Mood Disorders Practice Questions

Q: A 27-year-old woman has been feeling low for the past 2 weeks. She has little energy and has trouble concentrating. She states that 6 weeks ago she had been feeling very good, with lots of energy and no need for sleep. This pattern has been occurring for at least the past 3 years, although the episodes have never been severe enough to prevent her from working. What is the most likely diagnosis?

Cyclothymic disorder. ### Explanation The correct diagnosis is **Cyclothymic Disorder**. **1. Why Cyclothymic Disorder is correct:** The patient presents with a chronic pattern (at least **2 years** in adults) of fluctuating moods. These include periods of **hypomanic symptoms** (high energy, decreased need for sleep) and periods of **depressive symptoms** (low mood, low energy). Crucially, the symptoms have never met the full diagnostic criteria for a Major Depressive Episode or a Manic Episode, and they are not severe enough to cause significant social or occupational impairment (she continues to work). **2. Why the other options are incorrect:** * **Borderline Personality Disorder:** While characterized by mood instability, it is primarily defined by unstable relationships, self-image issues, impulsivity, and a chronic fear of abandonment, which are not described here. * **Seasonal Affective Disorder:** This is a subtype of Major Depression or Bipolar disorder where episodes occur at specific times of the year (usually winter). The history here describes a 3-year pattern not linked to seasons. * **Major Depression, Recurrent:** This requires episodes of severe depression lasting at least 2 weeks. It does not account for the periods of high energy and decreased need for sleep (hypomanic symptoms) described in the vignette. **3. NEET-PG Clinical Pearls:** * **Duration Criteria:** For Cyclothymia, symptoms must be present for at least **2 years** (1 year in children/adolescents), with symptoms present at least half the time and never absent for more than 2 months. * **The "Milder" Spectrum:** Think of Cyclothymia as a chronic, lower-intensity version of Bipolar II disorder. * **Treatment:** Mood stabilizers (e.g., Lithium or Valproate) are the first-line treatment; antidepressants should be used cautiously as they may trigger "switching" into hypomania.

Q: Delusion of nihilism and early morning insomnia are characteristic features of which psychiatric condition?

Major depression. **Explanation:** The correct answer is **Major Depression**, specifically depression with **melancholic or psychotic features**. 1. **Why Major Depression is correct:** * **Delusion of Nihilism (Cotard’s Syndrome):** This is a specific type of delusion where the patient believes they are dead, non-existent, or that their internal organs/the world have ceased to exist. It is a hallmark of severe psychotic depression. * **Early Morning Insomnia (Terminal Insomnia):** This refers to waking up at least 2 hours before the scheduled time and being unable to fall back asleep. It is a "biological marker" for endogenous or melancholic depression, reflecting a disturbance in the circadian rhythm. 2. **Why other options are incorrect:** * **Mania:** Characterized by a *decreased need for sleep* (feeling refreshed after only 3 hours) rather than insomnia, and delusions are typically **grandiose** (inflated self-worth) rather than nihilistic. * **Personality Disorder:** These are enduring patterns of behavior/inner experience. While they can co-occur with depression, nihilistic delusions and specific sleep architecture changes are symptoms of Axis I clinical disorders, not personality traits. * **Schizophrenia:** While delusions are common (usually persecutory or bizarre), early morning awakening is not a diagnostic feature. Nihilism is specifically tied to the profound "low mood" of depression. **Clinical Pearls for NEET-PG:** * **Beck’s Cognitive Triad:** Hopelessness, Helplessness, and Worthlessness (common in depression). * **Sleep Changes in Depression:** Decreased REM latency (REM sleep starts sooner), increased REM density, and decreased slow-wave (Stage 3 & 4) sleep. * **Cotard’s Syndrome:** Often associated with atrophy in the nondominant cerebral hemisphere or severe depressive states.

Q: Which type of delusion is typically mood-congruent in depression?

