Affective Flashcards
(126 cards)
1
Q
Chronicity of depressive sx is associated with what?
A
Underlying personality, anxiety & substance misuse disorders and reduces the likelihood of full symptom resolution
2
Q
What happens to risk of recurrence of depressive symptoms over time
A
Progressively lower over time
3
Q
Persistence of mild depressive symptoms during remission is a powerful predictor of what?
A
Recurrence
4
Q
First line treatment of mild to moderate MDD in adolescence
A
Psychotherapy CBT/ IBT
5
Q
First line pharmacological agent for MDD in children/adolescents
A
Fluoxetine
6
Q
A score of less than what on the Ham-D indicates remission?
A
<7
7
Q
First, second & third line Rx for depression in kids
A
- CBT/IPT/internet based psychotherapy
- Fluoxetine, or escitalopram
- Venlafaxine & tricyclics
8
Q
Rx resistant MDD in kids, 1st, 2nd & 3rd line
A
- SSRI & psychotherapy
- Switch to another SSRI
- Venlafaxine, TCA, neuro stimulation
9
Q
Definition of early onset in PDD
A
Onset <21 years
10
Q
Concordance rate for mood disorder amongst MZ twins
A
70-90%
11
Q
Stressful life events tend to be related to episodes of mood disorders when?
A
They more often precede first rather than subsequent episodes
12
Q
Lifetime prevalence of major depressive disorder
A
17%, the highest of any psychiatric disorder
13
Q
Mean age of onset for major depressive disorder
A
40
14
Q
Is there a correlation between MDD and socioeconomic status
A
No
15
Q
How does DSM V define two separate episodes of depression to meet criteria for recurrent depression?
A
They must be separated by two months during which a pt has no significant symptoms of depression
16
Q
How many episodes in a 12 month period to be a rapid cycler according to DSM V?
A
Four
17
Q
Prevalence of dysthymia in the gen pop
A
5-6%
18
Q
Most common target for rTMS in depression
A
DLPFC
19
Q
Absolute and relative contraindications to rTMS
A
- Absolute- metal of any type in head eg aneurysm clips, shrapnel
- Relative- epilepsy/ hx of seizures, brain lesion, cardiac pacemaker, internal defibrillator
20
Q
Canmat 2016 guidelines best augmentation for MDD
A
ORAL (olanzapine, risperidone, abilify, lithium)
21
Q
Commonest side effect of rTMS
A
Headache
22
Q
Define dysthymia
A
A reactive nonpsychotic depression of mild to moderate intensity with predominant anxiety (K&S)
23
Q
Depressive disorders are more common in women T/F
A
T
24
Q
About 5% of depressed patients commit suicide eventually T/F
A
F it’s about 15% (K&S)
25
Manic forms of mood disorders predominate in women T/F
F
26
The incidence of depression in younger age groups is increasing T/F
T (K&S)
27
Hypersexuality in depressed patients usually indicates what?
A mixed episode of bipolar disorder (K&S)
28
Chronic stress does what to serotonin stores?
Depletes them despite acute stress increasing serotonin
29
Symptoms shared by depression and mania
Agitation, insomnia, anger, irritability
30
Parental loss before adolescence is a risk factor for adult depression T/F
T (K&S)
31
Hypomanic episodes lack psychotic features T/F
T
32
Manic episodes last for at least how long?
One week
33
Hypomanic episodes last for at least how long?
Four days (K&S)
34
what is the key difference between hypomania & mania
Hypomania is not sufficiently severe to cause impairment in social or occupational functioning
35
The defence mechanism associated with depression according to Freud
Introjection
36
L-tryptophan is the amino acid precursor to what?
Serotonin
37
What is the amino acid precursor to dopamine?
Tyrosine
38
Why have L-tryptophan containing products been recalled in the US?
They were associated with eosinophilia-myalgia syndrome
39
Bad prognostic indicators in depression
1. A history of more than one previous depressive episode
2. Co-existing dysthymic disorder
3. Alcohol & substance misuse
4. Anxiety disorder symptoms
5. Being male.
40
Is advanced age at onset a good or bad prognostic indicator in MDD?
Good
41
Alcohol, stimulant & caffeine use is a risk factor for rapid cycling T/F
T
42
Rapid cyclers, M or F predominate?
