Mood Disorders Practice Questions

Q: Which is an objective sign of depression involving the upper eyelid?

Veraguth sign. **Explanation:** **Veraguth’s sign** is a classic objective physical finding in patients with melancholic depression. It refers to a characteristic triangular fold in the nasal corner of the **upper eyelid**, caused by the contraction of the corrugator supercilii muscles. This creates a look of fixed distress or "omega-like" tension specifically localized to the upper lid area. **Analysis of Options:** * **Omega sign (Option B):** While also associated with depression, the Omega sign refers to the furrowing of the brow where wrinkles on the **forehead** (above the root of the nose) form the shape of the Greek letter Omega (Ω). It is a sign of chronic mourning or severe depression but involves the forehead, not the eyelid. * **Empty delta sign (Option C):** This is a neuroimaging finding seen on contrast-enhanced CT scans of the head, indicating **Dural Venous Sinus Thrombosis**. It represents a lack of filling in the superior sagittal sinus. * **Hoffman's sign (Option D):** This is a clinical sign used in neurology to detect **Upper Motor Neuron (UMN) lesions** involving the cervical spine. It is elicited by flicking the nail of the middle finger, resulting in involuntary flexion of the thumb and index finger. **High-Yield Clinical Pearls for NEET-PG:** * **Veraguth’s fold** and the **Omega sign** are both considered "facies of depression." * **Cotard’s Syndrome:** A severe form of depressive psychosis where the patient has nihilistic delusions (e.g., believing their organs are rotting or they are dead). * **Beck’s Cognitive Triad:** A psychological model of depression consisting of negative views about the **Self, the World, and the Future.**

Q: Electroconvulsive therapy (ECT) is indicated in which of the following conditions?

Delusional Depression. **Explanation:** **1. Why Delusional Depression is Correct:** Delusional Depression (also known as Psychotic Depression) is a severe subtype of Major Depressive Disorder where the patient experiences delusions or hallucinations. **ECT is a first-line treatment** for this condition because it offers a faster and more robust response compared to pharmacotherapy alone. In severe depression, ECT is specifically indicated when there is a high risk of suicide, refusal to eat (stupor), or the presence of psychotic features (delusions/hallucinations). **2. Analysis of Incorrect Options:** * **A. Neurotic Depression:** This refers to milder, chronic depressive symptoms often linked to personality traits or environmental stressors (Dysthymia). It is primarily managed with psychotherapy and SSRIs; ECT is not indicated for mild or non-psychotic depression. * **B. Auditory Hallucination:** This is a symptom, not a diagnosis. While ECT can treat conditions that cause hallucinations (like Schizophrenia), it is not a primary treatment for the symptom itself unless it occurs within a specific indicated disorder. * **C. Schizophrenia:** While ECT is used in Schizophrenia, it is generally a **second-line** treatment reserved for specific subtypes like Catatonic Schizophrenia or cases resistant to antipsychotics. In the context of this question, Delusional Depression is a more "classical" and definitive indication for ECT. **3. NEET-PG High-Yield Pearls:** * **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 and anterograde amnesia (usually transient). * **Mechanism:** ECT works by inducing a generalized tonic-clonic seizure lasting at least 25–30 seconds. * **Gold Standard Indication:** Severe Suicidal Ideation (where immediate rapid response is life-saving).

Q: What is the major risk factor for bipolar disorder?

Positive family history of bipolar disorder. **Explanation:** **1. Why Option A is correct:** Bipolar Disorder (BD) has one of the highest heritability rates among all psychiatric conditions (approximately 60–80%). A **positive family history** is the single most significant risk factor. If one parent has Bipolar I disorder, the risk to the child is approximately 10–25%; if both parents are affected, the risk escalates to 50–75%. In monozygotic twins, the concordance rate is as high as 40–70%. **2. Why other options are incorrect:** * **B. High neuroticism:** While personality traits like neuroticism are associated with an increased risk for Unipolar Depression and Anxiety disorders, they are not the primary drivers for Bipolar Disorder. * **C. Low socioeconomic status (SES):** Unlike Schizophrenia or Major Depressive Disorder, which show a strong correlation with low SES (Social Drift Hypothesis), Bipolar Disorder is often found to be more prevalent in **higher socioeconomic groups** or shows no specific correlation with poverty. * **D. Stressful life events:** These often act as "triggers" for the first few episodes of mania or depression (Kindling Hypothesis), but they are considered environmental precipitants rather than the major underlying risk factor. **Clinical Pearls for NEET-PG:** * **Most common mood disorder in the elderly:** Depression. * **Most common psychiatric co-morbidity in Bipolar Disorder:** Anxiety disorders (followed by substance abuse). * **Kindling Phenomenon:** Postulated by Robert Post; suggests that early episodes are triggered by stressors, but later episodes occur spontaneously as the brain becomes "sensitized." * **Drug of Choice for Bipolar Prophylaxis:** Lithium.

