Mood Disorders (Depressive Disorders, Bipolar Disorder) MCQs

Psychiatry · 50 free questions with answers & explanations.

1. A 35-year-old woman on lithium for bipolar I disorder presents at 8 weeks of gestation for prenatal counselling. She has had three prior manic episodes, the most recent requiring hospitalisation. Which statement best reflects the risk-benefit discussion regarding lithium continuation?
2. A 40-year-old man describes months of increased energy, decreased need for sleep to four hours, heightened goal-directed activity, and pressured speech. His symptoms have never been severe enough to cause hospitalisation or marked occupational impairment. He also reports three months of persistent low mood with anhedonia earlier in the year. What is the most likely diagnosis?
3. A 28-year-old woman with a first episode of major depressive disorder, no suicidality, and no psychotic features is started on sertraline. After four weeks she reports mild improvement in sleep but persistent depressed mood and anhedonia. What is the most appropriate next step?
4. A 52-year-old man presents with recurrent episodes of sadness, guilt, and fatigue lasting 2–3 days, interspersed with days of mild elevated mood and impulsivity, over the past three years. Neither phase meets full criteria for a major depressive episode or hypomanic episode. What is the most accurate diagnosis?
5. A 32-year-old woman with bipolar I disorder is stable on lithium carbonate. She presents with polyuria, polydipsia, and fine tremor. Her serum lithium is 0.9 mEq/L. Which mechanism best explains the polyuria in this setting?
6. A 45-year-old woman with bipolar I disorder on lithium has a serum level of 0.8 mEq/L. She is started on ibuprofen 400 mg TDS for knee pain. Two weeks later she presents with coarse tremor, ataxia, and confusion. Her lithium level is now 2.4 mEq/L. What is the mechanism of this interaction?
7. In DSM-5, which of the following correctly describes a Mixed Features specifier in Major Depressive Episode?
8. A 38-year-old man with bipolar I disorder is maintained on lithium (level 0.85 mEq/L) but experiences a breakthrough manic episode. He weighs 95 kg. Which augmentation or switch strategy has the best evidence for acute mania?
9. Persistent Depressive Disorder (dysthymia) in DSM-5 requires depressed mood for most of the day, more days than not, for at least:
10. A 52-year-old woman is started on an SSRI for major depression. After 3 weeks she develops restlessness, inability to sit still, pacing, and distress but no muscle rigidity or fever. CK is normal. What is the most likely diagnosis and recommended management?
11. A 32-year-old woman presents with a 4-day episode of elevated mood, decreased sleep (feeling rested after 3 hours), increased talkativeness, and starting three new business ventures simultaneously. She is fully functional at work and denies any distress. This episode most likely represents:
12. A patient with bipolar I disorder has been stable on lithium for 3 years. She becomes pregnant. The neonatologist is concerned about which lithium-associated fetal risk, and which management strategy is most evidence-based in early pregnancy?
13. Which antidepressant mechanism is most associated with causing a discontinuation syndrome characterised by 'brain zaps', dizziness, flu-like symptoms, and sensory disturbances when abruptly stopped?
14. A 45-year-old man with treatment-resistant unipolar depression fails two adequate antidepressant trials. Augmentation with lithium is considered. The minimum therapeutic serum lithium level recommended for augmentation of antidepressants is:
15. DSM-5 introduced 'Disruptive Mood Dysregulation Disorder (DMDD)' primarily to address which clinical concern?
16. A 45-year-old woman presents with persistent sadness, anhedonia, weight gain, hypersomnia, psychomotor retardation, and significant fatigue for 8 weeks. She denies suicidal ideation. She previously had a 4-day episode of elevated mood, decreased sleep, and increased productivity which she described as 'feeling great.' According to DSM-5, what is the MOST likely diagnosis?
17. A patient with bipolar I disorder on lithium monotherapy experiences a breakthrough manic episode. His lithium level is 0.7 mEq/L. The psychiatrist decides to add an antipsychotic. Which second-generation antipsychotic has the STRONGEST evidence for acute mania AND is LEAST likely to cause metabolic syndrome?
