Chapter 4 pt 2

Question 1

what is the Hamilton Depression Rating Scale

Answer 1

measures the severity of depression and is used in research to assess the effectiveness of therapies

Question 2

what is the depression screening often used in primary care setting

Answer 2

PHQ-9

Question 3

loss of parent before what age is associated with later development of MDD

Answer 3

11

Question 4

what are the side effects of SSRIs

Answer 4

headache
GI
SEXUAL DYSFUCNTION
rebound anxiety

Question 5

what are the side effects of TCAs

Answer 5

lethal cardiac arrhythmia
sedation
weight gain
orthostatic hypotension
anticholinergic effects
QTc prolongation

Question 6

what are the side effects of MAOIs

Answer 6

hypertensive crisis when used with sympathomimetics or tyramine
Serotonin Syndrome with SSRIs

Question 7

what is seen in serotonin syndrome

Answer 7

autonomic instability
hyperthermia
hyperreflexia (myoclonus)
seizure

Question 8

what period conveys an elevated risk of depression in women

Answer 8

postpartum

Question 9

what medication is considered particularly useful for “atypical depression”

Answer 9

MAOIs

Question 10

what psychotherapy is used in MDD

Answer 10

COGNITIVE-BEHAVIORAL THERAPY (CBT)

interpersonal

Question 11

when is electroconvulsive therapy (ECT) indicated in MDD

Answer 11

pt is unresponsive to pharmacotherapy
if the patient cannot tolerate pharmacotherapy (pregnancy, etc)
rapid reduction of symptoms is desired (immediate suicide risk, refusal to drink/eat, catatonia)

Question 12

primary risk of ECT is from what

Answer 12

anesthesia

Question 13

what medication is typically used before ECT

Answer 13

ATROPINE
then anesthesia (methohexial)
and then muscle relaxant (succinylcholine)

Question 14

how many ECT treatments are required for MDD

Answer 14

usually 6-12 (average of 7) over 2-3 week period

Question 15

what are common side effects of ECT

Answer 15

retro and anterograde amnesia (resolved in 6 months usually)

headaceh, nausea, muscle soreness

Question 16

what are melancholic features of a depressive disorder

Answer 16

present in approx 25-30% of MDE
more likely in severely ill inpatients, including those with psychotic features
ANHEDONIA, early morning awakenings, depressing WORSE IN MORNING, psychomotor disturbance, excessive GUILT, and ANOREXIA

Question 17

what are atypical features of a depressive disorder

Answer 17

HYPERSOMINA
HYPERPHAGIA
REACTIVE mood
LEADEN PARALYSIS
hypersensitive to interpersonal rejection

Question 18

what are mixed features of a depressive disorder

Answer 18

manic.hypomanic symtoms present during the majority of days during MDE
elevated mood, grandiosity, talkativeness/pressured speech, flight of ideas/racing thoughts, increased energy/goal directed activity, excessive involvement in dangerous activities, decreased need for sleep

Question 19

what are cataonia features of a depressive disorder

Answer 19

catalepsy (immobility)
purposeless motor activity
extreme negativism or mutism
bizarre postures
echolalia
especially responsive to ECT

Question 20

what are psychotic features of a depressive disorder

Answer 20

presence of delusions and/or hallucinations

24-53% of older, hospitalized patients with MDD

Question 21

what are anxious distress features of a depressive disorder

Answer 21

feeling keyed up/tense
restless
difficulty concentrating
fears of something bad happening
feelings of loss of control

Question 22

what are PERIpartum onset features of a depressive disorder

Answer 22

onset of MDD symptoms occur during pregnancy or FOUR WEEKS following delivery

Question 23

what are seasonal pattern features of a depressive disorder

Answer 23

terminal relationship between onset of MDD and particular time of the year (most commonly the winter)
fall-onset responds really well to light therapy

Question 24

what is the triad for seasonal affective disorder

Answer 24

irritability
carbohydrate craving
hypersomnia

Question 25

what is bereavement

Answer 25

simple greif- reaction to a major loss, usually of a loved one (not a mental illness)
usually self-limited and only last for several months
if individual meets criteria for MDE he or she has MDD