Mood Disorders Practice Questions

Q: A 22-year-old male presents with decreased sleep, increased sexual activity, excitement, and excessive spending for the past 8 days. What is the most likely diagnosis?

Mania. ### Explanation **Correct Option: B (Mania)** The clinical presentation of this patient—decreased need for sleep, increased psychomotor activity (excitement), hypersexuality, and impulsivity (excessive spending)—is a classic triad of symptoms for a **Manic Episode**. According to ICD-11 and DSM-5 criteria, a diagnosis of Mania requires a distinct period of abnormally elevated or irritable mood and increased energy lasting **at least 1 week**. This patient’s 8-day duration fits the criteria perfectly. The symptoms represent a significant change from baseline functioning and involve the "DIG FAST" domains (Distractibility, Indiscretion/Spending, Grandiosity, Flight of ideas, Activity increase, Sleep deficit, and Talkativeness). **Why other options are incorrect:** * **A. Confusion:** This refers to a clouding of consciousness or disorientation, typically seen in Delirium or Organic Brain Syndromes, not primary mood disorders. * **C. Hyperactivity:** While hyperactivity is a *symptom* of mania (increased psychomotor agitation), it is not a diagnosis. It can also be seen in ADHD or hyperthyroidism. * **D. Loss of memory:** This is a cognitive deficit characteristic of Dementia or Amnestic syndromes; it is not a core feature of a manic episode. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** Mania (≥7 days), Hypomania (≥4 days). * **Hypomania vs. Mania:** Hypomania does *not* cause significant social/occupational impairment and *never* features psychotic symptoms or requires hospitalization. * **Drug of Choice:** **Lithium** is the gold standard for long-term prophylaxis and acute mania. For acute agitation in mania, atypical antipsychotics (e.g., Haloperidol or Olanzapine) are often used first. * **Most common mood disorder** in the general population is Depression, but the **most common psychiatric cause of "decreased need for sleep"** is Mania.

Q: Delusion of grandiosity is commonly seen in:

Mania. **Explanation:** **1. Why Mania is the Correct Answer:** Delusion of grandiosity is a hallmark feature of **Mania** (and Bipolar Disorder). It is a fixed, false belief where the patient possesses inflated self-esteem, extraordinary power, wealth, or a special relationship with a deity or famous person. In Mania, this occurs alongside a "congruent" elevated or expansive mood. According to ICD and DSM criteria, grandiosity is a key diagnostic feature of a manic episode, often manifesting as the patient claiming they have a "cure for cancer" or are "sent by God." **2. Why Other Options are Incorrect:** * **Schizophrenia:** While delusions of grandeur can occur in the Paranoid subtype, they are usually fragmented or bizarre. However, Mania is the *most common* and classic association for this specific delusion in psychiatric exams. * **Depression:** The typical delusions here are "mood-congruent" to a low state, such as **delusions of guilt, poverty, or nihilism** (Cotard’s syndrome). Grandiosity is diametrically opposite to the depressive mindset. * **Dementia:** Patients with dementia (like Alzheimer’s) primarily present with cognitive deficits and memory loss. While they may have delusions (often persecutory, like "people are stealing my things"), grandiosity is not a primary or common feature. **Clinical Pearls for NEET-PG:** * **Mood-Congruent Delusions:** In Mania, grandiosity matches the "high" mood. In Depression, nihilism matches the "low" mood. * **Schneiderian First Rank Symptoms (SFRS):** If a patient has delusions of grandeur *without* mood symptoms, consider Schizophrenia. * **Differential:** Always rule out **General Paresis of Insane (Neurosyphilis)**, which is a classic organic cause of grandiosity. * **Management:** Acute mania with delusions is treated with a combination of **Lithium/Valproate** and **Antipsychotics**.

Q: Which of the following medical conditions can present with depression?

