Diagnoses - Depression Flashcards
In learned helplessness model, the behavioral deficits in animals exposed to uncontrollable stress is reversed by? (5x)
ANTIDEPRESSANTS
65y/o had MDD but was treated w/ CBT to remission. Usually has 1 glass of wine w/ dinner. Same level of drinking for many years. Family h/o dementia in both parents. Advice? (3x)
CONTINUE THE ALCOHOL AS LONG AS THE PATTERN OF USE DOES NOT CHANGE
Which d/o is treated w/ light therapy? (3x)
SEASONAL AFFECTIVE DISORDER
21 y/o F hospitalized for excessive bleeding following elective first trimester abortion. Pt reports having anxiety about bleeding, but is relieved about abortion. Pt reports that baby’s father is abusive but does not want to leave him. What is the strongest predictor of depression? (3x)
HX OF PRE-PREGNANCY DEPRESSION
WHO study in 1990, what is the 2nd worldwide leading source of years of healthy life lost to premature death/disability (#1 is ischemic heart disease): (x2)
UNIPOLAR MAJOR DEPRESSION
79y/o asks for eval for STD. Upset and guilty about an affair. Spouse says affair happened many years ago. Pt is sad but not confused. Dx? (2x)
MAJOR DEPRESSION WITH PSYCHOSIS
Which depressive symptom is a melancholic feature specifier in DSM-IV? (2x)
LACK OF PLEASURE
60 y/o w/ depressive syndrome has memory problems. Incorrect on date, messes up serial sevens, spells backwards, but slowly. After 4 wks of trazodone, both mood and cognition are improved. Dx? (2x)
PSEUDODEMENTIA
Depression increases risk of mortality from what disease? (2x)
ISCHEMIC HEART DISEASE
50 y/o PT w/ depression believes that he is responsible for the destruction of the world. This is an example of: (2x)
MOOD-CONGRUENT DELUSION
Depression, according to Beck’s model is a manifestation of: (2x)
DISTORTED NEGATIVE THOUGHTS (COGNITIVE DISTORTIONS)
Which of the following characteristics is considered particularly likely to be found in patients with MDD with atypical features? (2x)
INTERPERSONAL REJECTION SENSITIVITY
34 y/o F presents “unable to reach her potential” w mood switches frequently (day to day, sometimes within one day) from mildly to moderately. Depressed to happy in the morning. No episodes meeting criteria for mania. Hx suggests most likely Dx? (2x)
CYCLOTHYMIC DISORDER
Melancholia is characterized as (2x):
ANHEDONIA
Patient with depression on admission. Which risk factor suggests need for maintenance psychotherapy? (2X)
3 OR MORE EPISODES OF DEPRESSION IN A LIFETIME
In cancer patients, what should you use to treat sub-threshold depression sx?
START AN SSRI
Screening tool/list for depression in primary care setting?
PHQ (patient health questionnaire)
Average # of yrs from start of mood d/o to dx?
6-8YRS
Finding from studies of neuroimmune mechanisms of depression
PRO-INFLAMMATORY CYTOKINES ARE OFTEN ELEVATED
Symptoms that may dominate picture of mood disorders w catatonia?
EXCESSIVE PURPOSELESS MOTOR ACTIVITY NOT INFLUENCED BY EXTERNAL STIMULI
35 year old woman reports history of recurrent depression always beginning in fall/early winter and remit by spring. She is trying to become pregnant, what’s best tx?
LIGHT THERAPY
40 y/o eats and sleeps too much, craves sweets, poor concentration, irritable, constant conflicts with husband. States “I always feel better in spring.” What is the treatment?
PHOTOTHERAPY
Clinical circumstance that best warrants consideration of psychotherapy as the sole treatment for mild to moderate depression:
PREGNANCY, LACTATION, OR WISH TO BECOME PREGNANT
Which is NOT common in patients >65: depression, cog d/o, phobias, ETOH d/o, psychotic d/o
PSYCHOTIC D/O
Pts w late-life depression compared w early onset depression more likely to report:
PSYCHOTIC SXS
52 y/o with h/o unipolar depression is brought to ED with a first episode of catatonia. Pt is on no meds, UDS is neg. Further w/u should initially focus on what factor?
METABOLIC DISORDERS
Pt with MDD 4-wks into sertraline 200mg trial without improvement. Duloxetine 90mg added for an additional 6 weeks followed by 4-weeks on phenelzine 90mg. Pt cont to be depressed. What would be the most definitive treatment:
ECT
Pt with low mood, middle insomnia, impaired concentration and memory x 3 months, onset shortly after adult child was convicted with felony and imprisoned x 10 years. Most likely Dx?
ADJUSTMENT D/O WITH DEPRESSED MOOD
Blunted response to TRH stimulation test correlates with …
DEPRESSION
Most common psych d/o that occurs in pts s/p organ transplant
MAJOR DEPRESSION
The mood disturbance of PMDD (premenstrual dysmorphic disorder) is characterized by …
IT CAN BE AS SEVERE AS IN MDD
Defining feature of mood in atypical depression
REACTIVE
27 y/o F, 1 week postpartum, has sudden emotional outbursts; not sad, wants the baby. What’s going on?
