Mental Health_Depression

Question 1

What age group has the highest incidence of depression?

Answer 1

25-34 years

Question 2

What age group is twice as likely to commit suicide as the general population?

Answer 2

Elderly

Question 3

What diseases can present with depressive symptoms?

Answer 3

• Thyroid problems
• Parkinson disease
• viral illnesses
• carcinoid syndrome
• cancer (especially pancreatic cancer)
• systemic lupus erythematosus (SLE)
• cerebrovascular disease

Question 4

What are some common medications/substances that can induce depression?

Answer 4

• Alcohol
• beta-blockers
• barbiturates
• steroids
• anticonvulsants
• diuretics
• stimulant withdrawal

Question 5

What are the symptoms of major depression?

Answer 5

SIGECAPS:

• Decreased Sleep (early morning awakenings common)
• Loss of Interest
• Feelings of Guilt
• Loss of Energy
• Decreased Concentration
• Change in Appetite
• Change in Psychomotor activity
• Suicidal ideation

Question 6

How long must a person have a depressed mood (or anhedonia) in addition to at least four of the symptoms of depression in order to have a diagnosis of a major depressive episode? Two weeks

Answer 6

2 weeks

Question 7

Episodic depression occurring only during months with fewer daylight hours, and often characterized by irritability, hypersomnia, and carbohydrate craving is what subtype of major depressive disorders?

Answer 7

Seasonal affective disorder

Question 8

What is the nonpharmacologic therapy for seasonal affective disorder?

Answer 8

Light therapy

Question 9

What are the most common side effects of selective serotonin reuptake inhibitors (SSRIs)?

Answer 9

• Headache
• gastrointestinal (GI) complaints
• sexual dysfunction

Question 10

What are the most common side effects of tricyclic antidepressants (TCAs)?

Answer 10

• Sedation
• weight gain
• orthostatic hypotension
• anticholinergic side effects (dry mouth, dizziness, urinary retention, constipation)
• prolonged QT syndrome

Question 11

A patient who is on a monoamine oxidase inhibitor (MAOI) runs out of medications so she borrows her friend’s antidepressant medication (SSRI). Later, she presents to the emergency department with autonomic instability, hyperthermia, and seizures. What is the diagnosis?

Answer 11

Serotonin syndrome

Question 12

A Patient who presents three months after the loss of a loved one with feeling of guilt, mild sleep disturbance visual or auditory hallucinations of the deceased person, and weight loss is most likely experiencing what reaction?

Answer 12

normal grief or bereavement.

Question 13

If symptoms of grief, such as feeling of guilt, sleep disturbance, visual or auditory hallucination of the deceased person and weight loss, were to persist for more than a year, or involve suicidal ideation, what would be your diagnosis?

Answer 13

Abnormal grief(major depression)

Question 14

Why is it important to screen a patient for manic symptoms before starting patient on an antidepressant?

Answer 14

Antidepressants such as SSRIs can trigger a manic episode in bipolar disorder

Question 15

What are symptoms of a manic episode?

Answer 15

DIG FAST

• Distractibility
• Insomnia
• Grandiosity
• Flight of ideas
• Increased goal directed activity
• Pressured speech
• Thoughts racing.

Question 16

What is the pharmacologic treatment of bipolar I/II disorders?

Answer 16

• anticonvulsants eg carbamazepine, valproic acid
• Lithium.
• Atypical antipsychotics, Eg olanzapine, aripiprazole Risperidone.

Question 17

How does depression manifest itself differently in children as opposed to adults?

Answer 17

Children often present with irritability instead of depressed mood

Question 18

what percentage of new mothers experience postpartum depression?

Answer 18

10%

Question 19

What emergent side effect of trazodone must you warn patients about?

Answer 19

Priapism

Question 20

What does a person taking an MAOI need to avoid?

Answer 20

• Tyramine-rich foods(cheese and wine)
• Pseudoephedrine –> hypertensive crisis
• TCAs —> hyperpyrexia
• meperidine —> serotonin syndrome
• SSRIs —> serotonin syndrome

Question 21

What antidepressent is classically associated with an increased incidence of seizures?

Answer 21

• Bupropion

Question 22

What class of drugs is associated with cardiac dysrhythmias and can be lethal in overdose?

Answer 22

• TCAs (limit quantities of these drugs in potentially suicidal patients)

Question 23

Why do physicians need to closely monitor a child on an antidepressant?

Answer 23

Antidepressant use is associated with an increased risk of suicidal ideation and suicide-related behaviours in children

Question 24

What are indications for electroconvulsive therapy(ECT)?

Answer 24

• unresponsiveness to pharmacotherapy
• intolerable side effects of pharmacotherapy(elderly)
• need for rapid symptom decrease (high suicidality)

Question 25

What is the major side effect of ECT?

Answer 25

• retrograde amnesia

Question 26

What percent of patients with eating disorders have depression?

Answer 26

50-75%

Question 27

what eating disorder is characterised by a fear of and refusal to gain weight despite weighting less than 85% of expected?

Answer 27

• anorexia nervosa

Question 28

what eating disorder is characterised by a lack of control over followed by compensatory behaviour to gain weight (self-induced vomiting, misuse of medications such as laxatives, excessive exercise, fasting)?

Answer 28

• Bulimia nervosa