Mood Disorders Practice Questions

Q: 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?

Rule out depression.. **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.

Q: All of the following are features of mania except?

Decreased motor activity. **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.

Q: A 40-year-old woman is being evaluated and is noted to have a decreased latency of REM sleep. Which disorder is she most likely suffering from?

Major depression. ### Explanation The correct answer is **Major Depressive Disorder (MDD)**. **Understanding REM Latency** REM latency is the interval between falling asleep and the first episode of REM (Rapid Eye Movement) sleep. In a healthy adult, this typically takes about 90 minutes. **Decreased REM latency** (entering REM sleep sooner than normal) is a hallmark polysomnographic finding in Major Depression. **Why Major Depression is Correct:** In patients with MDD, the architecture of sleep is significantly altered. Key findings include: * **Decreased REM Latency:** The most characteristic finding. * **Increased REM Duration:** The first REM period is longer. * **Increased REM Density:** More frequent eye movements during REM. * **Reduced Slow-Wave Sleep (N3):** Deep sleep is diminished. * **Early Morning Awakening:** Terminal insomnia. **Analysis of Incorrect Options:** * **Schizophrenia:** While sleep disturbances (like insomnia) occur, decreased REM latency is not a diagnostic or characteristic feature. * **PTSD:** Patients often experience nightmares and fragmented sleep, but the specific finding of shortened REM latency is not the primary physiological marker. * **Obsessive-Compulsive Disorder (OCD):** Sleep patterns in OCD are generally non-specific and do not consistently show the shortened REM latency seen in mood disorders. **High-Yield Clinical Pearls for NEET-PG:** * **Biological Markers of MDD:** Along with decreased REM latency, look for **increased cortisol levels** (due to HPA axis hyperactivity) and a **positive Dexamethasone Suppression Test** (failure to suppress cortisol). * **Antidepressant Effect:** Most antidepressants (especially SSRIs and TCAs) **increase REM latency** and decrease total REM sleep, which is thought to contribute to their therapeutic effect. * **Cholinergic-Aminergic Balance:** Depression is associated with an overactive cholinergic system, which triggers REM sleep earlier.

Q: All are features of mania, except?

Low self-esteem. ### Explanation The correct answer is **C. Low self-esteem**. In psychiatry, **Mania** is characterized by a distinct period of abnormally and persistently elevated, expansive, or irritable mood. According to the DSM-5 and ICD-11 criteria, the core features of mania are diametrically opposed to those of depression. **Why Low Self-Esteem is the Correct Answer:** Low self-esteem is a hallmark feature of **Depressive Episodes**, not mania. In mania, patients typically exhibit **inflated self-esteem or grandiosity**, ranging from uncritical self-confidence to delusional beliefs about having special powers, wealth, or status. **Analysis of Incorrect Options:** * **A. Flight of Ideas:** This is a formal thought disorder common in mania where thoughts move rapidly from one topic to another, usually connected by rhymes, puns (clang associations), or distracting stimuli. * **B. Psychomotor Agitation:** Manic patients show a marked increase in goal-directed activity or physical restlessness. They often feel "charged" and have a decreased need for sleep without feeling tired. * **D. Pressure to Talk:** Manic speech is typically loud, rapid, and difficult to interrupt. The patient feels an internal compulsion to keep speaking continuously. **NEET-PG High-Yield Pearls:** * **DIG FAST Mnemonic for Mania:** **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit (decreased need), **T**alkativeness (pressure of speech). * **Duration Criteria:** Symptoms must last at least **1 week** for Mania and **4 days** for Hypomania. * **Key Distinction:** Hypomania does *not* cause marked impairment in social/occupational functioning and *never* features psychotic symptoms. If psychosis is present, the diagnosis is automatically Mania.

Q: Talkativeness and flight of ideas are suggestive of which condition?

Mania. **Explanation:** The correct answer is **Mania**. This condition is a distinct period of abnormally elevated, expansive, or irritable mood and increased energy. **Why Mania is correct:** The core clinical features of Mania are often summarized by the mnemonic **DIG FAST**. **Talkativeness** (Pressure of speech) and **Flight of ideas** (a rapid shifting of ideas where the connection between thoughts is based on rhymes, puns, or chance associations) are hallmark symptoms of psychomotor agitation and racing thoughts. In mania, the patient speaks rapidly, is difficult to interrupt, and jumps from one topic to another while maintaining a logical (though tenuous) thread. **Why other options are incorrect:** * **Schizophrenia:** While "disorganized speech" occurs, the classic finding is **Loosening of Associations** (Knight’s move thinking), where the connection between thoughts is absent or bizarre, unlike the rapid but connected flow in flight of ideas. * **Hysteria (Dissociative/Conversion Disorder):** This typically presents with physical symptoms (e.g., paralysis, seizures) or memory gaps triggered by psychological stress, not a formal thought disorder or pressured speech. * **Tricyclic Antidepressants (TCAs):** These are medications used to treat depression. While they can *trigger* a manic switch in patients with underlying Bipolar Disorder, the drugs themselves are not a "condition" characterized by these symptoms. **High-Yield Clinical Pearls for NEET-PG:** * **Flight of ideas** is characteristic of Mania; **Loosening of associations** is characteristic of Schizophrenia. * **Pressure of speech:** The patient speaks so rapidly that it is nearly impossible to interject. * **Clang associations:** Choosing words based on sound (rhyming) rather than meaning; frequently seen alongside flight of ideas. * **Treatment of choice for acute mania:** Lithium or Valproate (Mood stabilizers) and Atypical Antipsychotics.

