Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Hung's Board Topics > Mood > Flashcards

Mood Flashcards

1
Q 
All of these people were involved in distinguishing unipolar depression from bipolar disorders except?
A. Kraepelin
B. Angst
C. Leonhard
D. Perris
A

Answer: A. Kraepelin (Psychiatry: 12,000 Questions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q 
Melancholia is also known as:
A. Reactive depression
B. Exogenous depression
C. Endogenous depression
D. Psychotic depression
E. Masked depression
A

Answer: C. Endogenous depression (Psychiatry: 12,000 Questions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q 
All of the following are features of endogenous depression EXCEPT:
A. Lack of appetite
B. Irritability
C. Weight loss
D. Psychomotor retardation
E. Anhedonia
A

Answer: B. Irritability (Psychiatry: 12,000 Questions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q 
One-year prevalence of bipolar affective disorder is
A. 3%
B. 2%
C. 1%
D. 5%
E. 10%
A

Answer: C. 1%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q 
When compared to patients with unipolar disorder, patients with bipolar disorder have:
A. Less genetic loading
B. Greater genetic loading
C. The same genetic loading
D. No genetic loading
A

Answer: B. Greater genetic loading

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

According to DSM-IV, rapid-cycling bipolar disorder is characterized by:
A. Four or more mood episodes per year
B. Four or more mood episodes per month
C. Four or more episodes of mania or hypomania in a year
D. Four or more episodes of depression per year

A

Answer: A. Four or more mood episodes per year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

All of the following are features of rapid-cycling bipolar disorder EXCEPT:
A. Four or more mood episodes per year
B. More common in women
C. Occurs early in the course of illness
D. Usually resistant to treatment with lithium
E. Antidepressant-induced hypomania

A

Answer: C. Occurs early in the course of illness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q 
All of the following medications are approved by the FDA for bipolar affective disorder EXCEPT:
A. Lithium
B. Valproic acid
C. Olanzapine
D. Lamotrigine
E. Carbamazepine
A

Answer: E. Carbamazepine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q 
The dose of lamotrigine should be lower than the usual dose, if lamotrigine is used in combination with:
A. Valproic acid
B. Escitalopram
C. Olanzapine
D. Lithium
E. Sertraline
A

Answer: A. Valproic acid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q 
Evidence exists for the effectiveness of all of the following antiepileptics as mood stabilizers EXCEPT:
A. Valproic acid
B. Gabapentin
C. Lamotrigine
D. Carbamazepine
E. Oxcarbamazepine
A

Answer: B. Gabapentin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

One of the primary reasons for slow titration of lamotrigine when it is used in treatment of bipolar disorder is:
A. Hypotension
B. Rash leading to Stevens-Johnson syndrome
C. Extrapyramidal side effects
D. Sedation
E. Toxicity

A

Answer: B. Rash leading to Stevens-Johnson syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q 
Which of the following drugs has been shown to decrease the suicide rate?
A. Carbamazepine
B. Olanzapine
C. Sertraline
D. Lithium
E. Valproic acid
A

Answer: D. Lithium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q 
All of the following are indicators of good response to lithium EXCEPT: 
A. Family history of bipolar disorder
B. Good baseline functioning
C. Nonrapid cycling
D. Mixed episode
A

Answer: D. Mixed episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q 
Studies have shown that relapse of bipolar disorder after discontinuation of lithium is
A. 10% in 1 year
B. 50% in 1 year
C. 50% in 6 months
D. 20% in 6 months
E. 50% in 2 years
A

Answer: C. 50% in 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q 
According to an ECA study, the lifetime prevalence of depressive illness is:
A. 13%
B. 70%
C. 40%
D. 6%
E. 3%
A

D. 6%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

According to Brown and Harris, all of the following are vulnerability factors for depression in women EXCEPT:
A. Loss of mother before the age of 11
B. Three or more children under the age of 15
C. Lack of work outside the house
D. Lack of anyone in whom to confide
E. Living in a homeless shelter

A

E. Living in a homeless shelter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q 
Who proposed the theory of “learned helplessness” to explain depression?
A. Wolpe
B. Seligman
C. Freud
D. Beck
E. Kraepelin
A

B. Seligman

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q 
The “negative cognitive triad” was proposed by Beck to explain:
A. Anxiety
B. Depression
C. Bereavement reaction
D. Adjustment disorder
E. Post-traumatic stress disorder
A

B. Depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q 
A 67-year-old woman with depression and anxiety is prescribed paroxetine and clonazepam by her primary care physician. She also has a history of seizure disorder, which has been stable with phenytoin for many years. A few weeks after she begins taking paroxetine and clonazepam, the patient complains of unsteady gait. Which of the following is the most common cause of ataxia in this patient?
A. Paroxetine
B. Clonazepam
C. Phenytoin
D. Phenytoin toxicity
E. All of the above
A

B. Clonazepam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

All of the following are true about carbamazepine EXCEPT:
A. Can cause SIADH
B. Induces its own metabolism
C. Eliminated by extrahepatic metabolism
D. Reduces levels of valproic acid
E. Toxicity is not accurately indicated by plasma level

A

C. Eliminated by extrahepatic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q 
The following are recognized side effects of lithium at therapeutic dose except
A. Thirst
B. Fine tremors
C. Polydipsia
D. Diplopia
E. Erectile dysfunction
A

D. Diplopia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

A 36-year-old White male patient has been stable on lithium for bipolar illness for the past 4 years. During his routine visit with his primary care provider, he complains of feeling weak and lacking motivation and energy. He also says that he has been feeling particularly cold this winter and wonders if he is getting depressed again. The primary care provider should
A. Diagnose depression and start the patient on antidepressants
B. Obtain the patient’s lithium levels
C. Check TSH levels
D. Discontinue lithium
E. Refer the patient to a psychiatrist immediately

A

C. Check TSH levels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

A 23-year-old woman is diagnosed with schizophrenia, paranoid type, following a first episode of psychosis and is started on an atypical antipsychotic. She is worried that the antipsychotics will cause weight gain. Which of the following is the most accurate statement regarding weight gain and antipsychotics?
A. There is no significant weight gain with antipsychotics.
B. Weight gain occurs mainly in the first 2 months.
C. Weight gain is related to the patient’s pretreatment BMI.
D. All antipsychotics cause the same amount of weight gain.
E. Weight gain is associated with clinical improvement.

