Mood disorders: vascular depression: practice question

A Psychiatry question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Psychiatry · Mood disorders: vascular depression

Sample item

A 72-year-old hypertensive man has a first depressive episode with marked apathy, psychomotor slowing, poor executive function and little guilt. MRI shows extensive periventricular and deep white matter hyperintensities. He responds poorly to an SSRI. Which concept best explains his depression?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Vascular depression from frontostriatal disruption

Vascular depression is a late-onset depression associated with cerebrovascular risk factors and subcortical white matter lesions that disrupt frontostriatal circuits. It is characterised by apathy, executive dysfunction, slowing, less guilt and a poorer response to antidepressants.

Option by option

  • A. Vascular depression from frontostriatal disruption (correct)

    Correct. Late-life onset with white matter disease and executive dysfunction fits vascular depression.

  • B. Adjustment disorder with depressed mood

    Adjustment disorder needs an identifiable stressor and does not explain the structural findings.

  • C. Dementia with Lewy bodies

    Dementia with Lewy bodies would show fluctuating cognition, visual hallucinations and parkinsonism.

  • D. Early-onset recurrent melancholic depression

    An early-onset recurrent pattern would have started decades earlier and does not explain the white matter lesions.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Psychiatry question

What is the answer to this Psychiatry question?

The best answer is A, Vascular depression from frontostriatal disruption. Vascular depression is a late-onset depression associated with cerebrovascular risk factors and subcortical white matter lesions that disrupt frontostriatal circuits.

Why is "Adjustment disorder with depressed mood" not the answer?

Adjustment disorder needs an identifiable stressor and does not explain the structural findings.

Why is "Dementia with Lewy bodies" not the answer?

Dementia with Lewy bodies would show fluctuating cognition, visual hallucinations and parkinsonism.

Why is "Early-onset recurrent melancholic depression" not the answer?

An early-onset recurrent pattern would have started decades earlier and does not explain the white matter lesions.

What concept does this question test?

It tests Mood disorders: vascular depression in Psychiatry. It is characterised by apathy, executive dysfunction, slowing, less guilt and a poorer response to antidepressants.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Mood disorders: vascular depression?

Learn each diagnosis by its core features and its first-line treatment. Then use the flashcards and the other Psychiatry questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.