Ch. 9 Depressive Disorders and Bipolar Disorders

Question 1

What is the single strongest predictor of depression?:
a. alcohol use b. having a depressed parent c. age over 65 d. co-morbid anxiety

Answer 1

b. having a depressed parent
-children of depressed parents 3x more likely to experience MDD in their lifetimes than general pop
-40% chance of depressive episode before age 18

Question 2

Neurovegetative symptoms seen in MDD are related to functions of the ______ and the _____ and the hormones they secrete

Answer 2

hypothalamus and pituitary

Question 3

True or False: dysphoria is often triggered by changes in levels of sex steroids that occur during the menstrual cycle

Answer 3

True

Question 4

In response to stress the hypothalamus releases ______, which stimulates the pituitary to release ______. This then stimulates the adrenals to release _______.

Answer 4

-CRH (corticotropin-releasing hormone)
-ACTH (adrenocorticotropic hormone)
-cortisol

Question 5

True or False: hyperactivity of the HPA has been shown to be present in people with MDD

Answer 5

True,
HPA-axis controls physiological response to stress
-feedback pathways

Question 6

Overtime, elevated ______ levels damage the CNS by altering neurotransmission and electrical signal conduction

Answer 6

cortisol
-can cause changes in size and function of brain tissue

Question 7

True or False: MDD may be associated w/ proinflammatory cytokine activation

Answer 7

True

Question 8

All of the following are possible NT function abnormalities causing depression except:
a. dysregulation of biogenic amine NTs b. low levels of endogenous catecholamines c. low levels of tryptophan d. high levels of 5HTIAA e. unusually high receptor sensitivity for NTs f. low density of receptor sites in certain areas

Answer 8

d. high levels of 5HTIAA, it is instead LOW levels of the serotonin metabolite 5HTIAA

Question 9

True or False: structural changes in those w/ chronic/severe depression show hypovolemic hippocampus and prefrontal cortex-limbic striatal regions

Answer 9

True

Question 10

What is the average age of onset for MDD?
a. adolescence b. mid-20s c. 30-40 yrs d. over 50 years

Answer 10

b. mid-20s
-risk is equal between genders before puberty and after menopause, otherwise greater in women
-also a greater source of morbidity than with any other illness

Question 11

True or False: 15% of people with MDD will die by suicide

Answer 11

True

Question 12

Risk Factors for MDD include all of the following except:
a. genetic loading b. prior episode MDD c. male gender d. postpartum period e. medical comorbidity f. single marital status g. environmental stressors

Answer 12

c. male gender
-female gender is a risk factor for MDD

Question 13

Which of the following is not an assessment tool for MDD?
a. GAD-7 b. PHQ-9 c. EPDS d. BDI f. HAM-D

Answer 13

a. GAD-7

Question 14

True or False: initial presentation of MDD often manifests as vague somatic complaints

Answer 14

True,
body aches, pains, headaches, muscle pains, lack of energy, GI issues

Question 15

symptoms of ______ and ______ are almost always present in some degree in MDD

Answer 15

anhedonia and sleep disturbance

Question 16

True or False: in children MDD may present more as an irritable mood

Answer 16

True

Question 17

SIGECAPS stands for:

Answer 17

Sleep: insomnia or hypersomnia
Interest: reduced, with loss of pleasure
Guilt: often unrealistic
Energy: mental and physical fatigue
Concentration: distractibility, memory disturbance, indecisiveness
Appetite: decreased or increased
Psychomotor: retardation or agitation
Suicide: thoughts, plans, behaviors.

