Mood Disorders Practice Questions

Q: Erotomania is a feature of which of the following conditions?

Bipolar mania. **Explanation:** **Erotomania** (also known as **De Clérambault's Syndrome**) is a delusional belief that another person, usually of higher social status or a celebrity, is deeply in love with the patient. 1. **Why Bipolar Mania is correct:** Erotomania is most commonly encountered as a symptom of **Delusional Disorder (Erotomanic type)** or as a feature of **Bipolar I Disorder during a manic episode**. In the context of mania, the patient’s heightened self-esteem (grandiosity) and increased psychomotor agitation often manifest as the delusional conviction that they are the object of someone’s affection. Since "Delusional Disorder" is not an option, Bipolar Mania is the most clinically relevant choice. 2. **Why other options are incorrect:** * **Unipolar Mania:** This is an outdated clinical term. Almost all patients who experience mania will eventually experience depression, thus they are classified under Bipolar Disorder. * **Neurosis:** This is a broad, archaic term for non-psychotic conditions (like anxiety). Erotomania is a **psychotic** symptom (delusion) and does not fit here. * **Obsessive-Compulsive Disorder (OCD):** OCD involves intrusive thoughts (obsessions) recognized as irrational by the patient. Erotomania is a fixed, false belief (delusion) held with absolute certainty, making it a psychotic feature rather than an obsession. **High-Yield Clinical Pearls for NEET-PG:** * **De Clérambault's Syndrome:** Primary erotomania occurring in the absence of other psychotic symptoms. * **Demographics:** More common in females in clinical settings, though forensic cases often involve males (stalking behavior). * **Old vs. New:** In the DSM-5, it is classified under **Delusional Disorder**. * **Key Distinction:** Unlike simple infatuation, the patient believes the "lover" initiated the relationship through "secret signals" (e.g., telepathy or TV messages).

Q: A 45-year-old female patient reports that over the last 3 months she has lost her appetite and interest in her usual activities, and often feels that life is not worth living. Compared with typical sleep, in this patient the percentage of REM sleep, percentage of delta sleep, and REM latency, respectively, are most likely to

increase, decrease, decrease. ### Explanation The patient presents with classic symptoms of **Major Depressive Disorder (MDD)**: anhedonia (loss of interest), anorexia, and suicidal ideation (life not worth living). In MDD, sleep architecture undergoes specific, high-yield neurobiological changes. **1. Why Option A is Correct:** The characteristic polysomnography (PSG) findings in depression include: * **Increased REM sleep percentage:** There is an overall increase in the total amount and density of REM sleep, particularly in the first half of the night. * **Decreased Delta sleep (Slow Wave Sleep):** Stages 3 and 4 of NREM sleep are significantly reduced. * **Decreased REM Latency:** This is the most specific marker. REM latency is the time from sleep onset to the first REM period. In depression, this interval shortens (often <60 minutes). **2. Why Other Options are Incorrect:** * **Option B:** Incorrect because REM latency **decreases** in depression, not increases. Increased REM latency is seen in healthy individuals or those using certain antidepressants (like SSRIs). * **Options C & D:** Incorrect because REM sleep percentage **increases** in depression due to "REM pressure," and REM latency **decreases**. **Clinical Pearls for NEET-PG:** * **Sleep Continuity:** Depressed patients also show increased sleep-onset latency (difficulty falling asleep) and increased early morning awakenings (terminal insomnia). * **REM Density:** There is an increase in the frequency of rapid eye movements during REM sleep. * **Cholinergic-Aminergic Balance:** The shift toward REM sleep in MDD is thought to be due to an imbalance between acetylcholine (which triggers REM) and monoamines (which inhibit REM). * **Treatment Effect:** Most antidepressants (SSRIs, TCAs, MAOIs) **suppress REM sleep** and **increase REM latency**, which is the opposite of the disease state.

Q: A clinical sign of mania is?