A

C. Weight gain is related to the patient’s pretreatment BMI.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q 
Which of the following antipsychotics also has an antidepressant effect?
A. Flupenthixol
B. Chlorpromazine
C. Haloperidol
D. Trifluperazine
E. Fluphenazine
A

A. Flupenthixol (Also Amoxapine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q 
Peripheral neuropathy is a side effect of:
A. SSRI
B. TCA
C. SNRI
D. MAOI
E. NRI
A

D. MAOi (due to pyridoxine deficiency)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q 
A 48-year-old male patient with difficult-to-treat depression has tried all the antidepressants except MAOIs. He is currently on an SSRI. Which of the following SSRIs needs the longest washout period before switching a patient to an MAOI?
A. Paroxetine
B. Fluoxetine
C. Citalopram
D. Sertraline
E. Escitalopram
A

B. Fluoxetine (half life is 5-7 days; needs 5 weeks for washout before starting MAOi)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q 
Which of the following tricyclic antidepressants closely resembles an SSRI in its action mechanism?
A. Amitriptyline
B. Nortriptyline
C. Imipramine
D. Clomipramine
E. Doxepine
A

D. Clomipramine (Has strong serotonin reuptake inhibition effect)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q 
Which of the following antidepressant blocks reuptake of dopamine?
A. Venlafaxine
B. Bupropion
C. Buspirone
D. Mirtazapine
E. Fluoxetine
A

B. Bupropion (blocks reuptake of both adrenaline and dopamine; improves psychomotor retardation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q 
Which of the following can cause depression?
A. Methyldopa
B. Procyclidine
C. Tryptophan
D. Flupenthixol
E. Testosterone
A

A. Methyldopa (an antihypertensive, converted to alphamethylnoradrenaline in the central presynaptic neurons, acting as a false neurotransmitter; This reduces overall noradrenergic neurotransmission to the postsynaptic neurons, resulting in depression)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q 
Which of the following is used as an augmenting agent in the treatment of depression?
A. Propranolol
B. Pindolol
C. Metaprolol
D. Sotalol
E. Labetolol
A

B. Pindolol (5HT1A antagonist, is used as an augmenting agent in the treatment of depression, particularly with SSRIs.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q 
Which of the following are risk factors for tardive dyskinesia?
A. Old age
B. Diffuse brain damage
C. Duration of antipsychotic treatment
D. Affective psychosis
E. All of the above
A

E. All of the above (Having an affective psychosis increases the risk of tardive dyskinesia. Increasing age is a much stronger risk factor for men than women)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

All of the following are true about antidepressant discontinuation syndromes EXCEPT:
A. More common with short half-life drugs
B. Are caused by most antidepressants
C. May be caused by abrupt discontinuation of antidepressants
D. Indicate that the patient is dependent on these medicines
E. Cause irritability, insomnia, and restlessness

A

D. Indicate that the patient is dependent on these medicines

(Patients on antidepressants do not show evidence of tolerance, compulsive desire to take the drug, or difficulty controlling the level of use despite knowledge of harmful effects, etc.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

All of the following are true about eszopiclone EXCEPT:
A. Can cause tolerance
B. Binds preferentially to BDZ receptors
C. Is a benzodiazepine derivative
D. Dose should be reduced by half in elderly patients.
E. Dependence can be an issue if the drug is prescribed for long periods.

A

C. Eszopiclone is a cylopyrrolone and not a benzodiazepine derivative.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

All of the following are true about dystonia EXCEPT:
A. More common in men than in women
B. More common in younger than older patients
C. Is more common than akathisia in patients treated with neuroleptics
D. Treated with lorazepam or diphenhydramine hydrochloride
E. Can cause trismus

A

C. Is more common than akathisia in patients treated with neuroleptics

(Acute dystonia is usually seen in the first few days after starting neuroleptics, although it can occur anytime. Akathisia, which is a subjective sense of psychomotor restlessness, is more common than acute dystonia.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q 
A 37-year-old man is admitted to an acute psychiatric unit for psychosis and agitation, where he is prescribed haloperidol 10 mg IM. Later in the evening, the resident on call is summoned because the patient is noticed to be having rigidity and fever. The resident suspects neuroleptic malignant syndrome (NMS). Which of the following is NOT a feature of NMS?
A. Clear consciousness
B. Rigidity
C. Elevated temperature
D. Leukocytosis
E. Elevated CK
A

A. Clear consciousness

(Altered sensorium is a common feature with confusion or delirium. NMS is an emergency and needs aggressive treatment. Mortality is high if untreated.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q 
All of the following drugs are effective in the treatment of the acute phase of mania EXCEPT:
A. Lithium
B. Lamotrigine
C. Olanzapine
D. Valproic acid
E. Haloperidol
A

