Mehl. Depressive disorders + NBME 10 155Q, 55Q, 138Q 04-19 (3)

Question 1

MDD. What are the SIGECAPS criteria for diagnosing depression?

Answer 1

At least 5 out of 9 must be present for at least a 2-week period.

Question 2

MDD. What does the ‘S’ in SIGECAPS stand for?

Answer 2

Sleep disturbance (insomnia or hypersomnia).

Question 3

MDD. What does the ‘I’ in SIGECAPS represent?

Answer 3

Interest loss.

Question 4

MDD. What does the ‘G’ in SIGECAPS indicate?

Answer 4

Guilt or feelings of worthlessness.

Question 5

MDD. What is represented by the ‘E’ in SIGECAPS?

Answer 5

Energy loss.

Question 6

MDD. What does the ‘C’ in SIGECAPS stand for?

Answer 6

Concentration problems.

Question 7

MDD. What does the ‘A’ in SIGECAPS refer to?

Answer 7

Appetite changes (usually causes weight loss, but sometimes weight gain).

Question 8

MDD. What does the ‘P’ in SIGECAPS signify?

Answer 8

Psychomotor agitation (restlessness; slowed speech or movements).

Question 9

MDD. What does the ‘S’ in SIGECAPS denote?

Answer 9

Suicidal ideation.

Question 10

MDD. The symptoms must cause socio-occupational impairment and must not be attributed to a substance or another medication condition.

Answer 10

.

Question 11

MDD. As far as NBME Qs go, I can say that USMLE doesn’t actually give a fuck about fulfilling the 5/9 criteria. They’ll give you an elderly male who’s a bit quiet + teary- eyed + who’s had weight loss, and the answer is just depression. Students get confused because they don’t count 5/9, but as I said, USMLE doesn’t care.

Answer 11

.

Question 12

MDD. It’s to my observation that ………. is one of the most buzzy indicators in a psych vignette that MDD is likely the answer.????

Answer 12

WEIGHT LOSS

Question 13

MDD. what regarding sleeping?

Answer 13

Terminal insomnia (patient wakes up too early in the morning) can be seen.

Question 14

MDD. what about libido? erection?

Answer 14

Can cause decr. libido, but patient still has nocturnal erections (asked on NBME).

Question 15

MDD. what medication can cause?

Answer 15

Can be caused by beta-blockers (propranolol); asked on NBME.

Question 16

MDD. Tx?

Answer 16

SSRIs, CBT, and occasionally ECT.

Question 17

Depression due to a medical condition. what is most important cause?

Answer 17

Hypothyroidism is important cause of low mood and apathy.

Question 18

Depression due to a medical condition. USMLE likes what 2 conditions as causes of depression.??

Answer 18

post-MI and cancer

Question 19

Depression due to a medical condition.
Q might give guy who’s had weight loss + teary-eyed post-MI; answer on an NBME form is just sertraline (an SSRI).

Answer 19

.

Question 20

Atypical depression. CP? budingi CP lyginant su tiesiog depresija

Answer 20

Hypersomnolence + hyperphagia in the setting of depression that is reactive / ameliorates when positive circumstances present themselves.

This latter aspect is called “mood reactivity,” where positive events of experiences can significantly improve mood; this distinguishes atypical depression from other forms of depression, where mood usually remains persistently low regardless of external circumstances.

Question 21

Atypical depression. Tx?

Answer 21

Tx = CBT, SSRIs, or monoamine oxidase inhibitors (MAOIs

Question 22

Atypical depression. Why MAOIs are not first line?

Answer 22

MAOIs are considered to be highly efficacious but are not usually used first-line because of serotonin syndrome risk (discussed later).

Question 23

Pseudodementia. definition?

Answer 23

Not actual dementia.
This is depression that presents as cognitive decline, usually in elderly.

Question 24

Pseudodementia. what abnormal test?

Answer 24

Patients with depression who have apathy will perform poorly on the MMSE.

Question 25

Pseudodementia. The Q might say the patient is unable to draw a clockface, but when prompted, is able to finish it quickly. They might also say patient remembers 0 out of 3 objects after 5 minutes.

Answer 25

.

Question 26

Pseudodementia. Look for obvious signs of depression, such as short, quiet answers, and low mood.

Answer 26

.

Question 27

Depression due to a medical condition. IN PEDS. what cause?

Answer 27

Hypothyroidism is important cause of low mood and apathy. There is 2CK Peds Q where they give Hashimoto in a 14-year-old. Can occur after severe diagnoses, e.g., ALL.

Question 28

NBME 10. 138Q. MDD symptoms disrupt everyday functioning.

Answer 28

.

Question 29

NBME 10. 138Q. The pathogenesis of MDD involves a genetic vulnerability combined with environmental stressors (eg, the death of a loved one).

Answer 29

.

Question 30

NBME 10. 138Q. MDD - most effective Tx?

Answer 30

The most effective treatment includes both psychotherapy and antidepressant medication

Question 31

NBME 10. 138Q. MDD. all patients need to be screened for what?

