Major Depressive Disorder

Question 1

Superior efficacy antidepressants? CANMAT level 1

Answer 1

Escitalopram
Mirtazapine
Sertraline
Venlafaxine

Question 2

What are level 2 antidepressants ?

Answer 2

Agomelatine

Citalopram

Question 3

What are level 1 evidence psychological treatments?

Answer 3

CBT

mCBT

Question 4

What are level 2 - psychological?

Answer 4

Behavioral activation
iPT
cAsp

Question 5

First line augmenting agents for MDD after non response ?

Answer 5

1. Aripiprazole - Level 1
2. Quetiapine- Level 1
3. Risperidone- Level 1

Second line:
Bupropion
Lithium
Mirtazapine
Olanzapine
T3

Question 6

First line switching - non response ?

Answer 6

Escitalopram
Sertraline
Venlafaxine

Question 7

Persistent Depressive Disorder Criterion

Answer 7

CHAS LEE
C- poor concentration
H - hopelessness
A - Poor appetite or overeating
S - Insomnia or hypersomnia
LE - low self esteem
E - Low energy/fatigue

Question 8

What are early onset PDD patients at risk for developing ?

Answer 8

Bipolar - 5% progress to bipolar 1, 15% to bipolar II

MDD - 20% get MDD

Question 9

Brief PD postpartum/peripartum specifier?

Answer 9

occurs during or four weeks after pregnancy

psychotic symptoms at least one day but less than 1 month

Question 10

Once a woman has had a postpartum episode with psychotic features, the risk of recurrence with each subsequent delivery is ?

Answer 10

30-50%

Question 11

What are the three subtypes of brief psychotic disorder?

Answer 11

1) Presence of a stressor
2) Absence of a stressor
3) Postpartum onset

Question 12

Baby blues

Answer 12

30-75 % women that give birth
3-5 days after delivery
duration: days to weeks

Question 13

Postpartum depression

Answer 13

10-15% women who give birth

within 3-6 months

Question 14

Features suggestive of atypical depression

Answer 14

a.ka hysteroid dysphoria
younger, more severe psychomotor slowing
more frequent comorbid panic disorder, substance abuse, and somatization
may preference to MAOi or SSRI
social phobia + avoidant personality disorder = more at risk*

Question 15

Atypical features

Answer 15

A. Mood reactivity
B. 2 of the following:
Weight gain
Hypersomnia
Leaden paralysis (heavy feelings in arms or legs)
Longstanding pattern of interpersonal rejection sensitivity

Question 16

What is a postnatal postpartum depression scale?

Answer 16

Edinburg

Question 17

Etiology of postpartum depression?

Answer 17

rapid decrease in progesterone or estrogen after childbirth

Question 18

Risk factors for Chronic or Recurrent Episodes of Depression ?

Answer 18

1-early age of onset, 2-greater # of episodes, 3-severity of index episode, 4-psych
comorbidity (+dysthymia), 5-stressful life events, 6-family psych hx, 7-lack of social
supports, 8-disruption of sleep wake cycle, 9-high neuroticism, 10-negative cognitions.

Question 19

Clinical features of bipolar disorder?

Answer 19

early age of onset
psychotic depression before age 25
postpartum depression , especially with psychotic features
rapid onset and offset of depressive episodes of short duration (< 3 months)
Seasonality
family history of bipolar disorder
repeated loss of efficacy of antidepressants
depressive mixed state

Question 20

Complications of SSRI in pregnancy ?

Answer 20

third trimester :
- respiratory distress, cyanosis
- seizures
- increased risk for persistent pulmonary hypertension of newborn
1/1000
most common is poor neonatal adaptation syndrome

Question 21

Maternal depression and link with boys?

Answer 21

more aggressive - antisocial

Question 22

Risk of relapse after 1 episode of MDD?

Answer 22

50%

Question 23

Risk of relapse after 2 episodes of MDE ?

Answer 23

70%

Question 24

Risk of relapse after 3 episodes of MDE ?

