Ch. 9 Depressive Disorders and Bipolar Disorders Flashcards
What is the single strongest predictor of depression?:
a. alcohol use b. having a depressed parent c. age over 65 d. co-morbid anxiety
b. having a depressed parent
-children of depressed parents 3x more likely to experience MDD in their lifetimes than general pop
-40% chance of depressive episode before age 18
Neurovegetative symptoms seen in MDD are related to functions of the ______ and the _____ and the hormones they secrete
hypothalamus and pituitary
True or False: dysphoria is often triggered by changes in levels of sex steroids that occur during the menstrual cycle
True
In response to stress the hypothalamus releases ______, which stimulates the pituitary to release ______. This then stimulates the adrenals to release _______.
-CRH (corticotropin-releasing hormone)
-ACTH (adrenocorticotropic hormone)
-cortisol
True or False: hyperactivity of the HPA has been shown to be present in people with MDD
True,
HPA-axis controls physiological response to stress
-feedback pathways
Overtime, elevated ______ levels damage the CNS by altering neurotransmission and electrical signal conduction
cortisol
-can cause changes in size and function of brain tissue
True or False: MDD may be associated w/ proinflammatory cytokine activation
True
All of the following are possible NT function abnormalities causing depression except:
a. dysregulation of biogenic amine NTs b. low levels of endogenous catecholamines c. low levels of tryptophan d. high levels of 5HTIAA e. unusually high receptor sensitivity for NTs f. low density of receptor sites in certain areas
d. high levels of 5HTIAA, it is instead LOW levels of the serotonin metabolite 5HTIAA
True or False: structural changes in those w/ chronic/severe depression show hypovolemic hippocampus and prefrontal cortex-limbic striatal regions
True
What is the average age of onset for MDD?
a. adolescence b. mid-20s c. 30-40 yrs d. over 50 years
b. mid-20s
-risk is equal between genders before puberty and after menopause, otherwise greater in women
-also a greater source of morbidity than with any other illness
True or False: 15% of people with MDD will die by suicide
True
Risk Factors for MDD include all of the following except:
a. genetic loading b. prior episode MDD c. male gender d. postpartum period e. medical comorbidity f. single marital status g. environmental stressors
c. male gender
-female gender is a risk factor for MDD
Which of the following is not an assessment tool for MDD?
a. GAD-7 b. PHQ-9 c. EPDS d. BDI f. HAM-D
a. GAD-7
True or False: initial presentation of MDD often manifests as vague somatic complaints
True,
body aches, pains, headaches, muscle pains, lack of energy, GI issues
symptoms of ______ and ______ are almost always present in some degree in MDD
anhedonia and sleep disturbance
True or False: in children MDD may present more as an irritable mood
True
SIGECAPS stands for:
Sleep: insomnia or hypersomnia
Interest: reduced, with loss of pleasure
Guilt: often unrealistic
Energy: mental and physical fatigue
Concentration: distractibility, memory disturbance, indecisiveness
Appetite: decreased or increased
Psychomotor: retardation or agitation
Suicide: thoughts, plans, behaviors.
True or False: suicide risk is high for persons w/ history of past attempts, family history of first-degree relative committing suicide, and presence of psychotic symptoms
True,
also:
-concurrent substance abuse or dependency
-current serious health problem
Once started, antidepressants should be continued for minimum of:
a. 4 weeks b. 3 months c. 6 to 12 months d. 2 to 4 years
c. 6 to 12 months
-if pt has >2 prior episodes of MDD< consider continuing antidepressants indefinitely
Most antidepressants take _______ (how many weeks) to have therapeutic effect
4 to 6 weeks
True or False: antidepressant rebound is common when stopping abruptly, particularly w/ the drugs that have short half-lives
True
SSRIs act primarily to ______ by _______:
Increase serotonin levels in the CNS by inhibiting their presynaptic reuptake
TCAs act to ______ by ______:
Elevate serotonin and norepinephrine levels primarily by inhibiting their presynaptic reuptake
MAOIs act to _____ by ____:
Elevate serotonin and norepinephrine levels by inhibiting MAO, the enzyme that breaks down monoamine neurotransmitters
SNRIs act to _____ by____:
Elevate norepinephrine and serotonin levels by inhibiting dual reuptake of norepinephrine and serotonin
-action very selective on NTs
Which of these is not a common side effect of SSRIs?
a. sedation or agitation b. GI disturbances c. EPS d. sexual dysfunction
c. EPS
NDRIs act to _____ by ______:
Increase norepinephrine and dopamine by inhibiting dual presynaptic reuptake.
-Action is very selective
SARIs act to ____ by _____:
Elevate serotonin levels by inhibiting serotonin reuptake
-dual action, agonist of 5HT-2 receptors
True or False: aged cheese, smoked meats, smoked fish, and fermented beverages are tyramine-free and ok to have with MAOIs
False, should avoid these foods if taking MAOIs because they contain tyramine
Anticholinergic side effects of TCAs include all of these except:
a. dry mouth b. cardiac dysrhythmias c. blurred vision d. constipation e. memory issues
b. cardiac dysrhythmias, these can occur with TCAs, but are not an anticholinergic effect
(sorry this is a sneaky question)
Which of these is an antiadrenergic side effect?
a. orthostatic hypotension b. sedation c. weight gain d. dry mouth
a. orthostatic hypotension
the sedation and weight gain are antihistaminergic side effects and the dry mouth is anticholinergic
*all of these are possible side effects of TCAs
True or False: you should adhere to at least 2-week washout period before switching between TCAs and another class of antidepressants
True, but should take 5 weeks for fluoxetine
True or False: A hypertensive crisis can occur while taking MAOIs if the patient also eats foods containing tyramine
True,
can also occur if adding other medications to MAOIs such as TCAs, decongestants, St. John’s wort, asthma meds, stimulants, etc….
