Mood Disorders US Medical PG Practice Questions and MCQs
Practice US Medical PG questions for Mood Disorders. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Mood Disorders US Medical PG Question 1: A researcher is investigating whether there is an association between the use of social media in teenagers and bipolar disorder. In order to study this potential relationship, she collects data from people who have bipolar disorder and matched controls without the disorder. She then asks how much on average these individuals used social media in the 3 years prior to their diagnosis. This continuous data is divided into 2 groups: those who used more than 2 hours per day and those who used less than 2 hours per day. She finds that out of 1000 subjects, 500 had bipolar disorder of which 300 used social media more than 2 hours per day. She also finds that 400 subjects who did not have the disorder also did not use social media more than 2 hours per day. Which of the following is the odds ratio for development of bipolar disorder after being exposed to more social media?
- A. 1.5
- B. 6 (Correct Answer)
- C. 0.17
- D. 0.67
Mood Disorders Explanation: ***6***
- To calculate the odds ratio, we first construct a 2x2 table [1]:
- Bipolar Disorder (Cases): 500
- No Bipolar Disorder (Controls): 500 (1000 total subjects - 500 cases)
- Cases exposed to more social media (>2 hrs/day): 300
- Cases not exposed to more social media (≤2 hrs/day): 200 (500 - 300)
- Controls not exposed to more social media (≤2 hrs/day): 400
- Controls exposed to more social media (>2 hrs/day): 100 (500 - 400)
- The odds ratio (OR) is calculated as (odds of exposure in cases) / (odds of exposure in controls) = (300/200) / (100/400) = 1.5 / 0.25 = **6** [1].
*1.5*
- This value represents the **odds of exposure** (more than 2 hours of social media) in individuals with bipolar disorder (300 cases exposed / 200 cases unexposed = 1.5).
- It is not the odds ratio, which compares these odds to the odds of exposure in the control group.
*0.17*
- This value is close to the reciprocal of 6 (1/6 ≈ 0.166), suggesting a potential miscalculation or an inverted odds ratio.
- An odds ratio of 0.17 would imply a protective effect (lower odds of bipolar disorder with more social media), which is contrary to the calculation and typical interpretation in this context.
*0.67*
- This value is the reciprocal of 1.5 (1/1.5 ≈ 0.67) which represents the odds of *not* being exposed in cases (200/300).
- It does not represent the correct odds ratio, which compares the odds of exposure in cases to the odds of exposure in controls.
Mood Disorders US Medical PG Question 2: A 35-year-old man is brought to the emergency department by his wife. She was called by his coworkers to come and pick him up from work after he barged into the company’s board meeting and was being very disruptive as he ranted on about all the great ideas he had for the company. When they tried to reason with him, he became hostile and insisted that he should be the CEO as he knew what was best for the future of the company. The patient’s wife also noted that her husband has been up all night for the past few days but assumed that he was handling a big project at work. The patient has no significant past medical or psychiatric history. Which of the following treatments is most likely to benefit this patient’s condition?
- A. Antidepressants
- B. Valproic acid (Correct Answer)
- C. Haloperidol
- D. Psychotherapy
- E. Clozapine
Mood Disorders Explanation: ***Valproic acid***
- This patient presents with symptoms highly suggestive of a **manic episode**, including grandiosity (believing he should be CEO), decreased need for sleep (up all night for days), pressured speech (ranting), and impulsivity with poor judgment (disruptive behavior at a board meeting).
- **Valproic acid** is a **first-line, guideline-recommended mood stabilizer** for acute mania. It is particularly effective for managing the core symptoms of mania including mood elevation, irritability, and impulsivity.
- It has a relatively rapid onset of action and a favorable side effect profile compared to typical antipsychotics, making it an excellent choice for initial management of acute mania in the emergency setting.
*Antidepressants*
- Administering **antidepressants** during a manic or hypomanic episode can exacerbate symptoms, potentially leading to a rapid cycling pattern or worsening mania.
- Antidepressants are primarily used for depressive episodes in bipolar disorder, typically in conjunction with a mood stabilizer, never as monotherapy in a patient presenting with mania.
*Haloperidol*
- **Haloperidol** is a typical antipsychotic that can be used for acute agitation in mania, but it does not address the underlying mood dysregulation.
- While it may help with immediate behavioral control, mood stabilizers like valproic acid or lithium are preferred as primary treatments because they target the core pathophysiology of bipolar disorder.
- Haloperidol also has a higher risk of extrapyramidal symptoms and does not prevent future mood episodes.
*Psychotherapy*
- **Psychotherapy** is a crucial component of long-term management for bipolar disorder but is not effective as a sole treatment for acute mania.