All of the above. **Explanation:** Secondary depression (depression due to a general medical condition) is a high-yield topic in NEET-PG. Several endocrine and metabolic disorders can manifest with depressive symptoms, often preceding the physical diagnosis. **1. Hypothyroidism (Option A):** This is the most classic endocrine cause of depression. Low levels of thyroid hormones lead to psychomotor retardation, fatigue, cognitive slowing ("pseudodementia"), and depressed mood. It is a standard practice to screen for TSH levels in any patient presenting with a first episode of depression. **2. Cushing Syndrome (Option B):** Hypercortisolism is strongly associated with psychiatric morbidity. Approximately 50–60% of patients with Cushing syndrome experience significant depression. It can also present with mania, irritability, or psychosis. **3. Addison’s Disease (Option C):** Adrenocortical insufficiency often presents with "vague" psychiatric symptoms before a crisis occurs. Depression, apathy, fatigue, and social withdrawal are common early manifestations. **Why "All of the above" is correct:** Depression is a multi-systemic manifestation. Since thyroid dysfunction (Hypo), adrenal excess (Cushing), and adrenal insufficiency (Addison) all disrupt the hypothalamic-pituitary-adrenal (HPA) or thyroid axes—which regulate mood and energy—all three conditions are recognized medical causes of depression. **Clinical Pearls for NEET-PG:** * **Hyperparathyroidism:** Often associated with the mnemonic "Moans" (psychiatric moans/depression) due to hypercalcemia. * **Pancreatic Cancer:** Depression is often a **prodromal symptom** (occurring before physical symptoms like jaundice or pain). * **Vitamin Deficiencies:** B12 (Cobalamin) and Folate deficiency are common reversible causes of depression and cognitive decline. * **Post-Stroke Depression:** Most common in lesions involving the **left frontal cortex**.

Q: A primigravida female presents with feelings of depression and emotional lability soon after delivery. What is the most likely cause?

Postpartum blues. **Explanation:** The clinical presentation of a primigravida experiencing mild depressive symptoms and emotional lability shortly after delivery is classic for **Postpartum Blues** (also known as "Baby Blues"). **1. Why Postpartum Blues is correct:** Postpartum blues is the most common puerperal mood disturbance, affecting up to 50–80% of new mothers. It typically onset within **3–5 days** of delivery and is characterized by emotional lability, irritability, tearfulness, and sleep disturbances. Crucially, it is **self-limiting** (resolving within 10–14 days) and does not significantly impair the mother's ability to function or care for the infant. **2. Why other options are incorrect:** * **Postpartum Depression (PPD):** This is more severe and persistent, usually peaking at 2–4 weeks postpartum. It involves functional impairment, loss of interest (anhedonia), and sometimes suicidal ideation. It requires formal psychiatric treatment. * **Postpartum Psychosis:** A psychiatric emergency (incidence 0.1–0.2%) characterized by delusions, hallucinations (often involving the infant), and gross disorientation. It typically requires hospitalization. * **Postpartum Pinks:** A transient state of euphoria or hypomania sometimes seen immediately after birth; it is the opposite of the "blues" and is not a depressive state. **High-Yield Clinical Pearls for NEET-PG:** * **Management:** Postpartum blues requires only **reassurance and support**; pharmacotherapy is not indicated. * **Risk Factors:** History of PMS or a family history of mood disorders increases the risk. * **Timeline Rule:** Blues (Days 3–5) → Depression (Weeks 2–6) → Psychosis (Early weeks, sudden onset). * **Edinburgh Postnatal Depression Scale (EPDS):** The gold standard screening tool for identifying postpartum mood disorders.

Q: Which of the following is a defense mechanism commonly observed in depression?

