Mood Disorders Practice Questions

Q: What is the most common psychiatric illness?

Depression. **Explanation:** **1. Why Depression is Correct:** Depression (specifically Major Depressive Disorder or Unipolar Depression) is recognized globally and in India as the most common psychiatric disorder in the general population. According to epidemiological studies and the Global Burden of Disease, it has the highest prevalence among all mental health conditions. In the context of NEET-PG, when asked for the "most common psychiatric illness," **Depression** is the standard answer. If the question specifically asks for the most common *neurotic* or *anxiety* disorder, the answer would be Phobia. **2. Why Other Options are Incorrect:** * **Bipolar Disorder:** This is a mood disorder characterized by alternating episodes of mania/hypomania and depression. Its lifetime prevalence (approx. 1%) is significantly lower than that of Unipolar Depression (approx. 10-15%). * **Mania:** Mania is a *phase* or a clinical state of Bipolar Disorder Type I, not a standalone chronic illness that occurs more frequently than depression. * **Cyclothymia:** This is a chronic, fluctuating mood disturbance involving numerous periods of hypomanic symptoms and mild depressive symptoms. It is considered a milder but much rarer form of mood disorder compared to Major Depression. **3. Clinical Pearls & High-Yield Facts for NEET-PG:** * **Most common psychiatric disorder:** Depression. * **Most common neurotic/anxiety disorder:** Phobia (specifically Specific Phobia). * **Most common psychiatric disorder in the elderly:** Depression. * **Most common symptom of Depression:** Depressed mood (Anhedonia is also a core feature). * **Gender Predominance:** Depression is twice as common in females (F:M = 2:1), whereas Bipolar Disorder has an almost equal gender distribution (F:M = 1:1). * **Most common side effect of ECT:** Retrograde amnesia.

Q: What is the treatment of choice in depression with suicidal tendencies?

Electroconvulsive therapy (ECT). **Explanation:** The correct answer is **Electroconvulsive Therapy (ECT)**. In psychiatric practice, the primary goal when managing a patient with active suicidal tendencies is the **rapid reduction of symptoms** to ensure patient safety. **1. Why ECT is the Correct Choice:** ECT is the most effective and fastest-acting treatment available for severe depression. While pharmacological treatments (antidepressants) typically take 2–4 weeks to show a therapeutic effect, ECT can produce a significant clinical response within a few sessions. Therefore, it is the **treatment of choice (TOC)** in emergency psychiatric conditions where there is an immediate risk of self-harm, suicide, or severe inanition (refusal to eat/drink). **2. Why Other Options are Incorrect:** * **Tricyclic Antidepressants (TCAs):** These have a slow onset of action. More importantly, TCAs are highly cardiotoxic in overdose; prescribing them to a suicidal patient is dangerous as the medication itself can be used as a means of suicide. * **MAO-Inhibitors:** These also have a delayed onset and require strict dietary restrictions (tyramine-free diet) to avoid hypertensive crises, making them impractical for acute suicidal crises. * **Fluoxetine + TCA + MAO-Inhibitor:** This combination is contraindicated. Combining MAO-Is with other antidepressants can lead to **Serotonin Syndrome**, a potentially fatal condition. **3. NEET-PG High-Yield Pearls:** * **Absolute Contraindication for ECT:** Increased intracranial pressure (ICP). * **Most Common Side Effect of ECT:** Retrograde and anterograde amnesia (usually transient). * **Drug of Choice for ECT Pre-medication:** Atropine (to reduce secretions/vagal bradycardia), Methohexital/Propofol (anesthetic), and Succinylcholine (muscle relaxant). * **Indications for ECT:** Severe depression with suicide risk, Catatonia, Treatment-resistant Depression, and Severe Mania.

Q: What is the most common cause of suicide?

