Mood Disorders Practice Questions

Q: Which cognitive model of depression is widely recognized?

Beck. **Explanation:** The correct answer is **Beck (Option B)**. Aaron Beck is the pioneer of the **Cognitive Theory of Depression**, which posits that depression is maintained by distorted information processing. According to Beck, individuals with depression possess negative schemas (deep-seated beliefs) that lead to a **"Cognitive Triad"** consisting of negative views about: 1. **The Self** (e.g., "I am worthless") 2. **The World/Environment** (e.g., "Everything is unfair") 3. **The Future** (e.g., "Things will never get better") **Analysis of Incorrect Options:** * **A. Ellis:** Albert Ellis developed **Rational Emotive Behavior Therapy (REBT)**. While also a cognitive-behavioral approach, it focuses on the "ABC" model (Activating event, Beliefs, Consequences) and challenging "irrational beliefs" rather than the specific cognitive triad of depression. * **C. Godfrey:** This is a distractor and is not associated with a major recognized cognitive model in psychiatry. * **D. Meichenbaum:** Donald Meichenbaum is known for **Self-Instructional Training** and **Stress Inoculation Training (SIT)**, focusing on "cognitive-behavior modification" rather than a primary model of depression. **High-Yield Clinical Pearls for NEET-PG:** * **Cognitive Distortions:** Beck identified specific errors in logic used by depressed patients, such as **Arbitrary Inference** (jumping to conclusions) and **Selective Abstraction** (focusing only on negative details). * **Treatment:** Beck’s model forms the basis of **Cognitive Behavioral Therapy (CBT)**, which is as effective as antidepressants for mild-to-moderate depression. * **Learned Helplessness:** Another high-yield model of depression is **Martin Seligman’s** theory, which suggests depression arises when individuals feel they have no control over repeated stressful events.

Q: What is the recurrent risk for postpartum psychosis in a subsequent pregnancy?

50%. **Explanation:** **Postpartum Psychosis (PPP)** is a psychiatric emergency characterized by a rapid onset of psychotic symptoms (hallucinations, delusions, and delirium-like confusion) typically occurring within the first 2 weeks after delivery. **1. Why the correct answer is 50%:** The risk of recurrence for postpartum psychosis is exceptionally high. Epidemiological studies and clinical data indicate that a woman who has experienced one episode of PPP has a **30% to 50% risk** of recurrence in subsequent pregnancies. If the patient has an underlying diagnosis of Bipolar Disorder, the risk of a postpartum relapse (either manic or psychotic) can even exceed 50%. **2. Analysis of Incorrect Options:** * **A (10%) & B (20%):** These figures are too low for PPP. However, **10-15%** is the approximate prevalence of *Postpartum Depression* in the general population. * **C (35%):** While some studies show a lower range starting at 30%, "50%" is the standard high-yield figure taught for competitive exams like NEET-PG to emphasize the gravity of the recurrence risk. **3. High-Yield Clinical Pearls for NEET-PG:** * **Incidence:** 1 to 2 per 1,000 births (much rarer than "Baby Blues" or Postpartum Depression). * **Strongest Risk Factors:** Personal or family history of Bipolar Disorder and a previous episode of Postpartum Psychosis. * **Clinical Presentation:** Often begins with insomnia, restlessness, and emotional lability, progressing rapidly to disorganized behavior and delusions (often involving the infant). * **Management:** Immediate hospitalization is mandatory due to the high risk of **infanticide and suicide**. * **Treatment of Choice:** Mood stabilizers (Lithium), antipsychotics, and in severe/refractory cases, **Electroconvulsive Therapy (ECT)** is highly effective and safe.

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 patient presents with the classic clinical triad of mania: **elevated mood (excitement), increased psychomotor activity (increased sexual activity/spending), and a decreased need for sleep.** According to ICD-10 and DSM-5 criteria, a diagnosis of Mania requires symptoms to last for at least **one week** (7 days) and be severe enough to cause significant social or occupational impairment. This patient’s 8-day duration and behavioral changes (excessive spending/hypersexuality) are hallmark indicators of a manic episode. **Why other options are incorrect:** * **A. Confusion:** This refers to a clouding of consciousness or disorientation, typically seen in Delirium (Organic Brain Syndromes), not primary mood disorders. * **C. Hyperactivity:** While hyperactivity is a *symptom* of mania, it is not a diagnosis. Hyperactivity alone could also be seen in ADHD or hyperthyroidism, but the cluster of symptoms here points to a mood disorder. * **D. Loss of memory:** This is a cognitive deficit characteristic of Dementia or Amnestic syndromes. Memory is usually intact in patients with mania, though they may be distractible. **High-Yield Clinical Pearls for NEET-PG:** * **Duration Criteria:** Hypomania (≥ 4 days); Mania (≥ 7 days); Depressive episode (≥ 2 weeks). * **Key Symptoms (DIG FAST):** **D**istractibility, **I**ndiscretion (spending/sex), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit, **T**alkativeness (pressured speech). * **Drug of Choice:** **Lithium** is the gold standard for long-term prophylaxis; however, for acute mania with agitation, atypical antipsychotics (e.g., Haloperidol or Olanzapine) are often used first. * **Difference between Mania and Hypomania:** Mania involves marked impairment or psychotic features (delusions/hallucinations); Hypomania does not.

