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Psychiatry > Affective > Flashcards

Affective Flashcards

1
Q

Chronicity of depressive sx is associated with what?

A

Underlying personality, anxiety & substance misuse disorders and reduces the likelihood of full symptom resolution

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2
Q

What happens to risk of recurrence of depressive symptoms over time

A

Progressively lower over time

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3
Q

Persistence of mild depressive symptoms during remission is a powerful predictor of what?

A

Recurrence

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4
Q

First line treatment of mild to moderate MDD in adolescence

A

Psychotherapy CBT/ IBT

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5
Q

First line pharmacological agent for MDD in children/adolescents

A

Fluoxetine

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6
Q

A score of less than what on the Ham-D indicates remission?

A

<7

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7
Q

First, second & third line Rx for depression in kids

A
  1. CBT/IPT/internet based psychotherapy
  2. Fluoxetine, or escitalopram
  3. Venlafaxine & tricyclics
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8
Q

Rx resistant MDD in kids, 1st, 2nd & 3rd line

A
  1. SSRI & psychotherapy
  2. Switch to another SSRI
  3. Venlafaxine, TCA, neuro stimulation
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9
Q

Definition of early onset in PDD

A

Onset <21 years

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10
Q

Concordance rate for mood disorder amongst MZ twins

A

70-90%

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11
Q

Stressful life events tend to be related to episodes of mood disorders when?

A

They more often precede first rather than subsequent episodes

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12
Q

Lifetime prevalence of major depressive disorder

A

17%, the highest of any psychiatric disorder

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13
Q

Mean age of onset for major depressive disorder

A

40

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14
Q

Is there a correlation between MDD and socioeconomic status

A

No

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15
Q

How does DSM V define two separate episodes of depression to meet criteria for recurrent depression?

A

They must be separated by two months during which a pt has no significant symptoms of depression

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16
Q

How many episodes in a 12 month period to be a rapid cycler according to DSM V?

A

Four

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17
Q

Prevalence of dysthymia in the gen pop

A

5-6%

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18
Q

Most common target for rTMS in depression

A

DLPFC

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19
Q

Absolute and relative contraindications to rTMS

A
  1. Absolute- metal of any type in head eg aneurysm clips, shrapnel
  2. Relative- epilepsy/ hx of seizures, brain lesion, cardiac pacemaker, internal defibrillator
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20
Q

Canmat 2016 guidelines best augmentation for MDD

A

ORAL (olanzapine, risperidone, abilify, lithium)

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21
Q

Commonest side effect of rTMS

A

Headache

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22
Q

Define dysthymia

A

A reactive nonpsychotic depression of mild to moderate intensity with predominant anxiety (K&S)

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23
Q

Depressive disorders are more common in women T/F

A

T

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24
Q

About 5% of depressed patients commit suicide eventually T/F

A

F it’s about 15% (K&S)

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25
Q

Manic forms of mood disorders predominate in women T/F

A

F

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26
Q

The incidence of depression in younger age groups is increasing T/F

A

T (K&S)

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27
Q

Hypersexuality in depressed patients usually indicates what?

A

A mixed episode of bipolar disorder (K&S)

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28
Q

Chronic stress does what to serotonin stores?

A

Depletes them despite acute stress increasing serotonin

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29
Q

Symptoms shared by depression and mania

A

Agitation, insomnia, anger, irritability

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30
Q

Parental loss before adolescence is a risk factor for adult depression T/F

A

T (K&S)

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31
Q

Hypomanic episodes lack psychotic features T/F

A

T

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32
Q

Manic episodes last for at least how long?

A

One week

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33
Q

Hypomanic episodes last for at least how long?

A

Four days (K&S)

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34
Q

what is the key difference between hypomania & mania

A

Hypomania is not sufficiently severe to cause impairment in social or occupational functioning

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35
Q

The defence mechanism associated with depression according to Freud

A

Introjection

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36
Q

L-tryptophan is the amino acid precursor to what?

A

Serotonin

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37
Q

What is the amino acid precursor to dopamine?

A

Tyrosine

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38
Q

Why have L-tryptophan containing products been recalled in the US?

A

They were associated with eosinophilia-myalgia syndrome

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39
Q

Bad prognostic indicators in depression

A
  1. A history of more than one previous depressive episode
  2. Co-existing dysthymic disorder
  3. Alcohol & substance misuse
  4. Anxiety disorder symptoms
  5. Being male.
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40
Q

Is advanced age at onset a good or bad prognostic indicator in MDD?

A

Good

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41
Q

Alcohol, stimulant & caffeine use is a risk factor for rapid cycling T/F

A

T

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42
Q

Rapid cyclers, M or F predominate?