Reactive depression. **Explanation:** The most common cause of suicide globally and clinically is **Reactive Depression** (also known as Adjustment Disorder with depressed mood). 1. **Why Reactive Depression is correct:** Reactive depression occurs in response to identifiable external stressors—such as financial loss, academic failure, relationship breakups, or the death of a loved one. Because these life stressors are ubiquitous and affect a larger portion of the general population compared to endogenous or clinical syndromes, they account for the highest volume of suicidal attempts and completed suicides. The acute nature of the stressor often leads to impulsive suicidal behavior. 2. **Why other options are incorrect:** * **Childhood depression:** While serious, it is statistically less common than adult depression and accounts for a smaller fraction of total suicide cases. * **Depression in the evolutionary stage:** This is not a standard clinical term used to categorize the primary etiology of suicide in psychiatric literature. * **Psychiatric depression (Endogenous/Major Depressive Disorder):** While MDD has a higher *relative risk* (the likelihood of an individual committing suicide is very high), the *absolute number* of cases in the population is lower than those triggered by reactive, situational stressors. **NEET-PG High-Yield Pearls:** * **Most common psychiatric disorder associated with suicide:** Depression (specifically Unipolar Depression). * **Single best predictor of suicide:** A previous history of suicide attempts. * **Strongest demographic risk factor:** Male gender (for completed suicide) and Female gender (for attempted suicide). * **Protective factor:** Pregnancy and strong social support (especially children in the home for women).

Q: Which of the following best characterizes Bipolar II disorder?

Hypomania and severe depression. **Explanation:** Bipolar II Disorder is clinically defined by the occurrence of at least one **Hypomanic Episode** and at least one **Major Depressive Episode**. The hallmark of this condition is that the patient never experiences a full-blown manic episode. While hypomania is less severe than mania, the depressive episodes in Bipolar II are often frequent, severe, and carry a high risk of suicide. **Analysis of Options:** * **Option A (Incorrect):** This describes **Bipolar I Disorder**, which requires at least one episode of mania. In Bipolar I, major depression is common but not strictly required for diagnosis (though it occurs in the vast majority of cases). * **Option C (Incorrect):** Hypomania alone does not meet the criteria for Bipolar II. Furthermore, if a patient has only hypomania without depression, it is rarely diagnosed as a clinical disorder unless it evolves into Bipolar I. * **Option D (Incorrect):** This describes **Unipolar Depression** (Major Depressive Disorder). The presence of any history of hypomania or mania excludes this diagnosis. **NEET-PG High-Yield Pearls:** * **Bipolar I vs. II:** The "Gold Standard" differentiator is the severity of the "up" mood. **Mania + Depression = Bipolar I**; **Hypomania + Depression = Bipolar II**. * **Cyclothymia:** A chronic mood disturbance (at least 2 years) involving periods of hypomanic symptoms and depressive symptoms that do not meet the full criteria for a major episode. * **Treatment:** Lithium is the classic mood stabilizer. However, in Bipolar II, treating the depressive phase is the primary challenge; antidepressants should generally be avoided as monotherapy to prevent "switching" into hypomania. * **Mnemonic:** Bipolar **1** is "Higher" (Mania); Bipolar **2** is "Lower" (Hypomania).

Q: All of the following are true about bipolar disorder except?

Prevalence is more amongst females than males. **Explanation:** **1. Why Option A is the correct answer (The Exception):** In Bipolar Affective Disorder (BPAD), the prevalence is **equal among males and females** (1:1 ratio). This is a high-yield distinction from Major Depressive Disorder (MDD), where the prevalence is significantly higher in females (2:1). While the overall prevalence is equal, gender differences exist in clinical presentation: manic episodes are more common in men, whereas depressive episodes and "rapid cycling" patterns are more common in women. **2. Analysis of Incorrect Options (True Statements):** * **Option B:** The lifetime prevalence of Bipolar I disorder is consistently cited as approximately **1%** (ranging from 0.8% to 1.6% in various studies). * **Option C:** The mean age of onset for BPAD is typically in the **early 20s** (approximately 21 years). It is generally lower than the age of onset for Unipolar Depression. * **Option D:** Unlike Schizophrenia (which is more common in lower socioeconomic groups), Bipolar Disorder is often found to have a higher prevalence in **upper socioeconomic classes**, indicating that prevalence does indeed vary with status. **Clinical Pearls for NEET-PG:** * **Strongest Genetic Link:** BPAD has the highest heritability among all major psychiatric disorders (monozygotic twin concordance is ~70-80%). * **Lithium:** The gold standard mood stabilizer; it is the only drug proven to reduce suicide risk in BPAD patients. * **Bipolar II vs. I:** Bipolar I requires at least one **Manic** episode; Bipolar II requires at least one **Hypomanic** episode AND one Major Depressive episode. * **Cyclothymia:** A chronic mood disturbance (at least 2 years) involving hypomanic and depressive symptoms that do not meet full criteria for BPAD.

