symptoms
A key diagnostic feature that distinguishes a manic episode from hypomania is:
A) Absence of psychotic features
B) Marked functional impairment or need for hospitalisation
C) Duration >2 weeks
B) Marked functional impairment or need for hospitalisation
Hypomania lacks severe impairment/hospitalisation.
The single strongest heritability estimate (twin studies) applies to:
A) Unipolar major depression
B) Bipolar disorder
C) Cyclothymia
B) Bipolar disorder
Bipolar has higher heritability than unipolar depression.
Which basal ganglia / circuit abnormality is most implicated in the psychomotor slowing and anergia of depression?
A) Hyperactivation of subthalamic nucleus
B) Reduced prefrontal striatal connectivity and hypofunction of dorsolateral prefrontal cortex circuits
C) Increased cerebellar vermis output
B) Reduced prefrontal–striatal connectivity and hypofunction of dorsolateral prefrontal cortex circuits.
For an acute manic episode with psychosis and severe agitation, first-line in-patient pharmacotherapy is:
A) High-dose SSRI monotherapy
B) Antipsychotic plus mood stabiliser (e.g., haloperidol or atypical + lithium/valproate)
C) Immediate ECT as sole first step
B) Antipsychotic plus mood stabiliser (e.g., haloperidol or atypical + lithium/valproate).
Which symptom is most characteristic of melancholic depression (vs atypical)?
A) Diurnal mood variation with worse mornings and early morning awakening
B) Mood reactivity to positive events
C) Significant interpersonal rejection sensitivity
A - Diurnal mood variation with worse mornings and early morning awakening.
Which environmental exposure is most consistently linked to later risk of major depressive disorder?
A) Childhood maltreatment / abuse
B) Late-life vitamin D deficiency
C) Single transient bereavement in adulthood
A) Childhood maltreatment / abuse.
In bipolar disorder, neurobiological changes most associated with manic episodes include:
A) Decreased glutamatergic transmission in prefrontal cortex
B) Increased dopaminergic tone and disrupted circadian gene expression
C) Autoimmune demyelination of corpus callosum
B) Increased dopaminergic tone and disrupted circadian gene expression.
For rapid cycling bipolar disorder not responsive to lithium, which agent has the best evidence for reducing frequency of episodes?
A) Lamotrigine
B) Imipramine
C) Fluoxetine
A) Lamotrigine
“Mixed features” on a depressive episode means:
A) Co-occurrence of depressive and at least three manic/hypomanic symptoms (without meeting mania)
B) Rapid alternation between full mania and full depression within 24 hours
C) Psychotic features only during depressive episodes
A) Co-occurrence of depressive and at least three manic/hypomanic symptoms (without meeting mania).
Among these medical conditions, which most increases risk of depressive symptoms via systemic inflammation and cytokine activity?
A) Type 1 diabetes mellitus
B) Hyperthyroidism
C) Chronic hepatitis C infection
C) Chronic hepatitis C infection
Which biomarker pattern is most consistently (though imperfectly) associated with severe, treatment-resistant depression?
A) Elevated inflammatory markers (CRP, IL-6) and reduced hippocampal volume
B) Low baseline cortisol and small hippocampal volume
C) High B12 and increased caudate volume
A) Elevated inflammatory markers (CRP, IL-6) and reduced hippocampal volume
Which antidepressant strategy risks precipitating mania in undetected bipolar disorder and therefore should be combined with a mood stabiliser when bipolar is possible?
A) Bupropion monotherapy
B) Psychotherapy without medication
C) SSRI monotherapy (e.g., sertraline)
C) SSRI monotherapy (e.g., sertraline)