Seasonal Affective Disorder — MCQs
Double depression is seen in:
Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
Cyclothymia is classified as which type of mood disorder?
A 20-year-old male presents with weight loss, heat intolerance, bilateral exophthalmos, a lid lag, sweating, and tachycardia. These symptoms are due to an increased production and secretion of a hormone that is derived from which one of the following?
Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:
Parents are carrier of an autosomal recessive disorder. Chances of offspring to get affected?
What is the primary characteristic feature of Klein-Levin syndrome?
All of the following are true about bipolar disorder rapid cycling EXCEPT:
All of the following are tricyclic antidepressants except?
In depression, there is a deficiency in which neurotransmitter?
Seasonal Affective Disorder Indian Medical PG Practice Questions and MCQs
Question 1: Double depression is seen in:
- A. Depression with dysthymia (Correct Answer)
- B. Depression with anxiety attack
- C. Major depression with OCD
- D. Major depressive disorder from 2 years
Explanation: ***Depression with dysthymia*** - **Double depression** is a specific mood disorder characterized by the co-occurrence of a **major depressive episode** on top of a pre-existing **dysthymic disorder** (persistent depressive disorder). - This means an individual experiences the chronic, milder symptoms of dysthymia, which are then worsened by the more severe symptoms of a major depressive episode. *Depression with anxiety attack* - While depression and anxiety attacks can co-occur, this specific combination is not referred to as **double depression**. - **Anxiety attacks** are acute episodes of intense fear and discomfort, often associated with panic disorder, and are distinct from chronic low-grade depressive symptoms. *Major depression with OCD* - **Obsessive-compulsive disorder (OCD)** is a distinct anxiety disorder characterized by obsessions and compulsions, which can co-occur with major depression. - However, the term **double depression** specifically refers to the combination of major depression and dysthymia, not other psychiatric comorbidities. *Major depressive disorder from 2 years* - Experiencing **major depressive disorder for 2 years** implies a chronic course of major depression. - If the symptoms meet the criteria for major depressive disorder continuously for at least two years, it might be termed **chronic major depressive disorder**, but not double depression, unless there was an underlying dysthymia.
Question 2: Which of the following treatments cannot be used for management of Obsessive Compulsive Disorder (OCD)?
- A. Fluoxetine
- B. Carbamazepine (Correct Answer)
- C. Cognitive Behaviour Therapy
- D. Clomipramine
Explanation: ***Carbamazepine*** - **Carbamazepine** is an **anticonvulsant** and **mood stabilizer** primarily used for epilepsy and bipolar disorder. - It does not have established efficacy for the treatment of **Obsessive-Compulsive Disorder (OCD)**. *Fluoxetine* - **Fluoxetine** is a **Selective Serotonin Reuptake Inhibitor (SSRI)** and is a **first-line pharmacotherapy** for OCD. - SSRIs, including fluoxetine, are effective in reducing the severity of **obsessions and compulsions**. *Cognitive Behaviour Therapy* - **Cognitive Behavioural Therapy (CBT)**, specifically **Exposure and Response Prevention (ERP)**, is the **gold standard psychotherapy** for OCD. - It involves gradually exposing patients to feared situations or thoughts while preventing their ritualistic responses. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that has potent inhibitory effects on **serotonin reuptake**. - It is one of the **most effective medications** for OCD, often used when SSRIs are insufficient.
Question 3: Cyclothymia is classified as which type of mood disorder?