F
43
What is the lifetime prevalence of cyclothymic disorder?
0.2-1%
44
You need how many years of symptoms to meet criteria for cyclothymia?
Two years
45
Men or women predominate in cyclothymia?
M=F
46
Two key differences between dysthymia and MDD according to K&S
1. The symptoms outnumber the signs
2. Dysthymic pts say they have always been depressed
47
In the DSM criteria for depression at least one of the symptoms should be one of which two?
1. Depressed mood
2. Loss of interest or pleasure
48
Depression rates are increasing in Canada T/F
F (Ottawa)
49
Never married people have higher rates of depression T/F
T (Ottawa)
50
Depression rates higher in rural settings T/F
F Urban is higher (Ottawa)
51
There is a dose response relationship between childhood adversity and depression T/F
T (Ottawa - prospective Swedish data)
52
What % of MDEs are chronic? (\>2 years in duration)
26.5% (Canmat)
53
High neuroticism is a risk factor for chronic/ recurrent depression T/F
T
54
What are the three first line psychological therapies recommended for acute treatment of MDD?
1. CBT
2. IPT
3. Behavioural activation
55
What are the two psychological therapies which are first line treatments for maintenance of treatment in depression?
1. CBT
2. Mindfulness-based cognitive therapy
56
Best ADT for pts with sleep disturbance (w level 1 evidence)
Agomelatine
57
What effect do SSRIs have on suicide risk in terms of % change?
40% decrease in risk
58
Lack of early response to antidepressant therapy at 2-4 weeks predicts later non-response T/F
T
59
ECT is a second line treatment for psychotic depression T/F
F first line
60
ECT for MDD is contraindicated in pregnancy T/F
F it's third line
61
Exercise is a first line recommendation for mild-mod depression T/F
T
62
Yoga is a second line treatment for mild-mod depression T/F
T
63
There is no evidence for acupuncture in the treatment of mild-mod depression T/F
F it's third line
64
Which natural remedy has first line evidence for mild-mod depression?
St. John's Wort
65
Tryptophan has second level evidence for mild-mod depression T/F
F it is not recommended
66
What is the standard protocol for light therapy?
10,000 lux for 30 mins each day in the early morning for up to six weeks
67
Light therapy is a second line treatment for mild-mod nonseasonal MDD T/F
T - level 2
68
Average age at onset of bipolar disorder
25y
69
BPAD is associated with an increasing risk of dementia as the disorder progresses T/F
T
70
Unipolar depression tends to start earlier in life than bipolar T/F
F bipolar \<25, unipolar \>25
71
There is only one adjunctive psychological therapy for the treatment of bipolar disorder, what is it?
Psychoeducation, level 2 evidence as a first line for maintenance
72
First line Rx for acute management of bipolar II depression
Quetiapine (only one with level 1)
73
Persistent mania following antidepressant treatment is bipolar disorder T/F
T
74
For a diagnosis of mania mood need not be elevated but irritability needs to be present T/F
T
75
Rapid cycling is a bad prognostic sign in bipolar affective disorder T/F
T
76
Stimulants are associated with rapid cycling T/F
T
77
Younger age at onset of bipolar disorder is associated with reduced risk of recurrence T/F
F the opposite is true
78
Risk of recurrence of BPAD in pregnancy if mood stabilizers are discontinued
85%. It's 37% if you continue them
79
Bilateral and unilateral ECT have the same efficacy T/F
F Bilateral is better but is associated with greater cognitive side effects like retrograde memory loss
80
CANMAT 2016 level 1 for MDE
1. Agomelatine
2. Bupropion (Wellbutrin)
3. Citalopram (Celexa, Cipramil)
4. Desvenlafaxine (Pristiq)
5. Duloxetine (Cymbalta)
6. Escitalopram (Cipralex, Lexapro)
7. Fluoxetine (Prozac)
8. Fluvoxamine (Luvox)
9. Mianserin (Tolvon)
10. Milnacipran (Ixel)
11. Mirtazapine (Remeron)
12. Paroxetine (Paxil)d
13. Sertraline (Zoloft)
14. Venlafaxine (Effexor)
15. Vortioxetine (Brintellix, Trintellix)
81
CANMAT level 1 for MDE + psychotic features