- Patients in acute mania are often too agitated, impulsive, and lack sufficient insight to meaningfully engage in therapeutic interventions.
- Psychotherapy should be initiated after mood stabilization with pharmacotherapy.
*Clozapine*
- **Clozapine** is an atypical antipsychotic reserved for treatment-resistant schizophrenia or treatment-resistant bipolar disorder, particularly with prominent psychotic features that have not responded to multiple other medications.
- Given its significant side effect profile, including agranulocytosis requiring regular blood monitoring, it is not a first-line or even second-line treatment for an initial presentation of mania.
- This patient has no psychiatric history and requires standard first-line treatment, not a medication reserved for refractory cases.
Mood Disorders US Medical PG Question 3: A 25-year-old woman is brought to the emergency department by EMS after being found naked in a busy downtown square. The patient stated that she is liberating people from material desires and was found destroying objects. Her temperature is 99.5°F (37.5°C), blood pressure is 127/68 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is deferred due to patient combativeness. The patient is given diphenhydramine and haloperidol and transferred to the psychiatric ward. On day 1 on the ward, the patient is no longer aggressive or agitated and has calmed down. She states that she feels severely depressed and wants to kill herself. The patient is started on a medication and monitored closely. On day 3 of the patient's stay in the hospital she is found in her room drawing up plans and states that she has major plans to revamp the current energy problems in the country. Which of the following is the most likely medication that was started in this patient?
- A. Quetiapine
- B. Olanzapine
- C. Lamotrigine
- D. Sertraline (Correct Answer)
- E. Lithium
Mood Disorders Explanation: ***Sertraline***
- This patient exhibits classic **bipolar I disorder** with rapid mood cycling from **mania** (naked in public, grandiose delusions, destroying objects) to **severe depression** (suicidal ideation on Day 1) and back to **mania** (grandiose plans on Day 3).
- The key clinical clue is the **rapid return to mania by Day 3** after starting medication during the depressive phase. This suggests **antidepressant-induced mania/mood switch**, a well-known complication of using **SSRI antidepressants** (like sertraline) **without adequate mood stabilization** in bipolar disorder.
- **Antidepressants can precipitate manic episodes** within days in bipolar patients, which is why they should be avoided or used only with concomitant mood stabilizers. This question tests recognition of this critical psychiatric principle.
*Lithium*
- Lithium is a first-line **mood stabilizer** for bipolar disorder and would be appropriate for long-term management. However, lithium **prevents manic episodes** rather than causing them.
- Lithium takes **1-2 weeks to reach therapeutic levels**, so it would not explain the rapid mood switch to mania by Day 3. If lithium had been started, we would expect **stabilization or improvement**, not a return to mania.
*Quetiapine*
- Quetiapine is an **atypical antipsychotic** effective for both acute mania and bipolar depression. It can provide rapid mood stabilization.
- If quetiapine was started on Day 1, we would expect **mood stabilization or sedation**, not a switch back to mania. Quetiapine does **not precipitate manic episodes**.
*Olanzapine*
- Olanzapine is another **atypical antipsychotic** used for acute mania and maintenance in bipolar disorder.
- Like quetiapine, olanzapine would **stabilize mood** and reduce manic symptoms, not trigger them. It would not explain the return to mania on Day 3.
*Lamotrigine*
- Lamotrigine is a mood stabilizer particularly effective for **preventing depressive episodes** in bipolar disorder, though less effective for acute mania.
- Lamotrigine **does not precipitate manic episodes** and takes weeks to titrate to therapeutic doses due to risk of Stevens-Johnson syndrome. It would not explain the rapid mood switch observed here.
Mood Disorders US Medical PG Question 4: A 32-year-old woman is brought to the physician by her husband, who is concerned about her ability to care for herself. Three weeks ago, she quit her marketing job to start a clothing company. Since then, she has not slept more than 4 hours per night because she has been working on her business plans. She used a significant portion of their savings to fund business trips to Switzerland in order to buy “only the best quality fabrics in the world.” She has not showered and has eaten little during the past 3 days. She has had 2 similar episodes a few years back that required hospitalization and treatment in a psychiatry unit. She has also suffered from periods of depression. She is currently not taking any medications. She appears unkempt and agitated, pacing up and down the room. She speaks very fast without interruption about her business ideas. She has no suicidal ideation or ideas of self-harm. Toxicology screening is negative. Which of the following is the most appropriate pharmacotherapy for the management of this patient?
- A. Clonazepam therapy for one year
- B. Long-term lithium therapy (Correct Answer)
- C. Sertraline therapy for one year
- D. Long-term risperidone therapy
- E. Long-term clozapine therapy
Mood Disorders Explanation: ***Long-term lithium therapy***
- This patient presents with classic symptoms of **mania** (decreased need for sleep, grandiosity, compulsive spending, rapid speech) and a history of both manic and depressive episodes, consistent with **bipolar I disorder**.
