Psychiatry/Behavioral Medicine (5%)

Question 1

What are some risk factors for developing major depressive disorder?

More common in males or females?

What is the age range that this dx is most commonly seen in?

Answer 1

FHx

female (2:1)

20-40 y/o with highest incidence

Question 2

How to make the dx of MDD?

Answer 2

Depressed mood or anhedonia (loss of pleasure) or loss of interest in activities with >=5 associated sx almost every day for most of the days for at least 2 weeks:

Fatigue almost all day, insomnia or hypersomnia, feelings of guilt or worthlessness, recurring thoughts of death or suicide, psychomotor agitation, significant weight change (gain or loss), decreased or increased appetite, decreased concentration/indecisiveness

^{The sx are <strong>not</strong> due to substance use, bereavement or medical conditions}

Somatic: constipation, HA, skin changes, CP, abd pain, cough, dyspnea

Question 3

To make the dx of major depressive d/o, which two sx must be ABSENT?

Answer 3

Mania and hypomania

Question 4

What is seasonal affective d/o?

Atypical depression?

Melancholia?

Catatonic depression?

Answer 4

1. Seasonal affective d/o: the presence of depressive sx at the same time each year (MC in winter due to reduction of sunlight & cold weather)

^{Management: SSRls, light therapy, Bupropion}

2. Atypical depression: shares many of the typical sx of major depression but pts experience mood reactivity (improved mood in response to positive events)

^{Management: MAO inhibitors}

3. Melancholia: characterized by anhedonia, lack of mood reactivity, depression, severe weight loss/loss of appetite, excessive guilt, psychomotor agitation or retardation & sleep disturbance (increased REM time & reduced sleep)
4. Catatonic depression: motor immobility, stupor & extreme withdrawal

Question 5

Major depressive d/o may be due to an alteration in _______ or a _______ dysregulation

Answer 5

neurotransmitters

neuroendocrine

Question 6

What is the principle therapy for mild-moderate depression?

Answer 6

Psychotherapy

Question 7

What medications are often first line in patients with mild-moderate depression?

How long should antidepressants be continued for to determine if they are efficacious?

Answer 7

SSRIs

Should be continued for a minimum of 3- 6 weeks to determine efficacy

Question 8

What should be attempted for tx in pts who fail to respond to medical therapy?

Answer 8

Electroconvulsive therapy (ECT)

Question 9

What is the difference between bipolar I and bipolar II disorder?

What is 1st line tx for each?

Answer 9

Bipolar I: >=1 manic or mixed episode, which often cycles w/ occasional depressive episodes, but major depressive episodes are not required for dx

Bipolar II: >=1 hypomanic episode + >=1 major depressive episode (mania or mixed episodes are absent)

Tx: LITHIUM

Question 10

What is mania?

Answer 10

MANIA: abnormal & persistently elevated, expansive, or irritable mood at least 1 week (or less if hospitalization is required) with marked impairment of social/occupational function, >=3:

• MOOD: euphoria, irritable, labile or dysphoric
• THINKING: racing, flight of ideas, disorganized, easily distracted, expansive or grandiose thoughts, judgment is impaired
• BEHAVIOR: physical hyperactivity, pressured speech, decreased need for sleep, increased impulsivity and excessive involvement in pleasurable activities including risk-taking and hypersexuality, disinhibition, increased goal directed activity –> Psychotic sx (paranoia, delusions, hallucinations) may be seen in these pts

Question 11

What is hypomania?

Answer 11

Sx similar to manic sx: period of elevated, expansive or irritably mood @ least 4 days that is clearly different from the usual nondepressed mood but does NOT cause MARKED impairment

No psychotic features and usually does not require hospitalization

Does not include racing thoughts or excessive psychomotor agitation

Question 12

Persistent depressive d/o, or dysthymia, is defined as a chronic depressed mood for how long in children/adolescents?

Answer 12

>1 year

Question 13

What is 1st line tx for dysthymia (persistent depressive disorder)?

Answer 13

SSRIs

Question 14

Cyclothymic disorder is similar to what other condition, but less severe?

Answer 14

Bipolar II d/o

Question 15

What are some examples of panic attack sx?

Answer 15

Dizziness, trembling, choking feeling, parasthesias, sweating, SOB, CP, chills, hot flashes, fear of losing control, fear of dying, palpitations, nausea, abd pain, depersonalization

Question 16

What is the recommended management for an acute panic attack?

Answer 16

Benzodiazepines

Question 17

Panic d/o is more common in men or women?

Answer 17

Women (2-3x)

Question 18

What is the diagnostic criteria for panic disorder?

Answer 18

Recurrent, unexpected panic attacks (at least 2)

Panic attacks often followed by concern about future attacks

Worry about the implication of the attacks

Significant change in behavior related to the attacks

Question 19

What is agoraphobia?

Answer 19

anxiety about being in places or situations from which escape may be difficult

Question 20

What is 1st line medical treatment for long term management of panic disorder?

Answer 20

SSRIs 1st line

Cognitive behavioral therapy

Question 21

What is the diagnostic criteria for generalized anxiety?

Answer 21

Excessive anxiety or worry a majority of days >6 month period about various aspects of life

^{<em>not episodic, situational, or focal</em>}

Question 22

Generalized anxiety d/o is associated with how many of the following sx?

fatigue, restlessness, difficulty concentrating, muscle tension, sleep disturbance, irritability, shakiness, HA

Answer 22

greater than or equal to 3

Question 23

Is generalized anxiety d/o more common in males or females?

When is the age range of anticipated onset of GAD?

Answer 23

Females

Early 20s

Question 24

What medications are used in the management of generalized anxiety d/o?

Answer 24

Antidepressants (SSRIs)

Buspirone (does not cause drowsiness)

BZDs for short term use only, BBs, TCAs

Psychotherapy (CBT)

Question 25

Which d/o is described below?

Persistent (> 6 months), INTENSE FEAR OF SOCIAL OR PERFORMANCE SITUATIONS in which the person is exposed to the scrutiny of others for fear of embarrassment

Answer 25

Social anxiety d/o

Question 26

What medications and otherwise can be used in the management of social anxiety d/o?

Answer 26

Antidepressants (SSRIs)

Beta Blockers (for performance anxiety)

BZDs (short term)

Psychotherapy (CBT)

Question 27

What condition is described below?

Persistent (> 6 months}, intense fear/anxiety of a specific situation (ex. heights, flying), object (ex. pigeons, snakes, blood) or place (ex. hospital)

Answer 27

Specific phobias

Question 28

T/F: In a pt with a specific phobia, the fear is in proportion to any real danger

Answer 28

FALSE, it is out of proportion!

Question 29

_____ _____ must be impaired by distress or avoidance of the situation or object, for a pt’s phobia to be diagnosed

Answer 29

Everyday activities

Question 30

Childhood phobias may ______ with age

Answer 30

lessen

Question 31

What are options for the management of a pt’s phobia?

Answer 31

Exposure/desensitization therapy (tx of choice)

Short term BZDs and BBs can be used in some pts