Test: Mood Disorders - 2 - NEET PG MCQ

In children and teenagers, depression often manifests as:

• irritability
• disinterest
• behavioural changes, including withdrawal or argumentative tendencies

It is essential to exclude depression as a diagnosis initially.

The diagnosis in this scenario is depression. This condition can be triggered by numerous stressors, and regardless of the cause, it must always be addressed.

• All available antidepressants exhibit comparable effectiveness.
• The selection of antidepressants is typically influenced by the drug's side effect profile.
• SSRIs are commonly prescribed as the first line of treatment due to their advantageous side effect profile.

The patient exhibits symptoms such as a depressed mood, loss of sleep, feelings of worthlessness, and difficulties in concentration for the past month. These signs are indicative of depression.

In treating depression, the most commonly recommended medications are SSRIs (Selective Serotonin Reuptake Inhibitors). They are effective and generally well-tolerated.

Other options like atypical antidepressants, lithium, and tricyclic antidepressants may be considered, but SSRIs are typically the first line of treatment.

Therefore, for this patient's condition, SSRIs would be the most suitable choice.

The postpartum blues encompass temporary signs like:

• irritability
• tearfulness
• low mood
• reduced sleep
• loss of appetite

Typically, these symptoms resolve by the tenth day after giving birth.

The suicidal intentions of an individual exhibiting formal thought disorder, likely a patient with schizophrenia, along with chronic severe physical illness and social isolation, should be regarded with utmost seriousness. Immediate actions should involve:

• Evaluation by a specialist.

If the individual has conveyed suicidal thoughts while intoxicated, it is crucial to ensure their safety and prevent self-harm; however, the specialist assessment can be postponed until they are sober.

Chronic and milder depressive symptoms, combined with regular sleep and appetite, suggest the presence of dysthymia.

In this instance, a more accurate diagnosis would be depression. While the question states that his sleep and appetite remain normal, the reality that he is isolated from society suggests significant symptom severity, making depression a more fitting diagnosis than dysthymia.

• Typically, individuals with dysthymia experience minimal disruption in overall functioning.
• This factor serves as a crucial indicator for making a diagnosis.

The following medications are classified as serotonin norepinephrine reuptake inhibitors (SNRIs):

• Venlafaxine

However, the following are not SNRIs:

• Paroxetine - This is a selective serotonin reuptake inhibitor (SSRI).
• Mirtazapine - This is classified as a noradrenergic and specific serotonergic antidepressant (NaSSA).
• Escitalopram - This is also an SSRI.

Therefore, the correct answer is that Escitalopram is not a serotonin norepinephrine reuptake inhibitor.

The use of SSRIs can elevate suicidal thoughts. This adverse effect is more prevalent among children and adolescents, thus these medications should be administered with caution in that age bracket.

In serotonin syndrome, hyperthermia is a characteristic symptom.

Recent studies indicate that it is not the elevation of neurotransmitter levels in the synapse that leads to the antidepressant effect. Instead, it is the alterations in receptor sensitivity that occur over time, which are secondary to the increased neurotransmitter levels, that are responsible for the antidepressant effect.

Bupropion works primarily by increasing levels of certain neurotransmitters in the brain. These neurotransmitters are important for mood regulation and other functions. Here’s how it acts:

• Norepinephrine: Bupropion raises the levels of norepinephrine in the synaptic cleft, which helps improve mood and energy.
• Dopamine: It also increases dopamine levels, contributing to feelings of pleasure and motivation.

Thus, the combined increase in both norepinephrine and dopamine levels is crucial for its effectiveness in treating conditions like depression and aiding in smoking cessation.

Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive procedure used to treat various mental health conditions. It has been shown to be effective for people suffering from depression that does not respond to traditional treatments.

• rTMS uses magnetic fields to stimulate nerve cells in the brain.
• It is generally considered for patients who have not had success with medications or therapy.
• Studies indicate that rTMS can lead to significant improvements in mood and overall mental health.

While rTMS is approved for depression, it is not currently approved for other conditions, such as schizophrenia or obsessive-compulsive disorder.

This patient was likely taking tricyclic antidepressants, and it seems to be a case of tricyclic antidepressant overdose since the patient is showing signs of arrhythmias, hypotension, and has developed an altered sensorium.

The primary treatment for TCA-induced cardiotoxicity is intravenous sodium bicarbonate. It is administered if the QRS interval is extended (typically over 100 milliseconds) and can mitigate the toxic effects of TCAs.

• Due to the large volume of distribution and significant protein binding of TCAs, hemodialysis is ineffective.
• Additionally, flumazenil and fomepizole have no therapeutic role in this scenario.

In cases of depression accompanied by suicidal tendencies, ECT is regarded as the preferred treatment option.

This patient is likely experiencing depression accompanied by stupor. ECT remains the preferred treatment option.

This is the history of the cheese reaction in relation to MAO inhibitors.

Tricyclic antidepressants are a type of medication used to treat depression and other conditions. They have several important actions:

• Anticholinergic action: They can block certain nerve signals, leading to side effects such as dry mouth and blurred vision.
• Blocks reuptake: They prevent the reabsorption of serotonin and norepinephrine, which helps improve mood.
• Causes sedation: These medications can make you feel sleepy, which can be beneficial for those struggling with insomnia.

However, they do not have anti-MAO action, which means they do not work by inhibiting monoamine oxidase, an enzyme that breaks down neurotransmitters.

The signs are indicative of an overdose of tricyclic antidepressants, characterised by anticholinergic side effects.

Due to their anticholinergic properties, TCAs should not be used in cases of glaucoma.