18. A 38-year-old woman with recurrent major depression is started on fluoxetine. After 4 weeks, she remains symptomatic. Her Hamilton Depression Rating Scale score is unchanged. What is the MOST appropriate next pharmacological strategy according to evidence-based guidelines?
19. Persistent Depressive Disorder (Dysthymia) as defined in DSM-5 requires a minimum duration of depressed mood for:
20. A 52-year-old man on lithium for bipolar I disorder develops fine resting tremor, polyuria, and polydipsia. His lithium level is 1.0 mEq/L. TSH is elevated. Which complication of long-term lithium use does the elevated TSH indicate?
21. A 38-year-old woman presents with persistent low mood for 2 years with periods of 2-month improvement but never achieving full euthymia. She has never had a major depressive episode or hypomanic episode. What is the DSM-5 diagnosis and minimum symptom duration required for this diagnosis?
22. A 42-year-old man on lithium for bipolar I disorder develops coarse tremor, polydipsia, polyuria, hypothyroidism, and a serum lithium of 0.9 mEq/L (therapeutic). Which mechanism explains the lithium-induced hypothyroidism?
23. A 29-year-old woman with bipolar II disorder is being started on lamotrigine. Which serious adverse effect requires a mandatory slow titration protocol (dose escalation over 6 weeks), and which concurrent drug most dangerously accelerates this risk?
24. DSM-5 introduced a new specifier 'with mixed features' for major depressive episodes. Which combination of symptoms qualifies a depressive episode for this specifier?
25. A 55-year-old depressed man fails two adequate antidepressant trials. He is now on venlafaxine 225 mg/day. His psychiatrist considers augmentation. Which augmentation strategy has the strongest evidence base (Level I) for treatment-resistant depression?
26. A 22-year-old patient presents with a 4-day episode of elevated mood, decreased need for sleep, pressured speech, and increased goal-directed activity. This episode does not require hospitalisation and is not precipitated by substances. According to DSM-5, this duration and severity most likely characterises:
27. Which of the following best describes the 'mixed features specifier' in DSM-5 Major Depressive Disorder?
28. A patient on lithium presents with coarse tremor, cogwheel rigidity, confusion, and oliguria. Serum lithium is 2.8 mEq/L. The immediate priority in management is:
29. Persistent Depressive Disorder (PDD/Dysthymia) in DSM-5 requires depressed mood for at least how long in adults, and which symptom count distinguishes it from Major Depressive Disorder?
30. Rapid cycling in Bipolar Disorder is defined by DSM-5 as at least how many mood episodes per year, and which pharmacological agent is notorious for precipitating or worsening rapid cycling?
31. A 35-year-old woman with treatment-resistant depression has failed 2 adequate antidepressant trials. She is started on ketamine infusion. The primary mechanism by which ketamine produces rapid antidepressant effects (within hours) is:
32. In Major Depressive Disorder, which psychotherapy has the STRONGEST evidence base specifically for preventing relapse and is recommended for patients who have had multiple depressive episodes?
33. A patient with bipolar I disorder has been stable on lithium for 3 years. He develops polyuria (3.5 L/day), polydipsia, and urine specific gravity of 1.003 that does not concentrate after water deprivation but partially responds to desmopressin. Serum lithium is in the therapeutic range. What is the most likely complication?
34. A 45-year-old woman presents with persistent depressed mood, hypersomnia (sleeping 14 hours/day), increased appetite with carbohydrate craving, weight gain of 5 kg, and extreme sensitivity to interpersonal rejection, resulting in significant occupational impairment. There is NO seasonal pattern, NO bipolar history. The appropriate DSM-5 specifier for this depressive episode is:
35. A 45-year-old woman has recurrent depression treated with sertraline. She develops hypomanic episodes 5 days after starting sertraline. This pattern suggests the underlying diagnosis should be revised to:
36. Which of the following antidepressants is most associated with switch to mania in bipolar disorder and should generally be AVOIDED as monotherapy?