A

F

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43
Q

What is the lifetime prevalence of cyclothymic disorder?

A

0.2-1%

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44
Q

You need how many years of symptoms to meet criteria for cyclothymia?

A

Two years

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45
Q

Men or women predominate in cyclothymia?

A

M=F

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46
Q

Two key differences between dysthymia and MDD according to K&S

A
  1. The symptoms outnumber the signs
  2. Dysthymic pts say they have always been depressed
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47
Q

In the DSM criteria for depression at least one of the symptoms should be one of which two?

A
  1. Depressed mood
  2. Loss of interest or pleasure
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48
Q

Depression rates are increasing in Canada T/F

A

F (Ottawa)

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49
Q

Never married people have higher rates of depression T/F

A

T (Ottawa)

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50
Q

Depression rates higher in rural settings T/F

A

F Urban is higher (Ottawa)

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51
Q

There is a dose response relationship between childhood adversity and depression T/F

A

T (Ottawa - prospective Swedish data)

52
Q

What % of MDEs are chronic? (>2 years in duration)

A

26.5% (Canmat)

53
Q

High neuroticism is a risk factor for chronic/ recurrent depression T/F

54
Q

What are the three first line psychological therapies recommended for acute treatment of MDD?

A
  1. CBT
  2. IPT
  3. Behavioural activation
55
Q

What are the two psychological therapies which are first line treatments for maintenance of treatment in depression?

A
  1. CBT
  2. Mindfulness-based cognitive therapy
56
Q

Best ADT for pts with sleep disturbance (w level 1 evidence)

A

Agomelatine

57
Q

What effect do SSRIs have on suicide risk in terms of % change?

A

40% decrease in risk

58
Q

Lack of early response to antidepressant therapy at 2-4 weeks predicts later non-response T/F

59
Q

ECT is a second line treatment for psychotic depression T/F

A

F first line

60
Q

ECT for MDD is contraindicated in pregnancy T/F

A

F it’s third line

61
Q

Exercise is a first line recommendation for mild-mod depression T/F

62
Q

Yoga is a second line treatment for mild-mod depression T/F

63
Q

There is no evidence for acupuncture in the treatment of mild-mod depression T/F

A

F it’s third line

64
Q

Which natural remedy has first line evidence for mild-mod depression?

A

St. John’s Wort

65
Q

Tryptophan has second level evidence for mild-mod depression T/F

A

F it is not recommended

66
Q

What is the standard protocol for light therapy?

A

10,000 lux for 30 mins each day in the early morning for up to six weeks

67
Q

Light therapy is a second line treatment for mild-mod nonseasonal MDD T/F

A

T - level 2

68
Q

Average age at onset of bipolar disorder

69
Q

BPAD is associated with an increasing risk of dementia as the disorder progresses T/F

70
Q

Unipolar depression tends to start earlier in life than bipolar T/F

A

F bipolar <25, unipolar >25

71
Q

There is only one adjunctive psychological therapy for the treatment of bipolar disorder, what is it?

A

Psychoeducation, level 2 evidence as a first line for maintenance

72
Q

First line Rx for acute management of bipolar II depression

A

Quetiapine (only one with level 1)

73
Q

Persistent mania following antidepressant treatment is bipolar disorder T/F

74
Q

For a diagnosis of mania mood need not be elevated but irritability needs to be present T/F

75
Q

Rapid cycling is a bad prognostic sign in bipolar affective disorder T/F

76
Q

Stimulants are associated with rapid cycling T/F

77
Q

Younger age at onset of bipolar disorder is associated with reduced risk of recurrence T/F

A

F the opposite is true

78
Q

Risk of recurrence of BPAD in pregnancy if mood stabilizers are discontinued

A

85%. It’s 37% if you continue them

79
Q

Bilateral and unilateral ECT have the same efficacy T/F

A

F Bilateral is better but is associated with greater cognitive side effects like retrograde memory loss

80
Q

CANMAT 2016 level 1 for MDE

A
  1. Agomelatine
  2. Bupropion (Wellbutrin)
  3. Citalopram (Celexa, Cipramil)
  4. Desvenlafaxine (Pristiq)
  5. Duloxetine (Cymbalta)
  6. Escitalopram (Cipralex, Lexapro)
  7. Fluoxetine (Prozac)
  8. Fluvoxamine (Luvox)
  9. Mianserin (Tolvon)
  10. Milnacipran (Ixel)
  11. Mirtazapine (Remeron)
  12. Paroxetine (Paxil)d
  13. Sertraline (Zoloft)
  14. Venlafaxine (Effexor)
  15. Vortioxetine (Brintellix, Trintellix)
81
Q

