Mood disorders: late-onset mania: 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: late-onset mania

Sample item

A 64-year-old man with no previous psychiatric illness and no family history is brought with two weeks of elevated, irritable mood, reduced sleep and new disorientation. What is the most appropriate approach?

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

The answer and the reasoning

C. Look for a secondary cause with examination, investigations and neuroimaging

A first manic episode after the age of about 50 is more often secondary to a neurological or medical cause, such as stroke, tumour, dementia, thyroid disease or drugs including steroids. Medical and neurological evaluation is needed before attributing it to primary bipolar disorder.

Option by option

  • A. Attribute it to normal ageing and observe

    Mania and disorientation are never normal ageing and need investigation.

  • B. Diagnose bipolar I disorder and start lithium without further tests

    Primary bipolar disorder rarely starts this late, and treating without evaluation may miss an organic cause.

  • C. Look for a secondary cause with examination, investigations and neuroimaging (correct)

    Correct. New-onset mania in later life warrants a search for an organic cause.

  • D. Offer psychotherapy alone as first-line treatment

    Mania with confusion needs medical evaluation and pharmacological treatment; psychotherapy alone is inadequate.

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 C, Look for a secondary cause with examination, investigations and neuroimaging. A first manic episode after the age of about 50 is more often secondary to a neurological or medical cause, such as stroke, tumour, dementia, thyroid disease or drugs including steroids.

Why is "Attribute it to normal ageing and observe" not the answer?

Mania and disorientation are never normal ageing and need investigation.

Why is "Diagnose bipolar I disorder and start lithium without further tests" not the answer?

Primary bipolar disorder rarely starts this late, and treating without evaluation may miss an organic cause.

Why is "Offer psychotherapy alone as first-line treatment" not the answer?

Mania with confusion needs medical evaluation and pharmacological treatment; psychotherapy alone is inadequate.

What concept does this question test?

It tests Mood disorders: late-onset mania in Psychiatry. Medical and neurological evaluation is needed before attributing it to primary bipolar disorder.

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: late-onset mania?

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.