Comorbidities with mood disorders — MCQs

A 19-year-old woman is brought to the physician by her parents because of irritable mood that started 5 days ago. Since then, she has been staying up late at night working on a secret project. She is energetic despite sleeping less than 4 hours per day. Her parents report that she seems easily distracted. She is usually very responsible, but this week she spent her paycheck on supplies for her project. She has never had similar symptoms before. In the past, she has had episodes where she felt too fatigued to go to school and slept until 2 pm every day for 2 weeks at a time. During those times, her parents noticed that she cried excessively, was very indecisive, and expressed feelings of worthlessness. Two months ago, she had an asthma exacerbation and was treated with bronchodilators and steroids. She tried cocaine once in high school but has not used it since. Vital signs are within normal limits. On mental status examination, she is irritable but cooperative. Her speech is pressured and her thought process is linear. Which of the following is the most likely diagnosis?

A 29-year-old woman is hospitalized due to depression and suicidal ideation. She has a 5-year history of chaotic relationships that last only a few short weeks or months. Each relationship has left her feeling abandoned, empty, and extremely upset. During these periods, the patient confesses to shopping and making big purchases on impulse. She says she gets bored easily and moves on to the next adventure. The patient denies any changes in appetite, energy level, or concentration. On examination, multiple linear lacerations of varying phases of healing were noted on her forearms and trunk. Following consultation, she praises physicians to be ‘the best people on the planet’, but when the nurse came in to take her blood, she furiously stated that ‘all nurses are incompetent and cruel’. Which of the following is the most likely diagnosis?

A 35-year-old man with no past medical history presents to his primary care physician with complaints of fatigue. He states that his life has been hectic lately and that everything seems to be falling apart. He is scared that he will lose his job, that his wife will leave him, and that his children will not be able to afford to go to college. His worries are severe enough that they have begun to interfere with his daily activities. His wife is also present and states that he has a very secure job and that they are well off financially. She says that he has always worried about something since she met him years ago. What medication would benefit this patient long term?

A 55-year-old man with a history of myocardial infarction 3 months ago presents with feelings of depression. He says that he has become detached from his friends and family and has daily feelings of hopelessness. He says he has started to avoid strenuous activities and is no longer going to his favorite bar where he used to spend a lot of time drinking with his buddies. The patient says these symptoms have been ongoing for the past 6 weeks, and his wife is starting to worry about his behavior. He notes that he continues to have nightmares that he is having another heart attack. He says he is even more jumpy than he used to be, and he startles very easily. Which of the following is the most likely diagnosis in this patient?

A mental health volunteer is interviewing locals as part of a community outreach program. A 46-year-old man discloses that he has felt sad for as long as he can remember. He feels as though his life is cursed and if something terrible can happen to him, it usually will. He has difficulty making decisions and feels hopeless. He also feels that he has had worsening suicidal ideations, guilt from past problems, decreased energy, and poor concentration over the past 2 weeks. He is otherwise getting enough sleep and able to hold a job. Which of the following statement best describes this patient's condition?

A 24-year-old male comes into the psychiatric clinic complaining of consistent sadness. He endorses feelings of worthlessness, anxiety, and anhedonia for the past couple months but denies feeling suicidal. He further denies any past episodes of feeling overly energetic with racing thoughts. Confident of the diagnosis, you recommend frequent talk therapy along with a long-term prescription of a known first-line medication for this disorder. What is the drug and what are some of the most frequently encountered side effects?

A 45-year-old man is brought to the physician by his wife because of difficulty sleeping and poor appetite for the past 4 weeks. During this period, he also has had persistent sadness and difficulty concentrating on tasks, because of which he has been reprimanded at work for poor performance. Over the past 3 years, he has often had such phases, with a maximum symptom-free gap of one month between each of them. His behavior is causing a strain in his relationships with his wife and children. His mother died 4 months ago from breast cancer. Physical examination shows no abnormalities. Mental status examination shows a depressed mood and constricted affect. What is the most likely diagnosis in this patient?

A 24-year-old woman presents to her primary care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, difficulty with concentration, and trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 years. She has had moments where she felt better, but it lasted a few weeks out of the year. She currently lives alone and does not pursue romantic relationships because she feels she is not attractive. She has a past medical history of asthma. Her mother is alive and healthy. Her father committed suicide and suffered from major depressive disorder. On physical exam, the patient has a gloomy demeanor and appears restless and anxious. Which of the following is the most likely diagnosis?

A 29-year-old man comes to the physician with his wife because she has noticed a change in his behavior over the past 2 weeks. His wife reports that he is very distracted and irritable. His colleagues have voiced concerns that he has not been turning up for work regularly and behaves erratically when he does. Previously, her husband had been a reliable and reasonable person. The patient says that he feels “fantastic”; he only needs 4 hours of sleep each night and wakes up cheerful and full of energy each morning. He thinks that his wife is overreacting. The patient has been healthy except for a major depressive episode 5 years ago that was treated with paroxetine. He currently takes no medications. His pulse is 98/min, respirations are 12/min, and blood pressure is 128/62 mm Hg. Mental status examination shows frenzied speech and a flight of ideas. Which of the following is the strongest predisposing factor for this patient's condition?

A 28-year-old woman presents with depressed mood lasting for most days of the week for the past month. She also mentions that she has lost her appetite for the past 3 weeks. She adds that her job performance has significantly deteriorated because of these symptoms, and she feels like she will have to quit her job soon. Upon asking about her hobbies, she says that she used to enjoy dancing and music but does not have any desire to do them anymore. The patient’s husband says that she has had many sleepless nights last month. The patient denies any history of smoking, alcohol intake, or use of illicit substances. No significant past medical history. Physical examination is unremarkable. Routine laboratory tests are all within normal limits. Which of the following clinical features must be present, in addition to this patient’s current symptoms, to confirm the diagnosis of a major depressive episode?