Answer 24

90%

Question 25

MDD and neuroimaging finding?

Answer 25

amygdala hyperactivity

Question 26

Memory loss in dementia

Answer 26

severe for recent vs remote events | in pseudodementia - equal for remote and recent

Question 27

Features of pseudodementia?

Answer 27

Abrupt onset Emphasis on disability Fluctuating cognitive loss

Question 28

Bipolar - Therapy guidelines:

Answer 28

Depression: Level 2/2nd line: CBT, Family focused Third line/level 2: Interpesonal and Social rhythm Maintenance: First line: psychoeducation (level I) Second line: CBT/FFT (level 2) Third line: IPSRT/Peer support (level 2)

Question 29

Sleep disturbances in depression

Answer 29

decreased sleep efficiency shortened REM latency; higher REM density decreased slow wave sleep (stage III and IV) increase in nocturnal awakenings reduction in total sleep time increased REM sleep increased core body temperature

Question 30

What do antidepressants do to REM?

Answer 30

suppress

Question 31

A major depressive episode in prepubertal child is likely to manifest by:

Answer 31

somatic complaints psychomotor agitation mood congruent hallucinations

Question 32

PMDD

Answer 32

DSM 5 Premenstrual Dysphoric Disorder criteria include 5+ of the following (present during the week before menses, improve within days of menses onset, and become minimal/absent in the week post-menses): • 1. Marked affective lability • 2. Marked irritability/anger/increased interpersonal conflicts • 3. Marked depressed mood/feelings of hopelessness/self-deprecating thoughts • 4. Marked anxiety/tension

Question 33

What does PMDD not have vs MDD ?

Answer 33

no guilt no psychomotor changes no suicidality

Question 34

Good prognostic indicators for MDD tx response?

Answer 34

mild episodes, absence of psychotic symptoms short hospital stay advance age of onset

Question 35

Poor prognosis - MDD factors?

Answer 35

-coexisting dysthymic disorder, -abuse of alcohol and other substances, -anxiety disorder symptoms, and a history of more than one previous depressive episode • -early age of onset (typically worse prognosis) • Men are more likely than women to experience a chronically impaired course.

Question 36

When to use methylphendiate in augmentation - MDD ?

Answer 36

depression | with psychomotor retardation

Question 37

Cotard syndrome?

Answer 37

``` nihilistic and hypochondriacal delusions that are most often found in psychotic depression (correct answer; Cotard’s syndrome is a nihilistic delusion in which a person believes that their possessions, friends, or parts of their own body do not exist or are about to not exist) ```

Question 38

Poor prognosis in MDD tx

Answer 38

coexistence of dysthymic disorder alcohol and substance use disorders anxiety symptom disorders

Question 39

Possible mechanisms for SSRI-associated sexual dysfunction

Answer 39

1) nonspecific neurological effects eg. sedation 2) brain systems 3) peripheral sexual organs and tissues 4) direct or indirect effects on hormones 5) SSRI mediated inhibition of NO

Question 40

Risk factors for suicide

Answer 40

``` past attempts male family hx of mental health disorder personality disorder hopelessness substance abuse anxiety ```

Question 41

Associated features of Vascular depression

Answer 41

``` less responsive to pharmacotherapy Limited depressive ideation e.g. guilt •Cognitive impairment including executive dysfunction •Psychomotor retardation •Poor insight •Absence of family or personal history of mood disorder ```

Question 42

What does collobaration not do?

Answer 42

improve clinical outcomes - NO does not result in skill transfer or enduring changes to PCP - it does = increase medication adherence Colocation is impt*

Question 43

Risk factors for self harm

Answer 43

previous self harm previous psychiatric treatment employment status marital status

Question 44

Catatonic excitement

Answer 44

Catatonic delerium

Question 45

Impulse control disorders - DSM 5

Answer 45

``` ODD Conduct Disorder Intermittent explosive disorder Kleptomania Pyromania ```

Question 46

Major depressive disorder, mixed features

Answer 46

Lurasidone | Ziprasodone