CANMAT level 1 for MDE + psychotic features

A

ADT + antipsychotic

82
Q

CANMAT recommendations for MDE + cognitive dysfunction

A
  1. Vortioxetine (Level 1)
  2. Bupropion (Level 2)
  3. Duloxetine (Level 2)
  4. SSRIs (Level 2)b
  5. Moclobemide (Level 3)
83
Q

CANMAT the only level 1 drug for MDE + sleep disturbance

A

Agomelatine

84
Q

CANMAT level 1 for MDE + somatic symptoms

A

Duloxetine (pain) (Level 1)

85
Q

CANMAT MDE with sleep disturbance: three drugs with the highest adverse event rates of somnolence and daytime sedation

A

Mirtazapine, quetiapine, and trazodone

87
Q

The long-term use of SSRI antidepressants has been associated with increased risk of falls and fractures that is unrelated to postural hypotension T/F

88
Q

Depression increases the risk of DM II by 60% T/F

A

T (CANMAT)

89
Q

Maternal depression is associated with aggression in boys T/F

90
Q

Atypical depression tends to have an onset later in the lifespan T/F

91
Q

There is a role for Ritalin in MDE in older adults with medical illnesses T/F

92
Q

Anhedonia is a negative symptom of schizophrenia T/F

93
Q

The Beck depression inventory has a range of scores from 0-40 T/F

A

F 0-63, <10 is normal, 31-40 is severe depression, >40 is ‘extreme depression’

94
Q

How is early improvement on ADT’s defined?

A

>20%-30% reduction from baseline in a depression rating scale after 2-4 weeks

95
Q

Parental loss or separation is a RF for PDD T/F

96
Q

PDD cannot impact social and occupational function as much as MDE T/F

97
Q

Criteria for diagnosis of a manic episode - two things (DSMV)

A
  1. Abnormally & persistently elevated, expansive or irritable mood 2. Increased goal directed activity or energy
98
Q

An inability to censor immaterial external stimuli

A

Distractibility

99
Q

A manic episode in the context of cocaine use persisting beyond the physical effect of cocaine and when it is completely out of the system is sufficient for a diagnosis of bipolar I T/F

100
Q

A diagnosis of bipolar I requires a prior diagnosis of MDE T/F

101
Q

Mean age at onset bipolar I

102
Q

Onset of manic symptoms in mid life requires organic work up T/F

103
Q

Bipolar disorder is more common in high income countries T/F

104
Q

Strongest risk factor for BPAD

105
Q

1/4 of completed suicides may be due to bipolar T/F

106
Q

For a diagnosis of cyclothymia the criteria for MDE, mania & hypomania must never have been met T/F

107
Q

Lifetime prevalence of cyclothymia

108
Q

CANMAT 2016 comorbidities of bipolar I: substance misuse/ anxiety disorders/ ADHD/ ED

A
  1. Substance 67%
  2. Anxiety 46%
  3. ADHD 18%
  4. ED 14%
109
Q

Lithium in breastfeeding?

110
Q

Short duration of episode is a good prognostic factor in mania T/F

111
Q

Lithium is best for mania with elevated mood/ euphoria T/F

112
Q

Divalproex is best option for rapid cyclers T/F

113
Q

First line treatments for rapid cyclers

A
  1. Lithium
  2. LTG
  3. DVP
114
Q

Avoid carbemazepine in mixed affective states T/F

A

F it is best choice

115
Q

Psychotic features in deoresison in children are a strong predictor for future bipolar disorder T/F

116
Q

Being male is a good prognostic factor in mania

A

F it’s bad

117
Q

In bipolar depression I&II mixed symptoms are apparent in depression 30% of the time

A

T (EMBLEM study)

118
Q

late onset bipolar is associated with left hemispheric lesions T/F

119
Q

Late onset depression is assoc with white matter lesions T/F

A

T Chandarana

120
Q

Long duration of depression is assoc w reduced hippocampal volume T/F

121
Q

Lifetime prev of depression in Canada

A

9.9% Chandarana

122
Q

The rate of depression in Canada is changing T/F

123
Q

Biggest risk factor for suicide in depression, previous history of attempts or hopelessness?

A

Chandarana says previous history

124
Q

Vascular disease in depression predicts a poor response to treatment T/F

A

T, Chandarana course

125
Q

How long is the acute phase of depression treatment according to CANMAT, and how long is the maintenance phase?

A

Acute is 8-12 wweks and maintenance is 6-24 months or longer

126
Q

Combination therapy for depression is superior to monotherapy T/F

A

T, Chandarana

Psychiatry (27 decks)

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