NEET-PG High-Yield Pearls: * **Pressure of Speech:** The objective sign of "racing thoughts" in mania; the patient speaks rapidly and is difficult to interrupt. * **Flight of Ideas vs. Loosening of Associations:** In Flight of Ideas (Mania), the links between ideas are understandable (though superficial). In Loosening of Associations (Schizophrenia), the links are idiosyncratic and incomprehensible. * **Other Manic Symptoms:** Euphoria/Elation, decreased need for sleep, grandiosity, and increased psychomotor activity. * **Diagnostic Tip:** If a question mentions "Clang associations," always look for Mania/Flight of Ideas as the primary diagnosis.

Q: Somatic symptoms of Depression include all except?

Feelings of guilt. In psychiatry, symptoms of Major Depressive Disorder (MDD) are broadly categorized into **Psychological (Emotional/Cognitive)** and **Somatic (Biological/Vegetative)** symptoms. **Explanation of the Correct Answer:** **A. Feelings of guilt:** This is a **psychological/cognitive symptom**. Guilt, worthlessness, and hopelessness represent the patient’s thought content and emotional state. According to the ICD and DSM criteria, while guilt is a core feature of depression, it does not involve a physiological or bodily function, thus it is not classified as a somatic symptom. **Explanation of Incorrect Options:** Somatic symptoms (also known as "melancholic features" or "biological markers") involve physical changes in the body’s regulatory systems: * **B. Reduced libido:** A common biological symptom reflecting a decrease in sexual drive and energy. * **C. Insomnia:** Sleep disturbance (especially early morning awakening) is a hallmark somatic feature of depression. * **D. Weight change:** Significant weight loss or gain (and changes in appetite) are primary physiological indicators of the depressive state. **High-Yield Clinical Pearls for NEET-PG:** * **Biological/Somatic Syndrome (ICD-10):** To diagnose the "somatic syndrome," at least four of the following must be present: loss of interest/pleasure, lack of emotional reactivity, early morning awakening (2+ hours early), diurnal variation (worse in the morning), psychomotor retardation/agitation, loss of appetite, weight loss (>5% in a month), and loss of libido. * **Diurnal Variation:** In typical depression, symptoms are usually **worse in the morning** and improve slightly as the day progresses. * **Beck’s Cognitive Triad:** Includes negative views about the **Self, World, and Future** (Guilt belongs to the 'Self' component).

Q: An IT employee, experiencing guilt, hopelessness, and difficulty concentrating on work, reports symptom onset three years ago during college. What is the likely diagnosis?

Dysthymia. **Explanation:** The patient presents with core symptoms of depression (guilt, hopelessness, poor concentration) that have persisted for **three years**. According to DSM-5 and ICD criteria, the hallmark of **Dysthymia** (Persistent Depressive Disorder) is a chronic depressed mood for most of the day, for more days than not, for at least **two years** (one year in children/adolescents). **Why the other options are incorrect:** * **Depressive Disorder (Major Depressive Disorder):** While the symptoms overlap, MDD is characterized by discrete episodes lasting at least two weeks. The chronic, low-grade nature over three years without significant remission points specifically to Dysthymia. * **Adjustment Disorder:** This diagnosis requires a clear identifiable stressor, and symptoms must develop within three months of the stressor and typically resolve within six months once the stressor is removed. * **Cyclothymia:** This is a chronic mood disturbance (at least two years) involving alternating periods of hypomanic symptoms and mild depressive symptoms. This patient lacks any history of hypomania. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of 2":** Dysthymia requires symptoms for **2 years** in adults, and the patient must not be symptom-free for more than **2 months** at a time. * **Double Depression:** This occurs when a patient with underlying Dysthymia experiences an 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).

Q: Which of the following is/are included in bipolar disorders?

Hypomania and Cyclothymia. **Explanation:** Bipolar disorders represent a spectrum of mood disorders characterized by pathological shifts in energy, activity levels, and mood. According to ICD and DSM criteria, the bipolar spectrum includes several distinct clinical entities: 1. **Bipolar I Disorder:** Characterized by at least one **Manic episode**. 2. **Bipolar II Disorder:** Characterized by at least one **Hypomanic episode** and one Major Depressive episode. 3. **Cyclothymic Disorder (Cyclothymia):** A chronic mood disturbance (lasting at least 2 years) involving numerous periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for a manic or major depressive episode. **Why Option D is Correct:** Both **Hypomania** (the hallmark of Bipolar II) and **Cyclothymia** are integral components of the Bipolar Disorder spectrum. Therefore, they are both included under the umbrella of bipolar disorders. **Analysis of Incorrect Options:** * **Paranoid Disorder (Option C):** This is a psychotic or personality disorder (e.g., Delusional Disorder, Paranoid type) characterized by persistent delusions of persecution. While psychosis can occur during severe mania, paranoia itself is not a defining feature of the bipolar mood spectrum. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** For diagnosis, Mania must last at least **1 week**, Hypomania at least **4 days**, and Cyclothymia at least **2 years** (1 year in children/adolescents). * **Key Distinction:** Hypomania does **not** cause marked impairment in social or occupational functioning and **never** includes psychotic features. If psychosis is present, the episode is classified as Mania by definition. * **Drug of Choice:** **Lithium** remains the gold standard for maintenance treatment and prophylaxis in Bipolar Disorder.