ADT + antipsychotic
82
CANMAT recommendations for MDE + cognitive dysfunction
1. Vortioxetine (Level 1)
2. Bupropion (Level 2)
3. Duloxetine (Level 2)
4. SSRIs (Level 2)b
5. Moclobemide (Level 3)
83
CANMAT the only level 1 drug for MDE + sleep disturbance
Agomelatine
84
CANMAT level 1 for MDE + somatic symptoms
Duloxetine (pain) (Level 1)
85
CANMAT MDE with sleep disturbance: three drugs with the highest adverse event rates of somnolence and daytime sedation
Mirtazapine, quetiapine, and trazodone
86
87
The long-term use of SSRI antidepressants has been associated with increased risk of falls and fractures that is unrelated to postural hypotension T/F
T
88
Depression increases the risk of DM II by 60% T/F
T (CANMAT)
89
Maternal depression is associated with aggression in boys T/F
T
90
Atypical depression tends to have an onset later in the lifespan T/F
F
91
There is a role for Ritalin in MDE in older adults with medical illnesses T/F
T
92
Anhedonia is a negative symptom of schizophrenia T/F
T
93
The Beck depression inventory has a range of scores from 0-40 T/F
F 0-63, \<10 is normal, 31-40 is severe depression, \>40 is 'extreme depression'
94
How is early improvement on ADT's defined?
\>20%-30% reduction from baseline in a depression rating scale after 2-4 weeks
95
Parental loss or separation is a RF for PDD T/F
T (DSM V)
96
PDD cannot impact social and occupational function as much as MDE T/F
F (DSM V)
97
Criteria for diagnosis of a manic episode - two things (DSMV)
1. Abnormally & persistently elevated, expansive or irritable mood 2. Increased goal directed activity or energy
98
An inability to censor immaterial external stimuli
Distractibility
99
A manic episode in the context of cocaine use persisting beyond the physical effect of cocaine and when it is completely out of the system is sufficient for a diagnosis of bipolar I T/F
T
100
A diagnosis of bipolar I requires a prior diagnosis of MDE T/F
F
101
Mean age at onset bipolar I
18
102
Onset of manic symptoms in mid life requires organic work up T/F
T
103
Bipolar disorder is more common in high income countries T/F
T
104
Strongest risk factor for BPAD
FH
105
1/4 of completed suicides may be due to bipolar T/F
T (DSM V)
106
For a diagnosis of cyclothymia the criteria for MDE, mania & hypomania must never have been met T/F
T (DSM V)
107
Lifetime prevalence of cyclothymia
0.4-1%
108
CANMAT 2016 comorbidities of bipolar I: substance misuse/ anxiety disorders/ ADHD/ ED
1. Substance 67%
2. Anxiety 46%
3. ADHD 18%
4. ED 14%
109
Lithium in breastfeeding?
No
110
Short duration of episode is a good prognostic factor in mania T/F
T
111
Lithium is best for mania with elevated mood/ euphoria T/F
T
112
Divalproex is best option for rapid cyclers T/F
T
113
First line treatments for rapid cyclers
1. Lithium
2. LTG
3. DVP
114
Avoid carbemazepine in mixed affective states T/F
F it is best choice
115
Psychotic features in deoresison in children are a strong predictor for future bipolar disorder T/F
T
116
Being male is a good prognostic factor in mania
F it's bad
117
In bipolar depression I&II mixed symptoms are apparent in depression 30% of the time
T (EMBLEM study)
118
late onset bipolar is associated with left hemispheric lesions T/F
F, Right
119
Late onset depression is assoc with white matter lesions T/F
T Chandarana
120
Long duration of depression is assoc w reduced hippocampal volume T/F
T
121
Lifetime prev of depression in Canada
9.9% Chandarana
122
The rate of depression in Canada is changing T/F
F
123
Biggest risk factor for suicide in depression, previous history of attempts or hopelessness?
Chandarana says previous history
124
Vascular disease in depression predicts a poor response to treatment T/F
T, Chandarana course
125
How long is the acute phase of depression treatment according to CANMAT, and how long is the maintenance phase?
Acute is 8-12 wweks and maintenance is 6-24 months or longer
126
Combination therapy for depression is superior to monotherapy T/F
T, Chandarana