Q: Leaden paralysis is seen in which of the following conditions?

Atypical depression. **Explanation:** **Atypical Depression** is a subtype of Major Depressive Disorder (MDD) characterized by specific clinical features that differ from "classic" or melancholic depression. **Leaden paralysis** is a hallmark symptom of this condition; it refers to a heavy, weighted-down feeling in the arms or legs, often described by patients as if their limbs are made of lead. According to the DSM-5, the diagnosis of Atypical Depression requires **Mood Reactivity** (the ability to feel better in response to positive events) plus at least two of the following: 1. **Leaden paralysis.** 2. **Hyperphagia** (increased appetite or weight gain). 3. **Hypersomnia** (increased sleep). 4. **Long-standing pattern of interpersonal rejection sensitivity.** **Analysis of Incorrect Options:** * **Severe/Melancholic Depression:** These are characterized by "vegetative" symptoms which are the opposite of atypical features. Patients typically experience **insomnia** (specifically early morning awakening) and **anorexia** (weight loss), rather than hypersomnia and hyperphagia. * **Narcolepsy:** While narcolepsy involves sleep disturbances and **cataplexy** (sudden loss of muscle tone), it does not feature the chronic heavy-limb sensation defined as leaden paralysis. **High-Yield Clinical Pearls for NEET-PG:** * **Treatment of Choice:** SSRIs are the first-line treatment. However, **MAO Inhibitors** (like Phenelzine) are historically noted for being exceptionally effective for atypical depression if SSRIs fail. * **Mood Reactivity** is the "must-have" core feature for the DSM-5 specifier. * Atypical depression often has an earlier age of onset and a more chronic course compared to melancholic depression.

Q: All of the following statements concerning bipolar disorder (manic-depressive psychosis) are true EXCEPT:

The female to male ratio is 2:1.. **Explanation:** **1. Why Option B is the correct answer (The False Statement):** In **Bipolar Disorder (BPAD)**, the prevalence is **equal among men and women (1:1 ratio)**. This is a crucial distinction from Major Depressive Disorder (MDD), where the female-to-male ratio is indeed 2:1. In BPAD, while the overall prevalence is equal, clinical presentations differ: manic episodes are more common in men, whereas depressive episodes and rapid cycling are more frequent in women. **2. Analysis of Incorrect Options (True Statements):** * **Option A:** Studies indicate that women often have an earlier age of onset for bipolar symptoms compared to men, frequently presenting with a depressive episode as their first manifestation. * **Option C:** Historically, psychoanalytic and personality theories (such as those by Kretschmer) suggested a predisposition to bipolarity in individuals with "cyclothymic" temperaments or specific personality traits, including aggressive or assertive behaviors in women. * **Option D:** Unlike some personality disorders, the diagnostic criteria for Bipolar Disorder (based on ICD-11 or DSM-5) are highly standardized. The core symptoms of mania (elation, pressured speech, decreased need for sleep) are cross-culturally consistent and reliable. **Clinical Pearls for NEET-PG:** * **Mean age of onset:** 20–25 years (Earlier than MDD). * **Strongest Genetic Link:** BPAD has the highest heritability among major psychiatric disorders (Concordance rate: ~70-80% in monozygotic twins). * **First-line treatment:** Lithium is the gold standard for prophylaxis. * **Postpartum risk:** Women with BPAD have a significantly higher risk of developing **Postpartum Psychosis**.

