Mood Disorders Practice Questions

Q: A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?

Bipolar disorder - manic episode. ***Bipolar disorder - manic episode*** - The constellation of extremely elevated mood features, including **rapid speech** (or pressured speech), severely **decreased need for sleep**, highly aggressive and **hyperactive behavior** (psychomotor agitation), defines a **manic episode**.- Discontinuation of established mood-stabilizing medication is a very strong predictor for relapse into a full-blown manic state in individuals with **bipolar disorder (Type I)**.*Depression* - Depression typically manifests with symptoms opposite to those observed, such as **low energy**, pervasive sadness, **anhedonia**, and often psychomotor **retardation**.- The patient's **aggression**, **hyperactivity**, and **pressured speech** are inconsistent with the core diagnostic features of a depressive episode.*Schizophrenia* - Schizophrenia is characterized fundamentally by prominent **psychotic symptoms** (hallucinations, delusions) and profound **disorganization** in speech and thought.- While agitation can occur, the cyclical mood features, specifically the dramatic decrease in the **need for sleep** and **pressured speech**, are hallmarks of mania, not schizophrenia.*Substance- induced mood disorder* - This diagnosis requires symptoms to be directly attributable to the physiological effects of **substance intoxication** or withdrawal.- Although substance use can mimic mania, the presence of a known **psychiatric disorder** and the exacerbation following cessation of **prescribed medication** make primary Bipolar I disorder relapse the most likely explanation.

Q: Which of the following is not an ICD-10 diagnostic criterion for depression?

Persistent worry about everyday matters. ### Explanation The diagnosis of a **Depressive Episode** according to **ICD-10** is based on a specific cluster of symptoms. The criteria are divided into **Typical (Core)** symptoms and **Other common** symptoms. #### Why Option D is Correct **Persistent worry about everyday matters** is the hallmark feature of **Generalized Anxiety Disorder (GAD)**, not Depression. While anxiety often co-exists with depression (comorbidity), it is not a diagnostic criterion for a depressive episode under ICD-10. #### Why Other Options are Incorrect Options A, B, and C represent the **three core (typical) symptoms** of depression in ICD-10. For a diagnosis, at least two of these must be present for a minimum of **2 weeks**: * **Low mood (Depressed mood):** To a degree that is definitely abnormal for the individual, present for most of the day and almost every day. * **Loss of interest or pleasure (Anhedonia):** In activities that are normally enjoyable. * **Low energy (Fatigability):** Increased fatigability or marked decrease in activity. #### High-Yield Clinical Pearls for NEET-PG/INI-CET * **ICD-10 Classification:** Depression is coded under **F32** (Depressive episode) and **F33** (Recurrent depressive disorder). * **Somatic Syndrome:** ICD-10 allows for a "somatic" specifier if symptoms like early morning awakening (2 hours early), diurnal variation (worse in morning), and psychomotor retardation are present. * **Severity Grading:** * **Mild:** 2 core + 2 others. * **Moderate:** 2 core + 3–4 others. * **Severe:** 3 core + $\geq$ 4 others. * **DSM-5 Difference:** Unlike ICD-10, **DSM-5** requires 5 out of 9 symptoms (must include either depressed mood or anhedonia) and does not list "low energy" as a separate core category in the same way.

Q: Which one of the following is correct regarding postpartum psychosis?

Recurrence rate in subsequent pregnancy is 60-70 %.. ***Recurrence rate in subsequent pregnancy is 60-70%.*** - Postpartum psychosis carries a **high recurrence risk**, making subsequent pregnancies a concern for women with a history of the condition. - This high recurrence rate (ranging from 50-80% across studies) underscores the importance of close monitoring and prophylactic treatment in future pregnancies. *Electro convulsive therapy is the first treatment of choice.* - **ECT** is considered for severe cases of postpartum psychosis, particularly when there is rapid deterioration, severe suicidality, or catatonia, rather than being the first-line treatment. - Initial management typically involves a combination of **antipsychotics and mood stabilizers**, often in an inpatient setting for safety. *There is often no family history of psychosis.* - A **family history of psychosis**, especially bipolar disorder or schizophrenia, is a **significant risk factor** for postpartum psychosis. - Genetic predisposition plays a substantial role, making this statement incorrect—family history is commonly present. *Its onset is usually within 4 days of delivery.* - While postpartum psychosis has a **rapid onset**, stating "usually within 4 days" is too restrictive. - The condition typically manifests within the **first 2-4 weeks after delivery**, with approximately **50% of cases occurring within the first week** and peak incidence in the first 2 weeks. - This makes the 4-day timeframe an underestimate of the typical onset window.