Q: Which of the following is NOT a somatic therapy used in depression?

Ultrasound brain stem stimulation. **Explanation:** In psychiatry, **Somatic Therapies** refer to biological treatments that directly influence the brain's physiological function to alleviate mental illness. These include brain stimulation techniques and pharmacotherapy. **Why Option D is correct:** **Ultrasound brain stem stimulation** is not a recognized or standard clinical somatic therapy for depression. While research into "Transcranial Focused Ultrasound" (tFUS) is emerging, it is currently experimental and not targeted specifically at the brain stem for depression. Therefore, it is the "incorrect" modality among the choices. **Why other options are incorrect:** * **A. Electroconvulsive Therapy (ECT):** The "Gold Standard" for treatment-resistant depression and suicidal patients. It involves inducing a generalized seizure under anesthesia. * **B. Deep Brain Stimulation (DBS):** An invasive procedure involving the surgical implantation of electrodes into specific brain areas (e.g., Subgenual Cingulate Cortex/Area 25) to modulate neural circuits. * **C. Transcranial Magnetic Stimulation (TMS):** A non-invasive procedure that uses magnetic fields to stimulate nerve cells in the Dorsolateral Prefrontal Cortex (DLPFC). **High-Yield Clinical Pearls for NEET-PG:** * **ECT:** Most common side effect is **retrograde amnesia**. Absolute contraindication: **Increased intracranial pressure**. * **TMS:** Does not require anesthesia or seizure induction, making it an outpatient alternative for moderate depression. * **Vagus Nerve Stimulation (VNS):** Another FDA-approved somatic therapy for chronic, treatment-resistant depression. * **DLPFC:** The primary target for TMS in depression; **Area 25 (Subgenual Cingulate)** is the primary target for DBS.

Q: "Learned helplessness" is typically seen in which of the following conditions?

Depression. **Explanation:** **Correct Answer: D. Depression** The concept of **Learned Helplessness** was proposed by **Martin Seligman** based on animal models (the "shuttle box" experiment with dogs). It describes a state where an individual, after facing repeated uncontrollable stressors, stops attempting to escape or change the situation, even when an opportunity for relief becomes available. In clinical psychiatry, this serves as a cognitive model for **Depression**. It explains the core symptoms of hopelessness, passivity, and a lack of motivation. Patients perceive that they have no control over their environment, leading to the belief that "nothing I do matters," which reinforces the depressive cycle. **Why other options are incorrect:** * **Delirium (A):** This is an acute organic brain syndrome characterized by fluctuating consciousness and impaired attention, not a learned cognitive behavior. * **Dementia (B):** This involves a chronic, global impairment of cognitive functions (memory, executive function). While patients may become passive, it is due to neurodegeneration rather than a learned psychological response. * **Schizophrenia (C):** While "avolition" (lack of motivation) is a negative symptom of schizophrenia, it is linked to dopamine dysregulation in the reward pathways rather than the cognitive framework of learned helplessness. **High-Yield Clinical Pearls for NEET-PG:** * **Attributional Style:** In depression, individuals attribute negative events to **Internal, Stable, and Global** causes (e.g., "It’s my fault, it will always be this way, and it affects everything"). * **Biochemical link:** Learned helplessness is associated with decreased levels of **Norepinephrine** and **Serotonin** in the brain. * **Treatment:** Cognitive Behavioral Therapy (CBT) aims to reverse learned helplessness by challenging these maladaptive thought patterns.

Q: According to DSM-IV criteria, what is the minimum duration of depressed mood or loss of interest or pleasure required for the diagnosis of a Major Depressive Episode?

