Mood Disorders Practice Questions

Q: Which of the following is not a typical feature of depression?

Increased energy. ***Increased energy*** - **Increased energy** is not a typical symptom of depression; rather, individuals with depression commonly experience **fatigue** and **loss of energy**. - This symptom is more characteristic of conditions like **mania** or **hypomania**, which are phases of bipolar disorder. *Loss of interest in activities* - **Anhedonia**, or the loss of interest or pleasure in nearly all activities, is a **core diagnostic criterion** for depression. - Patients often report that things they once enjoyed no longer bring them joy or satisfaction. *Suicidal thoughts* - **Suicidal ideation**, ranging from thoughts of death to specific plans, is a serious and common symptom of depression. - It reflects the intense emotional pain and hopelessness experienced by individuals with severe depression. *Persistent sadness* - **Persistent sadness** or a depressed mood is another **core diagnostic feature** of major depressive disorder. - This sadness is often pervasive and may not lift even with positive life events.

Q: Which of the following is a characteristic of Bipolar II disorder?

Major depression and hypomania. ***Major depression and hypomania*** - Bipolar II disorder is characterized by the occurrence of at least one **major depressive episode** and at least one **hypomanic episode**. - Crucially, it does not involve full-blown **manic or mixed episodes**. *Dysthymia* - **Dysthymia**, or persistent depressive disorder, involves chronic low-grade depression lasting at least two years, but without manic or hypomanic symptoms. - It is a form of depression and does not include the characteristic mood elevations seen in bipolar disorders. *Single manic episode* - A single manic episode is characteristic of **Bipolar I disorder**, which involves at least one manic episode, with or without previous depressive or hypomanic episodes. - Bipolar II disorder specifically excludes the presence of a **manic episode**. *Cyclothymic disorder* - **Cyclothymic disorder** involves numerous periods of hypomanic symptoms and numerous periods of depressive symptoms that do not meet the criteria for a major depressive episode. - It is a milder but chronic form of bipolar spectrum disorder, distinct from the full major depressive and hypomanic episodes of Bipolar II.

Q: Which of the following mental health disorders is most commonly associated with suicidal tendencies?

Depression. ***Depression*** - **Clinical depression**, especially severe or recurrent episodes, is a primary risk factor for **suicidal ideation** and attempts. - The symptoms of profound sadness, anhedonia, hopelessness, and worthlessness significantly increase the likelihood of **suicidal tendencies**. *Post-Traumatic Stress Disorder (PTSD)* - While **PTSD** is associated with an increased risk of suicide, particularly due to high rates of comorbidity with depression and substance abuse, it is not the most common standalone diagnosis linked to suicidal tendencies. - **Flashbacks**, nightmares, and hypervigilance are core symptoms, but direct suicidal intent is often mediated by co-occurring conditions. *Schizophrenia* - Individuals with **schizophrenia** have a significantly elevated risk of suicide, particularly during early stages of the illness or during psychotic exacerbations. - However, the overall prevalence of schizophrenia is lower than that of depression, making **depression** a more common underlying factor in the general population presenting with suicidal tendencies. *Obsessive-Compulsive Disorder (OCD)* - **OCD** can cause significant distress and impairment, and some individuals may experience suicidal ideation due to the chronicity and intrusiveness of their obsessions and compulsions. - However, **OCD** is generally considered to have a lower direct association with suicide compared to major depressive disorder, though comorbid depression can heighten the risk.

Q: Which of the following is NOT true about major depressive disorder?