Q: Which one of the following factors is the most significant as a risk factor for post-partum psychosis?

History of post-partum psychosis. ***History of post-partum psychosis*** - A **prior episode of postpartum psychosis** is the strongest risk factor for recurrence, with recurrence rates estimated to be as high as 50-70%. - This indicates a heightened **biological vulnerability** to the hormonal and psychosocial stresses of the postpartum period. *Primiparity* - While primiparity can be associated with increased stress, it is a **less significant risk factor** for postpartum psychosis compared to a history of the condition. - The stress of a first pregnancy and childbirth can contribute to other perinatal mood disorders, but does not carry the same high recurrence risk as previous psychosis. *Undesired pregnancy* - An undesired pregnancy is often associated with **increased maternal stress, anxiety, and depression**, but it is generally a **weaker predictor** of postpartum psychosis than a personal history of the disorder. - While it can complicate the perinatal period, it doesn't confer the same high risk for a severe psychotic episode. *Unmarried status* - Unmarried status may increase the risk of **postpartum depression** due to lack of social support or increased stress, but it is **not a primary risk factor** for postpartum psychosis itself. - The familial and social support systems are important for overall well-being, but a previous psychotic episode is a much stronger predictor.

Q: Which of the following is false about bipolar disorder?

Unipolar mania is more common than bipolar disorder. ***Unipolar mania is more common than bipolar disorder*** - This statement is **false** because **unipolar mania is extremely rare**, while **bipolar disorder (which includes both manic and depressive episodes)** is significantly more common. - **Unipolar mania** refers to recurrent manic episodes without any depressive episodes, a presentation that is seldom observed clinically. *Genetic factors play important role* - This statement is **true**, as **bipolar disorder has a strong genetic component**, with **heritability estimated between 60-80%**. - **First-degree relatives** of individuals with bipolar disorder are at a significantly higher risk of developing the condition. *Rapid cycling is more common in females* - This statement is **true**; **rapid cycling (4 or more mood episodes per year)** occurs more frequently in females with bipolar disorder. - **Women with bipolar disorder** are also more likely to experience **mixed features** and **more depressive episodes** compared to males. *Age of onset is earlier than unipolar depression* - This statement is **true** because the **typical age of onset for bipolar disorder is in early adulthood (late teens to early 20s)**, whereas **unipolar depression often has a later average onset**, though both can occur at any age. - An earlier age of onset in bipolar disorder is linked to poorer prognosis and more severe illness course.

Q: A woman has mild depressive symptoms a few days after delivery that disappear within 2 weeks postpartum. The most likely cause is ______

Postpartum blues. ***Postpartum blues*** - **Mild depressive symptoms** that onset a few days after delivery and resolve within **two weeks postpartum** are characteristic of postpartum blues. - This condition is very common, affecting 50-80% of new mothers, and is thought to be due to **hormonal shifts** and **sleep deprivation**. *Major depression* - **Major depression** involves more severe and persistent symptoms that last for **at least two weeks** and significantly impair functioning, often requiring intervention. - While it can occur postpartum (postpartum depression), the **mild nature** and rapid resolution of symptoms in this case make it less likely. *Mania* - **Mania** is characterized by elevated mood, increased energy, racing thoughts, and decreased need for sleep, which are not described here. - This condition is typically associated with **bipolar disorder** and represents a distinct mood disturbance from the mild depressive symptoms described. *Postpartum psychosis* - **Postpartum psychosis** is a severe and rare psychiatric emergency characterized by **hallucinations, delusions, and disorganized behavior**. - Its rapid onset, severe symptoms, and high risk of harm to mother and baby are distinct from the mild, self-resolving symptoms presented.