Flight of ideas. ### Explanation **Flight of Ideas** is a hallmark formal thought disorder characteristic of **Mania**. It is defined as a rapid succession of thoughts where the connection between ideas is based on chance associations, such as **rhyming (clanging)** or **punning**, rather than logical progression. While the flow is extremely fast (pressured speech), a listener can usually follow the train of thought, unlike in schizophrenia where associations are completely lost. #### Analysis of Options: * **A. Neologism:** This refers to the coining of new words that have no meaning to others. It is a classic feature of **Schizophrenia**, not mood disorders. * **B. Perseveration:** This is the persistent repetition of a specific response (word, phrase, or gesture) despite the absence or cessation of a stimulus. It is most commonly associated with **Organic Brain Disorders** (like Dementia) or Frontal Lobe lesions. * **C. Echolalia:** This is the involuntary, parrot-like repetition of words spoken by another person. It is typically seen in **Catatonic Schizophrenia**, Autism, or certain neurological conditions. #### NEET-PG High-Yield Pearls: * **Pressure of Speech:** The objective sign of "racing thoughts" in mania; the patient speaks rapidly and is difficult to interrupt. * **Flight of Ideas vs. Loosening of Associations:** In Flight of Ideas (Mania), the links between ideas are understandable (though superficial). In Loosening of Associations (Schizophrenia), the links are idiosyncratic and incomprehensible. * **Other Manic Symptoms:** Euphoria/Elation, decreased need for sleep, grandiosity, and increased psychomotor activity. * **Diagnostic Tip:** If a question mentions "Clang associations," always look for Mania/Flight of Ideas as the primary diagnosis.

Q: Somatic symptoms of Depression include all except?

Feelings of guilt. In psychiatry, symptoms of Major Depressive Disorder (MDD) are broadly categorized into **Psychological (Emotional/Cognitive)** and **Somatic (Biological/Vegetative)** symptoms. **Explanation of the Correct Answer:** **A. Feelings of guilt:** This is a **psychological/cognitive symptom**. Guilt, worthlessness, and hopelessness represent the patient’s thought content and emotional state. According to the ICD and DSM criteria, while guilt is a core feature of depression, it does not involve a physiological or bodily function, thus it is not classified as a somatic symptom. **Explanation of Incorrect Options:** Somatic symptoms (also known as "melancholic features" or "biological markers") involve physical changes in the body’s regulatory systems: * **B. Reduced libido:** A common biological symptom reflecting a decrease in sexual drive and energy. * **C. Insomnia:** Sleep disturbance (especially early morning awakening) is a hallmark somatic feature of depression. * **D. Weight change:** Significant weight loss or gain (and changes in appetite) are primary physiological indicators of the depressive state. **High-Yield Clinical Pearls for NEET-PG:** * **Biological/Somatic Syndrome (ICD-10):** To diagnose the "somatic syndrome," at least four of the following must be present: loss of interest/pleasure, lack of emotional reactivity, early morning awakening (2+ hours early), diurnal variation (worse in the morning), psychomotor retardation/agitation, loss of appetite, weight loss (>5% in a month), and loss of libido. * **Diurnal Variation:** In typical depression, symptoms are usually **worse in the morning** and improve slightly as the day progresses. * **Beck’s Cognitive Triad:** Includes negative views about the **Self, World, and Future** (Guilt belongs to the 'Self' component).

Q: Which of the following is TRUE about manic-depressive psychosis?

Mood disorders often have seasonal patterns. ### Explanation **Correct Option: D. Mood disorders often have seasonal patterns** Seasonal Affective Disorder (SAD) is a recognized specifier for mood disorders (Bipolar and MDD). It most commonly presents as "Winter Depression," characterized by atypical symptoms like hypersomnia and hyperphagia, triggered by reduced sunlight. This is linked to disruptions in circadian rhythms and melatonin metabolism. **Analysis of Incorrect Options:** * **Option A:** While Cyclothymic disorder involves hypomanic symptoms and depressive symptoms, the DSM-5/ICD criteria specify that these symptoms **must not meet the full criteria** for a Major Depressive Episode or a Manic Episode. The option's phrasing "episodes of depression" is technically imprecise in a clinical examination context compared to the definitive seasonal pattern. * **Option B:** Psychosocial stressors (e.g., sleep deprivation, major life events) are significant triggers for the onset and relapse of manic episodes. The "Kindling Hypothesis" suggests that while early episodes may require a stressor, later episodes may occur spontaneously. * **Option C:** While thyroid dysfunction affects mood, **Hypothyroidism** (not hyperthyroidism) is more classically associated with rapid-cycling bipolar disorder and treatment-resistant depression. **High-Yield Clinical Pearls for NEET-PG:** * **Rapid Cycling:** Defined as $\geq$ 4 mood episodes (manic, hypomanic, or depressive) within 12 months. * **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode PLUS one Major Depressive episode. * **Treatment of Choice:** Lithium is the gold standard for maintenance; however, Valproate is preferred for rapid cycling and mixed episodes. * **Seasonal Pattern Treatment:** Phototherapy (bright light therapy, 10,000 lux) is the first-line treatment for SAD.