2 weeks. **Explanation:** The diagnosis of a **Major Depressive Episode (MDE)** according to DSM-IV (and DSM-5) requires a specific cluster of symptoms to be present for a minimum duration to distinguish clinical depression from transient sadness or "the blues." 1. **Why Option B is Correct:** The diagnostic criteria mandate that at least **five** out of nine symptoms (including either depressed mood or anhedonia) must be present nearly every day for at least **2 consecutive weeks**. This 14-day threshold is the standard clinical benchmark used to ensure the symptoms represent a persistent change from previous functioning. 2. **Why Other Options are Incorrect:** * **Option A (1 week):** This is the duration required for a **Manic Episode**. A single week is considered too short for a definitive diagnosis of MDD. * **Option C (3 weeks):** This duration has no specific diagnostic significance in the classification of mood disorders. * **Option D (4 weeks):** While symptoms often last longer than a month, waiting four weeks would delay necessary clinical intervention. (Note: 4 weeks is the duration required for Post-Traumatic Stress Disorder symptoms). **High-Yield Clinical Pearls for NEET-PG:** * **The "SIGECAPS" Mnemonic:** Sleep, Interest (Anhedonia), Guilt, Energy, Concentration, Appetite, Psychomotor, Suicidal ideation. * **Dysthymia (Persistent Depressive Disorder):** Requires a depressed mood for at least **2 years** (1 year in children/adolescents). * **Cyclothymia:** Requires at least **2 years** of hypomanic and depressive periods that do not meet full criteria. * **Post-Stroke Depression:** Most commonly associated with lesions in the **Left frontal cortex**.

Q: Which of the following conditions is ECT most useful in?

Acute Depression. **Explanation:** Electroconvulsive Therapy (ECT) is a highly effective biological treatment in psychiatry. While it has several indications, **Acute Depression** (specifically Major Depressive Disorder with melancholic or psychotic features) is the condition where ECT shows the highest efficacy and most rapid response. **Why Acute Depression is Correct:** ECT is considered the "gold standard" for treatment-resistant depression or when a rapid clinical response is required (e.g., severe suicidal ideation, refusal to eat, or catatonia). It works by inducing a generalized seizure, which leads to a massive release of neurotransmitters and increases BDNF (Brain-Derived Neurotrophic Factor) levels. **Analysis of Incorrect Options:** * **A. Mania (Acute):** While ECT is effective for acute mania (especially delirious mania), it is typically reserved as a second or third-line treatment after mood stabilizers (Lithium, Valproate) and antipsychotics. * **B. Chronic Schizophrenia:** ECT is generally not effective for the negative symptoms of chronic schizophrenia. It is primarily used in schizophrenia for acute exacerbations, catatonic features, or when there is a strong affective (mood) component. * **C. Panic Disorder:** ECT has no established role in the treatment of anxiety disorders like Panic Disorder. These are managed with SSRIs and Cognitive Behavioral Therapy (CBT). **High-Yield Clinical Pearls for NEET-PG:** * **Absolute Contraindication:** There are **no absolute contraindications** for ECT, but increased intracranial pressure (ICP) is the most significant relative contraindication. * **Most Common Side Effect:** Retrograde amnesia (memory loss) and post-ictal confusion. * **Mortality Rate:** Approximately 0.01 per 1,000 patients (similar to general anesthesia). * **Electrode Placement:** Bilateral (Gold standard for efficacy) vs. Unilateral (Fewer cognitive side effects).

Question 1

Which cognitive model of depression is widely recognized?

Accepted Answer

Beck

Answer

Ellis

Answer

Godfrey

Answer

Meichenbaum

Question 2

What is the recurrent risk for postpartum psychosis in a subsequent pregnancy?

Accepted Answer

50%

Answer

10%

Answer

20%

Answer

35%

Question 3

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 4

Higher cortisol levels are seen in which of the following conditions?

Accepted Answer

Depression

Answer

Phobia

Answer

Schizophrenia

Answer

Parkinsonism

Question 5

A 41-year-old woman presented with a history of aches and pains all over the body and generalized weakness for four years. She cannot sleep because of the illness and has lost her appetite as well. She has a lack of interest in work and doesn't like to meet friends and relatives. She denies feelings of sadness. What is her most likely diagnosis?

Accepted Answer

Major depression

Answer

Somatoform pain disorder

Answer

Somatization disorder

Answer

Dissociative disorder

Question 6

Which of the following is NOT a somatic therapy used in depression?

Accepted Answer

Ultrasound brain stem stimulation

Answer

Electroconvulsive therapy

Answer

Deep brain stimulation

Answer

Transcranial magnetic stimulation

Question 7

True about bipolar disorder is:

Accepted Answer

The patient often experiences complete remission between episodes.

Answer

Personality deterioration is common.

Answer

The patient primarily suffers from mania or depression.

Answer

Unipolar depression is uncommon.

Question 8

"Learned helplessness" is typically seen in which of the following conditions?

Accepted Answer

Depression

Answer

Delirium

Answer

Dementia

Answer

Schizophrenia

Question 9

According to DSM-IV criteria, what is the minimum duration of depressed mood or loss of interest or pleasure required for the diagnosis of a Major Depressive Episode?

Accepted Answer

2 weeks

Answer

1 week

Answer

3 weeks

Answer

4 weeks

Question 10

Which of the following conditions is ECT most useful in?

Accepted Answer

Acute Depression

Answer

Mania (Acute)

Answer

Chronic Schizophrenia

Answer

Panic Disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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