Introjection. **Explanation** **Introjection** is the correct answer because it is a hallmark defense mechanism in depression. It involves the unconscious internalization of the qualities, values, or attributes of another person (often a significant "object") into one’s own self-structure. In the context of depression, an individual may introject the image of a lost or disappointing loved one. Consequently, any anger or resentment felt toward that person is turned inward against the self, leading to the characteristic symptoms of low self-esteem, intense guilt, and self-reproach. **Analysis of Incorrect Options:** * **Altruism (A):** This is a **mature** defense mechanism where an individual deals with emotional conflict by meeting the needs of others. It is generally associated with healthy adaptation rather than the pathology of depression. * **Projection (B):** This is a **neurotic/immature** defense where one attributes their own unacknowledged feelings or impulses to others. It is most classically associated with **Paranoid Personality Disorder** and Schizophrenia. * **Undoing (C):** This involves an act or communication aimed at "negating" or making amends for a previous unacceptable thought or action. It is the characteristic defense mechanism of **Obsessive-Compulsive Disorder (OCD)**. **Clinical Pearls for NEET-PG:** * **Introjection vs. Identification:** Introjection is often the precursor to identification; it is more primitive and involves "swallowing" the object whole, whereas identification is a more mature modeling of the self after another. * **Freud’s Theory:** Sigmund Freud, in *"Mourning and Melancholia,"* described depression as "anger turned inward" via introjection. * **High-Yield Associations:** * **Reaction Formation:** Obsessive-Compulsive Disorder. * **Splitting:** Borderline Personality Disorder. * **Acting Out:** Antisocial Personality Disorder.

Q: Depressive delusions that the world and everything related to it cease to exist is called:

Nihilistic delusion. ### Explanation **Correct Answer: C. Nihilistic delusion** **Nihilistic delusion** (also known as **Cotard’s delusion** or Cotard’s syndrome) is a specific psychopathology where the patient believes that they, a part of their body, or the entire world no longer exists. In the context of severe depression (Psychotic Depression), patients may claim their internal organs are rotting or that the world has ended. This stems from an extreme sense of hopelessness and "psychic death." **Analysis of Incorrect Options:** * **A. Persecutory delusion:** The false belief that one is being conspired against, spied on, or harmed by others. It is the most common type of delusion across psychiatric disorders (e.g., Schizophrenia). * **B. Delusion of infidelity (Othello Syndrome):** The irrational belief that one’s partner is being unfaithful. It is often associated with chronic alcoholism or organic brain syndromes. * **C. Delusion of reference:** The false belief that insignificant remarks, events, or objects in the environment have personal meaning or significance (e.g., believing a news anchor is sending them a secret message). **Clinical Pearls for NEET-PG:** * **Cotard’s Syndrome:** Often described as "walking corpse syndrome." It is a high-yield association with **Severe Depressive Episode with Psychotic Symptoms.** * **Mood-Congruent vs. Incongruent:** Nihilistic delusions are considered **mood-congruent** in depression because the "nothingness" matches the low mood. * **Treatment:** Severe depression with nihilistic delusions is a medical emergency due to the high risk of self-neglect or suicide. **Electroconvulsive Therapy (ECT)** is often the treatment of choice for rapid response.

Q: An 82-year-old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is consulted at the request of her daughters, who think their mother is depressed because she is tearful, often talks about her dead husband, and states that she has heard his voice several times. She blames herself for not having gone with him on his last visit to his sister and cries frequently. She has never seen a psychiatrist before and has been "strong" all her life. Which of the following is the most likely diagnosis?

