Mood Disorders Practice Questions

Q: All of the following are true about bipolar disorder rapid cycling EXCEPT:

More common in males. ***More common in males*** - **Rapid cycling** in bipolar disorder is actually **more common in females** than in males. - While overall prevalence of bipolar disorder is similar between sexes, rapid cycling and mixed features tend to be more frequent in women. *Defined by ≥4 mood episodes per year* - This is the correct definition of **rapid cycling** in bipolar disorder according to diagnostic criteria (DSM-5). - These episodes can be of major depressive, manic, hypomanic, or mixed types. *Often worsened by antidepressants* - **Antidepressants** can sometimes **induce mania** or **accelerate cycling** in vulnerable individuals with bipolar disorder. - This risk is particularly elevated in rapid cycling presentations, leading to caution in their use. *Associated with hypothyroidism* - There is a recognized association between **hypothyroidism** and **rapid cycling** in bipolar disorder. - Treating underlying thyroid dysfunction can sometimes help stabilize mood in these patients.

Q: Rapid cycling is characterized by all of the following except?

Occurs commonly in men. ***A. Occurs commonly in men*** - **Rapid cycling** is more common in **women** (approximately 70-90% of rapid cyclers are female) and is associated with comorbid conditions like **hypothyroidism**. - This is the **EXCEPT** answer because rapid cycling does NOT commonly occur in men—it predominantly affects women. *B. Commonly associated with concomitant hypothyroidism* - **Hypothyroidism** is a frequently noted comorbidity in individuals with **rapid-cycling bipolar disorder** (seen in 20-30% of cases). - Thyroid dysfunction can affect mood regulation and contribute to the instability characteristic of rapid cycling. - This IS a true characteristic of rapid cycling. *C. Antidepressants increase likelihood* - **Antidepressants** can sometimes **induce or worsen rapid cycling** in individuals with bipolar disorder, especially when used without a mood stabilizer. - This is why great care is taken when prescribing antidepressants in bipolar disorder to monitor for mood shifts. - This IS a true characteristic of rapid cycling. *D. At least 4 distinct episodes per year* - This is the **DSM-5 diagnostic criterion** for rapid cycling, meaning an individual experiences four or more mood episodes (depressive, manic, mixed, or hypomanic) within a 12-month period. - These episodes must be distinct and separated by either a full remission or a switch to an episode of opposite polarity. - This IS a true characteristic of rapid cycling.

Q: A 55-year-old female with major depressive disorder who has not responded to multiple antidepressant trials presents with significant cognitive impairment and vegetative symptoms. What is the next best treatment?

Start electroconvulsive therapy. ***Start electroconvulsive therapy*** - **Electroconvulsive therapy (ECT)** is a highly effective treatment for **severe major depressive disorder** that is **treatment-resistant**, especially when accompanied by severe vegetative symptoms or cognitive impairment. - Given the patient's long history of **treatment failure** with multiple antidepressants and significant functional impairment, ECT is the most appropriate next step. *Switch to an atypical antipsychotic* - While atypical antipsychotics can augment antidepressant treatment for severe or treatment-resistant depression, they are generally considered **add-on therapies** rather than a primary switch after multiple antidepressant failures, especially with significant cognitive and vegetative symptoms. - Without psychosis, starting an antipsychotic as a monotherapy or direct switch might not address the core issue as effectively as ECT. *Add a benzodiazepine* - Benzodiazepines are primarily used for **short-term anxiety relief** and can sometimes help with insomnia associated with depression. - They do not treat the underlying depressive illness, can cause **cognitive impairment** themselves, and are associated with dependence, making them unsuitable as a primary treatment for severe, treatment-resistant depression. *Increase the dose of current antidepressant* - The patient has already demonstrated a lack of response to "multiple antidepressant trials," suggesting that simply increasing the dose of a current, likely ineffective, antidepressant is unlikely to yield significant improvement. - This approach is generally considered before escalating to more intensive treatments like ECT, but in this specific scenario, a more robust intervention is warranted due to the **treatment resistance**.

Q: A 70-year-old woman with severe depression has not responded to multiple trials of antidepressants. What is the most appropriate next step?