Q: Which of the following disorders is most closely associated with thyroid disease?

Depression. **Explanation:** The correct answer is **Depression**. The endocrine system and mood regulation are intricately linked via the hypothalamic-pituitary-thyroid (HPT) axis. **Why Depression is the Correct Answer:** Thyroid hormones (T3 and T4) play a crucial role in modulating neurotransmitters like serotonin and norepinephrine in the brain. * **Hypothyroidism** is classically associated with "pseudodepression," presenting with symptoms such as low mood, psychomotor retardation, fatigue, and cognitive impairment (often termed "myxedema madness" if severe). * **Hyperthyroidism** can also present with depressive symptoms, though it more commonly mimics anxiety or mania. * In clinical practice, Thyroid Function Tests (TFTs) are a mandatory screening tool for any patient presenting with a first episode of depression. **Analysis of Incorrect Options:** * **Schizophrenia:** While some endocrine abnormalities can occur, there is no primary causative link between thyroid dysfunction and the core pathophysiology of schizophrenia. * **Alcohol Use Disorder:** Chronic alcohol use can affect the HPT axis, but the association is secondary to liver disease or malnutrition rather than a direct etiological link. * **Phobia:** Phobias are anxiety disorders typically triggered by specific environmental stimuli and are not primarily driven by hormonal imbalances. **NEET-PG High-Yield Pearls:** 1. **L-Thyroxine Augmentation:** In patients with treatment-resistant depression, adding T3 (Liothyronine) can enhance the antidepressant response, even in euthyroid patients. 2. **Lithium & Thyroid:** Lithium (used for Bipolar Disorder) commonly causes **hypothyroidism** as a side effect; monitoring TSH is essential. 3. **Rapid Cycling Bipolar Disorder:** This condition is frequently associated with hypothyroidism. 4. **Postpartum Thyroiditis:** Always consider this in new mothers presenting with "Postpartum Depression."

Q: Which one of the following is not a characteristic feature of mania?

Heightened concentration. ### Explanation In Mania, the core clinical feature is a state of **distractibility**, not heightened concentration. Patients experience a "flight of ideas" and are easily diverted by trivial external stimuli. While they may feel mentally sharp, their ability to focus on a single task is significantly impaired. **Why Option C is the Correct Answer:** * **Distractibility:** This is a hallmark symptom of mania (part of the **DIGFAST** mnemonic). The patient’s attention is easily drawn to irrelevant stimuli, leading to poor concentration and inability to complete tasks. **Analysis of Incorrect Options:** * **A. Elated mood:** This is the classic presentation of mania. The mood is described as euphoric, expansive, or "on top of the world." * **B. Increased energy:** Manic episodes are characterized by psychomotor agitation, decreased need for sleep, and excessive involvement in goal-directed activities (e.g., social, work, or sexual). * **D. Impaired judgment:** Due to impulsivity and grandiosity, patients often engage in high-risk behaviors with painful consequences, such as reckless spending, sexual indiscretions, or foolish business investments. ### High-Yield Clinical Pearls for NEET-PG: * **DIGFAST Mnemonic for Mania:** **D**istractibility, **I**ndiscretion (judgment), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep (decreased need), **T**alkativeness (pressured speech). * **Duration Criteria:** Symptoms must last at least **1 week** for Mania (ICD-11/DSM-5) and **4 days** for Hypomania. * **Key Differentiator:** Hypomania does **not** cause significant functional impairment and lacks psychotic features, whereas Mania often requires hospitalization.

Q: Rapid cycling Bipolar disorder is characterized by?

