Mood Disorders: Depression and Bipolar Disorder Practice Questions

25 multiple-choice questions on Mood disorders: depression and bipolar disorder for paramedic and EMT students, from Chapter 29 (Psychiatric Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

25 practice questions

1. Major depressive disorder requires symptoms lasting at least:

   1. A. 2 days
   2. B. 6 months
   3. C. 2 weeks
   4. D. 1 year
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   Answer: C. 2 weeks

   A major depressive episode is at least 2 weeks of depressed mood or loss of interest with other symptoms. Six months is the duration used for generalized anxiety disorder.

2. Anhedonia is best defined as:

   1. A. Inability to fall asleep or stay asleep
   2. B. Loss of interest or pleasure in activities
   3. C. Rapid shifts between happy and sad moods daily
   4. D. Absence of emotion shown on the face
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   Answer: B. Loss of interest or pleasure in activities

   Anhedonia is a core symptom of depression. Absence of displayed emotion is a flat affect, which can occur in depression but is not the same thing.

3. Which group of findings is consistent with major depression?

   1. A. Grandiosity, little need for sleep, racing ideas
   2. B. Flashbacks, nightmares, and hypervigilance
   3. C. Hallucinations, delusions, and flat affect
   4. D. Poor sleep, low energy, guilt, poor focus
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   Answer: D. Poor sleep, low energy, guilt, poor focus

   The SIG E CAPS findings (sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicide) describe depression. Little need for sleep with grandiosity describes mania.

4. Five days after delivery, a mother is tearful and moody but is caring for her baby well, sleeping when she can, and has no thoughts of harm. This most likely reflects:

   1. A. Postpartum blues
   2. B. Postpartum psychosis
   3. C. Bipolar mania
   4. D. Major depression with psychosis
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   Answer: A. Postpartum blues

   Postpartum blues affect most new mothers, start within days of delivery, cause tearfulness and mood swings, and resolve within about 2 weeks without impairing care of the baby. Postpartum psychosis causes hallucinations, confusion, and risk to the infant. Mania causes reduced need for sleep and grandiosity. Symptoms lasting beyond 2 weeks or thoughts of harm suggest postpartum depression and need evaluation.

5. A diagnosis of bipolar I disorder requires at least one episode of:

   1. A. Major depression
   2. B. Hypomania
   3. C. Mania
   4. D. Psychosis
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   Answer: C. Mania

   Bipolar I is defined by a manic episode; depression is common but not required. Bipolar II requires hypomania plus major depression.

6. A manic episode must last at least:

   1. A. 1 day
   2. B. 1 month
   3. C. 1 week
   4. D. 6 months
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   Answer: C. 1 week

   Mania lasts at least 1 week or any duration if hospitalization is needed. Hypomania requires only 4 days.

7. A 27-year-old man with bipolar disorder stopped his medication. He has not slept in 4 days, says he will be elected president, talks rapidly, and spent his savings on cars. This is most likely:

   1. A. A manic episode
   2. B. Schizophrenia
   3. C. Panic disorder
   4. D. Psychotic depression
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   Answer: A. A manic episode

   Decreased need for sleep, grandiosity, pressured speech, and reckless spending are classic mania. Stimulant use can look similar and should be asked about.

8. Hypomania differs from mania in that hypomania:

   1. A. Must last at least 2 weeks to be diagnosed
   2. B. Does not cause marked impairment or psychosis
   3. C. Involves a depressed rather than elevated mood
   4. D. Usually requires admission to a hospital
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   Answer: B. Does not cause marked impairment or psychosis

   Hypomania is a milder elevation that does not severely impair functioning. If psychosis or hospitalization occurs, the episode is mania by definition.

9. Lithium has a narrow therapeutic index, which means:

   1. A. It is effective only in a narrow age range
   2. B. It must be given by the intravenous route
   3. C. It causes almost no adverse side effects
   4. D. Toxic levels are close to therapeutic ones
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   Answer: D. Toxic levels are close to therapeutic ones

   Small changes in hydration, kidney function, or interacting drugs can push levels into the toxic range, so blood levels are monitored.