Start electroconvulsive therapy. ***Start electroconvulsive therapy*** - For **severe depression** that has not responded to **multiple adequate trials of antidepressants** in an elderly patient, **electroconvulsive therapy (ECT)** is often the most effective next step due to its rapid and robust response rates. - ECT is particularly effective in severe forms of depression, including **melancholic features**, **psychotic features**, and in cases where rapid response is critical, such as severe suicidality or catatonia. *Increase the dose of the current antidepressant* - The patient has already failed **multiple trials of antidepressants**, suggesting that simply increasing the dose of an already ineffective medication is unlikely to yield a significant response. - Dose increases are usually considered if the patient has only failed one or two medications and has not reached optimal therapeutic levels. *Add an antipsychotic medication* - While atypical antipsychotics can be used as **adjunctive therapy** for treatment-resistant depression, they are typically considered after optimizing antidepressant regimens or when there are **psychotic features**. - In a 70-year-old with severe, treatment-resistant depression without mention of psychosis, ECT would generally be a more potent and effective intervention before adding an antipsychotic. *Switch to a different class of antidepressant* - The patient has "not responded to **multiple trials of antidepressants**," implying that switches to different classes have likely already been attempted or that the current situation requires a more aggressive approach. - While switching is a common strategy, it is less likely to be the "most appropriate next step" compared to ECT in a case of severe, refractory depression in an elderly individual.

Q: A 35-year-old woman experiences periods of excessive energy, a decreased need for sleep, and increased goal-directed activity, followed by episodes of depression. What is the most likely diagnosis?

Bipolar disorder. ***Bipolar disorder*** - The combination of **manic symptoms** (excessive energy, decreased need for sleep, increased goal-directed activity) and **depressive episodes** is the hallmark of bipolar disorder. - This pattern of alternating mood states, specifically distinct episodes of **mania/hypomania** and **major depression**, distinguishes it from other mood disorders. *Major depressive disorder* - This diagnosis is characterized solely by **recurrent depressive episodes** without any history of manic or hypomanic episodes. - The presence of periods of **excessive energy** and decreased need for sleep rules out a diagnosis of unipolar major depressive disorder. *Schizoaffective disorder* - This disorder involves a concurrent presentation of a **mood episode** (manic or depressive) and **schizophrenia symptoms** (e.g., delusions, hallucinations) for at least two weeks in the absence of a prominent mood episode. - The patient's presentation primarily focuses on mood symptoms without mention of significant psychotic features independent of mood. *Cyclothymic disorder* - Cyclothymic disorder involves chronic, fluctuating mood disturbances with numerous periods of **hypomanic symptoms** and numerous periods of **depressive symptoms**, none of which meet criteria for a full manic, hypomanic, or major depressive episode. - The description of distinct periods of "excessive energy" and "episodes of depression" suggests full manic or depressive episodes, which are more severe than the symptoms seen in cyclothymia.

Q: A 30-year-old male is brought to the emergency department after an episode of violent behavior. He reports feeling euphoric, experiencing racing thoughts, and having a decreased need for sleep over the past week. What is the most likely diagnosis?

Bipolar disorder. ***Bipolar disorder*** - The combination of **euphoria**, **racing thoughts**, **decreased need for sleep**, and **violent behavior** is characteristic of a manic episode, which is central to **bipolar disorder**. - **Manic episodes** involve a distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased goal-directed activity or energy. *Major depressive disorder* - This disorder is characterized by a persistent feeling of **sadness** and **loss of interest** or pleasure in daily activities. - While it can involve **irritability**, it does not typically present with **euphoria**, **racing thoughts**, or **decreased need for sleep** as primary or prominent symptoms. *Schizophrenia* - Schizophrenia is characterized by **psychotic symptoms** such as **hallucinations**, **delusions**, **disorganized speech**, and **negative symptoms** like avolition or alogia. - Although there can be a **mood component**, the primary presentation of **euphoria** and **racing thoughts** along with reduced sleep specifically points away from schizophrenia as the most likely diagnosis. *Generalized anxiety disorder* - This disorder is characterized by **excessive worry** and **anxiety** about various events or activities, often accompanied by physical symptoms like restlessness and muscle tension. - It does not typically involve **euphoria**, **racing thoughts**, or significant **decreased need for sleep** as prominent features.

