Mental Health

Question 1

DSM criteria for major depressive episode, duration of symptoms

Answer 1

2 weeks

Question 2

Patient with major depressive episode must have 1 of two symptoms

Answer 2

1) depressed mood

2) diminished interest

Question 3

DSM criteria for Dysthymia/ PDD and duration of symptoms

Answer 3

Depressed mood for most of the day, for more days than not, for at least 2 years
During 2 year period, individual has never been without symptoms in A or B for more than 2 months at a time

Presence, while depressed, of ≥2 of the following:
A - Poor appetite or overeating

S - Insomnia or hypersomnia

E - Low energy or fatigue

G - Low self-esteem

C - Poor concentration or difficulty making decisions

I - Feelings of hopelessness

Question 4

All of the following are risk factors for:

• hormonal changes
• chronic pain
• female sex
• CV disease
• chronic illness
• insomnia
• somatic concerns

Answer 4

Depression

Question 5

3 top DDx for depression in older adults

Answer 5

Chronic pain
Anemia
Endocrine (thyroid)

Question 6

What medical conditions are associated with depression

Answer 6

COPD
Migraine
MS
Back pain
Cancer
Epilepsy
Asthma
Stroke
Thyroid
DM
Heart dx

Question 7

What risk assessment must be included with all patients with depression

Answer 7

suicide risk assessment

Question 8

Non-modifiable RF for suicide

Answer 8

S – Sex: 1 if male; 0 if female; (more females attempt, more males succeed)
A – Age: 1 if < 20 or > 44
D – Depression: 1 if depression is present
P – Previous attempt: 1 if present
E –Ethanol abuse: 1 if present
R – Rational thinking loss: 1 if present
S – Social Supports Lacking: 1 if present
O – Organized Plan: 1 if plan is made and lethal
N – No Spouse: 1 if divorced, widowed, separated, or single
S – Sickness: 1 if chronic, debilitating, and severe

Question 9

True/False

Older adults are more likely to die from attempted suicide

Answer 9

True

Question 10

What diagnostic tests are indicated for TCA for depression

Answer 10

ECG, postural VS

Question 11

All of the following are RF for what class of medication?

• Activation of mania or hypomania
• Bleeding risk
• Fragility fractures
• Hyponatremia
• Ocular effects (acute angle-closure glaucoma)
• QT prolongation

Answer 11

SSRI

Question 12

What two classes of medications for depression increase HR and BP?

Answer 12

SNRI

Buproprion

Question 13

What medications for depression lower seizure threshold?

Answer 13

Citalopram
Escitalopram
Buproprion

Question 14

MOA of Bupropion

Answer 14

dopaminergic and norepinephrine reuptake inhibitor because it inhibits the presynaptic reuptake and dopamine and norepinephrine.

Question 15

True/False

Bupropion is metabolized in the liver by cytochrome P450 enzyme

Answer 15

True

Question 16

Risk factors for SIADH with SSRIs

Answer 16

risk factors include adults >65 years, female sex, low weight, diuretic use, low baseline sodium levels, and the use of other medications that may cause SIADH. within first 2 weeks of starting SSRI

Question 17

S&S of hyponatremia

Answer 17

anorexia, fatigue, and confusion

Severe - seizures, coma, and death

Question 18

Withdrawal symptoms SSRI

Answer 18

FINISH acronym (flu-like symptoms x 10 days

Flu-like symptoms

Insomnia

Nausea

Imbalance

Sensory disturbances

Hyperarousal

Question 19

Tapering for SSRI

Answer 19

SSRI’s decrease no more than 25%/week

Question 20

S&S of serotonin syndrome

Answer 20

Shivering:

Hyperreflexia and Myoclonus:

Increased Temperature:

Vital Sign Abnormalities: Tachycardia, tachypnea, and labile blood pressure

Encephalopathy: Mental status changes such as agitation, delirium, and confusion

Restlessness:

Sweating:

Question 21

Complimentary medicines 1st or 2nd line for MDD

Answer 21

Exercise - Minimum 30 min moderate intensity exercise 3x/week . Duration: 9 weeks

Light therapy - 30 min/day in early morning daily . Duration: up to 6 weeks
.Results in 1-3 weeks.

Yoga (2nd line) 2-4 sessions weekly

St John’s Wort **MANY medication interactions including warfarin, oral contraceptives, SSRIs, digoxin, anticonvulsants. very long list
**risk of serotonin syndrome and hypomania with SSRIs and triptans

Omega 3 - 2nd line
SAM-3 - 2nd line

Question 22

What is the proposed mechanism for why light therapy works as a treatment for depression?

Answer 22

Essentially, there are receptors in the eye (melanopsin) that are photosensitive. They may inhibit breakdown of serotonin into melatonin by the pineal gland when stimulated.