Q: During a manic episode, a patient typically exhibits:

Grandiosity. ***Grandiosity*** - **Grandiosity**, characterized by an inflated sense of self-esteem, importance, or power, is a **hallmark symptom** of a manic episode. - Patients often believe they have special talents, abilities, or connections that are not based in reality. - This is one of the **core diagnostic criteria** for mania per DSM-5. *Delusion of persecution* - **Delusions of persecution**, where an individual believes they are being harmed or conspired against, are more characteristic of **schizophrenia** or **paranoid disorders**. - While psychotic features can occur in severe mania, **persecutory delusions** are less common than grandiose delusions during a manic episode. *Crying spells* - **Crying spells** are typically associated with **depressive episodes**, emotional lability, or conditions like **pseudobulbar affect**. - Manic episodes are marked by an **elevated or irritable mood**, and while irritability can lead to emotional outbursts, sustained crying spells are not typical. *Low self-esteem* - **Low self-esteem** is a core feature of **depressive episodes**, where individuals feel worthless, guilty, or inadequate. - In stark contrast, a manic episode is characterized by **inflated self-esteem** and grandiosity, not low self-esteem.

Q: Double depression is seen in:

Depression with dysthymia. ***Depression with dysthymia*** - **Double depression** is a specific mood disorder characterized by the co-occurrence of a **major depressive episode** on top of a pre-existing **dysthymic disorder** (persistent depressive disorder). - This means an individual experiences the chronic, milder symptoms of dysthymia, which are then worsened by the more severe symptoms of a major depressive episode. *Depression with anxiety attack* - While depression and anxiety attacks can co-occur, this specific combination is not referred to as **double depression**. - **Anxiety attacks** are acute episodes of intense fear and discomfort, often associated with panic disorder, and are distinct from chronic low-grade depressive symptoms. *Major depression with OCD* - **Obsessive-compulsive disorder (OCD)** is a distinct anxiety disorder characterized by obsessions and compulsions, which can co-occur with major depression. - However, the term **double depression** specifically refers to the combination of major depression and dysthymia, not other psychiatric comorbidities. *Major depressive disorder from 2 years* - Experiencing **major depressive disorder for 2 years** implies a chronic course of major depression. - If the symptoms meet the criteria for major depressive disorder continuously for at least two years, it might be termed **chronic major depressive disorder**, but not double depression, unless there was an underlying dysthymia.

Q: A 72 year old lady is severely depressed. For the past 2 days she has suicidal thoughts with an actual intent to die. Which of the following is best suitable to alleviate the symptoms?

ECT. ***ECT (Electroconvulsive Therapy)*** - **ECT** is the most effective and rapid treatment for severe depression, especially when associated with active **suicidal ideation** and intent. - Its quick onset of action (often within days) makes it vital in situations requiring urgent symptom alleviation to ensure patient safety. - **First-line treatment** for geriatric depression with suicidal risk and when rapid response is needed. *Selegiline* - **Selegiline** is a monoamine oxidase inhibitor (MAOI) used for depression and Parkinson's disease, but its antidepressant effects are not immediate. - It would not sufficiently address the patient's acute suicidal intent due to its slower therapeutic onset (several weeks). *Haloperidol + Chlorpromazine* - This combination consists of **antipsychotics**, primarily used for conditions with psychotic features or severe agitation but not as a primary treatment for severe depression with suicidal ideation. - While they might provide some sedation, they do not treat the underlying depressive disorder effectively and rapidly enough to resolve acute suicidal intent. *Amitriptyline* - **Amitriptyline** is a tricyclic antidepressant (TCA) that can be effective for depression but has a delayed onset of action (2-4 weeks). - **Highly contraindicated in suicidal patients** due to its extreme lethality in overdose (cardiotoxic effects). - Its slow therapeutic effect would not be appropriate for an urgent situation involving active suicidal thoughts with intent.