Q: A 35-year-old woman with a history of depressive episodes presents with hyperactivity, rapid speech, and a decreased need for sleep lasting for one week. What is the diagnosis?

Bipolar I disorder. ***Bipolar I disorder*** - The presence of a **manic episode**, characterized by hyperactivity, rapid speech, and decreased need for sleep lasting for at least one week, is diagnostic of **Bipolar I Disorder**. - A history of depressive episodes, along with the current manic symptoms, further supports this diagnosis, fitting the criteria for Bipolar I. *Major depressive disorder* - This disorder is characterized by persistent **depressed mood** and/or loss of interest or pleasure, along with other symptoms like changes in sleep, appetite, or energy. - It does not involve the presence of **manic or hypomanic episodes**, which are key features in the presented case. *Bipolar II disorder* - Bipolar II disorder involves at least one **hypomanic episode** (less severe and shorter duration than a manic episode) and at least one major depressive episode. - The symptoms described (hyperactivity, rapid speech, decreased need for sleep) are suggestive of a **full manic episode** due to their intensity and one-week duration, thus ruling out hypomania. *Cyclothymia* - Cyclothymia is characterized by numerous periods of **hypomanic symptoms** and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode. - The described symptoms meet the criteria for a **manic episode**, which is more severe than hypomanic symptoms and is not seen in cyclothymia.

Q: A 60-year-old woman complains of sadness, lack of interest in activities, and feelings of worthlessness. She also experiences difficulty concentrating, as well as changes in appetite and sleep patterns. What is the most likely diagnosis?

Major depressive disorder. ***Major depressive disorder*** - The patient exhibits classic symptoms of **major depressive disorder**, including **sadness**, **anhedonia** (lack of interest), feelings of **worthlessness**, difficulties with **concentration**, and significant changes in **appetite and sleep patterns**. These symptoms collectively meet the diagnostic criteria. - The duration and pervasiveness of these symptoms, coupled with their impact on functioning, are characteristic of a depressive episode. *Bipolar disorder* - While depression can be a feature of bipolar disorder, there is no mention of **manic or hypomanic episodes**, which are essential for this diagnosis. - The clinical picture provided exclusively details depressive symptoms, without the alternating mood states indicative of bipolar disorder. *Schizophrenia* - **Schizophrenia** is characterized by **psychotic symptoms** such as **hallucinations, delusions, disorganized thought, and negative symptoms**, none of which are described in this patient's presentation. - The patient's symptoms are primarily mood-related, rather than reflecting a thought disorder. *Generalized anxiety disorder* - **Generalized anxiety disorder (GAD)** involves **excessive, uncontrollable worry** about multiple events or activities, often accompanied by physical symptoms like muscle tension and restlessness. - While anxiety can co-occur with depression, the primary and most prominent symptoms described here are those of depression, such as anhedonia and feelings of worthlessness, rather than overwhelming worry.

Q: A 65-year-old man with a history of depression presents with memory loss, weight loss, and sleep disturbances. He believes he is responsible for a tragic accident that occurred years ago. What is the most likely diagnosis?

Major depressive disorder with psychotic features. ***Major depressive disorder with psychotic features*** - This diagnosis is indicated by the patient's **depression history**, **memory loss**, **weight loss**, and **sleep disturbances**, combined with a **delusion of guilt** (belief in being responsible for an accident). - The presence of **psychotic features**, specifically delusions congruent with the depressive mood, points to this particular subtype of major depressive disorder. *Schizophrenia* - Schizophrenia typically involves **disorganized thought processes**, **hallucinations**, and negative symptoms, which are not explicitly described here. - While delusions are present, they are focused on guilt and align with depressive themes, rather than the often bizarre or non-mood-congruent delusions seen in schizophrenia. *Delusional disorder* - Delusional disorder is characterized by **non-bizarre delusions** that persist for at least one month, without other prominent psychotic symptoms or significant impairment in functioning. - The patient's presentation includes significant depressive symptoms, weight loss, and memory loss, which are not typical for delusional disorder, where functioning is relatively preserved outside of the delusion. *Bipolar disorder* - Bipolar disorder involves distinct periods of **mania or hypomania** alternating with depressive episodes. - While the patient exhibits depressive symptoms, there is no mention of manic or hypomanic episodes, which are essential for a bipolar diagnosis.