- A. Major depression
- B. Dysthymia
- C. Persistent mood disorder
- D. Bipolar mood disorder (Correct Answer)
Explanation: ***Bipolar mood disorder*** - **Cyclothymia (Cyclothymic Disorder)** is classified under **Bipolar and Related Disorders** in both DSM-5 and ICD-11, making it part of the bipolar spectrum. - It is characterized by **chronic, fluctuating mood disturbances** lasting at least 2 years (1 year in children/adolescents) with numerous periods of hypomanic and depressive symptoms that do not meet full criteria for hypomanic or major depressive episodes. - The alternating, less severe mood swings share the fundamental **bipolar pattern** of mood elevation and depression, hence its classification under bipolar mood disorders. *Major depression* - **Major depressive disorder** is a unipolar mood disorder involving persistent feelings of sadness, loss of interest, and other depressive symptoms that significantly impair daily functioning, **without any episodes of mania or hypomania**. - Cyclothymia involves **mood instability with both elevated and depressed periods**, which distinguishes it from unipolar major depression. *Dysthymia* - **Dysthymia** (now termed **Persistent Depressive Disorder** in DSM-5) is characterized by chronic, low-grade depressive symptoms lasting at least 2 years, **without manic or hypomanic episodes**. - While both involve sub-threshold symptoms, cyclothymia includes periods of **hypomanic symptoms** (elevated mood, increased energy), which are absent in dysthymia. *Persistent mood disorder* - This is a broad, non-specific descriptive term rather than a formal diagnostic category in DSM-5 or ICD-11. - While cyclothymia is indeed a persistent condition, it is **specifically categorized under Bipolar and Related Disorders** due to the presence of both elevated (hypomanic) and depressed mood states.
Question 4: A 20-year-old male presents with weight loss, heat intolerance, bilateral exophthalmos, a lid lag, sweating, and tachycardia. These symptoms are due to an increased production and secretion of a hormone that is derived from which one of the following?
- A. Tryptophan
- B. Dopamine
- C. Cholesterol
- D. Tyrosine (Correct Answer)
Explanation: ***Tyrosine*** - The symptoms described (weight loss, heat intolerance, exophthalmos, lid lag, sweating, tachycardia) are characteristic of **hyperthyroidism**, specifically **Graves' disease**. - Thyroid hormones (**T3 and T4**) are synthesized from the amino acid **tyrosine** through iodination of tyrosine residues on thyroglobulin in the thyroid gland. - This makes tyrosine the direct precursor for thyroid hormone synthesis. *Tryptophan* - **Tryptophan** is a precursor for the synthesis of **serotonin** and **melatonin**, neurotransmitters involved in mood regulation and sleep-wake cycles, not thyroid function. - Deficiency or altered metabolism of tryptophan is associated with conditions like **depression** or **carcinoid syndrome**, which have different clinical presentations. *Dopamine* - **Dopamine** is a catecholamine neurotransmitter, not a precursor for thyroid hormones. - While dopamine is synthesized from tyrosine (via the pathway: tyrosine → L-DOPA → dopamine), this is a completely separate biochemical pathway from thyroid hormone synthesis. - Symptoms of altered dopamine levels are associated with conditions like **Parkinson's disease** (dopamine deficiency) or **schizophrenia** (dopamine dysregulation), which do not match this patient's hyperthyroid presentation. *Cholesterol* - **Cholesterol** is the precursor for **steroid hormones** (glucocorticoids, mineralocorticoids, androgens, estrogens) and vitamin D, but not thyroid hormones. - Conditions related to altered cholesterol-derived hormone metabolism include various **endocrine disorders** involving adrenal or gonadal dysfunction, which present with different clinical features.
Question 5: Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:
- A. Chlorpromazine
- B. Haloperidol
- C. Diazepam
- D. Lithium carbonate (Correct Answer)
Explanation: **Lithium carbonate** - **Lithium** is a well-established and highly effective **mood stabilizer**, considered a first-line treatment for managing both **manic** and **depressive episodes** in bipolar disorder. - It helps prevent recurrent episodes and reduces the severity of mood swings, acting as a prophylactic agent. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** that is primarily used to treat **schizophrenia** and other psychotic disorders. - While it can be used acutely to manage severe manic agitation, it is not a first-line agent for the long-term mood stabilization characteristic of bipolar disorder. *Haloperidol* - **Haloperidol** is another **first-generation antipsychotic** often used for acute treatment of **psychotic symptoms** or severe agitation, including in mania. - It is not a primary long-term mood stabilizer for bipolar disorder due to its side effect profile and lack of efficacy in preventing future mood episodes compared to lithium. *Diazepam* - **Diazepam** is a **benzodiazepine** primarily used for treating **anxiety**, muscle spasms, and acute seizures. - While it can help manage acute agitation and insomnia during a manic episode, it does not have mood-stabilizing properties and is not a long-term treatment for bipolar disorder.
Question 6: Parents are carrier of an autosomal recessive disorder. Chances of offspring to get affected?