10. A patient started lamotrigine for bipolar disorder 3 weeks ago. She now has fever, painful blisters, peeling skin, and sores in her mouth. You should suspect:

    1. A. Lithium toxicity from the drug
    2. B. Serotonin syndrome
    3. C. Stevens-Johnson syndrome
    4. D. A simple sunburn reaction
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    Answer: C. Stevens-Johnson syndrome

    Lamotrigine carries a boxed warning for serious rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, most often in the first 2 to 8 weeks. Mucosal sores, blistering, and skin loss make this an emergency, treated like a burn. Lithium toxicity causes tremor, vomiting, and confusion, not blistering. Serotonin syndrome causes clonus and hyperthermia. Sunburn does not cause mouth sores or skin sloughing.

11. Which medication can raise a patient's lithium level?

    1. A. Acetaminophen
    2. B. Ibuprofen
    3. C. Ondansetron
    4. D. Loratadine
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    Answer: B. Ibuprofen

    NSAIDs, thiazide diuretics, and ACE inhibitors reduce renal lithium clearance. Acetaminophen does not affect lithium elimination.

12. For a vomiting patient with suspected lithium toxicity, prehospital care focuses on:

    1. A. IV fluids and supportive care
    2. B. Activated charcoal to bind it
    3. C. Naloxone to reverse sedation
    4. D. Flumazenil to reverse toxicity
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    Answer: A. IV fluids and supportive care

    Restoring volume helps the kidneys clear lithium; severe cases need hemodialysis. Activated charcoal does not bind lithium or other metals.

13. A woman stopped her paroxetine suddenly 3 days ago. She has dizziness, nausea, irritability, and brief electric-shock feelings in her head. This is most likely:

    1. A. Serotonin syndrome from the drug
    2. B. A new transient stroke
    3. C. Worsening of her depression
    4. D. SSRI discontinuation syndrome
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    Answer: D. SSRI discontinuation syndrome

    Stopping an SSRI abruptly, especially a short-acting one such as paroxetine, can cause discontinuation symptoms within days: dizziness, nausea, irritability, flu-like feelings, and 'brain zaps.' They are uncomfortable but not dangerous and resolve when the drug is restarted or tapered. Serotonin syndrome comes from too much serotonin, not stopping a drug, and causes clonus and hyperthermia. Brief shocks without focal deficits do not suggest stroke.

14. Early tricyclic antidepressant toxicity commonly includes:

    1. A. Bradycardia, sweating, and pinpoint pupils
    2. B. Tachycardia, dry skin, and dilated pupils
    3. C. Hypothermia, drooling, and wheezing
    4. D. Hypertension, tearing, and diarrhea
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    Answer: B. Tachycardia, dry skin, and dilated pupils

    TCAs have strong anticholinergic effects. Sweating, pinpoint pupils, and drooling are cholinergic findings, the opposite pattern.

15. Compared with tricyclic antidepressants, SSRIs taken in overdose are:

    1. A. More likely to cause wide-QRS dysrhythmias
    2. B. Readily reversed with IV naloxone in the field
    3. C. Much less likely to cause fatal dysrhythmias
    4. D. More likely to cause severe hypotension
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    Answer: C. Much less likely to cause fatal dysrhythmias

    SSRIs are relatively safe in overdose, although citalopram can prolong the QT. TCAs, not SSRIs, cause sodium-channel QRS widening.

16. A man with bipolar disorder was started on an antidepressant alone by a new clinic. Two weeks later he has not slept in days, talks rapidly, and has spent his savings. The most likely explanation is:

    1. A. Normal recovery from depression
    2. B. Serotonin syndrome from the drug
    3. C. A side effect called akathisia only
    4. D. The antidepressant triggered mania
    Show answer

    Answer: D. The antidepressant triggered mania

    In bipolar disorder, an antidepressant given without a mood stabilizer can switch the patient into mania, with decreased need for sleep, pressured speech, and reckless spending. Recovery from depression does not produce these behaviors. Serotonin syndrome causes clonus, hyperthermia, and autonomic signs. Akathisia is inner restlessness, not grandiose behavior.