Q: Which disorder is characterized by periods of depression and hypomania?

Bipolar II Disorder. ***Bipolar II Disorder*** - This disorder is defined by the presence of at least one major depressive episode and at least one **hypomanic episode**. - **Hypomania** involves elevated mood, increased energy, and decreased need for sleep, but it is less severe than mania and does not cause significant functional impairment or psychosis. *Major Depressive Disorder* - This disorder is characterized by one or more **major depressive episodes** without any history of manic or hypomanic episodes. - While it involves periods of depression, it does not include episodes of hypomania. *Cyclothymic Disorder* - This disorder involves chronic, fluctuating mood disturbances with numerous periods of **hypomanic symptoms** and numerous periods of **depressive symptoms** for at least two years. - The symptoms are milder than those seen in major depressive or hypomanic episodes and do not meet the full criteria for either. *Bipolar I Disorder* - This disorder is defined by the occurrence of at least one **manic episode**, which may be preceded or followed by hypomanic or major depressive episodes. - While it can include depressive periods, the hallmark is the presence of full-blown **mania**, not just hypomania.

Question 1

All of the following are true about bipolar disorder rapid cycling EXCEPT:

Accepted Answer

More common in males

Answer

Associated with hypothyroidism

Answer

Often worsened by antidepressants

Answer

Defined by ≥4 mood episodes per year

Question 2

Rapid cycling is characterized by all of the following except?

Accepted Answer

Occurs commonly in men

Answer

Commonly associated with concomitant hypothyroidism

Answer

Antidepressants increase likelihood

Answer

At least 4 distinct episodes per year

Question 3

A 55-year-old female with major depressive disorder who has not responded to multiple antidepressant trials presents with significant cognitive impairment and vegetative symptoms. What is the next best treatment?

Accepted Answer

Start electroconvulsive therapy

Answer

Switch to an atypical antipsychotic

Answer

Add a benzodiazepine

Answer

Increase the dose of current antidepressant

Question 4

A 70-year-old woman with severe depression has not responded to multiple trials of antidepressants. What is the most appropriate next step?

Accepted Answer

Start electroconvulsive therapy

Answer

Increase the dose of the current antidepressant

Answer

Add an antipsychotic medication

Answer

Switch to a different class of antidepressant

Question 5

A 35-year-old woman experiences periods of excessive energy, a decreased need for sleep, and increased goal-directed activity, followed by episodes of depression. What is the most likely diagnosis?

Accepted Answer

Bipolar disorder

Answer

Major depressive disorder

Answer

Schizoaffective disorder

Answer

Cyclothymic disorder

Question 6

A 30-year-old male is brought to the emergency department after an episode of violent behavior. He reports feeling euphoric, experiencing racing thoughts, and having a decreased need for sleep over the past week. What is the most likely diagnosis?

Accepted Answer

Bipolar disorder

Answer

Major depressive disorder

Answer

Schizophrenia

Answer

Generalized anxiety disorder

Question 7

A 35-year-old woman with a history of depressive episodes presents with hyperactivity, rapid speech, and a decreased need for sleep lasting for one week. What is the diagnosis?

Accepted Answer

Bipolar I disorder

Answer

Major depressive disorder

Answer

Bipolar II disorder

Answer

Cyclothymia

Question 8

A 60-year-old woman complains of sadness, lack of interest in activities, and feelings of worthlessness. She also experiences difficulty concentrating, as well as changes in appetite and sleep patterns. What is the most likely diagnosis?

Accepted Answer

Major depressive disorder

Answer

Schizophrenia

Answer

Generalized anxiety disorder

Answer

Bipolar disorder

Question 9

A 65-year-old man with a history of depression presents with memory loss, weight loss, and sleep disturbances. He believes he is responsible for a tragic accident that occurred years ago. What is the most likely diagnosis?

Accepted Answer

Major depressive disorder with psychotic features

Answer

Schizophrenia

Answer

Delusional disorder

Answer

Bipolar disorder

Question 10

Which disorder is characterized by periods of depression and hypomania?

Accepted Answer

Bipolar II Disorder

Answer

Major Depressive Disorder

Answer

Cyclothymic Disorder

Answer

Bipolar I Disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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