Symptoms of hypertensive crisis include all of the following except:
a. explosive-like headache b. elevated BP c. facial flushing d. palpitations e. pupillary constriction f. diaphoresis g. fever
e. pupillary constriction, instead pupillary dilation occurs
When treating hypertensive crisis ________ binds with NE receptor sites and blocks NE
phentolamine
-should also d/c the MAOI, stabilize fever
True or False: tyramine is a precursor to NE
True
True or False: When MAO is inhibited, tyramine exerts a strong vasopressor effect, stimulating the release of catecholamines, epinephrine, and NE
True
Symptoms of serotonin syndrome include all of the following except:
a. agitation and restlessness b. decreased HR and decreased BP c. headache d. sweating e. myoclonic jerking f. confusion g. fever
b. decreased in HR and BP, instead causes increased HR and BP
-other symptoms include shivering, goose bumps, loss of coordination, seizures and unconsciousness
All of the following can be part of treating serotonin syndrome except:
a. discontinue offending agent b. cyproheptadine c. anticonvulsants e. phenelzine d. autonomic support
e. phenelzine
Significant side effects of MAOIs include all of the following except: a. hypotension b. insomnia c. weight gain d. anticholinergic side effects d. lightheaded and dizzy e. sexual dysfunction
a. hypotension, instead could cause hypertensive crisis
True or False: NT theory of how ECT works suggests increase in dopamine, serotonin, and norepinephrine
True
Which theory suggests that ECT works by releasing hormones such as prolactin, TSH, pituitary hormones, endorphins, and adrenocorticotropic hormone:
a. NT theory b. neuroendocrine theory c. anticonvulsant theory d. cognitive theory
b. neuroendocrine theory
Which theory suggest that ECT works by exerting an anticonvulsant effect, which then produces an antidepressant effect:
a. NT theory b. neuroendocrine theory c. anticonvulsant theory d. cognitive theory
c. anticonvulsant theory
Contradiction to ECT include all of the following except: a. cardiac disease b. compromised pulmonary status b. hx of brain injury/tumor c. hx of SJS d. anesthesia medical complications
c. history of SJS
Which of these involves inducing a grand mal seizure induced in an anesthetized person:
a. ECT b. TMS c. VNS d. Phototherapy
a. ECT, electroconvulsive therapy
-usual course 6 to 12 tx
Which of these involves placement of a small wire coil on the scalp to conduct electrical current, creating a magnetic field, through the tissues of the head:
a. ECT b. TMS c. VNS d. Phototherapy
b. TMS
transcranial magnetic stimulation
-performed without anesthesia, office setting
-usually 40 min session, 5x/wk for 6 weeks
Which of these involves a pacemaker-like device implanted in the left side of the chest to simulate left branch of nerve:
a. ECT b. TMS c. VNS d. Phototherapy
c. VNS
-can be outpatient but anesthesia required
Which of these involves 2,500 to 10,000 lux light for 30 min up to 2 hrs, 1 to 2x daily:
a. ECT b. TMS c. VNS d. Phototherapy
d. phototherapy
All of the following are risk factors for suicide except:
a. 45 or older if male b. 55 or older if female c. divorced/single d. white e. female gender
e. female, males are at greater risk for suicide
other risk factors include living alone, psych disorder, physical illness, substance abuse, previous suicide attempt, family hx of suicide, recent loss
All of the following symptoms are more pronounced in children with MDD except: a. irritability b. motor retardation c. somatic complaints d. social withdrawal
b. motor retardation, this is less common before the onset of puberty, along with:
-psychosis
-hypersomnia
-increase appetite
True or False: MDD has a strong separation anxiety component in children
True
Drug combinations that can cause serotonin syndrome include all of these except:
a. SSRIs and MAOIs b. SSRIs and mood stabilizers c. drug and herbal interactions d. SSRIs and St. John’s wort
b. SSRIs and mood stabilizers
symptoms of discontinuation syndrome include all of the following except: a. flu-like symptoms b. increased concentration c. fatigue d. myalgia e. nausea and vomiting f. impaired memory g. vertigo
b. increased concentration, instead decreased concentration
other symptoms include: lethargy, paresthesia’s, irritability, anxiety, insomnia, crying without w/out provocation, and dizzyness
Evidence indicates clients should take an antidepressant agent for at least _____ months after remission of symptoms:
a. 3 months b. 8 months c. 9 months d. 12 months
d. 12 months
True or False: dysthymia is similar to MDD but has less severe symptoms, and no psychotic symptoms
True,
also vegetative symptoms are less likely with dysthymia
True or False: women are 2-3 times more likely to develop dysthymia
True
Dysthymia is characterized by a chronically depressed mood that occurs for most of the day, more days than not, for at least ____ (how long?)
2 years
-also prominent: low self-esteem, self-criticism, and a perception of general incompetence compared to others
True or False: it can be considered grief/bereavement when symptoms develop within 3 months of the stressor
True