B. Lamotrigine

(Lamotrigine, although one of the drugs approved for the treatment of bipolar disorder, is not effective for the treatment of acute mania. Lamotrigine has to be started in a small dose and has to be titrated gradually over the next few weeks. Data exists about its utility in improving bipolar depression.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Venlafaxine acts as an antidepressant by:
A. Inhibiting the reuptake of dopamine
B. Antagonizing H1 receptors
C. Inhibiting the reuptake of serotonin and noradrenaline
D. Stimulating the glutamate receptors
E. Inhibiting the GABA receptors

A

C. Inhibiting the reuptake of serotonin and noradrenaline

acts in dose dependent manner

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

All of the following are true about cyproterone acetate EXCEPT:
A. Used sometimes in the treatment of sexually disinhibited behavior in the context of mental illness
B. Decreases the erectile response to stimulation
C. Can be given orally or intramuscularly
D. More effective in older men
E. Has been used to control sexual disinhibition in mentally retarded people

A

D. More effective in older men

(it reduces sex drive in men who have excessive sex drive and for the treatment of pronounced sexual aggression. It is also prescribed to treat severe hirsutism in women of childbearing age as well as to treat androgenic alopecia in women. Like cimetidine and other similar drugs, cyproterone acetate exerts its effect by blocking binding of dihydrotestosterone (DHT) to its receptors. Cyproterone acetate is found to be most effective in individuals with high testosterone and high sex drive, i.e., young people.)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q 
A 36-year-old woman is diagnosed with bipolar illness and, after a discussion of the risks and benefits, she agrees to take lithium. The psychiatrist advises her to undergo a few tests before starting lithium. All of the following are relevant in this patient EXCEPT:
A. Pregnancy test
B. TSH
C. Urea and creatinine
D. ECG
E. Liver function tests
A

E. Liver function tests

eliminated almost entirely by the kidneys and does not undergo any hepatic metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

A 68-year-old man is admitted to an acute psychiatric unit for severe suicidal ideation. He is very much preoccupied with death and refuses to agree to a contract for safety. The diagnostician determines the patient to be severely depressed because of noncompliance with medication and severe social stressors. The patient refuses to take any medication because, he says, “Nothing will change, anyway.” He also stops eating and drinking and becomes increasingly dehydrated. A reasonable choice of treatment in this patient would be to
A. Persuade the patient to take antidepressants
B. Wait and watch for the patient to change his mind
C. Restrain the patient and administer intravenous fluids
D. Prescribe electroconvulsive therapy
E. Prescribe intensive psychotherapy

A

D. Prescribe electroconvulsive therapy

This elderly patient has major depressive disorder, severe, with suicidal ideation. His deteriorating physical health is a real cause of concern and so is his severe suicidal ideation. To obtain response quickly, electroconvulsive treatment is a reasonable option in this patient.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q 
A 48-year-old man with treatment-resistant schizophrenia has been relatively stable for the past 6 months on clozapine. On a routine follow-up visit, the patient is observed to be depressed and reports lack of appetite and insomnia, among other features of depression. The attending psychiatrist decides to treat the patient with antidepressants. Which of the following antidepressants would mandate particular caution in this patient?
A. Mirtazapine
B. Fluoxetine
C. Sertraline
D. Citalopram
E. Trazodone
A

A. Mirtazapine

Mirtazapine can cause neutropenia and agranulocytosis and should be used with caution in patients who are being treated with clozapine.

42
Q 
A 28-year-old woman is being assessed for bipolar disorder. She complains of mood swings from time to time ranging from “tearfulness to feeling really good.” On further questioning, she reveals that she has not been able to maintain any relationships because of her mood swings and feels empty. She fears abandonment by her friends because of her mood swings but also blames everyone for her “current state.” The most important differential diagnosis in this patient is:
A. Major depressive disorder
B. Borderline personality disorder
C. Histrionic personality
D. Depressive personality
E. Generalized anxiety disorder
A

B. Borderline personality disorder

(borderline personality disorder may be very difficult to distinguish from bipolar disorder. Intense mood swings are common in borderline personality, and persons with borderline personality do not have any sustained periods of normal mood in between episodes as seen in bipolar disorder. The patient in question has other traits of borderline personality, including unstable relationships, feelings of emptiness, and fear of abandonment.)

43
Q 
A 54-year-old with a history of coronary artery disease is diagnosed with psychosis NOS and treatment with an atypical antipsychotic, ziprasidone, is considered. The pharmacist requests an ECG before she can dispense ziprasidone. The most important thing to look at on the ECG is:
A. QTc interval
B. Heart rate
C. Signs of ischemia
D. Signs of old infarction
E. Signs of hypokalemia
A

A. QTc interval

Ziprasidone is known to cause prolongation of QT interval (prolonged QT interval predisposes to arrhythmias)

44
Q 
Which of the following SSRIs is least likely to cause discontinuation syndrome?
A. Sertraline
B. Citalopram
C. Escitalopram
D. Paroxetine
E. Fluoxetine
A

E. Fluoxetine

All the SSRIs with the exception of fluoxetine can cause discontinuation syndrome because of their short half-life. Norfluoxetine, the active metabolite of fluoxetine, has a half-life of 5 to7 days and “tapers off” on its own.

45
Q

A 32-year-old woman is admitted to an acute psychiatric inpatient unit for severe depression. The patient has been ruminating about suicide and guilt feelings. She believes that she has committed a sin and deserves to be punished. The resident physician thinks that the patient is obsessed with thoughts of guilt and suspects that patient has a primary obsessional disorder. The attending psychiatrist explains that patient is not obsessional but severely depressed because
A. The patient has suicidal ideation.
B. The patient has indeed committed a sin.
C. The patient is not distressed by the guilt feelings and is mood congruent.
D. The psychiatrist thinks so.
E. Antidepressants alone were not effective.