37. A 50-year-old woman experiences 2 years of numerous periods of hypomanic symptoms and numerous depressive symptoms, none of which meet full criteria for a hypomanic or major depressive episode. She has never been symptom-free for more than 2 months. The DSM-5 diagnosis is:
38. A 32-year-old woman with bipolar I disorder becomes pregnant. She is maintained on lithium. At which gestational period is the risk of Ebstein's anomaly (tricuspid valve malformation) highest?
39. A patient with major depressive disorder fails to respond to two adequate SSRI trials. She is started on a medication that requires a tyramine-free diet to prevent hypertensive crises. Which enzyme does this drug inhibit?
40. Which of the following is the hallmark feature that distinguishes Bipolar II disorder from Bipolar I?
41. A 55-year-old man has been on lithium for 15 years for bipolar disorder. His serum creatinine is 1.8 mg/dL, GFR 45 mL/min. What is the MOST appropriate management?
42. A 45-year-old man has recurrent episodes of elevated mood with decreased sleep, increased goal-directed activity, and grandiosity lasting 3-4 days. These episodes are distinct from his usual self and represent a clear change in behavior, but he functions without hospitalization. He also has major depressive episodes. The diagnosis is:
43. Which antidepressant is ABSOLUTELY CONTRAINDICATED in bipolar depression due to high risk of inducing mania/rapid cycling when used as monotherapy without a mood stabilizer?
44. A 50-year-old woman presents with persistent depressed mood for most of the day, nearly every day, for 3 years, with low energy, poor concentration, and hypersomnia, but symptoms never met full criteria for major depressive episode. The DSM-5 diagnosis is:
45. A 34-year-old woman presents with a 3-week history of depressed mood, anhedonia, 6 kg weight gain, hypersomnia, and profound fatigue that is worse in the morning but improves slightly by evening. She reports feeling 'leaden' heaviness in her limbs that lasts for hours. She has had two previous depressive episodes. Which specifier best describes her current episode?
46. A 28-year-old man is brought to the emergency department by his family. Over the past 5 days he has slept only 2 hours per night, spent his savings on an elaborate business scheme, speaks so rapidly that he is difficult to interrupt, and believes he has been specially chosen to lead a new world religion. He has no prior psychiatric history and takes no medications. His urine toxicology screen is negative. What is the minimum duration of symptoms required to diagnose a manic episode?
47. A 45-year-old woman with a known diagnosis of bipolar I disorder, currently maintained on lithium 900 mg/day, presents for routine follow-up. Her serum lithium level is 0.7 mEq/L. She reports a new episode of depressed mood, hopelessness, and suicidal ideation without any hypomanic or manic symptoms for the past 3 weeks. Which pharmacological addition is FDA-approved specifically for bipolar depression?
48. A 52-year-old man presents with depressed mood for 8 months. He reports passive death wishes but no active suicidal plan. His appetite is decreased and he has lost 4 kg. He denies any prior manic or hypomanic episodes. His PHQ-9 score is 19. His thyroid-stimulating hormone is 9.2 mIU/L (normal 0.4–4.0). Levothyroxine is initiated. After 6 weeks of adequate thyroid replacement, depressive symptoms persist. Which antidepressant class should be avoided due to its potential to worsen hypothyroidism-associated cardiac conduction?
49. A 39-year-old woman has experienced depressed mood on most days for the past 3 years. She describes her baseline as 'always feeling down' but is still able to work and maintain relationships. She has never had a full major depressive episode, manic episode, or hypomanic episode. She denies vegetative symptoms meeting MDD criteria. What is the most likely diagnosis?
50. A 67-year-old man with a first episode of major depression is started on citalopram. Two weeks later he presents to the emergency department with confusion, agitation, diaphoresis, tremor, and fever of 38.8°C. His family reveals he was recently prescribed tramadol for back pain by his general practitioner. What is the most likely diagnosis?