Delusion of nihilism. **Explanation:** In psychiatry, delusions in mood disorders are categorized as **mood-congruent** (consistent with the patient's emotional state) or **mood-incongruent**. **1. Why Delusion of Nihilism is correct:** In severe depression (Melancholic or Psychotic depression), the patient’s mood is characterized by extreme hopelessness, guilt, and despair. **Nihilistic delusions** (also known as **Cotard delusion**) involve the belief that oneself, a body part, or the world has ceased to exist or is "dead." This profound sense of loss and non-existence perfectly mirrors the "empty" and "low" emotional state of depression, making it a classic mood-congruent feature. **2. Analysis of Incorrect Options:** * **A. Delusion of Grandeur:** This is a belief in one's own inflated importance, power, or identity. It is **mood-congruent to Mania**, not depression. * **C. Delusional Parasitosis (Ekbom Syndrome):** This is a monosymptomatic hypochondriacal psychosis where patients believe they are infested with insects. It is generally considered mood-neutral. * **D. Delusion of Reference:** The belief that neutral environmental cues (e.g., a news anchor’s comments) are directed specifically at the patient. While it can occur in depression, it is more characteristic of Schizophrenia and is considered **mood-incongruent** in the context of a primary mood disorder. **Clinical Pearls for NEET-PG:** * **Cotard Syndrome:** Often associated with the "Walking Corpse" syndrome; it is a severe form of nihilistic delusion seen in elderly depressed patients. * **Mood-Congruent Delusions in Depression:** Include delusions of guilt, poverty, nihilism, and somatic ruin. * **Prognostic Significance:** The presence of mood-incongruent delusions in a mood disorder usually indicates a poorer prognosis and a higher risk of transitioning to Schizoaffective disorder.

Q: What is the treatment for depression with suicidal tendencies?

ECT. **Explanation:** **1. Why ECT is the Correct Answer:** Electroconvulsive Therapy (ECT) is the gold-standard treatment for severe depression with **active suicidal ideation**. While antidepressants take 2–4 weeks to show clinical effects, ECT provides a **rapid therapeutic response**, making it life-saving in emergency psychiatric situations. It is the treatment of choice when a quick reduction in suicidal risk or depressive stupor is required. **2. Analysis of Incorrect Options:** * **Clozapine (A):** This is an atypical antipsychotic used for treatment-resistant schizophrenia. While it is the only drug FDA-approved specifically to reduce suicidal behavior in **schizophrenia**, it is not the primary treatment for suicidal depression. * **Mirtazapine (B):** An antidepressant (NaSSA) often used for depression with insomnia or weight loss. However, like all oral antidepressants, its onset of action is too slow for an acute suicidal crisis. * **Olanzapine (D):** An atypical antipsychotic used in bipolar disorder or as an adjunct in depression, but it does not have a primary role in the acute management of suicidal tendencies. **3. High-Yield Clinical Pearls for NEET-PG:** * **Indications for ECT:** Severe depression with suicide risk (Top priority), Catatonia, Depressive Stupor, and Treatment-resistant Depression. * **Most common side effect of ECT:** Retrograde amnesia (usually transient). * **Absolute Contraindication:** There are no absolute contraindications, but **Increased Intracranial Pressure (ICP)** is the most significant relative contraindication. * **Lithium:** Along with Clozapine, Lithium is one of the few pharmacological agents proven to reduce the long-term risk of suicide (specifically in Bipolar Disorder).

Q: Suicide is most common in which of the following conditions?

Depression. **Explanation:** **1. Why Depression is Correct:** Depression (Major Depressive Disorder) is the psychiatric condition most strongly associated with completed suicide. Statistically, approximately **15% of patients** with severe depression eventually die by suicide. The core symptoms of hopelessness, worthlessness, and psychomotor retardation (or agitation) create a high-risk profile. Hopelessness, in particular, is considered the strongest psychological predictor of suicidal intent. **2. Analysis of Incorrect Options:** * **Alcohol Dependence:** While substance abuse significantly increases impulsivity and is the second most common psychiatric diagnosis associated with suicide, the lifetime risk (approx. 7%) is lower than that of primary mood disorders. * **Dementia:** Patients with dementia may experience depression or confusion, but they have a lower overall rate of completed suicide compared to functional psychiatric disorders, often due to cognitive and physical limitations. * **Schizophrenia:** There is a significant risk in schizophrenia (approx. 5-10% lifetime risk), particularly in young patients with high premorbid functioning who have "insight" into their deteriorating condition (post-psychotic depression). However, it remains statistically lower than Major Depression. **3. High-Yield Clinical Pearls for NEET-PG:** * **Single most important risk factor:** A previous history of suicide attempts. * **Strongest predictor of suicide:** Hopelessness (Beck’s Hopelessness Scale). * **Demographics:** Men "commit" suicide more often (higher lethality), while women "attempt" suicide more frequently. * **Protective Factor:** Pregnancy and strong social/family support are significant protective factors. * **Bipolar Disorder:** The risk of suicide is actually higher during the **depressive phase** or **mixed episodes** than in pure mania.