MATERNITY BLUES
Implantation of DBS electrodes has been shown to lead to remission in about half of patients with treatment-refractory depression. To obtain this effect, the electrode is placed in the:
SUBGENUAL CINGULATE CORTEX
Important distinction between depressive symptoms in pts with cancer as compared to those patients with depression but no cancer is that the patients w cancer?
USUALLY MAINTAIN INTACT SELF-ESTEEM
17 y/o with depressed mood, low self esteem and poor concentration possibly has dysthymia. Which feature would support the Dx?
SYMPTOMS >1 YEAR
27 y/o M seen in ED c/o insomnia, hopelessness, anorexia, decreased concentration for 2 weeks and is now acutely suicidal. Pt has hx of ETOH use daily for the past 3 months. The most likely Dx?
SIMD (substance induced mood disorder)
65 y/o morbidly obese pt with new onset of depression endorses fatigue and hypersomnia. He is not on meds and has no PMH. What test?
POLYSOMNOGRAPHY
40 y/o M reports long hx of continuous dysphoria and insomnia (dysthymia). Recently he feels worse and reports poor energy, hopelessness and SI. Dx:
DOUBLE DEPRESSION
Dx for 40yo male w/ mild chronic dysphoria, insomnia, fatigue, and lessened job performance, now with despondency, tearfulness, lack of energy, skipping work, hopelessness, psychomotor agitation, and SI
DOUBLE DEPRESSION
Strongest predictor in pt following MI (ever stronger than EF):
DEPRESSION
59 y/o ER physician with alcohol problem and depressed mood, less tolerant to day and night shift. In addition to abstinence from ETOH, what is next step?
RECOMMEND RELIEF FROM THE NIGHT SHIFT
Women at highest risk of MDD during:
REPRODUCTIVE YEARS
Man w/ HTN and MI, has stressors and depression, Tx?
RELAXATION TRAINING
60 y/o w/ depression & paranoia treated with 50mg Zoloft and 6mg risperidone. On follow up pt c/o slow thinking & excessive salivation. On PE masked faces and cogwheel rigidity present. Mood and paranoia have greatly improved. What is the next step?
LOWER DOSE OF ANTIPSYCHOTIC MEDS
What is a characteristic of atypical depression?
LEADEN PARALYSIS
Dexamethasone suppression test for diagnosing mood disorders:
NOT USEFUL IN ROUTINE CLINICAL PRACTICE
77 y/o F whose husband died 6 wks ago, complains about the length of time it took for her to dress. She sounds irritable, looks fatigued. “I can’t accept he is gone…. I should have been able to save him”. She says “When the real darkness descends on me specially in the middle of the night I don’t want to call anyone.” What is more indicative of MDD rather than uncomplicated bereavement:
HAVING THOUGHTS OF SUICIDE.
Cognitive triad of depression: negative self-perception, experience the world as self-defeating, AND?
EXPECTATION OF CONTINUED FAILURE
What augmentation strategies for treatment-refractory depression has shown the highest efficacy and replicability?
ELECTROCONVULSIVE THERAPY (ECT)
Tx for worsening depression, severe weight loss, dehydration, catatonia.
ELECTROCONVULSIVE THERAPY (ECT)
Presence/severity of depressive Sx in MS is correlated with:
CEREBRAL INVOLVEMENT
50 y/o pt is being treated for sadness, anorexia, poor energy, and difficulty concentrating. Fluoxetine 20mg is prescribed and the pt achieves full remission. Later pt admits that she had visual and auditory hallucinations. This improved with treatment and pt currently denies any hallucinations. Dx?
MDD WITH PSYCHOTIC FEATURES
25 y/o pt reports experiencing intense periods of profound tiredness over the past 2-3 weeks. During these periods she has increased need for sleep and spend much of day in bed. Pt also reports increased appetite. These episodes often occur in setting of interpersonal discord. Dx?
MDD WITH ATYPICAL FEATURES
Pt is initiating light therapy for seasonal depression. What statement accurately represents what is known about the type, dose, and timing of effective treatment?
MORNING LIGHT TREATMENT APPEARS TO BE MORE EFFECTIVE THAN MID- AFTERNOON EXPOSURE.
Characterizes depression in pt with MS:
RESPONDS TO ANTIDEPRESSANTS
How many symptom-free weeks must be between two episodes of depression for them to be considered separate and therefore recurrent according to DSM-IV?
8 SYMPTOM-FREE WEEKS
Which of the following functions is most likely to normalize in an 80 y/o pt successfully treated for depression?
INFORMATION PROCESSING SPEED
In pts with recurrent depression, successful treatment with antidepressants should be followed by which treatment strategy?
CONTINUING ANTIDEPRESSANTS AT THE SAME DOSAGE
Associated with improved outcome in late-life depression?
FAMILY HISTORY OF DEPRESSION
