Depressive Disorders (Major Depressive Disorder) Flashcards
Which of the following statements about how grief differs from a major depressive episode (MDE) is false?
A. In grief the predominant affect is feelings of emptiness and loss, while in MDE it is persistent depressed mood and the inability to anticipate happiness or pleasure.
B. The pain of grief may be accompanied by positive emotions and humor that are uncharacteristic of the pervasive unhappiness and misery characteristic of MDE.
C. The thought content associated with grief generally features a preoccupation with thoughts and memories of the deceased, rather than the self-critical or pessimistic ruminations seen in MDE.
D. In grief, feelings of worthlessness and self-loathing are common; in MDE, self-esteem is generally preserved.
E. If a bereaved individual thinks about death and dying, such thoughts are generally focused on the deceased and possibly about “joining” the deceased, whereas in MDE such thoughts are focused on ending one’s own life because of feeling worthless, undeserving of life, or unable to cope with the pain of depression.
Correct Answer: D. In grief, feelings of worthlessness and self-loathing are common; in MDE, self-esteem is generally preserved.
What DSM-5 diagnostic provision is made for depressive symptoms following the death of a loved one?
A. Depressive symptoms lasting less than 2 months after the loss of a loved one are excluded from receiving a diagnosis of major depressive episode.
B. To qualify for a diagnosis of major depressive episode, the depression must start no less than 12 weeks following the loss.
C. To qualify for a diagnosis of major depressive episode, the depressive symptoms in such individuals must include suicidal ideation.
D. Depressive symptoms following the loss of a loved one are not excluded from receiving a major depressive episode diagnosis if the symptoms otherwise fulfill the diagnostic criteria.
E. Depressive symptoms following the loss of a loved one are excluded from receiving a major depressive episode diagnosis; however, a proposed diagnostic category for postbereavement depression is included in “Conditions for Further Study” (DSM-5 Appendix) pending further research.
Answer: D. Depressive symptoms following the loss of a loved one are not excluded from receiving a major depressive episode diagnosis if the symptoms otherwise fulfill the diagnostic criteria.
How do individuals with substance/medication-induced depressive disorder differ from individuals with major depressive disorder who do not have a substance use disorder?
A. They are more likely to be female.
B. They are more likely to have graduate school education.
C. They are more likely to be male.
D. They are more likely to be white.
E. They are less likely to report suicidal thoughts/attempts.
Correct Answer: C. They are more likely to be male.
A 50-year-old man presents with persistently depressed mood for several weeks that interferes with his ability to work. He has insomnia and fatigue, feels guilty, has thoughts he would be better off dead, and has thought about how he could die without anyone knowing it was a suicide. His wife informs you that he requests sex several times a day and that she thinks he may be going to “massage parlors” regularly, both of which are changes from his typical behavior. He has told her he has ideas for a “better Internet,” and he has invested thousands of dollars in software programs that he cannot use. She notes that he complains of fatigue but sleeps only 1 or 2 hours each night and seems to have tremendous energy during the day. Which diagnosis best fits this patient?
A. Manic episode.
B. Hypomanic episode.
C. Major depressive episode.
D. Major depressive episode, with mixed features.
E. Major depressive episode, with atypical features.
Correct Answer: D. Major depressive episode, with mixed features.
A 45-year-old man with classic features of schizophrenia has always experienced co-occurring symptoms of depression— including feeling “down in the dumps,” having a poor appetite, feeling hopeless, and suffering from insomnia— during his episodes of active psychosis. These depressive symptoms occurred only during his psychotic episodes and only during the 2-year period when the patient was experiencing active symptoms of schizophrenia. After his psychotic episodes were successfully controlled by medication, no further symptoms of depression were present. The patient has never met full criteria for major depressive disorder at any time. What is the appropriate DSM-5 diagnosis?
A. Schizophrenia.
B. Schizoaffective disorder.
C. Persistent depressive disorder (dysthymia).
D. Schizophrenia and persistent depressive disorder (dysthymia).
E. Unspecified schizophrenia spectrum and other psychotic disorder.
Correct Answer: A. Schizophrenia.
Explanation: Depressive symptoms are a common associated feature of chronic psychotic disorders (e.g., schizoaffective disorder, schizophrenia, delusional disorder). A separate diagnosis of persistent depressive disorder is not made if the symptoms occur only during the course of the psychotic disorder (including residual phases).
A depressed patient reports that he experiences no pleasure from his normally enjoyable activities. Which of the following additional symptoms would be required for this patient to qualify for a diagnosis of major depressive disorder with melancholic features?
A. Despondency, depression that is worse in the morning, and inability to fall asleep.
B. Depression that is worse in the evening, psychomotor agitation, and significant weight loss.
C. Inappropriate guilt, depression that is worse in the morning, and early-morning awakening.
D. Significant weight gain, depression that is worse in the evening, and excessive guilt.
E. Despondency, significant weight gain, and psychomotor retardation.
Correct Answer: C. Inappropriate guilt, depression that is worse in the morning, and early-morning awakening.