Q: Episodes of depression in major depressive disorder tend to:

Increase in frequency with age. **Explanation:** The correct answer is **A: Increase in frequency with age.** Major Depressive Disorder (MDD) is often a recurrent illness. According to the natural history of the disease, as a patient ages, the **inter-episodic remission periods tend to shorten**, while the **frequency and severity of episodes tend to increase**. This phenomenon is sometimes explained by the "Kindling Hypothesis," which suggests that initial episodes require a significant environmental stressor, but subsequent episodes occur more spontaneously and frequently due to electrobiological changes in the brain. **Analysis of Incorrect Options:** * **B. Decrease in length with age:** Incorrect. As the disease progresses, untreated episodes typically tend to **increase in duration**, not decrease. * **C. Last for about 9 months when treated:** Incorrect. An untreated episode typically lasts 6 to 13 months. With appropriate antidepressant treatment, episodes generally last about **3 months**. * **D. Have a rapid onset:** Incorrect. Depression usually has a **gradual onset**, developing over weeks to months. In contrast, Bipolar Disorder (Manic episodes) often presents with a more acute or rapid onset. **High-Yield Clinical Pearls for NEET-PG:** * **Recurrence Risk:** After one episode of MDD, the risk of a second is 50%. After two episodes, it rises to 70%, and after three, it is 90%. * **Treatment Duration:** For a first episode, continue medication for **6–9 months** after remission to prevent relapse. * **Most Common Symptom:** Psychomotor retardation is the most common objective finding, while depressed mood and anhedonia are core subjective symptoms. * **Suicide Risk:** The risk is highest as the patient begins to recover and their energy levels (psychomotor activity) improve before their mood does.

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** The clinical presentation of this 22-year-old male—characterized by a **decreased need for sleep**, **hypersexuality**, **psychomotor excitement**, and **impulsivity (excessive spending)**—is a classic description of a **Manic Episode**. **Why Mania is Correct:** According to ICD-11 and DSM-5 criteria, a diagnosis of Mania requires a distinct period of abnormally elevated, expansive, or irritable mood and increased energy lasting **at least 1 week**. Key symptoms include: * **Decreased need for sleep:** Feeling rested after only 3 hours of sleep (distinct from insomnia). * **Increased goal-directed activity:** Often manifesting as increased libido or social activity. * **Poor judgment:** Excessive involvement in activities with high potential for painful consequences (e.g., spending sprees, foolish investments). **Why Other Options are Incorrect:** * **Confusion:** Refers to a clouding of consciousness or disorientation (common in Delirium), which is not the primary feature here. * **Hyperactivity:** This is a non-specific symptom. While present in mania, it is also seen in ADHD or hyperthyroidism. Mania is a comprehensive mood syndrome, not just a physical state. * **Memory Loss:** This is a cognitive deficit (Dementia/Amnesia) and is not associated with the expansive, high-energy state described. **NEET-PG High-Yield Pearls:** 1. **Duration Criteria:** Mania ≥ 7 days; Hypomania ≥ 4 days. 2. **Hypomania vs. Mania:** Hypomania does **not** cause marked impairment in social/occupational functioning and **never** includes psychotic features or requires hospitalization. 3. **Drug of Choice:** **Lithium** is the gold standard for long-term prophylaxis of Bipolar Disorder. 4. **DIG FAST Mnemonic:** **D**istractibility, **I**ndiscretion (spending/sex), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit, **T**alkativeness.

Q: Which of the following symptoms must be present for the diagnosis of major depressive disorder?

Loss of interest or pleasure. To diagnose **Major Depressive Disorder (MDD)** according to DSM-5 criteria, a patient must experience at least five symptoms for a minimum of 2 weeks. Crucially, at least one of these symptoms **must** be one of the two "core" symptoms: 1. **Depressed mood** 2. **Loss of interest or pleasure (Anhedonia)** ### Why Option A is Correct **Loss of interest or pleasure (Anhedonia)** is one of the two mandatory gateway symptoms. Without either a depressed mood or anhedonia, a diagnosis of MDD cannot be made, regardless of how many other physical or cognitive symptoms are present. ### Why Other Options are Incorrect While **Recurrent suicidal ideation (B)**, **Insomnia (C)**, and **Indecisiveness (D)** are all recognized diagnostic criteria for MDD under the DSM-5, they are considered **accessory symptoms**. A patient can be diagnosed with MDD without having these specific symptoms, provided they meet the overall threshold (5/9 symptoms) including one core symptom. ### NEET-PG High-Yield Pearls * **Mnemonic for MDD Criteria:** **SIGECAPS** (Sleep, Interest, Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal ideation). * **Duration:** Symptoms must persist for at least **2 weeks** and cause significant functional impairment. * **Exclusion:** Symptoms must not be attributable to substance use or another medical condition (e.g., Hypothyroidism). * **Pseudodementia:** In elderly patients, MDD often presents as cognitive impairment (memory loss), which is reversible with antidepressants—a common NEET-PG differentiator from Alzheimer’s.

