Mood Disorders — MCQs

Mood Disorders Indian Medical PG Practice Questions and MCQs

Question 361: What is the core feature required for diagnosing a manic episode?

A. Decreased appetite
B. Increased sleep
C. Grandiosity
D. Elevated mood (Correct Answer)

Explanation: ***Elevated mood*** - The **DSM-5 criteria** for a manic episode explicitly state that an abnormally and persistently **elevated, expansive, or irritable mood** must be present for at least one week. - This core mood disturbance is what differentiates mania from other psychiatric conditions and is a prerequisite for diagnosis. *Grandiosity* - While **grandiosity** (inflated self-esteem or sense of importance) is a common associated symptom of a manic episode, it is not the sole diagnostic requirement. - It is one of several symptom criteria that must be present in addition to the mood disturbance for a diagnosis of mania. *Decreased appetite* - **Decreased appetite** is generally not a feature of a manic episode; in fact, individuals in a manic state often have an **increased appetite** or engage in impulsive eating due to lack of inhibition. - A decreased appetite is more commonly associated with depressive episodes. *Increased sleep* - **Increased sleep** is contrary to the typical presentation of a manic episode, where individuals often experience a **decreased need for sleep** and can function on very little sleep, feeling energized. - A significant reduction in the need for sleep is a characteristic symptom of mania, not an increase.

Question 362: All are required to diagnose major depression except?

A. Depressed mood
B. Decreased concentration
C. Nihilistic ideas (Correct Answer)
D. Insomnia

Explanation: ***Nihilistic ideas*** - While nihilistic ideas (e.g., belief that life is meaningless or that nothing matters) can occur in severe depression, they are **not a mandatory diagnostic criterion** for major depressive disorder (MDD). - The diagnosis of MDD requires a specific number of core symptoms, and nihilistic ideation is not listed as one of them in diagnostic manuals like the DSM-5. *Depressed mood* - A **depressed mood** for most of the day, nearly every day, is one of the two **cardinal symptoms** required for a diagnosis of major depressive disorder. - The other cardinal symptom is anhedonia (loss of interest or pleasure). *Insomnia* - **Insomnia** (difficulty falling or staying asleep) or hypersomnia (sleeping excessively) is a common neurovegetative symptom of major depressive disorder and is one of the **nine diagnostic criteria**. - At least 5 of these 9 criteria must be present for a diagnosis, including at least one of the two cardinal symptoms. *Decreased concentration* - **Diminished ability to think or concentrate**, or indecisiveness, is another of the **nine diagnostic criteria** for major depressive disorder. - This cognitive symptom highlights the impact of depression on mental function beyond mood.

Question 363: Which neurotransmitter is believed to be increased in mania?

A. Decreased dopamine
B. Increased dopamine (Correct Answer)
C. Increased norepinephrine
D. Decreased norepinephrine

Explanation: ***Increased dopamine*** - **Dopamine** is the primary neurotransmitter implicated in the pathophysiology of mania according to the **dopaminergic hypothesis** of mood disorders. - Increased dopaminergic activity in the **mesolimbic and mesocortical pathways** contributes to the core symptoms of mania including **euphoria**, **increased goal-directed activity**, **reduced need for sleep**, **psychosis**, and **impulsivity**. - Evidence includes: response to dopamine antagonists (antipsychotics) in treating mania, and dopamine agonists can precipitate manic episodes. - Studies using neuroimaging and CSF analysis support elevated dopamine activity during manic episodes. *Increased norepinephrine* - While norepinephrine is also increased in mania and contributes to **arousal**, **attention**, and **energy levels**, it is considered a secondary or contributory mechanism rather than the primary pathophysiological change. - The **catecholamine hypothesis** suggests both dopamine and norepinephrine are elevated, but dopamine plays the more central role in the characteristic manic symptoms. *Decreased dopamine* - Decreased dopamine is associated with **depression**, **Parkinson's disease**, and **negative symptoms of schizophrenia**, not mania. - Low dopamine leads to reduced motivation, anhedonia, psychomotor retardation, and lack of energy—the opposite of manic presentation. *Decreased norepinephrine* - Decreased norepinephrine is linked to **depressive states**, characterized by low energy, poor concentration, and reduced arousal. - This is directly contrary to the hyperarousal, excessive energy, and heightened activity seen in mania.

Question 364: In a patient with depression who has experienced a relapse after treatment with SSRIs or TCAs, which vitamin deficiency is most likely to contribute to this relapse?