A

C. The patient is not distressed by the guilt feelings and is mood congruent.

This patient is convinced that she has committed a sin and has guilt feelings about it. The feelings are mood congruent and the patient is not distressed by these thoughts and does not resist them. In patients who are depressed and delusional like this, a low-dose antipsychotic is often necessary.

46
Q 
A 54-year-old woman is diagnosed with seasonal affective disorder and light therapy is prescribed. Ideally the intensity of the light should be
A. 1,000 lux
B. 10,000 lux
C. 100,000 lux
D. 500 lux
E. 5,000 lux
A

B. 10,000 lux

47
Q 
A 36-year-old man is treated for depression with an SSRI. He has a less than full recovery despite taking the highest recommended dose of the SSRI. The attending psychiatrist is considering using an augmenting agent. All of the following can be used EXCEPT:
A. Thyroxine
B. Lithium
C. Tryptophan
D. Propranolol
E. Pindolol
A

D. Propranolol

Propranolol is a beta-blocker and in fact can worsen the depression. Pindolol is a 5HT1A antagonist and is used as an augmenting agent in conjunction with an SSRI.

48
Q

Which of the following support the serotonin deficiency hypothesis of depression?
A. Decreased 5HT platelet uptake
B. Decreased plasma tryptophan levels
C. Decreased 5HIAA levels in CSF
D. Blunted 5HT1 mediated prolactin release in response to L-tryptophan
E. All of the above

A

E. All of the above

49
Q

All of the following support the norepinephrine deficiency hypothesis of depression EXCEPT:
A. Decreased norepinephrine mediated release of growth hormone in response to clonidine
B. Decreased cAMP turnover in platelets following stimulation with clonidine
C. Increased platelet alpha 2 adrenergic receptor binding
D. Increased beta adrenergic receptors in depression and suicides
E. Decreased levels of cAMP in CSF

A

E. Decreased levels of cAMP in CSF

Deficiency of norepinephrine has long been thought to be the cause of depression. The efficacy of antidepressants, which specifically inhibit the reuptake of norepinephrine, supports this theory. There is no evidence relating to abnormal cAMP levels in CSF.

50
Q

One of the consistent findings in depression, cortisol secretion abnormality, can be explained by
A. Primary hypersecretion of cortisol
B. Primary hypersecretion of ACTH
C. Primary hypersecretion of CRF by hypothalamus
D. Positive dexamethasone test
E. Higher incidence of adrenal tumors in depression

A

C. Primary hypersecretion of CRF by hypothalamus

Primary hypersecretion of cortocotropin-releasing factor (CRF) by the hypothalamus results in increased secretion of ACTH, which in turn leads to elevated cortisol levels. There is no evidence to suggest there is primary hypersecretion of either ACTH or cortisol. Dexamethasone suppression test is positive in 50% of depressed patients and is secondary to increased cortisol levels.

51
Q

All of the following are true regarding sodium and mood disorders EXCEPT
A. Increased “residual sodium” found in some patients with depression
B. Decreased “residual sodium” found in some patients with mania
C. Increased sodium pump activity in the erythrocytes of drug-free manic patients
D. Increased Na-K pump activity on recovery from depression
E. Increased Na-K pump activity on recovery from mania

A

B. Decreased “residual sodium” found in some patients with mania

Increased “residual sodium” is observed in manic patients, too. The relationship between sodium levels and mood disorders is not well understood, but these are some of the abnormalities found.

52
Q

According to psychoimmunology, patients with depression are generally more prone to other illnesses because:
A. Patients with depression do not take care of themselves.
B. Patients with depression do not get adequate care because they have mental illness.
C. Antibiotics are not as effective in depressed patients compared to other patients.
D. Hypothalamic-pituitary-adrenal dysfunction causes immune suppression.
E. Replication of T cells is increased in these patients.

A

D. Hypothalamic-pituitary-adrenal dysfunction causes immune suppression.

HPA axis dysfunction leads to increased cortisol level, which is thought to be responsible for various immune system abnormalities found in depression.

53
Q 
All of the following immunologic abnormalities are found in depression EXCEPT
A. Decreased natural killer cells
B. Decreased interleukin 2
C. Decreased absolute neutrophil count
D. Decreased T-cell replication
E. Increased monocyte activity
A

C. Decreased absolute neutrophil count

Absolute neutrophil count is found to be normal in depressed patients. All the other abnormalities mentioned above are thought to be secondary to abnormal HPA axis.

54
Q

A 39-year-old man being treated for major depressive disorder complains of persistent sleep problems since the onset of depression. He is otherwise healthy and does not have any physical health problems. He is referred for a sleep study. The EEG is likely to show all of the following EXCEPT
A. Decrease in the total duration of deep sleep
B. Increase in the total duration of REM sleep
C. Decrease in the latency to the onset of REM sleep
D. Increased latency to the onset of REM sleep
E. Impaired sleep continuity

A

D. Increased latency to the onset of REM sleep

In depressive disorder, there is a decrease in the latency to the onset of rapid eye movement (REM) sleep and an increase in the total duration of REM sleep. Slow-wave deep sleep is decreased, and patients do not feel refreshed when they wake up in the morning.

55
Q

All of the following are found in brain imaging studies of persons with depression EXCEPT
A. Decreased volume of the parietal lobes
B. Decreased volume of the frontotemporal lobes
C. Decreased caudate size
D. Increased ventricular size
E. Decreased blood flow in the dorsolateral prefrontal cortex

A

A. Decreased volume of the parietal lobes

Brain imaging studies have shown no consistent abnormalities in the parietal lobes of patients with depression.