Q: Otto Veraguth sign is seen in which of the following conditions?

Depression. **Explanation:** **Veraguth’s Sign** (or Veraguth’s fold) is a classic clinical sign associated with **Major Depressive Disorder**. It refers to a characteristic triangular fold in the nasal corner of the upper eyelid, caused by the contraction of the corrugator supercilii muscle. This gives the patient a look of persistent sorrow or "omega melancholicum." * **Why Depression is correct:** In severe depression (melancholic type), chronic contraction of the facial muscles involved in frowning leads to this specific skin fold. It is considered an objective physical marker of a depressed mood. * **Why other options are incorrect:** * **Mania:** Characterized by psychomotor agitation and "bright eyes" rather than specific eyelid folds. * **OCD:** Primarily involves repetitive thoughts and behaviors; it lacks specific pathognomonic facial skin signs. * **Anxiety:** Often presents with horizontal forehead wrinkling (due to frontalis muscle contraction) and a "startled" expression, but not the specific triangular fold of Veraguth. **High-Yield Clinical Pearls for NEET-PG:** * **Schüle’s Sign:** Another sign of depression; it is an "omega-shaped" (Ω) wrinkling of the forehead skin between the eyebrows. * **Omega Melancholicum:** The combination of Veraguth’s sign and Schüle’s sign. * **Darwin’s Ear:** Often confused in exams, this is a congenital ear prominence and is unrelated to psychiatry. * **Key Association:** Always link Veraguth’s sign with **Melancholic Depression** and **Psychomotor Retardation**.

Q: Which of the following is NOT characteristic of Type A personality?

Experiencing mood fluctuations. **Explanation:** The concept of **Type A Personality**, first described by cardiologists Friedman and Rosenman, refers to a specific pattern of behavior and emotion characterized by a chronic struggle to achieve more in less time. It is clinically significant because it is strongly associated with an increased risk of **Coronary Artery Disease (CAD)**. **Why Option D is correct:** **Experiencing mood fluctuations** is not a defining feature of Type A personality. Mood instability or emotional lability is more characteristic of **Cluster B Personality Disorders** (specifically Borderline Personality Disorder) or **Cyclothymic Disorder**. Type A individuals are generally consistent in their high-drive, high-stress baseline rather than shifting between emotional extremes. **Why the other options are incorrect:** * **A. Hostility:** This is considered the most "toxic" component of Type A behavior. It is the strongest predictor of cardiovascular morbidity. * **B. Feeling of time urgency:** Also known as "hurry sickness," these individuals are obsessed with deadlines, speak rapidly, and are impatient with delays. * **C. Competitiveness:** Type A individuals possess a high achievement drive and often view life as a constant competition, leading to significant occupational stress. **NEET-PG High-Yield Pearls:** * **Type A:** High risk for CAD; key traits are Hostility, Impatience, and Ambition. * **Type B:** The opposite of Type A; relaxed, easy-going, and less prone to stress-related heart disease. * **Type C:** "Cancer-prone" personality; characterized by suppressing emotions (especially anger), being overly cooperative, and passive. * **Type D:** "Distressed" personality; characterized by negative affectivity and social inhibition; also linked to poor cardiac outcomes.