Answer 31

suicidal ideation.

Question 32

NBME 10. 138Q. MDD --> screening -> shows suicidal ideation. Next step?

Answer 32

If a patient endorses suicidal ideation with an active plan, then inpatient psychiatric hospitalization should be strongly considered.

Question 33

NBME 10.138Q. MDD. KITI ATS. Acute stress disorder. when occur?

Answer 33

within 1 month of a traumatic event such as physical or sexual violence.

Question 34

NBME 10.138Q. MDD. KITI ATS. Acute stress disorder. CP?

Answer 34

Intrusive thoughts or memories, changes in arousal and reactivity (eg, hypervigilance), avoidance of reminders of trauma, and negative mood/thoughts.

Question 35

NBME 10.138Q. MDD. KITI ATS. Adjustment disorder with depressed mood. onset?

Answer 35

Onset of disproportionate distress within 3 months of an identifiable stressor with associated depressive symptoms. do not experience a sufficient number of depressive symptoms to satisfy MDD criteria.

Question 36

NBME 10.138Q. MDD. KITI ATS. Dysthymic disorder (or persistent depressive disorder). definition/CP?

Answer 36

At least three depression symptoms (including depressed mood during more days than not) that have endured for at least 2 years. do not experience a sufficient number of depressive symptoms to satisfy MDD criteria.

Question 37

NBME 10.138Q. MDD. KITI ATS. Normal bereavement (Choice E), or uncomplicated grief reaction. duration?

Answer 37

Symptoms typically endure less than 6 months. do not experience a enough depressive symptoms to satisfy MDD criteria.

Question 38

NBME 10.138Q. MDD. KITI ATS. Normal bereavement (Choice E), or uncomplicated grief reaction. CP?

Answer 38

Include sadness, shock, anguish, guilt, regret, difficulty concentrating, decreased interest in usual activities, preoccupation with thoughts and memories of the deceased, and neurovegetative symptoms such as sleep, appetite, and energy disturbances.

Question 39

NBME 10. 155Q. MDD. kiti ats.

Question 40

NBME 10. 155Q. MDD. kiti ats. Generalized anxiety disorder. CP?

Answer 40

excessive and difficult to control worrying, hyperactivity, disordered sleep, fatigue, and trouble relaxing for at least 6 months.

Question 41

NBME 10. 155Q. MDD. kiti ats. Generalized anxiety disorder. duration at least?

Answer 41

least 6 months.

Question 42

NBME 10. 155Q. MDD. kiti ats Primary insomnia or psychophysiological insomnia. definition?

Answer 42

Refers to difficulty sleeping that is related to psychological barriers to sleep rather than secondary to medical problems or other psychiatric diagnoses. in the case: This patient’s insomnia is likely secondary to MDD.

Question 43

NBME 10. 55Q. Persistent depressive disorder (dysthymia). Definition?/CP. duration?

Answer 43

At least three depression symptoms that have endured for at least 2 years

Question 44

NBME 10. 55Q. Persistent depressive disorder (dysthymia). By definition, patients must experience a depressed mood on more days than not. Other symptoms of persistent depressive disorder include neurovegetative symptoms (decreased energy, sleep disturbances, appetite disturbances), impaired concentration, low self-esteem, and hopelessness.

Answer 44

.

Question 45

NBME 10. 55Q. Persistent depressive disorder (dysthymia). By definition, persistent depressive disorder symptoms must lead to clinically significant distress or impaired social or occupational functioning (eg, interpersonal friction).

Question 46

NBME 10. 55Q. Persistent depressive disorder (dysthymia). Mx?

Answer 46

Should be managed similarly to MDD: antidepressant medication plus psychotherapy is most effective. SSRI are generally the first-line medications given their low adverse effect burden.

Question 47

NBME 10. 55Q. Persistent depressive disorder (dysthymia). KITI ATS. Adjustment disorder with depressed mood. ONSET?

Answer 47

disproportionate distress within 3 months of an identifiable stressor with associated depressive symptoms

Question 48

NBME 10. 55Q. Persistent depressive disorder (dysthymia). KITI ATS. Substance-induced mood disorder. Definition? in case patient used heroin.

Answer 48

mood disturbance that developed during or within a month of intoxication with or withdrawal from a substance. This patient’s depressed mood preceded his cocaine use and therefore is unlikely to be secondary to cocaine use.

Question 49

NBME 10. 55Q. Persistent depressive disorder (dysthymia). KITI ATS. Borderline personality disorder. CP?

Answer 49

Is a cluster B personality disorder, the emotional or dramatic cluster, that features an unstable sense of self, unstable emotions, and tumultuous relationships. In case: his mood has been persistently depressed rather than unstable.

Question 50

what respiratory pathology is HY for depresion?

Answer 50

Obstructive sleep apnea is another HY cause of depression.

Question 51

M. Dysthymia. definition?

Answer 51

At least 2 years of depressed mood without fulfilling MDD criteria

Question 52

M. Cyclothymia. definition?

Answer 52

At least 2 years of oscillation between depressed mood and hypomania (discussed below).