56
Q

The criterion for unintended weight loss used in diagnosis of depression is
A. Loss of any amount of weight
B. Loss of 5% or more of the body weight in the past month
C. Loss of 10% or more of body weight in the past month
D. Loss of 10% of body weight in the past 2 weeks
E. Loss of 5% of the body weight in the past 2 weeks

A

B. Loss of 5% or more of the body weight in the past month

57
Q 
“Agitated depression” is a term more commonly used to describe depression in
A. Young children
B. Adolescents
C. Adults
D. Women
E. The elderly
A

E. The elderly

Depression tends to present differently in different people. Irritability may be the predominant symptom in adolescents, while agitation is a common symptom in the elderly.

58
Q 
All of the following are features of “atypical depression” except
A. Intense, unstable emotions
B. Increased appetite
C. Increased sleep
D. Mood reactivity
E. Rejection sensitivity
A

A. Intense, unstable emotions

Intense, unstable emotions are more characteristic of borderline personality disorder than atypical depression.

59
Q 
An obese 24-year-old woman is admitted to the psychiatry inpatient unit following an overdose of Tylenol. She has a history of being impulsive and on occasion has induced vomiting, but these instances were not frequent enough to warrant diagnosis of an eating disorder. Over the course of the next few days of observation, the psychiatrist determines that she is depressed and the treatment team debates over the choice of antidepressants. Which of the following would be the most appropriate in this patient?
A. Mirtazapine
B. Bupropion
C. Venlafaxine
D. Citalopram
E. Amitriptyline
A

D. Citalopram

For a patient who is impulsive, amitriptyline, venlafaxine, or bupropion is not a good choice because of the risk of overdose. Mirtazapine can cause significant weight gain and therefore is not indicated when the patient is already obese. Citalopram is one of the SSRIs, which are relatively safe and effective antidepressants.

60
Q

What does the term “double depression” describe?
A. Major depressive disorder superimposed on grief reaction
B. Major depressive disorder superimposed on dysthymia
C. Major depressive disorder not responding to treatment
D. Major depressive disorder with psychosis
E. Major depressive disorder with anxiety

A

B. Major depressive disorder superimposed on dysthymia

61
Q 
How many categories of unipolar depressive disorder are listed by DSM-IV?
A. 4
B. 3
C. 6
D. 10
E. 5
A

B. 3

DSM-IV lists three categories of unipolar depressive disorders: major depressive disorder, dysthymia, and depressive disorder not otherwise specified (NOS).

62
Q 
According to DSM-IV, for a diagnosis of major depressive disorder, the symptoms should be present for a minimum of
A. 2 months
B. 6 weeks
C. 4 weeks
D. 2 weeks
E. 6 months
A

D. 2 weeks

DSM-IV specifies that five or more of the symptoms should be present for at least 2 weeks and one of the symptoms should be depressed mood or loss of interest or pleasure. Other symptoms are lack of appetite, weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, guilt, lack of concentration, suicide ideation, and suicide attempt.

63
Q

All of the following statements are true regarding mood disorders EXCEPT
A. The interepisode duration in bipolar I disorder increases as the illness progresses.
B. The interepisode duration in bipolar I disorder decreases as the illness progresses.
C. The interepisode duration stabilizes at around 6 to 9 months after five or six episodes.
D. The average duration of an episode is about 6 months in recurrent depression.
E. Men have more manic episodes on average, and women have more depressed episodes on average.

A

A. The interepisode duration in bipolar I disorder increases as the illness progresses.

64
Q

A 34-year-old African American man is admitted to an inpatient psychiatry unit following a suicide attempt. The patient reports many symptoms consistent with major depressive disorder, including lack of interest, feelings of guilt, insomnia, and difficulty concentrating. He states that recently he has been hearing voices telling him that only he can save the world because he has a special gift from God. All of the following support a diagnosis of major depressive disorder, severe, EXCEPT
A. Voices telling him that he has a special gift
B. Insomnia
C. Fatigue
D. Guilt
E. The suicide attempt

A

A. Voices telling him that he has a special gift

DSM-IV specifies that mood-incongruent delusions or hallucinations should not be included to support a diagnosis of major depressive disorder. All the other features listed above support a diagnosis of major depressive disorder.

65
Q

A 56-year-old woman is seen in a psychiatry outpatient clinic because she reports she is “not being able to function.” She reports feeling rejected all the time and complains of depressed mood. She also complains of lack of appetite and feeling of heaviness in the arms and legs. She reports sleeping up to 15 hours every day over the past few weeks. Her affect is observed to be reactive when she states that her mother is coming to see her in two weeks. The most appropriate diagnosis is
A. Major depressive disorder, severe
B. Borderline personality disorder
C. Major depressive disorder with atypical features
D. Generalized anxiety disorder
E. Malingering

A

C. Major depressive disorder with atypical features

Features of atypical depression include reactive mood, increase in appetite or gain in weight, hypersomnia, leaden paralysis, and sensitivity to interpersonal rejection. In the vignette, there is nothing to suggest that this patient has borderline personality disorder or generalized anxiety disorder or is malingering.

66
Q 
A 24-year-old woman is referred to a psychiatrist by her primary care physician for assessment of depression. The mother of a 4-month-old infant, she reports feeling depressed for the past few weeks. The diagnosis of major depressive disorder with postpartum onset is made if the onset of symptoms is within how many weeks of delivery?
A. 2 weeks
B. 8 weeks
C. 10 weeks
D. 6 weeks
E. 4 weeks
A

E. 4 weeks

67
Q 
According to DSM-IV, for a mixed manic episode, criteria for both major depressive disorder and mania should be present every day for:
A. 1 day
B. 1 week
C. 1 month
D. 3 days
E. 2 months
A

B. 1 week

68
Q

All of the following statements are true of the epidemiology of depression EXCEPT:
A. The rates are equal in men and women after the age of 50 years.
B. Women are twice as affected as men between puberty and 50 years.
C. Girls are four times more affected than boys before puberty.
D. Point prevalence of depression is 2-3% for men and 5-9% for women.
E. Increased rates of depression have been observed over the past 4 to 5 decades.

