Mood Disorders Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Mood Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Mood Disorders Indian Medical PG Question 1: All of the following are tricyclic antidepressants except?
- A. Mianserin (Correct Answer)
- B. Imipramine
- C. Protriptyline
- D. Maprotiline
Mood Disorders 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.
Mood Disorders Indian Medical PG Question 2: 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)
Mood Disorders 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.
Mood Disorders Indian Medical PG Question 3: A 17-year-old boy is diagnosed with schizophrenia. What is the risk that one of his siblings will develop the disease?
- A. 2%
- B. 5%
- C. 9% (Correct Answer)
- D. 20%
Mood Disorders Explanation: **Explanation:**
The risk of developing schizophrenia is heavily influenced by genetic proximity. In the field of psychiatric genetics, the risk increases as the percentage of shared genes with an affected individual increases.
**1. Why 9% is Correct:**
For a sibling of an affected individual (who shares approximately 50% of their genes), the lifetime risk of developing schizophrenia is approximately **8–10%** (standardized at **9%** for examination purposes). This is nearly 10 times higher than the risk in the general population.
**2. Analysis of Incorrect Options:**
* **A (2%):** This is too low for a first-degree relative. However, the risk for a **second-degree relative** (uncles, aunts, nephews, nieces) is approximately **2–3%**.
* **B (5%):** This is an intermediate value but does not align with established epidemiological data for siblings. It is closer to the risk for a parent (approx. 6%).
* **D (20%):** This is too high for a single sibling. This value is more representative of the risk when **both parents** have schizophrenia (approx. 40%) or for a **dizygotic (fraternal) twin** of an affected individual (approx. 12–17%).
**Clinical Pearls & High-Yield Facts for NEET-PG:**
* **General Population Risk:** 1% (Baseline).
* **Monozygotic (Identical) Twin:** ~47–50% (Highest risk; proves it is not 100% genetic).
* **Dizygotic (Fraternal) Twin:** ~12–17%.
* **Child of one affected parent:** ~12–13%.
* **Child of two affected parents:** ~40–46%.
* **Sibling of affected individual:** ~8–10% (9%).
**Key Concept:** Schizophrenia is a **polygenic** disorder. The more closely related a person is to a patient, the higher the risk, with the highest concordance seen in monozygotic twins.
Mood Disorders Indian Medical PG Question 4: An 18-year-old student complains of a lack of interest in studies for the last 6 months. He has frequent quarrels with his parents and experiences frequent headaches. What is the most appropriate clinical approach?
- A. Consider it a normal adolescent problem.
- B. Rule out depression. (Correct Answer)
- C. Rule out migraine.
- D. Rule out oppositional defiant disorder.
Mood Disorders Explanation: **Explanation:**
The correct answer is **Rule out depression (Option B)**. In adolescents, depression often presents atypically compared to adults. While adults typically manifest "low mood" or sadness, adolescents frequently present with **irritable mood**, behavioral issues (quarrels with parents), and **somatic complaints** (frequent headaches). The patient’s "lack of interest in studies" for 6 months signifies **anhedonia** or a decline in socio-occupational functioning, which are core diagnostic criteria for Depressive Disorder under DSM-5 and ICD-11.
**Why other options are incorrect:**
* **Option A:** Attributing a 6-month decline in functioning and persistent somatic symptoms to "normal adolescent behavior" is a common clinical error. Any significant change in baseline behavior warrants a pathological workup.
* **Option C:** While he has headaches, the presence of behavioral changes and academic decline suggests the headache is likely a somatic manifestation of an underlying psychiatric condition rather than a primary neurological disorder like migraine.
* **Option D:** Oppositional Defiant Disorder (ODD) involves a pattern of angry/irritable mood and vindictiveness, but it does not typically explain the "lack of interest in studies" or the somatic symptoms as effectively as depression does.
**Clinical Pearls for NEET-PG:**
* **Atypical Presentation:** Irritability and somatic symptoms (headache, stomach ache) are the hallmarks of pediatric and adolescent depression.
* **Duration:** For a diagnosis of Major Depressive Disorder, symptoms must persist for at least **2 weeks**. This patient has been symptomatic for 6 months.
* **Pseudodementia:** In elderly patients, depression often mimics dementia; in adolescents, it often mimics "laziness" or "rebellion." Always screen for mood symptoms in cases of sudden academic decline.
Mood Disorders Indian Medical PG Question 5: All of the following are features of mania except?
- A. Decreased need for sleep
- B. Elated mood
- C. Delusion of grandeur
- D. Decreased motor activity (Correct Answer)
Mood Disorders Explanation: **Explanation:**
The correct answer is **D. Decreased motor activity**. Mania is a clinical syndrome characterized by a distinct period of abnormally elevated, expansive, or irritable mood and increased energy.
**Why D is correct:**
In mania, there is a characteristic **increase in psychomotor activity**. Patients are often restless, over-energetic, and may engage in excessive goal-directed activities (e.g., social, professional, or sexual). "Decreased motor activity" (psychomotor retardation) is instead a hallmark feature of **Depressive episodes**, not mania.
**Why other options are incorrect:**
* **A. Decreased need for sleep:** This is a classic diagnostic criterion. Unlike insomnia (where the person wants to sleep but can’t), a manic patient feels refreshed and energetic after only 2–3 hours of sleep or none at all.
* **B. Elated mood:** Elation (a feeling of "being on top of the world") is the core emotional feature of mania. It can progress from euphoria to exaltation and ecstasy.
* **C. Delusion of grandeur:** This is a common psychotic feature in mania where the patient believes they possess special powers, wealth, or a relationship with a famous person/deity.
**High-Yield Clinical Pearls for NEET-PG:**
* **DIG FAST Mnemonic** for Mania: **D**istractibility, **I**ndiscretion (excessive pleasure seeking), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressure of speech).
* **Duration:** Symptoms must last at least **1 week** for Mania (DSM-5) and **4 days** for Hypomania.
* **Drug of Choice:** **Lithium** is the gold standard for prophylaxis and acute mania, though atypical antipsychotics are often used for rapid control of agitation.
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