Mood Flashcards

Question

``` Peripheral neuropathy is a side effect of: A. SSRI B. TCA C. SNRI D. MAOI E. NRI ```

Answer 1

D. MAOi (due to pyridoxine deficiency)

Answer 2

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

Answer 3

D. Clomipramine (Has strong serotonin reuptake inhibition effect)

Answer 4

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

Answer 5

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)

Answer 6

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

Answer 7

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)

Answer 8

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.)

Answer 9

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

Answer 10

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.)

Answer 11

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.)

Answer 12

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.)

Answer 13

C. Inhibiting the reuptake of serotonin and noradrenaline | acts in dose dependent manner

Answer 14

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.)

Answer 15

E. Liver function tests | eliminated almost entirely by the kidneys and does not undergo any hepatic metabolism

Answer 16

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.

Answer 17

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

Answer 18

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.)

Answer 19

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

Answer 20

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.

Answer 21

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.

Answer 22

B. 10,000 lux

Answer 23

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.

Answer 24

E. All of the above

Answer 25

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.

Answer 26

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.

Answer 27

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.

Answer 28

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.

Answer 29

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.

Answer 30

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.

Answer 31

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

Answer 32

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

Answer 33

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.

Answer 34

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

Answer 35

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.

Answer 36

B. Major depressive disorder superimposed on dysthymia

Answer 37

B. 3 DSM-IV lists three categories of unipolar depressive disorders: major depressive disorder, dysthymia, and depressive disorder not otherwise specified (NOS).

Answer 38

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.

Answer 39

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

Answer 40

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.

Answer 41

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.

Answer 42

E. 4 weeks

Answer 43

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.

Answer 44

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.

Answer 45

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.

Answer 46

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.

Answer 47

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.

Answer 48

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

Answer 49

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.

Answer 50

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.

Answer 51

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.

Answer 52

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.

Answer 53

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.

Answer 54

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.

Answer 55

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%.

Answer 56

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.

Answer 57

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.

Answer 58

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.

Answer 59

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.

Answer 60

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.

Answer 61

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.

Answer 62

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.

Answer 63

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.

Answer 64

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.

Answer 65

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.

Answer 66

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.

Answer 67

D. All of the above

Answer 68

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.

Answer 69

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.

Answer 70

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.

Answer 71

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.

Answer 72

C. Before 11 years

Answer 73

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.