Q: Exercise is also prescribed as an adjuvant treatment for depression. Most probably, it acts by:

Raising endorphin levels. ### Explanation **Correct Option: C. Raising endorphin levels** Exercise is a well-established adjuvant therapy for mild-to-moderate depression. The primary neurobiological mechanism is the **"Endorphin Hypothesis."** Physical activity triggers the release of endogenous opioids (beta-endorphins) from the pituitary gland and hypothalamus. These endorphins bind to mu-opioid receptors in the brain, leading to an analgesic effect and a sense of euphoria (often called the "runner's high"), which directly counteracts depressive symptoms and improves mood. Additionally, exercise increases levels of Brain-Derived Neurotrophic Factor (BDNF), promoting neuroplasticity in the hippocampus. **Why other options are incorrect:** * **A & B (Pulse pressure and Hemodynamics):** While exercise improves cardiovascular health and systemic circulation, these are physiological adaptations of the autonomic and circulatory systems. They do not have a direct, evidence-based psychoactive effect on the core neurochemical pathology of depression. * **D (Inducing good sleep):** While exercise improves sleep hygiene and circadian rhythms (which is beneficial for depressed patients), it is considered a secondary benefit. The primary, immediate biochemical mechanism for mood elevation during exercise is the surge in neurochemicals like endorphins and monoamines. **NEET-PG High-Yield Pearls:** * **First-line for Mild Depression:** Lifestyle modifications, including exercise and CBT, are often preferred over pharmacotherapy for mild cases. * **Monoamine Hypothesis:** Exercise also increases the availability of Serotonin, Norepinephrine, and Dopamine, mimicking the action of antidepressants. * **Neurogenesis:** Chronic exercise is linked to increased volume in the **hippocampus**, a region often shrunken in chronic MDD. * **Adjuvant Role:** In moderate-to-severe depression, exercise is an *adjuvant* (add-on) to SSRIs/SNRIs, not a replacement.

Question 1

Which is an objective sign of depression involving the upper eyelid?

Accepted Answer

Veraguth sign

Answer

Omega sign

Answer

Empty delta sign

Answer

Hoffman's sign

Question 2

Electroconvulsive therapy (ECT) is indicated in which of the following conditions?

Accepted Answer

Delusional Depression

Answer

Neurotic Depression

Answer

Auditory hallucination

Answer

Schizophrenia

Question 3

Which of the following are included in Bipolar Affective Disorder (BPAD)?

Accepted Answer

Recurrent manic episodes, depressive episodes and hypomanic episodes

Answer

Recurrent manic episodes and depressive episodes

Answer

Recurrent depressive episodes, manic episodes and dysthymic episodes

Answer

Recurrent manic episodes, depressive episodes and dysthymic episodes

Question 4

What is the major risk factor for bipolar disorder?

Accepted Answer

Positive family history of bipolar disorder

Answer

High neuroticism in personality

Answer

Low socioeconomic status

Answer

Stressful life events

Question 5

Intense depression and misery without any apparent cause is characteristic of which of the following?

Accepted Answer

Melancholia

Answer

Mania

Answer

Schizophrenia

Answer

Major depressive disorder

Question 6

Leaden paralysis is seen in which of the following conditions?

Accepted Answer

Atypical depression

Answer

Severe depression

Answer

Melancholic depression

Answer

Narcolepsy

Question 7

All of the following statements concerning bipolar disorder (manic-depressive psychosis) are true EXCEPT:

Accepted Answer

The female to male ratio is 2:1.

Answer

It has a younger age of onset in women.

Answer

There is a predisposition in aggressive women with masculine traits.

Answer

Diagnosis is reliable across geographic areas.

Question 8

A 30-year-old lady is described as being very talkative, even to strangers. She frequently compares herself to her colleagues and exhibits agitation, moving from one task to another due to hyperactivity. Which of the following is the most likely diagnosis?

Accepted Answer

Mania

Answer

Depression

Answer

Schizophrenia

Answer

Psychosis

Question 9

A 27-year-old nurse, who recently experienced a relationship breakup, presented with a two-month history of losing interest in her hobbies and a conviction that she could not work again. She expressed thoughts of life not being worth living and attempted suicide by consuming phenobarbitone. What is the most likely diagnosis?

Accepted Answer

Depressive disorder

Answer

Adjustment disorder

Answer

Acute stress disorder

Answer

Post traumatic stress disorder

Question 10

Exercise is also prescribed as an adjuvant treatment for depression. Most probably, it acts by:

Accepted Answer

Raising endorphin levels

Answer

Increasing pulse pressure

Answer

Improving hemodynamics

Answer

Inducing good sleep

Mood Disorders — MCQs

Mood Disorders — MCQs

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