A. Pyridoxine
B. Cobalamin (Correct Answer)
C. Ascorbate
D. Retinol

Explanation: ***Cobalamin*** - **Vitamin B12 (cobalamin)** deficiency has been strongly linked to **mood disorders**, cognitive dysfunction, and treatment resistance in depression. - It plays a crucial role in **neurotransmitter synthesis** and myelin formation, and its deficiency can impair neural pathways involved in mood regulation, predisposing to relapse. *Pyridoxine* - While **pyridoxine (Vitamin B6)** is a cofactor in neurotransmitter synthesis, its deficiency is less commonly implicated as a primary cause of relapse in treated depression compared to B12. - Severe deficiency can cause neurological symptoms, but it's not typically the *most likely* vitamin to cause relapse after prior antidepressant success. *Ascorbate* - **Ascorbate (Vitamin C)** is important for overall health and acts as an antioxidant, but a deficiency is not directly or strongly associated with relapse in treated depression. - While essential for **collagen synthesis** and immune function, its direct impact on mood regulation pathways is less pronounced than B12. *Retinol* - **Retinol (Vitamin A)** is vital for vision, immune function, and cell growth. - However, there is no significant evidence to suggest that **retinol deficiency** is a common or direct cause of relapse in patients with depression who have responded to antidepressant treatment.

Question 365: Which of the following is a first-line treatment for bipolar affective (manic-depressive) disorder:

A. Chlorpromazine
B. Haloperidol
C. Diazepam
D. Lithium carbonate (Correct Answer)

Explanation: **Lithium carbonate** - **Lithium** is a well-established and highly effective **mood stabilizer**, considered a first-line treatment for managing both **manic** and **depressive episodes** in bipolar disorder. - It helps prevent recurrent episodes and reduces the severity of mood swings, acting as a prophylactic agent. *Chlorpromazine* - **Chlorpromazine** is a **first-generation antipsychotic** that is primarily used to treat **schizophrenia** and other psychotic disorders. - While it can be used acutely to manage severe manic agitation, it is not a first-line agent for the long-term mood stabilization characteristic of bipolar disorder. *Haloperidol* - **Haloperidol** is another **first-generation antipsychotic** often used for acute treatment of **psychotic symptoms** or severe agitation, including in mania. - It is not a primary long-term mood stabilizer for bipolar disorder due to its side effect profile and lack of efficacy in preventing future mood episodes compared to lithium. *Diazepam* - **Diazepam** is a **benzodiazepine** primarily used for treating **anxiety**, muscle spasms, and acute seizures. - While it can help manage acute agitation and insomnia during a manic episode, it does not have mood-stabilizing properties and is not a long-term treatment for bipolar disorder.

Question 366: In which condition is erotomania most commonly observed?

A. Bipolar mania
B. Delusional disorder (Correct Answer)
C. Neurosis
D. Obsessive compulsive disorder

Explanation: ***Delusional disorder*** - Erotomania (De Clérambault's syndrome) is **classically and most commonly** associated with **Delusional Disorder, Erotomanic Type**. - This condition is characterized by a **non-bizarre delusion** that another person, usually of higher social status, is in love with the patient. - In delusional disorder, the erotomanic delusion is the **primary and defining feature**, typically lasting at least **1 month** without other prominent psychotic symptoms. - The patient maintains functioning in other areas of life apart from the impact of the delusion. *Bipolar mania* - While **psychotic features** can occur in severe manic episodes, erotomania is **not a characteristic** delusion of mania. - Manic delusions typically involve **grandiose themes** (special powers, wealth, identity), **persecutory content**, or ideas of reference. - Erotomania, when it occurs in bipolar disorder, is **rare** and not the most common presentation. *Neurosis* - **Neurosis** is an outdated term referring to non-psychotic mental disorders characterized by distress without loss of contact with reality. - Erotomania is a **psychotic symptom** (a delusion), indicating a break from reality, and is therefore not characteristic of neurosis. *Obsessive compulsive disorder* - **OCD** is characterized by recurrent, intrusive thoughts (obsessions) and repetitive behaviors (compulsions). - The patient typically recognizes obsessions as **irrational** and experiences them as ego-dystonic. - Erotomania is a **fixed, false belief** (delusion) held with absolute conviction, not an unwanted intrusive thought, making it fundamentally different from OCD.

Question 367: Which of the following diseases has the maximum Disability-Adjusted Life Years (DALY) loss?

A. Schizophrenia (Mental Disorder)
B. Bipolar depression (Bipolar Disorder)
C. Mania (Bipolar Disorder Episode)
D. Unipolar depression (Major Depressive Disorder) (Correct Answer)

Explanation: ***Unipolar depression (Major Depressive Disorder)*** - **Major Depressive Disorder (MDD)** is considered a leading cause of **disability worldwide**, contributing significantly to DALYs due to its high prevalence, chronicity, and disabling nature. - The long-term impact on daily functioning, productivity, and overall quality of life makes it the mental disorder with the largest burden of disease. *Schizophrenia (Mental Disorder)* - While **schizophrenia** causes severe disability and is highly impactful on individuals and society, its prevalence is lower than that of unipolar depression. - The DALY burden for schizophrenia is substantial, but **unipolar depression** affects a much larger proportion of the global population. *Bipolar depression (Bipolar Disorder)* - **Bipolar disorder (depressive episodes)** also contributes significantly to disability, but it is less prevalent than unipolar depression. - Although the depressive phases are often more severe than unipolar depression, the overall DALYs are lower due to its **comparatively lower incidence**. *Mania (Bipolar Disorder Episode)* - **Mania**, a component of bipolar disorder, can cause significant impairment during an episode but is typically **episodic** and less frequent than depressive states in bipolar disorder. - The DALYs attributed to manic episodes alone are generally lower than the overall burden of persistent depressive states found in unipolar depression.