17. Persistent depressive disorder (dysthymia) is:

    1. A. Chronic low-grade depression for 2+ years
    2. B. Severe depression lasting about 2 weeks
    3. C. A pattern of alternating mania and depression
    4. D. Depression that occurs only during the winter
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    Answer: A. Chronic low-grade depression for 2+ years

    Dysthymia is milder but long-lasting. Alternating mania and depression describes bipolar disorder.

18. A woman 1 week postpartum says voices are telling her that her baby is evil. Your priority is to:

    1. A. Leave her home with family and follow up later
    2. B. Ensure the infant's safety and transport her
    3. C. Reassure her that the baby blues are normal
    4. D. Advise her to stop breastfeeding right away
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    Answer: B. Ensure the infant's safety and transport her

    Postpartum psychosis is a psychiatric emergency with risk of suicide and infanticide. Baby blues are mild, self-limited mood changes without hallucinations.

19. Depression in older adults often presents with:

    1. A. Pressured speech and grandiose plans
    2. B. Visual hallucinations of small animals
    3. C. Sudden, fluctuating confusion over hours
    4. D. Somatic complaints like fatigue or pain
    Show answer

    Answer: D. Somatic complaints like fatigue or pain

    Older adults may deny sadness and instead report vague physical complaints or memory problems. Sudden fluctuating confusion suggests delirium, which needs a medical search.

20. A 52-year-old woman has new depression, weight gain, cold intolerance, and dry skin. The most likely underlying cause is:

    1. A. Hypothyroidism
    2. B. Hyperthyroidism
    3. C. Addison disease
    4. D. Pheochromocytoma
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    Answer: A. Hypothyroidism

    Low thyroid hormone slows metabolism and mood. Hyperthyroidism causes heat intolerance, weight loss, and anxiety rather than these findings.

21. A 35-year-old man with depression has felt unable to work for 3 weeks. He denies suicidal thoughts, has decision-making capacity, and wants to stay home. You should:

    1. A. Transport him involuntarily for his depression
    2. B. Sedate him so he can be safely transported
    3. C. Respect his choice; give resources such as 988
    4. D. Leave without documenting the encounter
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    Answer: C. Respect his choice; give resources such as 988

    Depression alone does not remove a competent adult's right to refuse. Involuntary transport requires danger to self or others or grave disability, which he does not meet.

22. Normal grief differs from major depression in that grief usually:

    1. A. Involves constant worthlessness and self-hate
    2. B. Comes in waves tied to reminders of the loss
    3. C. Causes persistent psychotic symptoms
    4. D. Lasts for years without any easing
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    Answer: B. Comes in waves tied to reminders of the loss

    Grief tends to come in waves while self-esteem is preserved. Pervasive worthlessness and self-loathing point to major depression.

23. Antidepressants carry a boxed warning about increased suicidal thinking in:

    1. A. Adults over the age of 65
    2. B. Pregnant women
    3. C. Children and young adults
    4. D. Middle-aged men
    Show answer

    Answer: C. Children and young adults

    The risk appears in patients under 25, especially early in treatment or after dose changes. Older adults actually show a reduced risk with antidepressants.

24. Minutes after receiving esketamine nasal spray at a depression clinic, a patient feels detached and dizzy, and his BP is 166/94. This is best described as:

    1. A. A sign of a severe allergic reaction
    2. B. A hypertensive emergency needing drugs
    3. C. Proof the dose was given incorrectly
    4. D. Expected effects needing monitoring
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    Answer: D. Expected effects needing monitoring

    Esketamine commonly causes dissociation, dizziness, and a temporary rise in blood pressure that peaks about 40 minutes after the dose, which is why patients are observed for at least 2 hours in the clinic. Without chest pain, neurologic signs, or organ injury, this BP is not a hypertensive emergency. There are no allergic signs, and these effects do not mean the dose was wrong.

25. A 40-year-old woman with depression is tearful, responds slowly, and moves and speaks in a soft monotone. This slowing is called:

    1. A. Psychomotor retardation
    2. B. Catatonic excitement
    3. C. Flight of ideas with rapid speech
    4. D. Thought broadcasting
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    Answer: A. Psychomotor retardation

    Slowed thinking, movement, and speech are common in severe depression. Flight of ideas is accelerated thinking seen in mania.