Recovery is complete after treatment. ***Recovery is complete after treatment*** - While treatment can significantly improve symptoms and lead to remission, **major depressive disorder** often has a relapsing and remitting course. - Complete, lifelong recovery after just one episode of treatment is not guaranteed, and **recurrence** is common. *Commonly seen in females* - This statement is **true**; major depressive disorder is significantly more prevalent in **females** than in males. - The lifetime prevalence is approximately twice as high in women compared to men. *Associated with hypothyroidism* - This statement is **true**; **hypothyroidism** can present with symptoms that mimic or exacerbate depression, such as fatigue, low mood, and anhedonia. - Thyroid hormone levels should always be checked in patients presenting with depressive symptoms. *Family history of major depression is a risk factor* - This statement is **true**; a **family history** of major depression is a well-established and significant risk factor. - Genetic predisposition plays a substantial role in vulnerability to the disorder.

Q: A 30-year-old male was brought for evaluation, with a history of his 3-year-old son's death, 5 months prior, following a car accident. At the time of the accident, the patient was a witness. Since then, he has experienced symptoms of sadness, crying spells, feelings of hopelessness, poor sleep, and poor appetite. He has had suicidal thoughts on two occasions, but has not acted on them. He has not been attending work for the past 5 months. What is the likely diagnosis?

Major depressive disorder. ***Major depressive disorder*** - The duration of symptoms (5 months) and severity, including **suicidal ideation** and significant occupational impairment, exceed what is typically expected for **normal grief** or **adjustment disorder**. - Symptoms like **sadness**, crying spells, feelings of hopelessness, **poor sleep**, and poor appetite are classic for **major depressive disorder**, especially when persistent and functionally debilitating. *Post-traumatic stress disorder (PTSD)* - While experiencing a traumatic event (witnessing his son's death) is a prerequisite for PTSD, the patient's primary symptoms are **depressive** rather than the characteristic re-experiencing, avoidance, negative alterations in cognitions and mood, or hyperarousal associated with PTSD. - There is no mention of **flashbacks**, nightmares, or significant **avoidance behaviors** directly linked to the trauma beyond general withdrawal. *Normal grief reaction* - While grief is expected after the death of a child, the severity (suicidal ideation) and significant functional impairment (not attending work for 5 months) suggest a reaction beyond **normal grief**. - **Normal grief** typically doesn't involve persistent, severe functional impairment or recurrent suicidal thoughts over such a prolonged period without additional significant depressive symptoms. *Adjustment disorder with depressed mood* - **Adjustment disorder** usually resolves within 6 months of the stressor or its consequences ceasing, and symptoms are generally less severe than those seen in major depression. - The presence of **suicidal ideation** and profound, persistent functional impairment for 5 months makes **major depressive disorder** a more fitting diagnosis.

Q: A 40-year-old man presents with persistently elevated mood, increased energy, and decreased need for sleep for the past week. What is the most likely diagnosis?

Mania. ***Mania*** - **Elevated mood**, **increased energy**, and **decreased need for sleep** are classic symptoms of a manic episode. - This presentation, lasting for **at least a week**, meets the **diagnostic criteria for mania** (DSM-5 requires ≥7 days or any duration if hospitalization needed). - The distinct period of persistently elevated, expansive, or irritable mood with increased goal-directed activity distinguishes this from other conditions. *Schizophrenia* - Characterized primarily by **psychotic symptoms** such as hallucinations, delusions, and disorganized thought/speech, which are not described here. - While agitation can occur, the core symptoms of elevated mood and increased energy are not typical of an acute schizophrenic episode. *Hypomania* - Hypomania presents with similar symptoms (elevated mood, increased energy, decreased sleep) but is **less severe** and of **shorter duration** (requires only 4 consecutive days). - Hypomanic episodes do **not cause marked impairment** in social or occupational functioning and do not require hospitalization. - The question states symptoms have lasted "for the past week" which, if causing significant functional impairment, would suggest mania rather than hypomania. *Depression* - Depression is characterized by a **depressed mood**, **loss of interest or pleasure (anhedonia)**, **low energy**, and often **increased need for sleep** or insomnia with early morning awakening. - The patient's symptoms of elevated mood and increased energy are the opposite of what is seen in depression.