Q: A female presents with symptoms of being excessively talkative, hyperactive, sleeping very little, and spending large amounts of money on shopping sprees. When confronted, she becomes irritable. What is the most likely diagnosis?

Bipolar I + Mania. ***Bipolar I + Mania***- The presentation of *pressured speech* (excessively talkative), *decreased need for sleep*, *hyperactivity*, and severe *impulsivity* (large spending) meets the criteria for a **full manic episode**.- A manic episode is defined by lasting at least one week, causing severe functional impairment, and is necessary for the diagnosis of **Bipolar I Disorder**.*Bipolar II + Hypomania*- Symptoms of a **hypomanic episode** are similar but are less severe, last a minimum of 4 consecutive days, and *do not cause marked functional impairment* or require hospitalization.- The patient’s severe symptoms (reckless spending, irritability upon confrontation) leading to major social/occupational problems indicate **mania**, not hypomania.*Obsessive-compulsive disorder*- This disorder is characterized by intrusive, recurrent **obsessions** (thoughts) and repetitive **compulsions** (behaviors) performed to relieve anxiety, which are not the primary symptoms here.- While spending could be impulsive, it is part of a cluster of mood and activity disturbances, not an ego-dystonic ritualistic compulsion.*Schizophrenia*- The primary features of **Schizophrenia** involve psychosis, such as **hallucinations**, **delusions**, and **disorganized thinking**, which are not described in this presentation.- Although irritability and hyperactivity may overlap, the core presentation is dominated by symptoms of a disruptive mood state, making a primary mood disorder more likely.

Question 1

A 27-year-old woman has been feeling low for the past 2 weeks. She has little energy and has trouble concentrating. She states that 6 weeks ago she had been feeling very good, with lots of energy and no need for sleep. This pattern has been occurring for at least the past 3 years, although the episodes have never been severe enough to prevent her from working. What is the most likely diagnosis?

Accepted Answer

Cyclothymic disorder

Answer

Borderline personality disorder

Answer

Seasonal affective disorder

Answer

Major depression, recurrent

Question 2

Delusion of nihilism and early morning insomnia are characteristic features of which psychiatric condition?

Accepted Answer

Major depression

Answer

Mania

Answer

Personality disorder

Answer

Schizophrenia

Question 3

Which type of delusion is typically mood-congruent in depression?

Accepted Answer

Delusion of nihilism

Answer

Delusion of grandeur

Answer

Delusional parasitosis

Answer

Delusion of reference

Question 4

Which of the following is NOT a risk factor for suicide in patients with depression?

Accepted Answer

Female gender

Answer

Male gender over 45 years of age

Answer

Childhood conduct disorder

Answer

Family history of suicide

Question 5

What is the treatment for depression with suicidal tendencies?

Accepted Answer

ECT

Answer

Clozapine

Answer

Mirtazapine

Answer

Olanzapine

Question 6

Suicide is most common in which of the following conditions?

Accepted Answer

Depression

Answer

Alcohol dependence

Answer

Dementia

Answer

Schizophrenia

Question 7

Episodes of depression in major depressive disorder tend to:

Accepted Answer

Increase in frequency with age

Answer

Decrease in length with age

Answer

Last for about 9 months when treated

Answer

Have a rapid onset

Question 8

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

Memory loss

Question 9

Which of the following symptoms must be present for the diagnosis of major depressive disorder?

Accepted Answer

Loss of interest or pleasure

Answer

Recurrent suicidal ideation

Answer

Insomnia

Answer

Indecisiveness

Question 10

A female presents with symptoms of being excessively talkative, hyperactive, sleeping very little, and spending large amounts of money on shopping sprees. When confronted, she becomes irritable. What is the most likely diagnosis?

Accepted Answer

Bipolar I + Mania

Answer

Schizophrenia

Answer

Obsessive-compulsive disorder

Answer

Bipolar II + Hypomania

Mood Disorders — MCQs

Mood Disorders — MCQs

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