Explanation: Two criteria must be met to qualify for the specifier “with melancholic features” for major depressive disorder. Criterion A specifies that one of the following must be present during the most severe period of the current episode: 1) loss of pleasure in all, or almost all, activities; 2) lack of reactivity to usually pleasurable stimuli (does not feel much better, even temporarily, when something good happens). Criterion B specifies that three (or more) of the following must be present: 1) a distinct quality of depressed mood characterized by profound despondency, despair, and/or moroseness or by so-called empty mood; 2) depression that is regularly worse in the morning; 3) early-morning awakening (i.e., at least 2 hours before usual awakening); 4) marked psychomotor agitation or retardation; 5) significant anorexia or weight loss; 6) excessive or inappropriate guilt. The specifier “with melancholic features” can be applied to the current (or, if the full criteria are not currently met for major depressive episode, to the most recent) major depressive episode in major depressive disorder or in bipolar I or II disorder only if it is the most recent type of mood episode.
A 39-year-old woman reports that she became quite depressed in the winter last year when her company closed for the season, but she felt completely normal in the spring. She recalls experiencing several other episodes of depression over the past 5 years (for which she cannot identify a seasonal pattern) that would have met criteria for major depressive disorder. Which of the following correctly summarizes this patient’s eligibility for a diagnosis of “major depressive disorder, with seasonal pattern”?
A. She does not qualify for this diagnosis: the episode must start in the fall, and the patient must have no episodes that do not have a seasonal pattern.
B. She does qualify for this diagnosis: the single episode described started in the winter and ended in the spring.
C. She does not qualify for this diagnosis: the patient must have had two episodes with a seasonal relationship in the past 2 years and no nonseasonal episodes during that period.
D. She does qualify for this diagnosis: the symptoms described are related to psychosocial stressors.
E. She does qualify for this diagnosis: the symptoms are not related to bipolar I or bipolar II disorder.
Correct Answer: C. She does not qualify for this diagnosis: the patient must have had two episodes with a seasonal relationship in the past 2 years and no nonseasonal episodes during that period.
Which of the following statements about the prevalence of major depressive disorder in the United States is true?
A. The 12-month prevalence is 17%.
B. Females and males have equal prevalence at all ages.
C. Females have increased prevalence at all ages.
D. The prevalence in 18- to 29-year-olds is three times higher than that in 60-year-olds.
E. The prevalence in 60-year-olds is three times higher than that in 18- to 29-year-olds.
Correct Answer: D. The prevalence in 18to 29-year-olds is three times higher than that in 60-year-olds.
Explanation: The 12-month prevalence of major depressive disorder in the United States is 7%, with marked differences by age group such that the prevalence in 18to 29-year-old individuals is threefold higher than the prevalence in individuals age 60 years or older. Females experience 1.5to 3-fold higher rates than males beginning in early adolescence.
Which of the following statements about the heritability of major depressive disorder (MDD) is true?
A. Nearly 100% of people with genetic liability can be accounted for by the personality trait of dogmatism.
B. The heritability is approximately 40%, and the personality trait of neuroticism accounts for a substantial portion of this genetic liability.
C. Less than 10% of people with genetic liability can be accounted for by the personality trait of perfectionism.
D. Nearly 50% of people with genetic liability can be accounted for by the personality trait of aggressiveness.
E. The heritability of MDD depends on whether the individual’s mother or father had MDD.
Correct Answer: B. The heritability is approximately 40%, and the personality trait of neuroticism accounts for a substantial portion of this genetic liability.
Which of the following statements about diagnostic markers for major depressive disorder (MDD) is true?
A. No laboratory test has demonstrated sufficient sensitivity and specificity to be used as a diagnostic tool for MDD.
B. Several diagnostic laboratory tests exist, but no commercial enterprise will offer them to the public.
C. Diagnostic laboratory tests have been withheld for fear that people testing positive for MDD may attempt suicide.
D. Tests that exist are adequate diagnostically but are not covered by health insurance.
E. Only functional magnetic resonance imaging (fMRI) provides absolute diagnostic reliability for MDD.
Correct Answer: A. No laboratory test has demonstrated sufficient sensitivity and specificity to be used as a diagnostic tool for MDD.
Which of the following statements about gender differences in suicide risk and suicide rates in major depressive disorder (MDD) is true?
A. The risk of suicide attempts and completions is higher for women.
B. The risk of suicide attempts and completions is higher for men.
C. The risk of suicide attempts and completions is equal for men and women.
D. The disparity in suicide rate by gender is much greater in individuals with MDD than in the general population.
E. The risk of suicide attempts is higher for women, but the risk of suicide completions is lower.
Correct Answer: E. The risk of suicide attempts is higher for women, but the risk of suicide completions is lower.
A 12-year-old boy begins to have new episodes of temper outbursts that are out of proportion to the situation. Which of the following is not a diagnostic possibility for this patient?
A. Disruptive mood dysregulation disorder.
B. Bipolar disorder.
C. Oppositional defiant disorder.
D. Conduct disorder.
E. Attention-deficit/hyperactivity disorder.
Correct Answer: A. Disruptive mood dysregulation disorder.
Explanation: Criteria G and H of disruptive mood dysregulation disorder state that the chronological age at onset is at least 6 years (or equivalent developmental level) and the onset is before 10 years.
What is the approximate 12 month prevalence of Major Depressive Disorder in the US?
A. 10%
B. 69%
C. 12%
D. 7%
Correct Answer: D. 7%
What following statement is tru about Major Depressive Disorder:
A. Males experience MDD more than females beginning in early adolescence
B. Females experience 1.5 - 3 fold higher rates than males beginning in early adolescence
C. Males and females experience similar rates beginning in early adolescence
D. It is unknown whether males and females have different rates beginning in early adolescence
Correct Answer: B. Females experience 1.5 - 3 fold higher rates than males beginning in early adolescence