Q: A 30-year-old female with depressed mood, decreased appetite, and no interest for one year. What is the diagnosis?

Major Depressive Disorder. ***Major Depressive Disorder*** - The patient presents with classic symptoms of **depressed mood**, **decreased appetite**, and **anhedonia** (no interest) which are core criteria for **Major Depressive Disorder**. - The duration of one year indicates a chronic and significant impact on daily functioning, consistent with a major depressive episode. *Dysthymia* - While dysthymia also involves chronic depressed mood, it typically presents with **less severe** symptoms than major depressive disorder. - The patient's symptoms of significant anhedonia and appetite changes are more indicative of the severity seen in a major depressive episode. *Anxiety* - Anxiety disorders are characterized primarily by **excessive worry, fear, or apprehension**, often accompanied by physical symptoms like palpitations or shortness of breath. - Although anxiety can co-occur with depression, the primary symptoms described (depressed mood, anhedonia, appetite changes) are classic for a depressive diagnosis. *None of the options* - The patient's symptoms clearly align with **Major Depressive Disorder**, meeting the diagnostic criteria based on severity and duration. - There is a suitable diagnosis among the given options; therefore, this option is incorrect.

Q: Among which of the following conditions is suicide risk highest?

Depression. ***Depression*** - **Major depressive disorder** is the psychiatric condition most frequently associated with **suicide**, accounting for a large percentage of completed suicides. - The presence of severe depression, especially with features like **hopelessness**, **agitation**, and **prior suicide attempts**, significantly elevate the risk. *Alcohol dependence* - While **alcohol dependence** is a significant risk factor for suicide, it often co-occurs with mood disorders like depression; alcohol can exacerbate suicidal ideation and impulsivity. - It is an important comorbidity, but **major depression** alone has a higher prevalence in suicide statistics than alcohol dependence as a primary factor. *Dementia* - **Dementia** generally poses a lower risk of completed suicide compared to mood disorders, as cognitive decline can impair the ability to plan and execute such acts. - Early stages of dementia, particularly when insight into cognitive decline is preserved, may carry some risk, but it is not the highest risk condition overall. *Schizophrenia* - Individuals with **schizophrenia** have a significantly elevated risk of suicide compared to the general population, often due to factors like **command hallucinations**, hopelessness, and adverse effects of medication. - However, **depression** remains the leading psychiatric diagnosis associated with suicide completions.

Q: What neurotransmitter is found in increased quantities in mania?

Dopamine. ***Dopamine*** - **Dopamine levels are consistently elevated during manic episodes**, representing one of the most robust neurobiological findings in mania. - Increased dopaminergic activity contributes to **psychomotor agitation**, **goal-directed behavior**, **reward-seeking**, **decreased need for sleep**, and **psychotic features** (delusions, hallucinations). - **Dopamine antagonists** (antipsychotics like haloperidol, olanzapine) are **first-line treatments** for acute mania, supporting the dopamine hypothesis. - The dopamine hypothesis of mania is well-established in psychiatric literature and supported by neuroimaging studies. *Noradrenaline* - Noradrenergic hyperactivity is also implicated in mania, contributing to increased arousal, energy, and reduced sleep. - However, while elevated, the evidence is less consistent than for dopamine, and noradrenaline's role appears more modulatory. - The question asks for the neurotransmitter "found in increased quantities" - both are elevated, but dopamine has stronger evidence. *Serotonin* - Serotonin dysfunction is implicated in mood disorders, but manic episodes are generally associated with **reduced or dysregulated serotonin activity**, not an increase. - Low serotonin may contribute to impulsivity and mood instability in bipolar disorder. *GABA* - **GABA** (gamma-aminobutyric acid) is the primary **inhibitory neurotransmitter** in the CNS. - **Reduced GABAergic activity** has been reported in mania (not increased), which may contribute to disinhibition and hyperexcitability. - GABAergic drugs (e.g., benzodiazepines, valproate) are used as adjuncts in mania, supporting reduced GABA activity.