Q: According to DSM-IV, for a diagnosis of mania in Bipolar Disorder, how long must symptoms persist in an outpatient?

1 week. ### Explanation **1. Why Option A is Correct:** According to the **DSM-IV (and DSM-5)** criteria, a **Manic Episode** is defined as a distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting **at least 1 week** (or any duration if hospitalization is necessary). The symptoms must be present most of the day, nearly every day, and must cause significant impairment in social or occupational functioning. **2. Why Other Options are Incorrect:** * **Option B (2 weeks):** This is the minimum duration required for a **Major Depressive Episode (MDE)** or Dysthymia (where symptoms persist for 2 years). * **Options C & D (3 and 4 weeks):** These timeframes do not correspond to the diagnostic criteria for acute mood episodes in Bipolar Disorder. While chronic conditions like Cyclothymia require a 2-year duration, the acute manic phase is defined by the 1-week threshold. **3. High-Yield Clinical Pearls for NEET-PG:** * **Hypomania vs. Mania:** Hypomania requires a minimum duration of **4 consecutive days**. Unlike mania, it does *not* cause marked impairment, does *not* require hospitalization, and *never* features psychotic symptoms. * **The "DIG FAST" Mnemonic for Mania:** **D**istractibility, **I**ndiscretion (excessive involvement in pleasurable activities), **G**randiosity, **F**light of ideas, **A**ctivity increase, **S**leep deficit (decreased need for sleep), and **T**alkativeness (pressured speech). * **Bipolar I vs. II:** Bipolar I requires at least one **Manic** episode. Bipolar II requires at least one **Hypomanic** episode AND one **Major Depressive** episode. * **Mixed Features:** If symptoms of both mania and depression occur simultaneously for at least 1 week, it was termed a "Mixed Episode" in DSM-IV (now a "Mixed Features" specifier in DSM-5).

Q: All of the following personality disorders can be associated with bipolar disorder, except:

Antisocial. **Explanation:** The relationship between Personality Disorders (PDs) and Bipolar Disorder (BD) is characterized by significant diagnostic overlap due to shared features of emotional dysregulation and impulsivity. **Why Antisocial PD is the correct answer:** While patients with Bipolar Disorder (especially during manic episodes) may exhibit reckless behavior, irritability, and disregard for rules, **Antisocial Personality Disorder (ASPD)** is generally considered to have the *least* direct clinical or genetic association with the core pathology of Bipolar Disorder compared to the other options. In the context of standard psychiatric literature and NEET-PG patterns, ASPD is often viewed as a distinct entity of "sociopathy" rather than a comorbid affective spectrum disorder. **Analysis of Incorrect Options:** * **Borderline PD (BPD):** This has the highest association with Bipolar Disorder. Both share symptoms like mood lability, impulsivity, and intense anger. BPD is frequently comorbid with Bipolar II. * **Narcissistic PD:** Often associated with Bipolar I. The grandiosity, inflated self-esteem, and lack of empathy seen in Narcissistic PD mirror the symptoms of a manic or hypomanic episode. * **Anankastic (Obsessive-Compulsive) PD:** Research indicates a high prevalence of OCPD traits in Bipolar patients, particularly during the depressive phase or as a compensatory mechanism during euthymic periods to manage the chaos of previous episodes. **Clinical Pearls for NEET-PG:** * **Cluster B** (Borderline, Narcissistic, Histrionic) is the most common cluster associated with Bipolar Disorder. * **Differential Diagnosis:** Always rule out Bipolar Disorder before diagnosing BPD, as mood stabilizers are the mainstay for the former, while psychotherapy (DBT) is the mainstay for the latter. * **High-Yield Fact:** Borderline PD is the personality disorder most frequently misdiagnosed as Bipolar Disorder due to "rapid cycling" mood swings.

Q: Which of the following is NOT considered a differential diagnosis of premenstrual tension?

