Osteopathic Approach to Mood Disorders

Question 1

What does PROS stand for?

Answer 1

Psychiatric Review of Symptoms (not review of systems)

Question 2

SIGECAPS

Answer 2

Sleep: insomnia or hypersomnia
Interest: reduced w/ loss of pleasure
Guilt
Energy: low, fatigue
Concentration: distracted
Appetite: increased or decreased
Psychomotor: retardation or agitation
Suicide: thoughts, plans

Question 3

PHQ-2

Answer 3

patient health questionnaire screening for depression; if score is 3 or more followup with PHQ-9

Question 4

PHQ-9

Answer 4

patient health questionnaire screening for depression; if question 9 then MUST complete the Columbia Suicide Severity Risk Scale (C-SSRS)

Question 5

When is it indicated to complete the Columbia Suicide Severity Risk Scale (C-SSRS)?

Answer 5

if PHQ-9 is 20 or higher or if patient endorses item 9

Question 6

What is the role of the behavioral health consultant (BHC)?

Answer 6

assists the physician to identify, diagnose and treat psychiatric problems

Question 7

Some examples of PROS?

Answer 7

Sleep
Appetite
Substance
Cognition
Anxiety
Depression
Suicide
Mania

Question 8

Recommendation for a patient with diabetes and a mood disorder?

Answer 8

must be evaluated and treated simultaneously; diabetes can contribute to mood and the mood can contribute to motivation and compliance

Question 9

PE exam of someone who presents with a mood disorder?

Answer 9

Vitals, CN2-12, DTRs, strength, heart and lungs and remember:
Mental Status Exam (MSE) - at least 3 components
Thyroid exam

Question 10

How many components must be included in a mental status exam (MSE)?

Answer 10

3 components

Question 11

What some components of the mental status exam (MSE)?

Answer 11

Appearance, Behavior, Speech, Mood, Affect, Thought process, Thought content, Cognition, Perception, Insight/Judgement

Question 12

The difference between mood and affect?

Answer 12

Mood is what the patient tells you they feel in quotes “fantastic” “depressed” “sad”
Affect is what you observe euthymic (normal mood), dysphoric (depressed) or euphoric (elated)

Question 13

Congruency

Answer 13

if the affect matched the mood reported

Question 14

Incongruency

Answer 14

if the affect does NOT match the mood reported

Question 15

How do you determine passive vs active suicidal or homicidal ideation?

Answer 15

if they have the intent, plan and means

Question 16

When should you immediately referral a patient to the ED?

Answer 16

if they have active suicidal ideation

Question 17

What is the importance behind motivational interviewing?

Answer 17

helps the patient to explore and resolve ambivalence

Question 18

What are labs that are routinely ordered for patients presenting with a mood disorder?

Answer 18

TSH
CBC
CMP
UA

Question 19

What is a risk associated with benzodiazepine use?

Answer 19

cognitive dysfunction and dementia with long term use

Question 20

A patient presents with symptoms of insomnia, loss of pleasure, excessive remorse, fatigue, distractibility, poor appetite, sluggish movements, and wishing to be dead. Which of the following mnemonics assists with quick identification of this disorder?
a. CAGE
b. IPRFDAMD
c. CSSRS
d. SIGECAPS
e. PHQGAD

Answer 20

d. SIGECAPS

Question 21

Which of the following best describes the indication to perform the Columbia Suicide Severity Risk Scale?
a. the PHQ-2 is 6 or higher and the GAD-2 is 6 or higher
b. item 9 is endorsed on the PROS and the MSE score is 20
c. the patient endorses item 9 on the PHQ-9
d. the PHQ-9 score is 18 and the patient reports hallucinations
e. the MDQ-9 score is 23 and the patient is agitated

Answer 21

c. the patient endorses item 9 on the PHQ-9

Question 22

Which of the following best describes the PROS?
a. Psychiatric review of systems that assess for risk factors
b. Part of the physical examination assessing for psychiatric symptoms
c. Assesses for psychosis risk, obsessions, and suicide
d. Assesses for perception, reasoning, observation and speech
e. A survey of psychiatric symptoms past and present

Answer 22

e. A survey of psychiatric symptoms past and present

Question 23

In the integrated behavioral medicine model, which of the following best describes the function of the physical examination?
a. Serves to develop conflicting differential diagnosis
b. Can cause diagnostic confusion about co-morbid disorders
c. Enhances evaluation and management of interacting medical conditions
d. Often adds unnecessary complexity to the patient encounter
e. Determines which co-morbid condition can be disregarded

Answer 23

c. Enhances evaluation and management of interacting medical conditions

Question 24

Which of the following best describes the function of the mental status examination?
a. The interpretation of observed mental processes during a structured exam
b. A cognitive exam for the signs of a neurological disorder
c. Is a paper and pencil test to assess for signs and symptoms of dementia
d. Can rule out neuropsychiatric manifestations of an autoimmune disorder
e. Assesses for the presence of mind altering substances

Answer 24

a. The interpretation of observed mental processes during a structured exam

Question 25

Which of the following best describes the mood and affect components of the mental status examination?
a. The are interchangeable terms for the same component
b. If the affect matches the mood reported it is congruent
c. Mood is what is observed and affect is what is reported
d. Mood and affect are part of the perception analysis
e. The reported mood is depressed the affect must be reported as flat

Answer 25

b. If the affect matches the mood reported it is congruent

Question 26

Which factors determine id suicidal ideation is passive or active?
a. The patient endorses item 9 on the PHQ-9
b. The patient has recurrent thoughts of wishing to be dead
c. The patient is psychotic and severely depressed
d. The patient has plan, intent and means
e. The patient is severely depressed and is cutting on their ankles

Answer 26

d. The patient has plan, intent and means

Question 27

Which of the following is required if starting a patient on an atypical antipsychotic?
a. Head to toe neurological examination
b. Urine toxicology
c. Abnormal involuntary movement scale
d. Screening for dementia
e. Mood disorder questionnaire

Answer 27

c. Abnormal involuntary movement scale (AIMS)

Question 28

What are the minimal required labs for the routine work-up of depression or anxiety?
a. CBC, CMP, TSH, UA
b. CBC, LFT, TSH, tox screen
c. CMP, folate, B12, UA
d. CMP, HgbA1C, LDL, TSH
e. CBC, TSH, HgbA1c, tox screen

Answer 28

a. CBC, CMP, TSH, UA