Q: An elderly gentleman develops severe depression. What is this condition called?

Involutional melancholia. **Explanation:** **Involutional Melancholia** is a traditional psychiatric term used to describe a severe form of depression occurring for the first time in late middle life or old age (the "involutional" period). It is characterized by intense agitation, somatic delusions (often involving the bowels or body rotting), and profound guilt. While modern classifications like the DSM-5 categorize this under Major Depressive Disorder with melancholic or psychotic features, the term remains high-yield for NEET-PG in the context of geriatric psychiatry. **Analysis of Incorrect Options:** * **B. Late-onset melancholia:** While descriptive, this is not a formal historical or clinical diagnostic term used in standard textbooks to define this specific syndrome. * **C. Pseudo-dementia:** This refers to a condition where a patient with severe depression presents with cognitive deficits (memory loss, disorientation) that mimic dementia. Unlike true dementia, these deficits improve significantly once the depression is treated. * **D. Atypical depression:** This is characterized by "mood reactivity" (mood brightens in response to positive events) along with symptoms like increased appetite/weight gain, hypersomnia, and leaden paralysis. It is the opposite of the melancholic presentation seen in the elderly. **Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome:** Often associated with involutional melancholia; the patient holds nihilistic delusions (e.g., "my brain is missing" or "I am dead"). * **Treatment of Choice:** For severe, agitated depression in the elderly (especially with suicidal risk or refusal to eat), **Electroconvulsive Therapy (ECT)** is often the most effective and rapid treatment. * **Key Differentiator:** In pseudo-dementia, the patient often complains extensively about memory loss ("I don't know"), whereas in true dementia, patients often try to hide or minimize their deficits.

Question 1

According to the ICD-10 revision, for establishing a diagnosis of mania, the symptoms should persist for at least how long?

Accepted Answer

1 week

Answer

2 weeks

Answer

3 weeks

Answer

4 weeks

Question 2

A 45-year-old female patient reports that over the last 3 months she has lost her appetite and interest in her usual activities, and often feels that life is not worth living. Compared with typical sleep, in this patient the percentage of REM sleep, percentage of delta sleep, and REM latency, respectively, are most likely to

Accepted Answer

increase, decrease, decrease

Answer

increase, decrease, increase

Answer

decrease, stay the same, increase

Answer

decrease, decrease, increase

Question 3

Delusion of grandiosity is seen in which of the following conditions?

Accepted Answer

Schizoaffective disorder, manic type

Answer

Hypomania

Answer

Paranoid schizophrenia

Answer

Kleptomania

Question 4

What is the treatment of choice for bipolar mood disorder?

Accepted Answer

Lithium

Answer

Imipramine

Answer

Chlorpromazine

Answer

Fluoxetine

Question 5

ECT is indicated in which of the following conditions?

Accepted Answer

Severe depression

Answer

Thyrotoxicosis crisis

Answer

Alcohol withdrawal

Answer

Delirium tremens

Question 6

A clinical sign of mania is?

Accepted Answer

Flight of ideas

Answer

Neologism

Answer

Perseveration

Answer

Echolalia

Question 7

Somatic symptoms of Depression include all except?

Accepted Answer

Feelings of guilt

Answer

Reduced libido

Answer

Insomnia

Answer

Weight change

Question 8

An IT employee, experiencing guilt, hopelessness, and difficulty concentrating on work, reports symptom onset three years ago during college. What is the likely diagnosis?

Accepted Answer

Dysthymia

Answer

Depressive disorder

Answer

Adjustment disorder

Answer

Cyclothymia

Question 9

Which of the following is/are included in bipolar disorders?

Accepted Answer

Hypomania and Cyclothymia

Answer

Hypomania

Answer

Cyclothymia

Answer

Paranoid disorder

Question 10

An elderly gentleman develops severe depression. What is this condition called?

Accepted Answer

Involutional melancholia

Answer

Late onset melancholia

Answer

Pseudo-dementia

Answer

Atypical depression

Mood Disorders — MCQs

Mood Disorders — MCQs

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