A

C. Girls are four times more affected than boys before puberty.

In the prepubertal age groups, it is the boys who are more prone to depression than girls. However, the lifetime prevalence of depression is almost twice as high in women as in men, and this is thought to be secondary to high estrogen levels in women.

69
Q

All of the following are true about the course of a major depressive disorder EXCEPT:
A. Five to 10 percent of persons with a single episode will eventually develop bipolar disorder.
B. Thirty percent of patients recover within 6 months with or without treatment.
C. The recurrence rate is high, especially after two or more episodes.
D. Sudden onset of depression is usually associated with a severe psychosocial stressor.
E. The interepisode interval is less with an increasing number of episodes.

A

B. Thirty percent of patients recover within 6 months with or without treatment.

Up to 50% of patients recover from a depressive episode within 6 months with or without treatment. Recurrence of depression is as high as 80% after three episodes. In up to 80% of sudden-onset depression, a significant psychosocial stressor can be identified in the past 6 months.

70
Q 
All of the following antidepressants increase serotonin neurotransmission by reuptake inhibition EXCEPT:
A. Mirtazapine
B. Venlafaxine
C. Fluvoxamine
D. Citalopram
E. Sertraline
A

A. Mirtazapine

Mirtazapine blocks presynaptic alpha-2 receptors and thereby increases the release of norepinephrine. The released norepinephrine also stimulates central alpha-1 adrenoreceptors located on central serotonergic neurons, leading to release of serotonin. All of the other antidepressants mentioned increase serotonin transmission by reuptake inhibition.

71
Q 
In what proportion of depressed patients does the dexamethasone suppression test reveal decreased cortisol or nonsuppression of cortisol?
A. 50%
B. 30%
C. 80%
D. 20%
E. 100%
A

A. 50%

The dexamethasone suppression test is positive in about 50% of patients with major depression and 80% of patients with major depression and psychotic features.

72
Q

According to lipid homeostasis theory, high levels of cholesterol are found in all of the following conditions except
A. Generalized anxiety disorder
B. Panic disorder
C. Obsessive-compulsive disorder
D. Major depression with increased risk of suicide
E. Post-traumatic stress disorder

A

D. Major depression with increased risk of suicide

Several studies have shown low levels of cholesterol in persons with major depressive disorder and an association between low cholesterol and an increased risk of suicide. Some studies have shown a positive correlation between severity of depression and the ratio of omega 6 fatty acids to omega 3 fatty acids in plasma and red blood cell phospholipids.

73
Q 
A 73-year-old woman with a diagnosis of major depressive disorder fails to respond to treatment with an SSRI. The psychiatrist discusses the option of starting a tricyclic antidepressant. The woman states that “anything” is fine except that she does not like to be sedated by medications. Which of the following tricyclic antidepressants is relatively less sedating?
A. Doxepine
B. Amitriptyline
C. Trimipramine
D. Nortriptyline
E. Imipramine
A

D. Nortriptyline

Of all the tricyclic antidepressants, nortriptyline, desipramine, and clomipramine are relatively less sedating. Maprotiline (Ludiomil), a tetracyclic antidepressant, is very sedating.

74
Q 
Which of the following is a reversible MAOI?
A. Moclobomide
B. Tranylcypromine
C. Phenelzine
D. L-deprenyl
E. Maprotiline
A

A. Moclobomide

Moclobomide is a reversible and selective inhibitor of MAO-B; phenelzine and tranylcypromine inhibit both MAO-A and MAO-B and are irreversible. Selegiline (L-deprenyl) is an irreversible inhibitor of MAO-B, but at higher doses it inhibits MAO-A too. Maprotiline is a tetracyclic antidepressant.

75
Q 
All of the following are side effects resulting from muscarinic receptor blockade of antidepressants except
A. Orthostatic hypotension
B. Dry mouth
C. Constipation
D. Blurred vision
E. Urinary retention
A

A. Orthostatic hypotension

Orthostatic hypotension results from alpha-1 adrenergic blockade and not from muscarinic receptor blockade. All of the other side effects mentioned are from muscarinic receptor blockade.

76
Q 
All of the following cause or contribute to confusion and memory problems following electroconvulsive therapy EXCEPT:
A. Prolonged seizures
B. Old age
C. High-intensity stimulus
D. Inadequate oxygenation
E. Unilateral electrode placement
A

E. Unilateral electrode placement

Unilateral electrode placement is associated with less confusion and fewer memory problems. Other factors that can reduce confusion and memory problems include brief pulse stimulation and hyperventilation with 100% oxygenation prior to applying the stimulus.

77
Q

Which of the following accurately states the role of therapy in depression?
A. Antidepressants are the treatment of choice in all severities of depression.
B. Cognitive-behavioral therapy (CBT) is the treatment of choice in all severities of depression.
C. CBT is as effective as antidepressants in the treatment of mild to moderate depression.
D. Combined treatment with cognitive-behavioral therapy and antidepressants is no better than either on its own.
E. Interpersonal therapy offers more rapid response than antidepressants.

A

choice in all severities of depression.
C. CBT is as effective as antidepressants in the treatment of mild to moderate depression.

All the evidence to date suggests that any form of therapy is as effective as antidepressants in the treatment of mild to moderate depression. Antidepressants are the treatment of choice in severe depression. Combined treatment with cognitive-behavorial therapy and antidepressants has shown to be better than either individually. It is also used if one modality fails to produce a complete response, if depression is chronic, or if multiple symptoms are present.