- A. 1:03
- B. 1:01
- C. 1:04 (Correct Answer)
- D. 1:02
Explanation: ***1:04*** - When both parents are **carriers** of an autosomal recessive disorder, each parent has one normal allele (A) and one affected allele (a). - The Punnett square cross (Aa x Aa) yields offspring genotypes in a 1:2:1 ratio: 1 **homozygous dominant (AA)**, 2 **heterozygous carriers (Aa)**, and 1 **homozygous recessive (aa)**. The homozygous recessive (aa) offspring will be affected, meaning there is a 1 in 4 chance, or 25%, for each child to be affected. *1:03* - This ratio does not represent the probability of an affected child when both parents are carriers of an autosomal recessive disorder. - The 1:3 ratio typically applies to the probability of an offspring being phenotypically normal (unaffected) when both parents are carriers, representing the sum of homozygous dominant and heterozygous genotypes. *1:01* - This ratio indicates a 100% chance of the offspring being affected, which would only occur if both parents were homozygous recessive (aa x aa) or if one parent was homozygous recessive and the other was a carrier and the disorder is dominant. - It does not apply to the scenario where both parents are heterozygous carriers of an autosomal recessive condition. *1:02* - This ratio suggests a 50% chance of the offspring being affected, which is incorrect for an autosomal recessive disorder where both parents are carriers. - A 1:2 ratio might represent the chances of specific genotypes (e.g., homozygous recessive vs. carriers) or specific phenotypes in some dominant inheritance patterns, but not the overall chance of being affected in this scenario.
Question 7: What is the primary characteristic feature of Klein-Levin syndrome?
- A. Insomnia
- B. Anxiety
- C. Depression
- D. Hypersomnia (Correct Answer)
Explanation: ***Hypersomnia*** - **Hypersomnia** is the cardinal and primary characteristic feature of Klein-Levin syndrome, characterized by recurrent episodes of excessive sleepiness lasting days to weeks. - During these episodes, individuals may sleep for **16 to 20 hours a day** and are extremely difficult to awaken. - Episodes are often accompanied by **cognitive disturbances** (confusion, derealization), **behavioral changes** (apathy, hyperphagia, hypersexuality), but **hypersomnia remains the defining feature**. - Normal functioning returns between episodes. *Insomnia* - **Insomnia** (difficulty falling or staying asleep) is the opposite of the key symptom seen in Klein-Levin syndrome. - Klein-Levin syndrome is a disorder of excessive sleep, not sleep deprivation. *Anxiety* - **Anxiety** may occur as a secondary feature or during the distress of episodes, but it is not the primary characteristic feature. - The core pathology manifests as profound sleep disturbance, not an anxiety disorder. *Depression* - **Depression** is sometimes observed during or after episodes of Klein-Levin syndrome, but it is not the primary defining feature. - The diagnostic hallmark is the **recurrent hypersomnia with associated cognitive and behavioral symptoms**, not mood disturbance.
Question 8: All of the following are true about bipolar disorder rapid cycling EXCEPT:
- A. Associated with hypothyroidism
- B. More common in males (Correct Answer)
- C. Often worsened by antidepressants
- D. Defined by ≥4 mood episodes per year
Explanation: ***More common in males*** - **Rapid cycling** in bipolar disorder is actually **more common in females** than in males. - While overall prevalence of bipolar disorder is similar between sexes, rapid cycling and mixed features tend to be more frequent in women. *Defined by ≥4 mood episodes per year* - This is the correct definition of **rapid cycling** in bipolar disorder according to diagnostic criteria (DSM-5). - These episodes can be of major depressive, manic, hypomanic, or mixed types. *Often worsened by antidepressants* - **Antidepressants** can sometimes **induce mania** or **accelerate cycling** in vulnerable individuals with bipolar disorder. - This risk is particularly elevated in rapid cycling presentations, leading to caution in their use. *Associated with hypothyroidism* - There is a recognized association between **hypothyroidism** and **rapid cycling** in bipolar disorder. - Treating underlying thyroid dysfunction can sometimes help stabilize mood in these patients.
Question 9: All of the following are tricyclic antidepressants except?
