Mood Disorders

Topics in this chapter

• Mood Disorder Diagnosis
• Depressive Disorders
• Bipolar Spectrum Disorders
• Mood Stabilizer Therapy
• Antidepressant Pharmacology
• Somatic and Seasonal Treatments

Practice questions

1. Question 1Q-765978

   A 32-year-old male is brought to the psychiatry emergency by his family. He presents with a 2-week history of persistently elevated mood, decreased need for sleep (sleeping only 2 hours per night), rapid and pressured speech, grandiosity, and reckless financial spending. He believes he has been chosen by a higher power to save the global economy. His symptoms cause significant impairment in occupational functioning, but he does not exhibit psychotic features outside of the grandiose delusions. Which of the following is the most appropriate diagnosis?

   1. A.Bipolar I disorder, current episode manic
   2. B.Bipolar II disorder, current episode hypomanic
   3. C.Cyclothymic disorder
   4. D.Schizoaffective disorder
   See the answer and solution
2. Question 2Q-978C2B

   A 28-year-old female presents with recurrent depressive episodes alternating with periods of mild elevation of mood and increased energy lasting for the past 3 years. She states she has never experienced a full major depressive episode or a full manic/hypomanic episode that meets criteria for Bipolar I or II. The mood fluctuations have been chronic, present more days than not, and she has never been without symptoms for more than 2 months at a time. What is the most likely diagnosis?

   1. A.Bipolar I disorder
   2. B.Bipolar II disorder
   3. C.Cyclothymic disorder
   4. D.Persistent depressive disorder (Dysthymia)
   See the answer and solution
3. Question 3Q-B07507

   A 45-year-old man with a 10-year history of Bipolar I disorder, successfully maintained on lithium carbonate for the past 5 years, presents for routine follow-up. He complains of passing a large volume of dilute urine (approx 4.5 liters/day) and excessive thirst. His serum sodium is 142 mEq/L, serum osmolality is 295 mOsm/kg, and urine osmolality is 180 mOsm/kg. Which of the following is the underlying pathophysiological mechanism of this complication?

   1. A.Inhibition of the action of antidiuretic hormone (ADH) in the collecting ducts
   2. B.Destruction of the posterior pituitary gland by lithium deposition
   3. C.Autoimmune destruction of the distal convoluted tubules
   4. D.Excessive secretion of atrial natriuretic peptide causing a salt-wasting nephropathy
   See the answer and solution
4. Question 4Q-20AD46

   A 55-year-old female is diagnosed with severe major depressive disorder with psychotic features. She has failed trials of multiple selective serotonin reuptake inhibitors (SSRIs). Her psychiatrist decides to initiate electroconvulsive therapy (ECT). Which of the following is the most common acute adverse effect associated with ECT?

   1. A.Permanent retrograde amnesia lasting several years
   2. B.Anterograde and retrograde memory impairment and post-ictal confusion
   3. C.Spontaneous intracranial hemorrhage
   4. D.Delayed onset tardive dyskinesia
   See the answer and solution
5. Question 5Q-58BD96

   A 36-year-old pregnant woman at 12 weeks gestation presents with a severe depressive relapse. She has a history of severe recurrent major depressive disorder and previously responded well to sertraline and lamotrigine, but has been off medications during pregnancy. After a risk-benefit discussion, the treatment team and patient decide to use pharmacotherapy. Which of the following first-generation or second-generation antidepressants is most strongly associated with an increased risk of congenital cardiac malformations (specifically Ebstein anomaly) when exposed during the first trimester?

   1. A.Sertraline
   2. B.Lithium
   3. C.Lamotrigine
   4. D.Fluoxetine
   See the answer and solution