Question 368: Which of the following factors is most commonly associated with suicidal tendencies?

A. Female gender
B. Severe depression (Correct Answer)
C. Chronic illness
D. Younger age group

Explanation: ***Severe depression*** - **Major depressive disorder** is the strongest and most common risk factor for suicidal ideation and attempts, significantly increasing suicidal tendencies [1]. - The profound **hopelessness**, **worthlessness**, and altered cognitive processing associated with severe depression contribute largely to suicidal thoughts [2]. - Depression is present in approximately **90%** of individuals who die by suicide. *Female gender* - While **females** have higher rates of **suicide attempts** and self-harm, **males** have a higher rate of completed suicides using more lethal methods. - Female gender alone is not the most common risk factor for suicidal tendencies compared to the profound impact of severe mental illness like depression [1]. *Chronic illness* - **Chronic medical conditions** can increase the risk of depression and subsequent suicidal ideation due to pain, functional limitations, and loss of independence [3]. - However, chronic illness is generally considered an **indirect risk factor**, often mediating its effect through the development of mental health disorders like depression [3]. *Younger age group* - Suicide is a leading cause of death in **adolescents and young adults**, highlighting significant concern in this demographic [1]. - While younger age is a risk factor, especially with concurrent mental health issues or stressors, it is not as universally predictive of suicidal tendencies as severe depression across all age groups [1].

Question 369: Clang associations are primarily associated with which of the following conditions?

A. Depressive disorder
B. Psychotic disorder
C. Anxiety disorder
D. Mania (Correct Answer)

Explanation: ***Mania*** - **Clang associations** are a characteristic **thought disorder** seen in mania, where a person selects words based on their **sound (rhyming)** rather than their meaning or logical connection. - This symptom reflects the **pressured speech** and **racing thoughts** commonly observed during manic episodes. - **Classic example**: "I'm feeling fine, wine, dine, spine" - words rhyme but lack logical connection. *Depressive disorder* - Patients with depressive disorder typically experience **paucity of speech** or **slowed thoughts**, not clang associations. - Their thought content often focuses on themes of **hopelessness, guilt, or worthlessness**. *Psychotic disorder* - While psychotic disorders like **schizophrenia** can occasionally involve clang associations during acute episodes, they are **much more classically and prominently** associated with **mania**. - Schizophrenia more typically shows other thought disorders like **loose associations, derailment, or word salad**. - Other psychotic symptoms like **delusions** and **hallucinations** are more central to psychotic disorders. *Anxiety disorder* - Anxiety disorders are characterized by excessive **worry, fear**, and **physical symptoms of arousal**. - They do not involve formal **thought disorders** like clang associations; thought content is usually coherent but focused on anxious themes.

Question 370: Which of the following is not a required symptom for the diagnosis of major depression?

A. Nihilistic ideas (Correct Answer)
B. Anhedonia
C. Significant weight loss
D. Depressed mood

Explanation: ***Nihilistic ideas*** - While nihilistic ideas (feelings that life is meaningless or that nothing exists) can occur in severe depression, they are **not a core diagnostic symptom** required by the DSM-5 criteria for major depressive disorder. - The diagnosis of major depression requires at least five specific symptoms, including either depressed mood or anhedonia, but **nihilism is not one of these mandatory criteria**. *Depressed mood* - This is one of the **two core symptoms** required for a diagnosis of major depressive disorder, alongside anhedonia. - The individual must experience a **subjective feeling of sadness, emptiness, or hopelessness**, or appear tearful to others, for most of the day, nearly every day. *Anhedonia* - This is the **other core symptom** required for a diagnosis of major depressive disorder if depressed mood is not present. - It refers to a **markedly diminished interest or pleasure** in all, or almost all, activities most of the day, nearly every day. *Significant weight loss* - **Significant unintentional weight loss** or weight gain (e.g., a change of more than 5% of body weight in a month) or **decrease/increase in appetite nearly every day** is one of the associated symptoms that can contribute to a diagnosis of major depression. - Changes in appetite or weight are common somatic symptoms associated with **mood dysregulation** in depression.

Practice by Chapter

Major Depressive Disorder

Practice Questions

Bipolar Disorder: Manic Episodes

Practice Questions

Bipolar Disorder: Depressive and Mixed Episodes

Practice Questions

Persistent Depressive Disorder (Dysthymia)

Practice Questions

Cyclothymic Disorder

Practice Questions

Seasonal Affective Disorder

Practice Questions

Suicide and Suicidal Behavior

Practice Questions

Pharmacotherapy of Mood Disorders

Practice Questions

Psychotherapy for Mood Disorders

Practice Questions

Brain Stimulation Therapies

Practice Questions

Treatment-Resistant Depression

Practice Questions

Mood Disorders in Special Populations

Practice Questions

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