Grief reaction. ### Explanation **1. Why Grief Reaction is Correct:** The patient is experiencing a **Normal Grief Reaction (Bereavement)**. Following the loss of a loved one, it is normal to experience sadness, tearfulness, and preoccupation with the deceased. Key features in this case that point toward grief rather than clinical depression include: * **Timeline:** Symptoms started 6 weeks ago (within the expected window of acute grief). * **Nature of Guilt:** Her guilt is specific to the deceased (not going on the last visit), rather than a generalized sense of worthlessness. * **Hallucinations:** Hearing the voice of the deceased (pseudohallucinations) is a common and normal finding in bereavement and does not signify psychosis. * **Functioning:** Despite her sadness, there is no mention of global functional impairment or pervasive suicidal ideation. **2. Why Other Options are Incorrect:** * **A. Depression secondary to GMC:** While she has cardiac issues, her symptoms are clearly linked to the psychological stressor of her husband’s death. * **B. Dysthymia (Persistent Depressive Disorder):** This requires a depressed mood for at least **2 years** (1 year in children). Her symptoms are acute (6 weeks). * **D. Major Depressive Disorder (MDD):** While grief can evolve into MDD, this patient lacks "SIGECAPS" severity. In MDD, guilt is usually pervasive/delusional, and hallucinations are typically not limited to the deceased. **3. Clinical Pearls for NEET-PG:** * **Normal Grief vs. MDD:** In grief, self-esteem is usually preserved. In MDD, feelings of worthlessness and self-loathing are prominent. * **Persistent Complex Bereavement Disorder:** Diagnosed if symptoms cause significant impairment and persist for at least **12 months** (DSM-5). * **Management:** Normal grief requires support and monitoring, not immediate antidepressants. * **Kubler-Ross Stages:** Denial, Anger, Bargaining, Depression, Acceptance (**DABDA**).

Question 1

A 22-year-old male presents with decreased sleep, increased sexual activity, excitement, and excessive spending for the past 8 days. What is the most likely diagnosis?

Accepted Answer

Mania

Answer

Confusion

Answer

Hyperactivity

Answer

Loss of memory

Question 2

Delusion of grandiosity is commonly seen in:

Accepted Answer

Mania

Answer

Schizophrenia

Answer

Depression

Answer

Dementia

Question 3

Which of the following medical conditions can present with depression?

Accepted Answer

All of the above

Answer

Hypothyroidism

Answer

Cushing syndrome

Answer

Addison's disease

Question 4

A primigravida female presents with feelings of depression and emotional lability soon after delivery. What is the most likely cause?

Accepted Answer

Postpartum blues

Answer

Postpartum psychosis

Answer

Postpartum depression

Answer

Postpartum pinks

Question 5

A woman with major depressive disorder underwent electroconvulsive therapy (ECT). Which of the following increases with ECT?

Accepted Answer

Brain derived neurotrophic factor

Answer

5-hydroxyindoleacetic acid

Answer

Dopamine

Answer

Serotonin

Question 6

Which of the following is a defense mechanism commonly observed in depression?

Accepted Answer

Introjection

Answer

Altruism

Answer

Projection

Answer

Undoing

Question 7

Major depression is thought to be caused by changes in which of the following?

Accepted Answer

Monoamine synapses in the Limbic System

Answer

Histamine synapses in the Basal Ganglia

Answer

Monoamine synapses in the Basal Ganglia

Answer

GABA synapses in the Cerebellum

Question 8

What is true regarding postpartum psychosis?

Accepted Answer

It usually occurs around 2 weeks postpartum.

Answer

It carries a good prognosis.

Answer

Recurrence in a future pregnancy is the rule.

Answer

It has an insidious onset.

Question 9

Depressive delusions that the world and everything related to it cease to exist is called:

Accepted Answer

Nihilistic delusion

Answer

Persecutory delusion

Answer

Delusion of infidelity

Answer

Delusion of reference

Question 10

An 82-year-old woman, whose husband passed away 6 weeks ago after a long illness, is admitted to the hospital for worsening of her cardiac problems. During the hospital stay, a psychiatrist is consulted at the request of her daughters, who think their mother is depressed because she is tearful, often talks about her dead husband, and states that she has heard his voice several times. She blames herself for not having gone with him on his last visit to his sister and cries frequently. She has never seen a psychiatrist before and has been "strong" all her life. Which of the following is the most likely diagnosis?

Accepted Answer

Grief reaction

Answer

Depression secondary to general medical condition

Answer

Dysthymia

Answer

Major depressive disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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