78
Q 
According to DSM-IV, one of the criteria for dysthymic disorder is that the patient should not be symptom free for more than a certain number of months in a 2-year period (or in a 1 year period in children or adolescents). How many months must the patient be symptom free?
A. 3 months
B. 2 months
C. 1 month
D. 6 months
E. 8 months
A

B. 2 months

A person who is symptom-free for more than 2 months does not meet the criteria for dysthymia. Also, there should be no evidence for major depressive disorder for the first 2 years of the disturbance.

Dysthymia is known as Persistent Depressive Disorder in DSM-5.

79
Q

In DSM-IV, the category of depressive disorder not otherwise specified (NOS) is used for all the following disorders except
A. Minor depressive disorder
B. Adjustment disorder with depressed mood
C. Recurrent brief depressive disorder
D. Premenstrual dysphoric disorder
E. Postpsychotic depressive disorder

A

B. Adjustment disorder with depressed mood

The category “depressive disorder not otherwise specified (NOS)” is used if the symptoms do not meet criteria for major depressive disorder, dysthymia, adjustment disorder with depressed mood, or adjustment disorder with mixed anxiety and depressed mood.

80
Q 
In what percentage of euthyroid patients with major depression does TRH stimulation reveal blunting of TSH response?
A. 15%
B. 5%
C. 10%
D. 25%
E. 1%
A

D. 25%

81
Q

All of the following are true about the epidemiology of bipolar disorder EXCEPT:
A. High incidence of comorbidity
B. Lifetime prevalence of about 1% in classic cases
C. Greater prevalence in women
D. Average age of onset around 19 to 20 years
E. Equal incidence in all socioeconomic strata

A

C. Greater prevalence in women

Bipolar disorder is equally prevalent in both men and women. Up to 60% of individuals with bipolar disorder develop substance abuse at some point, and up to 50% of individuals have anxiety disorder. Although the prevalence of classic bipolar disorder is 1%, the prevalence of all other variants of bipolar disorder is 2% to 5%.

82
Q

The key difference between mania and hypomania, according to DSM-IV, is:
A. Degree of elevation of mood
B. Presence of psychosis
C. Number of episodes
D. Extent of social and occupational dysfunction
E. Number of symptoms

A

D. Extent of social and occupational dysfunction

In mania, the person affected experiences significant social and occupational dysfunction, which usually results in hospitalization. This is not always the case with hypomania. The number of symptoms, number of episodes, and degree of elevation or psychosis have no bearing on the diagnosis.

83
Q

For a diagnosis of bipolar I disorder according to DSM-IV, which of the following criteria is a must?
A. At least one hypomanic episode
B. At least one major depressive disorder episode
C. Depressed mood for more than 2 years
D. Numerous periods of hypomania
E. At least one manic or mixed episode

A

E. At least one manic or mixed episode

For the diagnosis of bipolar I disorder, there should be at least one manic or mixed episode; there is no need for depressive or hypomanic episodes. However, for a diagnosis of bipolar II, the patient should never have a manic or mixed episode but should have at least one episode of hypomania and one or more episodes of major depression.

84
Q 
What is the approximate duration of untreated depressive episodes in patients with bipolar disorder?
A. 3 months
B. 3 to 6 months
C. 6 to 12 months
D. 2 to 4 weeks
E. 2 months
A

C. 6 to 12 months

In bipolar disorder, depressive episodes tend to last longer than manic episodes. The mean duration of an untreated depressive episode is 6 to 12 months, whereas the mean duration of an untreated manic episode is 3 to 6 months.

85
Q 
A 29-year-old man is admitted for further evaluation. He was brought to the hospital by his wife, who states that her husband has been demanding more sex, repeating the demand sometimes up to 10 to 15 times per day for the past 8 to 10 days. She also observes that he has been working late into the night, sleeping only 2 to 3 hours, and seems full of energy. He has been talking a lot and has taken on at least four new projects at work during the past 10 days. The woman denies any other physical health problems or drug abuse in her husband. The man himself sees no problem and believes that his wife is “just wasting” his time. As you are assessing the case, his colleague calls you and tells you that the man has been “making a mess” at work for the past few days. What is the most probable diagnosis?
A. Bipolar II disorder
B. Bipolar I disorder
C. Bipolar disorder, mixed type
D. Cyclothymia
E. Rapid-cycling bipolar disorder
A

B. Bipolar I disorder

This patient meets the criteria for mania because he has more than three manic symptoms that have been present for more than 7 days and that are also causing significant problems in his social and occupational functioning.

86
Q 
All of the following are known causes of secondary mania EXCEPT:
A. Cocaine
B. Propranolol
C. Steroids
D. Antidepressants
E. L-dopa
A

B. Propranolol

Propranolol, a β-blocker, is a known cause of depression and not mania. Other medications or substances known to cause secondary mania are alcohol, amphetamines, barbiturates, and ACTH.

87
Q 
In a manic patient, the affect could be:
A. Euphoric
B. Irritable
C. Labile
D. Depressed, in mixed state
E. All of the above
A

E. All of the above

The patient’s affect need not be euphoric all the time for a diagnosis of mania. In fact, mixed manic episodes are as common as pure manic episodes.

88
Q 
A 29-year-old man comes along with his wife of 4 years to the psychiatric clinic. The patient's wife reports that he has had repeated episodes of “highs and downs” for the last 3 years. The episodes are short, lasting only a few days. These episodes disrupt the patient's work schedule and sometimes the young couple's social life. What is the most appropriate diagnosis?
A. Bipolar I disorder
B. Bipolar II disorder
C. Cyclothymia
D. Dysthymia
A

C. Cyclothymia

Cyclothymia is characterized by numerous periods with hypomanic symptoms alternating over the course of 2 years with numerous periods of depressive symptoms that do not meet the diagnostic criteria for a major depressive episode. For a diagnosis of cyclothymia, the person must not be symptom-free for more than 2 consecutive months and should not have had any major depressive, mixed, or manic episodes during the 2 years.