- **Lithium** is a first-line agent for the **long-term maintenance treatment** of **bipolar I disorder**, particularly effective in preventing both manic and depressive episodes.
*Clonazepam therapy for one year*
- **Clonazepam** is a **benzodiazepine** primarily used for short-term management of acute agitation or severe insomnia, not for long-term mood stabilization in bipolar disorder.
- Long-term use of benzodiazepines carries risks of **tolerance** and **dependence**, making it inappropriate for chronic maintenance treatment.
*Sertraline therapy for one year*
- **Sertraline** is an **antidepressant** (SSRI) that, when used as monotherapy in bipolar disorder, can induce **mania** or **rapid cycling**.
- While periods of depression are mentioned, the current presentation is manic, and mood stabilizers are the priority for long-term management.
*Long-term risperidone therapy*
- **Risperidone** is a **second-generation antipsychotic** effective in treating acute mania and can be used for maintenance in bipolar disorder, often as an adjunct or in patients who cannot tolerate lithium.
- However, for long-term monotherapy in bipolar I disorder, **lithium** is generally considered more effective and is the preferred first-line agent, especially given the history of recurrent episodes.
*Long-term clozapine therapy*
- **Clozapine** is an **atypical antipsychotic** reserved for **treatment-resistant schizophrenia** and **refractory bipolar disorder**, often due to its significant side effect profile, including **agranulocytosis**.
- While it can be effective for severe or refractory cases of bipolar disorder, it is not a first-line long-term treatment given its risks and the availability of safer alternatives.
Mood Disorders US Medical PG Question 5: A 19-year-old woman presents to an outpatient psychiatrist after 2 weeks of feeling “miserable.” She has been keeping to herself during this time with no desire to socialize with her friends or unable to enjoy her usual hobbies. She also endorses low energy, difficulty concentrating and falling asleep, and decreased appetite. You diagnose a major depressive episode but want to screen for bipolar disorder before starting her on an anti-depressant. Which of the following cluster of symptoms, if previously experienced by this patient, would be most consistent with bipolar I disorder?
- A. Insomnia, anxiety, nightmares, and flashbacks for 6 months
- B. Elevated mood, insomnia, distractibility, and flight of ideas for 5 days
- C. Impulsivity, rapid mood swings, intense anger, self-harming behavior, and splitting for 10 years
- D. Auditory hallucinations, paranoia, and disorganized speech for 2 weeks
- E. Impulsivity, insomnia, increased energy, irritability, and auditory hallucinations for 2 weeks (Correct Answer)
Mood Disorders Explanation: ***Impulsivity, insomnia, increased energy, irritability, and auditory hallucinations for 2 weeks***
- This cluster of symptoms indicates a past **manic episode** with **psychotic features**, characteristic of **Bipolar I disorder**. The duration of 2 weeks meets the diagnostic criteria for a manic episode.
- The presence of **auditory hallucinations** during a manic episode signifies **psychosis**, which is a key differentiator in Bipolar I as opposed to Bipolar II.
*Elevated mood, insomnia, distractibility, and flight of ideas for 5 days*
- While these symptoms suggest a **hypomanic episode**, the duration of 5 days is insufficient to meet the criteria for a manic episode (which requires a minimum of 7 days or hospitalization).
- A hypomanic episode, without psychotic features, indicates **Bipolar II disorder**, not Bipolar I.
*Insomnia, anxiety, nightmares, and flashbacks for 6 months*
- This symptom cluster is highly suggestive of **Post-Traumatic Stress Disorder (PTSD)** due to the presence of nightmares and flashbacks over an extended period.
- These symptoms are not indicative of a manic or hypomanic episode, and thus do not point to bipolar disorder.
*Auditory hallucinations, paranoia, and disorganized speech for 2 weeks*
- This constellation of symptoms suggests a **psychotic disorder** such as **schizophrenia** or **schizophreniform disorder**, especially with auditory hallucinations and disorganized speech dominating the clinical picture.
- While psychosis can occur in bipolar disorder, the question specifically asks for symptoms *consistent with bipolar I*, and these symptoms alone do not describe the characteristic mood disturbance (mania) of bipolar disorder.
*Impulsivity, rapid mood swings, intense anger, self-harming behavior, and splitting for 10 years*
- This pattern of symptoms, particularly the chronic impulsivity, rapid mood swings, intense anger, and splitting, is highly suggestive of **Borderline Personality Disorder (BPD)**.
- The chronic nature and specific interpersonal and behavioral challenges are hallmarks of BPD, not primarily a manic or hypomanic episode of bipolar disorder.
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