More than 4 episodes per year. **Explanation:** **Rapid Cycling Bipolar Disorder** is a specifier used to describe a particularly severe course of Bipolar Disorder. 1. **Why Option A is Correct:** According to DSM-5 and ICD-10 criteria, rapid cycling is defined by the occurrence of **at least 4 or more mood episodes** (Manic, Hypomanic, or Depressive) within a single **12-month period**. These episodes must be demarcated by either a partial/full remission of at least 2 months or a switch to an episode of opposite polarity. 2. **Why Other Options are Incorrect:** * **Option B:** Unlike Bipolar Disorder in general (which has an equal sex distribution), rapid cycling is significantly **more common in females** (approx. 70-90% of cases). * **Option C:** Rapid cycling is frequently associated with **Hypothyroidism** (low thyroxine levels), not high levels. Lithium treatment can also induce hypothyroidism, potentially worsening the cycling. * **Option D:** Rapid cycling can occur in both Bipolar I and Bipolar II patterns; however, it is clinically more frequently associated with **Bipolar II** (hypomania and depression). **High-Yield Clinical Pearls for NEET-PG:** * **Triggers:** The most common triggers for rapid cycling are the use of **Antidepressants** (TCAs/SSRIs) and **Hypothyroidism**. * **Treatment:** The drug of choice for rapid cycling is **Valproate** (it is more effective than Lithium in this specific subtype). * **Prognosis:** It is associated with a poorer prognosis, higher suicide risk, and greater functional impairment compared to non-rapid cycling variants.

Q: Which of the following is true about psychotic features in depression?

Found in severe depression. Psychotic features in Major Depressive Disorder (MDD) are a hallmark of **Severe Depressive Episodes**. According to ICD and DSM criteria, psychosis does not occur in mild or moderate depression; its presence automatically upgrades the diagnosis to "Severe Depression with Psychotic Features." ### **Explanation of Options:** * **A (Correct):** Psychotic symptoms (delusions and hallucinations) occur only when the severity of the depressive episode is high. These patients often require hospitalization and a combination of antidepressants and antipsychotics or Electroconvulsive Therapy (ECT). * **B (Incorrect):** Moderate depression is characterized by a significant number of symptoms and functional impairment, but it lacks the loss of reality testing required for a diagnosis of psychosis. * **C (Incorrect):** While psychotic features in depression can be mood-incongruent, they are **typically mood-congruent** (e.g., delusions of guilt, poverty, or nihilism/Cotard syndrome). Mood-congruence is more characteristic of depression than incongruence. * **D (Incorrect):** Cyclothymia is a chronic, mild mood disorder involving hypomanic and depressive symptoms that do not meet the full criteria for a major episode. By definition, it does not include psychotic features. ### **High-Yield Clinical Pearls for NEET-PG:** * **Cotard Syndrome:** A specific nihilistic delusion found in severe depression where the patient believes they are dead, rotting, or do not exist. * **Treatment of Choice:** The combination of an **Antidepressant + Antipsychotic** is superior to either alone. * **ECT:** Severe depression with psychotic features or suicidal ideation is a prime indication for **Electroconvulsive Therapy**, often showing a faster response than pharmacotherapy. * **Prognosis:** The presence of psychosis in depression generally indicates a poorer prognosis and a higher risk of recurrence.

Question 1

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?

Accepted Answer

Rule out depression.

Answer

Consider it a normal adolescent problem.

Answer

Rule out migraine.

Answer

Rule out oppositional defiant disorder.

Question 2

All of the following are features of mania except?

Accepted Answer

Decreased motor activity

Answer

Decreased need for sleep

Answer

Elated mood

Answer

Delusion of grandeur

Question 3

A 40-year-old woman is being evaluated and is noted to have a decreased latency of REM sleep. Which disorder is she most likely suffering from?

Accepted Answer

Major depression

Answer

Schizophrenia

Answer

PTSD

Answer

Obsessive-compulsive disorder

Question 4

The period of normalcy is seen between two psychotic episodes. What is the diagnosis?

Accepted Answer

Manic depressive psychosis (Bipolar disorder)

Answer

Schizophrenia

Answer

Alcoholism

Answer

Depression

Question 5

All are features of mania, except?

Accepted Answer

Low self-esteem

Answer

Flight of ideas

Answer

Psychomotor agitation

Answer

Pressure to talk

Question 6

Talkativeness and flight of ideas are suggestive of which condition?

Accepted Answer

Mania

Answer

Schizophrenia

Answer

Hysteria

Answer

Tricyclic antidepressants

Question 7

Which of the following disorders is most closely associated with thyroid disease?

Accepted Answer

Depression

Answer

Schizophrenia

Answer

Alcohol use disorder

Answer

Phobia

Question 8

Which one of the following is not a characteristic feature of mania?

Accepted Answer

Heightened concentration

Answer

Elated mood

Answer

Increased energy

Answer

Impaired judgment

Question 9

Rapid cycling Bipolar disorder is characterized by?

Accepted Answer

More than 4 episodes per year

Answer

More common in males

Answer

High thyroxine levels

Answer

Bipolar 1 pattern of illness

Question 10

Which of the following is true about psychotic features in depression?

Accepted Answer

Found in severe depression

Answer

Found in moderate depression

Answer

Mood incongruent psychotic feature

Answer

Cyclothymia

Mood Disorders — MCQs

Mood Disorders — MCQs

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