Q: Early morning awakening is a feature of -

Depression. ***Depression*** - **Early morning awakening** (or terminal insomnia) is a classic symptom of major depressive disorder, where patients wake up several hours before their usual time and cannot return to sleep. - This symptom is often accompanied by other features like **anhedonia**, feelings of worthlessness, fatigue, and **psychomotor retardation** or agitation. *Mania* - Patients experiencing **mania** often have a significantly reduced need for sleep but do not typically report early morning awakening as a distressful symptom. - They may go days with very little sleep, feeling energetic and not tired, which differs from the insomnia associated with depression. *Psychosis* - **Psychotic disorders** can disrupt sleep patterns due to hallucinations, delusions, or disorganized thinking, leading to various sleep disturbances. - However, **early morning awakening** is not a specific or hallmark symptom of psychosis; rather, sleep architecture can be severely fragmented and irregular. *Anxiety neurosis* - **Anxiety neurosis** (now often termed generalized anxiety disorder or panic disorder) can cause sleep initiation difficulties due to racing thoughts and worries. - While anxiety can cause **insomnia**, it more commonly manifests as difficulty falling asleep or nocturnal awakenings, rather than the characteristic early morning awakening seen in depression.

Question 1

A young man with a psychiatric disorder has become very aggressive. He speaks very rapidly and sleeps very little. He exhibits hyperactive behavior after discontinuing his prescribed medication. What is the most likely diagnosis?

Accepted Answer

Bipolar disorder - manic episode

Answer

Schizophrenia

Answer

Substance-induced mood disorder

Answer

Depression

Question 2

Which of the following is not an ICD-10 diagnostic criterion for depression?

Accepted Answer

Persistent worry about everyday matters

Answer

Low energy levels

Answer

Low mood for most of the day

Answer

Loss of interest in pleasurable things

Question 3

Which one of the following is correct regarding postpartum psychosis?

Accepted Answer

Recurrence rate in subsequent pregnancy is 60-70 %.

Answer

Electro convulsive therapy is the first treatment of choice.

Answer

There is often no family history of psychosis.

Answer

Its onset is usually within 4 days of delivery.

Question 4

Which one of the following factors is the most significant as a risk factor for post-partum psychosis?

Accepted Answer

History of post-partum psychosis

Answer

Primiparity

Answer

Undesired pregnancy

Answer

Unmarried status

Question 5

Which of the following is false about bipolar disorder?

Accepted Answer

Unipolar mania is more common than bipolar disorder

Answer

Genetic factors play important role

Answer

Rapid cycling is more common in females

Answer

Age of onset is earlier than unipolar depression

Question 6

A woman has mild depressive symptoms a few days after delivery that disappear within 2 weeks postpartum. The most likely cause is ______

Accepted Answer

Postpartum blues

Answer

Major depression

Answer

Mania

Answer

Postpartum psychosis

Question 7

During a manic episode, a patient typically exhibits:

Accepted Answer

Grandiosity

Answer

Delusion of persecution

Answer

Crying spells

Answer

Low self-esteem

Question 8

Double depression is seen in:

Accepted Answer

Depression with dysthymia

Answer

Depression with anxiety attack

Answer

Major depression with OCD

Answer

Major depressive disorder from 2 years

Question 9

A 72 year old lady is severely depressed. For the past 2 days she has suicidal thoughts with an actual intent to die. Which of the following is best suitable to alleviate the symptoms?

Accepted Answer

ECT

Answer

Selegiline

Answer

Haloperidol + Chlorpromazine

Answer

Amitriptyline

Question 10

Early morning awakening is a feature of -

Accepted Answer

Depression

Answer

Mania

Answer

Psychosis

Answer

Anxiety neurosis

Mood Disorders — MCQs

Mood Disorders — MCQs

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