Q: What is the definition of "double depression" in the context of mental health?

Depression superimposed on dysthymia. ***Depression superimposed on dysthymia*** - **Double depression** refers to the co-occurrence of a major depressive episode in an individual who already suffers from **dysthymia** (persistent depressive disorder) - This means the person experiences periods of more severe depression on top of their chronic, milder low mood - This combination results in a more severe clinical presentation and worse prognosis *Recurrent major depressive episodes without chronic low mood* - This describes **recurrent major depressive disorder**, where distinct episodes of severe depression occur without a persistent background of mild depression - It does not involve the chronic, low-grade depressive state characteristic of dysthymia *Major depressive disorder occurring alongside cognitive decline* - While depression can be associated with cognitive symptoms, this is not the standard definition of "double depression" in psychiatric diagnostic criteria - This would represent a comorbidity rather than the specific term "double depression" *Chronic low-grade depression without major depressive episodes* - This describes **dysthymia** (persistent depressive disorder), characterized by chronic, low-grade depressed mood lasting at least two years - This definition specifically excludes major depressive episodes, which is the key component that differentiates "double depression"

Question 1

Which of the following is not a typical feature of depression?

Accepted Answer

Increased energy

Answer

Loss of interest in activities

Answer

Suicidal thoughts

Answer

Persistent sadness

Question 2

Which of the following is a characteristic of Bipolar II disorder?

Accepted Answer

Major depression and hypomania

Answer

Dysthymia

Answer

Single manic episode

Answer

Cyclothymic disorder

Question 3

Which of the following mental health disorders is most commonly associated with suicidal tendencies?

Accepted Answer

Depression

Answer

Post-Traumatic Stress Disorder (PTSD)

Answer

Obsessive-Compulsive Disorder (OCD)

Answer

Schizophrenia

Question 4

Which of the following is NOT true about major depressive disorder?

Accepted Answer

Recovery is complete after treatment

Answer

Associated with hypothyroidism

Answer

Commonly seen in females

Answer

Family history of major depression is a risk factor

Question 5

A 30-year-old male was brought for evaluation, with a history of his 3-year-old son's death, 5 months prior, following a car accident. At the time of the accident, the patient was a witness. Since then, he has experienced symptoms of sadness, crying spells, feelings of hopelessness, poor sleep, and poor appetite. He has had suicidal thoughts on two occasions, but has not acted on them. He has not been attending work for the past 5 months. What is the likely diagnosis?

Accepted Answer

Major depressive disorder

Answer

Post-traumatic stress disorder (PTSD)

Answer

Normal grief reaction

Answer

Adjustment disorder with depressed mood

Question 6

A 40-year-old man presents with persistently elevated mood, increased energy, and decreased need for sleep for the past week. What is the most likely diagnosis?

Accepted Answer

Mania

Answer

Schizophrenia

Answer

Hypomania

Answer

Depression

Question 7

A 30-year-old female with depressed mood, decreased appetite, and no interest for one year. What is the diagnosis?

Accepted Answer

Major Depressive Disorder

Answer

None of the options

Answer

Dysthymia

Answer

Anxiety

Question 8

Among which of the following conditions is suicide risk highest?

Accepted Answer

Depression

Answer

Alcohol dependence

Answer

Dementia

Answer

Schizophrenia

Question 9

What neurotransmitter is found in increased quantities in mania?

Accepted Answer

Dopamine

Answer

Noradrenaline

Answer

Serotonin

Answer

GABA

Question 10

What is the definition of "double depression" in the context of mental health?

Accepted Answer

Depression superimposed on dysthymia

Answer

Recurrent major depressive episodes without chronic low mood

Answer

Major depressive disorder occurring alongside cognitive decline

Answer

Chronic low-grade depression without major depressive episodes

Mood Disorders — MCQs

Mood Disorders — MCQs

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