Q: A violent manic patient should not be treated with:

Cognitive therapy. **Explanation:** The management of a **violent manic patient** constitutes a psychiatric emergency. The primary goal is rapid stabilization, sedation, and safety. **Why Cognitive Therapy is the Correct Answer:** Cognitive Behavioral Therapy (CBT) and other psychotherapies are **strictly contraindicated** during an acute manic episode, especially when the patient is violent. 1. **Lack of Insight:** Manic patients lack the insight and judgment necessary for psychotherapy. 2. **Cognitive Impairment:** The flight of ideas and distractibility make it impossible for the patient to engage in structured talk therapy. 3. **Agitation:** Attempting therapy can further frustrate and provoke a violent patient. Psychotherapy is only indicated during the **maintenance phase** once the patient is euthymic. **Analysis of Incorrect Options:** * **A. Benzodiazepines:** These are first-line for acute agitation. Drugs like Lorazepam provide rapid sedation and help control violent behavior. * **C. Atypical Antipsychotics:** These (e.g., Olanzapine, Risperidone) are the mainstay of treatment for acute mania due to their rapid onset of action in controlling psychotic symptoms and agitation. * **D. Quetiapine:** An atypical antipsychotic frequently used in mania for its sedative and mood-stabilizing properties. **NEET-PG High-Yield Pearls:** * **Drug of Choice (DOC) for Acute Mania:** Lithium is the gold standard, but for **acute agitation/violence**, injectable antipsychotics (Haloperidol) or Benzodiazepines are preferred for immediate control. * **Lithium vs. Valproate:** Lithium is preferred for "classic" mania; Valproate is preferred for "mixed" episodes or rapid cycling. * **Safe in Pregnancy:** High-potency antipsychotics (Haloperidol) are preferred over Lithium (Ebstein’s anomaly) in acute settings.

Question 1

What is the most common psychiatric illness?

Accepted Answer

Depression

Answer

Bipolar disorder

Answer

Mania

Answer

Cyclothymia

Question 2

What is the treatment of choice in depression with suicidal tendencies?

Accepted Answer

Electroconvulsive therapy (ECT)

Answer

Tricyclic antidepressants (TCA)

Answer

Monoamine oxidase inhibitors (MAO-Inhibitors)

Answer

Fluoxetine + TCA + MAO-Inhibitor

Question 3

What is the most common cause of suicide?

Accepted Answer

Reactive depression

Answer

Childhood depression

Answer

Depression in the evolutionary stage

Answer

Psychiatric depression

Question 4

Mania is characterized by which of the following?

Accepted Answer

High self-esteem

Answer

Paranoid delusion

Answer

Loss of orientation

Answer

All of the above

Question 5

A 26-year-old female diagnosed with depression has developed suicidal tendencies, thoughts, and ideas over the past 2 days. What is the best treatment?

Accepted Answer

Electroconvulsive Therapy (ECT)

Answer

Amitriptyline

Answer

Selegiline

Answer

Haloperidol + Chlorpromazine

Question 6

Which of the following best characterizes Bipolar II disorder?

Accepted Answer

Hypomania and severe depression

Answer

Severe mania and severe depression

Answer

Only hypomania

Answer

Only severe depression

Question 7

All of the following are true about bipolar disorder except?

Accepted Answer

Prevalence is more amongst females than males

Answer

Lifetime prevalence is around 1%

Answer

Mean age of onset is 21 years

Answer

Prevalence varies according to socioeconomic status

Question 8

Otto Veraguth sign is seen in which of the following conditions?

Accepted Answer

Depression

Answer

Mania

Answer

Obsessive-Compulsive Disorder

Answer

Anxiety

Question 9

Which of the following is NOT characteristic of Type A personality?

Accepted Answer

Experiencing mood fluctuations

Answer

Hostility

Answer

Feeling of time urgency

Answer

Competitiveness

Question 10

A violent manic patient should not be treated with:

Accepted Answer

Cognitive therapy

Answer

Benzodiazepines

Answer

Atypical antipsychotics

Answer

Quetiapine

Mood Disorders — MCQs

Mood Disorders — MCQs

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