89
Q 
Which of the following over-the-counter (OTC) medications is not advisable in a 22-year-old sexually active female college student?
A. Acetaminophen
B. Motrin
C. Loratidine
D. St. John's wort
A

D. St. John’s wort

St. John’s wort induces enzymes that increase the metabolism of oral contraceptive pills. So it is necessary to discuss the issue of over-thecounter antidepressants like St. John’s wort with sexually active women in the reproductive age group.

90
Q 
Following childbirth, a 32-year-old woman has developed severe depression. The woman refuses to eat, is found to be very agitated, and is expressing fears that her baby has an incurable illness. What is the most appropriate treatment at this point?
A. Tricyclic antidepressants
B. Wellbutrin
C. SSRIs and antipsychotics
D. ECT
A

D. ECT

Electroconvulsive therapy is the treatment of choice in patients suffering from postpartum depression. ECT is especially effective in people who are refusing to take any medicines orally. Its fast onset of action can be particularly life saving in women refusing to eat and refusing to take care of their newborn infants and for those harboring murderous impulses toward their newborn children.

91
Q 
Which psychologist from the University of Pennsylvania proposed the principle of “low rate of reinforcement” as the cause of depression?
A. Beck
B. Seligman
C. Lewinsohn
D. Bowlby
A

C. Lewinsohn

Lewinsohn propounded the theory of “low rate of reinforcement, or lack of appropriate rewards” as a cause for depression. Martin Seligman propounded the notion of “learned helplessness” as a theory for origin of depression. Beck propounded a cognitive triad of depression consisting of negative views of self, the world, and the future. Bowlby propounded the theory of “object loss” as a cause for depression.

92
Q 
Some studies of the genetics of bipolar disorder have found that the illness has a higher probability of being transmitted through mothers than through fathers. What is this phenomenon called?
A. Penetrance
B. Imprinting
C. Heterogeneity
D. None of the above
A

B. Imprinting

Imprinting is the phenomenon by which the probability of the disease depends on whether the gene is inherited from the mother or the father. Other examples of imprinting are Prader-Willi syndrome and Angelman syndrome.

93
Q 
Which of the following sleep abnormalities is found in depressed persons?
A. Decreased REM sleep latency
B. Increased REM density
C. Early morning awakening
D. All of the above
A

D. All of the above

94
Q 
Who coined the term “neurasthenia”?
A. James Braid
B. William Cullen
C. George Beard
D. Robert Post
A

C. George Beard

“Neurasthenia” is a term coined by George Beard to describe a chronic condition characterized by anxious-depressive symptomatology. In this condition, people are overly anxious with a chronic predisposition to mental fatigue, lethargy, exhaustion, and irritability. This diagnosis is most used in China.

95
Q 
A 42-year-old presents to the clinic 1 month after his spouse's death. He reports feeling extremely depressed and has a total lack of interest in all activities, decreased ability to go to sleep, and an inability to resume his work. He also reports feeling extremely guilty that he is alive, also reports feelings of worthlessness and hopelessness and says that he gets frequent impulses to commit suicide. Although he has been able to ward off the impulses until now, he reports that he doesn't feel safe. What is the patient suffering from?
A. Normal sadness
B. Bereavement
C. Major depression
D. Mental fatigue
E. None of the above
A

C. Major depression

According to DSM-IV-TR, the diagnosis of major depressive disorder (MDD) should not be given unless the symptoms are still present 2 months after the loss of a loved one. But if the depression is so severe that the person has thoughts of ending his own life, recurrent feeling of worthlessness, guilt about things other than actions taken or not taken by the survivor at the time of the loved one’s death, marked psychomotor impairment, hallucinatory experience other than thinking that he hears or sees the deceased person, then a diagnosis of MDD should be made.

96
Q 
What is the lifetime prevalence of dysthymic disorder?
A. 1%
B. 10%
C. 3%
D. 6%
E. 15%
A

D. 6%

97
Q 
What percentage of persons with bipolar disorder commit suicide?
A. Less than 5%
B. 5-10%
C. 10-15%
D. Greater than 20%
E. None of the above
A

C. 10-15%

It has been shown that 10% to 15% of persons diagnosed with bipolar disorder eventually commit suicide. An estimated 8% to 10% of patients with schizophrenia eventually commit suicide.

98
Q 
In some depressed persons, the main fold in the upper eyelid is angulated upward and backward at the junction of the inner third with the middle third of the fold. What is this sign called?
A. Omega sign
B. Veraguth's fold
C. Snout spasm
D. Temple sign
E. None of the above
A

B. Veraguth’s fold

Veraguth’s fold is seen in some depressed patients; in this sign, the main fold in the upper eyelid is angulated upward and backward at the junction of the inner third with the middle third of the fold.

99
Q 
The loss of a parent before what age is considered as a risk factor for the development of depression in adulthood?
A. Before 3 years
B. Before 7 years
C. Before 11 years
D. Before 15 years
E. Before 5 years
A

C. Before 11 years

100
Q 
Which of the following has an equal prevalence in both sexes?
A. Bipolar I disorder
B. Dysthymia
C. Major depressive disorder
D. All of the above
E. None of the above
A

A. Bipolar I disorder

Bipolar I disorder has an equal prevalence in women and men, whereas both dysthymia and major depressive disorder have a higher prevalence among women.

Hung's Board Topics (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions