Mood Disorders Practice Questions

Q: Catatonia is most commonly seen with which of the following psychiatric conditions?

Depression. **Explanation:** **1. Why Depression is the Correct Answer:** While catatonia was historically linked most closely with schizophrenia (Kahlbaum’s original description), modern epidemiological data and clinical practice show that it is most frequently associated with **Mood Disorders**. Among these, **Major Depressive Disorder (MDD)** is the single most common psychiatric condition where catatonia is observed. Approximately 20–25% of catatonic patients have an underlying primary mood disorder, whereas only about 10–15% have schizophrenia. **2. Analysis of Incorrect Options:** * **A. Schizophrenia:** Although "Catatonic Schizophrenia" is a well-known subtype in older classifications (ICD-10), it is statistically less common than mood-disorder-associated catatonia. In DSM-5, catatonia is now treated as a specifier that can be attached to any diagnosis, reflecting its prevalence in non-schizophrenic conditions. * **C. Anxiety Disorder:** While severe anxiety can lead to psychomotor agitation, it does not typically manifest as a full catatonic syndrome (stupor, waxy flexibility, mutism). * **D. Obsessive-Compulsive Disorder (OCD):** OCD is not a primary driver of catatonia. While some motor tics or compulsions may mimic catatonic movements, they do not meet the diagnostic criteria for catatonia. **3. NEET-PG High-Yield Pearls:** * **Most common cause overall:** Medical/Neurological conditions (always rule out organic causes first). * **Most common psychiatric cause:** Mood Disorders (Depression > Bipolar Disorder). * **Drug of Choice:** Benzodiazepines (specifically **Lorazepam**; the "Lorazepam Challenge Test" is used for diagnosis). * **Definitive Treatment for refractory cases:** Electroconvulsive Therapy (ECT). * **Key Signs:** Mutism, Stupor, Negativism, Waxy Flexibility, and Catalepsy.

Q: Repeated transcranial magnetic stimulation (rTMS) of the brain is used in the treatment of which of the following conditions?

Depression. **Explanation:** **Correct Option: A. Depression** Repeated Transcranial Magnetic Stimulation (rTMS) is a non-invasive neuromodulation technique that uses electromagnetic induction to generate small electrical currents in specific brain regions. In the treatment of **Major Depressive Disorder (MDD)**, rTMS is typically applied to the **Left Dorsolateral Prefrontal Cortex (DLPFC)**. High-frequency stimulation (10–20 Hz) in this area increases neuronal excitability and neurotransmitter release, which is often diminished in depressed patients. It is FDA-approved for patients who have not responded to at least one antidepressant medication. **Analysis of Incorrect Options:** * **B & C (Resistant Schizophrenia/OCD):** While rTMS is being researched for auditory hallucinations in schizophrenia (targeting the temporoparietal cortex) and for OCD (targeting the SMA or anterior cingulate), it is **not** the first-line or standard clinical indication compared to Depression. For NEET-PG, Depression remains the primary established indication. * **D (Acute Psychosis):** Acute psychosis is a psychiatric emergency requiring rapid stabilization, usually via antipsychotics or ECT. rTMS is not indicated for acute management due to its slower onset of action and limited efficacy in psychotic states. **High-Yield Clinical Pearls for NEET-PG:** * **Mechanism:** Electromagnetic induction (Faraday’s Law). * **Primary Target:** Left DLPFC (High frequency/Excitatory) or Right DLPFC (Low frequency/Inhibitory). * **Contraindication:** Presence of metallic implants (e.g., pacemakers, cochlear implants) or history of seizures (as rTMS can rarely induce seizures). * **Advantage over ECT:** No anesthesia required, no memory impairment, and no systemic side effects.

Q: Which of the following is NOT a feature of mania?

Disorientation. In psychiatry, **Mania** is a primary disorder of mood and affect. The hallmark of mania is that **consciousness and orientation remain intact**. If a patient presents with manic symptoms (like hyperactivity and talkativeness) along with **disorientation** to time, place, or person, the clinician must immediately suspect an organic cause (Delirium) or "Delirious Mania," rather than a typical manic episode. ### Why Disorientation is the Correct Answer: * **Disorientation (Option B):** This is a feature of **Cognitive Disorders** (like Delirium or Dementia) or organic brain syndromes. In functional psychiatric disorders like Bipolar Disorder (Mania), the sensorium is clear. The patient knows who they are, where they are, and the current time, even if they are highly distracted. ### Why Other Options are Incorrect: * **Elation (Option A):** This is the characteristic mood in mania. It is a state of confidence and enjoyment combined with a sense of well-being that is out of proportion to the circumstances. * **Pressure of speech (Option C):** A classic sign of "Flight of Ideas." The patient speaks rapidly, loudly, and is difficult to interrupt because their thoughts are racing. * **Delusion of grandeur (Option D):** A common psychotic feature in mania where the patient possesses inflated self-esteem or believes they have special powers, wealth, or a relationship with a famous person. ### High-Yield Clinical Pearls for NEET-PG: * **Core Triad of Mania:** Elation of mood, Psychomotor agitation, and Flight of ideas. * **Sleep Requirement:** A "decreased need for sleep" (feeling rested after only 3 hours) is one of the earliest and most specific signs of an impending manic episode. * **Distinguish from Hypomania:** Hypomania does **not** feature psychotic symptoms (like delusions) and does **not** cause marked impairment in social or occupational functioning.

Q: Essential criteria for major depression are all except?

Delusion of grandeur. To answer this question, we must refer to the **ICD-10** and **DSM-5** diagnostic criteria for Major Depressive Disorder (MDD). ### **Why "Delusion of Grandeur" is the correct answer:** Delusion of grandeur (an inflated sense of self-importance, power, or identity) is a hallmark symptom of a **Manic Episode** or Bipolar Disorder, not Major Depression. While depression can present with psychotic features, these are typically **mood-congruent**, such as delusions of guilt, poverty, or nihilism (Cotard syndrome). Grandiosity is diametrically opposed to the low self-esteem seen in depression. ### **Analysis of Incorrect Options:** * **Loss of Pleasure (Anhedonia):** This is one of the two **core symptoms** (along with depressed mood) required for a diagnosis. According to DSM-5, at least one of these two must be present for a 2-week period. * **Insomnia & Hypersomnia:** Sleep disturbance is a key physiological (somatic) criterion for MDD. While **insomnia** (specifically early morning awakening) is more common in melancholic depression, **hypersomnia** is a classic feature of **Atypical Depression**. Both are valid diagnostic criteria. ### **High-Yield Clinical Pearls for NEET-PG:** * **The "SIGECAPS" Mnemonic:** Used to remember MDD symptoms: **S**leep, **I**nterest (Anhedonia), **G**uilt, **E**nergy (Apathy), **C**oncentration, **A**ppetite, **P**sychomotor, **S**uicidal ideation. * **Minimum Duration:** Symptoms must be present for at least **2 weeks** for MDD. * **Most Common Sleep Abnormality:** On Polysomnography, depression shows **reduced REM latency** (entering REM sleep faster) and increased REM density. * **Atypical Depression:** Characterized by mood reactivity, weight gain (hyperphagia), hypersomnia, and "leaden paralysis." These patients often respond better to MAOIs.

Q: All of the following are features of masked depression except?

Depressed mood. **Explanation:** **Masked Depression** (also known as "Depressive Equivalent") is a clinical phenomenon where the core psychological symptoms of depression—such as sadness of mood, anhedonia, and hopelessness—are hidden or "masked" by prominent physical complaints. 1. **Why "Depressed Mood" is the correct answer:** By definition, in masked depression, the patient does not report a **depressed mood**. Instead, the underlying depressive illness manifests through somatic symptoms. The patient may even deny feeling sad, making "Depressed mood" the feature that is characteristically absent or hidden in this condition. 2. **Analysis of Incorrect Options:** * **Options A & B (Body aches and GI symptoms):** These are classic somatic manifestations of masked depression. Patients frequently present to general practitioners with chronic pain, fatigue, headaches, or vague gastrointestinal disturbances (like dyspepsia) rather than psychiatric complaints. * **Option C (Functional impairment):** Despite the absence of overt sadness, the underlying depressive process still causes significant socio-occupational dysfunction. The patient’s ability to work or maintain relationships is impaired due to the debilitating nature of their physical symptoms and underlying low energy. **NEET-PG High-Yield Pearls:** * **Target Population:** More common in elderly patients and certain cultural backgrounds where mental health stigma prevents the expression of emotional distress. * **Diagnosis:** It is often a diagnosis of exclusion after organic causes for somatic symptoms are ruled out. * **Treatment:** It responds well to standard **Antidepressants (SSRIs/TCAs)**, even though the patient presents with physical pain. * **Key Differentiator:** Unlike Somatization disorder, the physical symptoms in masked depression typically resolve once the underlying depressive episode is treated.

Q: A 25-year-old woman complains of intense depressed mood for 6 months with the inability to enjoy previously pleasurable activities. What is this symptom known as?

Anhedonia. **Explanation:** The correct answer is **Anhedonia**. **1. Why Anhedonia is correct:** Anhedonia is defined as the **inability to experience pleasure** from activities that were previously found enjoyable. It is a core symptom of Major Depressive Disorder (MDD) and is one of the two "gateway" symptoms required for diagnosis according to DSM-5 (the other being depressed mood). In this clinical scenario, the patient’s "inability to enjoy previously pleasurable activities" is a textbook description of this phenomenon. **2. Why other options are incorrect:** * **Avolition:** This refers to a total lack of motivation or "will" to initiate and persist in goal-directed activities (e.g., sitting for hours without doing anything). It is a common "negative symptom" of Schizophrenia. * **Apathy:** This is a state of indifference or a lack of emotional responsiveness, interest, or concern. While it overlaps with depression, it specifically denotes a lack of feeling rather than a lack of pleasure. * **Amotivation:** Similar to avolition, this is a lack of desire or drive to engage in activities. It is often seen in the "Amotivational Syndrome" associated with chronic cannabis use. **Clinical Pearls for NEET-PG:** * **Snaith-Hamilton Pleasure Scale (SHAPS):** A commonly used clinical scale to measure anhedonia. * **Biological Basis:** Anhedonia is linked to dysfunction in the **mesolimbic reward pathway** (dopaminergic system), particularly the Nucleus Accumbens. * **Melancholic Depression:** Anhedonia is a hallmark feature of the "Melancholic" subtype of MDD, which often responds well to TCAs or ECT. * **The "A"s of Schizophrenia:** Remember that Avolition, Anhedonia, Apathy, Alogia, and Affective flattening are the classic negative symptoms.

Question 1

Catatonia is most commonly seen with which of the following psychiatric conditions?

Accepted Answer

Depression

Answer

Schizophrenia

Answer

Anxiety disorder

Answer

Obsessive-compulsive disorder

Question 2

Repeated transcranial magnetic stimulation (rTMS) of the brain is used in the treatment of which of the following conditions?

Accepted Answer

Depression

Answer

Resistant schizophrenia

Answer

Resistant OCD

Answer

Acute psychosis

Question 3

Which of the following is NOT a feature of mania?

Accepted Answer

Disorientation

Answer

Elation

Answer

Pressure of speech

Answer

Delusion of grandeur

Question 4

A patient presents in a stupor. The patient's parents report a history of continuous sadness, suicidal attempts, and disturbances in eating and sleeping. What is the most appropriate initial treatment?

Accepted Answer

Electroconvulsive Therapy (ECT)

Answer

Antidepressant

Answer

Antipsychotic

Answer

Sedatives

Question 5

Which of the following statements regarding the pathophysiology of depression is true?

Accepted Answer

Decreased serotonin and norepinephrine levels

Answer

Increased serotonin and norepinephrine levels

Answer

Increased serotonin and decreased norepinephrine levels

Answer

Decreased serotonin and increased norepinephrine levels

Question 6

Essential criteria for major depression are all except?

Accepted Answer

Delusion of grandeur

Answer

Loss of pleasure

Answer

Insomnia

Answer

Hypersomnia

Question 7

All of the following are features of masked depression except?

Accepted Answer

Depressed mood

Answer

Body aches and pains

Answer

Gastrointestinal symptoms

Answer

Functional impairment

Question 8

Hypomania is differentiated from mania when?

Accepted Answer

Clinical symptoms are present for fewer days

Answer

Clinical symptoms are less severe

Answer

Symptoms cause social or occupational impairment

Answer

All of the above

Question 9

A 30-year-old man is brought to the emergency department by police, who arrested him because he was in the parking lot of a local mall, yelling "I am a golden god" as he stepped in front of moving cars. When questioned about his identity, he talks incessantly in a rapid fashion and threatens to "unleash God's wrath on those who do not submit." He reports that he has not slept in a week and does not need sleep. He has spent the last week preparing for a secret government mission that only the president knows about. When asked if he ever hears God talking to him, he says, "Of course not, I am God!" Police report that he has had several prior arrests for reckless driving and lewd acts. On examination, he is disheveled and malodorous. It is nearly impossible to get any further history, as he rapidly paces about and mutters, "I must go, I must go" over and over again. Which of the following is the most likely preliminary diagnosis?

Accepted Answer

Bipolar disorder

Answer

Antisocial personality disorder

Answer

Borderline personality disorder

Answer

Post traumatic stress disorder

Question 10

A 25-year-old woman complains of intense depressed mood for 6 months with the inability to enjoy previously pleasurable activities. What is this symptom known as?

Accepted Answer

Anhedonia

Answer

Avolition

Answer

Apathy

Answer

Amotivation

Mood Disorders — MCQs

Mood Disorders — MCQs

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