Chronic fatigue syndrome. **Explanation:** Premenstrual Dysphoric Disorder (PMDD) or Premenstrual Tension (PMT) is characterized by significant emotional and physical symptoms that occur during the **luteal phase** of the menstrual cycle and remit shortly after the onset of menses. **Why Chronic Fatigue Syndrome (CFS) is the correct answer:** Chronic Fatigue Syndrome is characterized by persistent, unexplained exhaustion lasting at least six months that is not relieved by rest. Unlike PMT, CFS symptoms are **chronic and continuous**, lacking the cyclical, hormone-dependent pattern essential for a PMT diagnosis. While fatigue is a symptom of PMT, the lack of periodicity in CFS makes it an unlikely differential diagnosis compared to mood and anxiety disorders that can "mimic" or be exacerbated by the menstrual cycle (premenstrual magnification). **Analysis of Incorrect Options:** * **A. Psychiatric Depressive Disorder:** Major Depressive Disorder (MDD) is a primary differential. Clinicians must distinguish whether the patient has PMT or a continuous depression that worsens premenstrually. * **B. Panic Disorder:** Many women experience increased autonomic arousal and panic attacks specifically during the luteal phase, making it a common differential. * **C. Generalized Anxiety Disorder (GAD):** GAD involves persistent worry. Because PMT often presents with high levels of irritability and anxiety, GAD must be ruled out by tracking symptoms on a daily prospective calendar. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Prospective daily charting of symptoms for at least **two consecutive menstrual cycles**. * **First-line Treatment:** SSRIs (e.g., Fluoxetine, Sertraline). Unlike in MDD, SSRIs for PMT can be effective even when taken only during the luteal phase (intermittent dosing). * **Key Symptom:** Irritability is often the most prominent emotional symptom in PMT/PMDD.

Question 1

Erotomania is a feature of which of the following conditions?

Accepted Answer

Bipolar mania

Answer

Unipolar mania

Answer

Neurosis

Answer

Obsessive-compulsive disorder

Question 2

A 45-year-old female patient reports that over the last 3 months she has lost her appetite and interest in her usual activities, and often feels that life is not worth living. Compared with typical sleep, in this patient the percentage of REM sleep, percentage of delta sleep, and REM latency, respectively, are most likely to

Accepted Answer

increase, decrease, decrease

Answer

increase, decrease, increase

Answer

decrease, stay the same, increase

Answer

decrease, decrease, increase

Question 3

Delusion of grandiosity is seen in which of the following conditions?

Accepted Answer

Schizoaffective disorder, manic type

Answer

Hypomania

Answer

Paranoid schizophrenia

Answer

Kleptomania

Question 4

A clinical sign of mania is?

Accepted Answer

Flight of ideas

Answer

Neologism

Answer

Perseveration

Answer

Echolalia

Question 5

Somatic symptoms of Depression include all except?

Accepted Answer

Feelings of guilt

Answer

Reduced libido

Answer

Insomnia

Answer

Weight change

Question 6

Which of the following is TRUE about manic-depressive psychosis?

Accepted Answer

Mood disorders often have seasonal patterns

Answer

Cyclothymic disorder consists of hypomanic and less severe episodes of depression

Answer

Psychosocial stressors have no influence on manic episodes

Answer

Hyperthyroidism causes rapid-cycling bipolar disorder in females

Question 7

According to DSM-IV, for a diagnosis of mania in Bipolar Disorder, how long must symptoms persist in an outpatient?

Accepted Answer

1 week

Answer

2 weeks

Answer

3 weeks

Answer

4 weeks

Question 8

Which of the following statements regarding rapid cycling bipolar disorder is true?

Accepted Answer

Alcohol, stimulants, and caffeine use are risk factors.

Answer

Defined as at least four episodes per year.

Answer

Hospitalization is common.

Answer

More common in women than men.

Question 9

All of the following personality disorders can be associated with bipolar disorder, except:

Accepted Answer

Antisocial

Answer

Anankastic

Answer

Borderline

Answer

Narcissistic

Question 10

Which of the following is NOT considered a differential diagnosis of premenstrual tension?

Accepted Answer

Chronic fatigue syndrome

Answer

Psychiatric depressive disorder

Answer

Panic disorder

Answer

Generalized anxiety disorder

Mood Disorders — MCQs

Mood Disorders — MCQs

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