- A. Mianserin (Correct Answer)
- B. Imipramine
- C. Protriptyline
- D. Maprotiline
Explanation: **Explanation:** The correct answer is **A. Mianserin**. **Why Mianserin is the correct answer:** Mianserin is classified as a **Tetracyclic Antidepressant (TeCA)**, not a Tricyclic Antidepressant (TCA). Chemically, it contains four fused rings. Pharmacologically, it acts as an alpha-2 adrenergic receptor antagonist and a serotonin receptor antagonist (NASSA—Noradrenergic and Specific Serotonergic Antidepressant). Unlike TCAs, it lacks significant anticholinergic side effects and is relatively safer in overdose. **Analysis of Incorrect Options:** * **B. Imipramine:** This is the prototypical **Tricyclic Antidepressant**. It is a tertiary amine that inhibits the reuptake of both serotonin and norepinephrine. It is historically significant as the first antidepressant discovered. * **C. Protriptyline:** This is a **Secondary Amine TCA**. It is unique among TCAs because it is more activating/stimulating rather than sedating, making it useful for patients with lethargy. * **D. Maprotiline:** While Maprotiline is technically a tetracyclic compound (like Mianserin), in the context of standard medical examinations and the NEET-PG curriculum, it is traditionally grouped with **TCAs** (specifically as a secondary amine-like drug) because its side effect profile and mechanism (potent Norepinephrine Reuptake Inhibition) closely mimic TCAs. However, between Mianserin and Maprotiline, Mianserin is the definitive "non-TCA" due to its unique NASSA mechanism. **High-Yield Clinical Pearls for NEET-PG:** * **DOC for Enuresis:** Imipramine is the drug of choice for nocturnal enuresis in children (though behavioral therapy is first-line). * **OCD Treatment:** Clomipramine is the most serotonin-selective TCA and is highly effective for OCD. * **Toxicity:** TCA overdose presents with the **3 C's**: Coma, Convulsions, and Cardiac arrhythmias (due to sodium channel blockade). The antidote is **Sodium Bicarbonate**. * **Amitriptyline:** The most sedating TCA, often used for chronic pain and migraine prophylaxis.
Question 10: In depression, there is a deficiency in which neurotransmitter?
- A. 5-HT (Serotonin) (Correct Answer)
- B. Acetylcholine (Ach)
- C. Dopamine
- D. GABA (Gamma-aminobutyric acid)
Explanation: ### Explanation **Correct Option: A. 5-HT (Serotonin)** The pathophysiology of depression is primarily explained by the **Monoamine Hypothesis**, which suggests that a deficiency in monoamine neurotransmitters—specifically **Serotonin (5-HT)** and **Norepinephrine (NE)**—leads to depressive symptoms. Serotonin is crucial for regulating mood, sleep, appetite, and impulse control. Most first-line antidepressants, such as SSRIs (Selective Serotonin Reuptake Inhibitors), work by increasing the synaptic concentration of 5-HT, reinforcing its central role in the disorder. **Incorrect Options:** * **B. Acetylcholine (Ach):** Increased cholinergic activity is sometimes associated with depression, while decreased levels are linked to cognitive deficits (e.g., Alzheimer’s). It is not the primary deficiency in depression. * **C. Dopamine:** While dopamine deficiency is linked to **anhedonia** (loss of pleasure) and is central to Parkinson’s disease, serotonin remains the hallmark neurotransmitter associated with the core diagnosis of Major Depressive Disorder (MDD). * **D. GABA:** GABA is the primary inhibitory neurotransmitter. Its deficiency is more classically associated with **Anxiety Disorders** and seizure activity rather than the primary etiology of depression. **Clinical Pearls for NEET-PG:** * **Metabolite Marker:** The primary metabolite of Serotonin is **5-HIAA** (5-Hydroxyindoleacetic acid). Low levels of 5-HIAA in the cerebrospinal fluid (CSF) are strongly associated with **impulsive suicide attempts**. * **Neuroendocrine Change:** Depression is often associated with **Hypercortisolism** (failure to suppress cortisol in the Dexamethasone Suppression Test). * **Sleep Changes:** High-yield findings in depression include **decreased REM latency** (REM sleep starts sooner) and increased REM intensity.
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