Question 18

True or False: suicide risk is high for persons w/ history of past attempts, family history of first-degree relative committing suicide, and presence of psychotic symptoms

Answer 18

True,
also:
-concurrent substance abuse or dependency
-current serious health problem

Question 19

Once started, antidepressants should be continued for minimum of:
a. 4 weeks b. 3 months c. 6 to 12 months d. 2 to 4 years

Answer 19

c. 6 to 12 months
-if pt has >2 prior episodes of MDD< consider continuing antidepressants indefinitely

Question 20

Most antidepressants take _______ (how many weeks) to have therapeutic effect

Answer 20

4 to 6 weeks

Question 21

True or False: antidepressant rebound is common when stopping abruptly, particularly w/ the drugs that have short half-lives

Answer 21

True

Question 22

SSRIs act primarily to ______ by _______:

Answer 22

Increase serotonin levels in the CNS by inhibiting their presynaptic reuptake

Question 23

TCAs act to ______ by ______:

Answer 23

Elevate serotonin and norepinephrine levels primarily by inhibiting their presynaptic reuptake

Question 24

MAOIs act to _____ by ____:

Answer 24

Elevate serotonin and norepinephrine levels by inhibiting MAO, the enzyme that breaks down monoamine neurotransmitters

Question 25

SNRIs act to _____ by____:

Answer 25

Elevate norepinephrine and serotonin levels by inhibiting dual reuptake of norepinephrine and serotonin -action very selective on NTs

Question 26

Which of these is not a common side effect of SSRIs? a. sedation or agitation b. GI disturbances c. EPS d. sexual dysfunction

Answer 26

c. EPS

Question 27

NDRIs act to _____ by ______:

Answer 27

Increase norepinephrine and dopamine by inhibiting dual presynaptic reuptake. -Action is very selective

Question 28

SARIs act to ____ by _____:

Answer 28

Elevate serotonin levels by inhibiting serotonin reuptake -dual action, agonist of 5HT-2 receptors

Question 29

True or False: aged cheese, smoked meats, smoked fish, and fermented beverages are tyramine-free and ok to have with MAOIs

Answer 29

False, should avoid these foods if taking MAOIs because they contain tyramine

Question 30

Anticholinergic side effects of TCAs include all of these except: a. dry mouth b. cardiac dysrhythmias c. blurred vision d. constipation e. memory issues

Answer 30

b. cardiac dysrhythmias, these can occur with TCAs, but are not an anticholinergic effect (sorry this is a sneaky question)

Question 31

Which of these is an antiadrenergic side effect? a. orthostatic hypotension b. sedation c. weight gain d. dry mouth

Answer 31

a. orthostatic hypotension the sedation and weight gain are antihistaminergic side effects and the dry mouth is anticholinergic *all of these are possible side effects of TCAs

Question 32

True or False: you should adhere to at least 2-week washout period before switching between TCAs and another class of antidepressants

Answer 32

True, but should take 5 weeks for fluoxetine

Question 33

True or False: A hypertensive crisis can occur while taking MAOIs if the patient also eats foods containing tyramine

Answer 33

True, can also occur if adding other medications to MAOIs such as TCAs, decongestants, St. John's wort, asthma meds, stimulants, etc....

Question 34

Symptoms of hypertensive crisis include all of the following except: a. explosive-like headache b. elevated BP c. facial flushing d. palpitations e. pupillary constriction f. diaphoresis g. fever

Answer 34

e. pupillary constriction, instead pupillary dilation occurs

Question 35

When treating hypertensive crisis ________ binds with NE receptor sites and blocks NE

Answer 35

phentolamine -should also d/c the MAOI, stabilize fever

Question 36

True or False: tyramine is a precursor to NE

Answer 36

True

Question 37

True or False: When MAO is inhibited, tyramine exerts a strong vasopressor effect, stimulating the release of catecholamines, epinephrine, and NE

Answer 37

True

Question 38

Symptoms of serotonin syndrome include all of the following except: a. agitation and restlessness b. decreased HR and decreased BP c. headache d. sweating e. myoclonic jerking f. confusion g. fever

Answer 38

b. decreased in HR and BP, instead causes increased HR and BP -other symptoms include shivering, goose bumps, loss of coordination, seizures and unconsciousness

Question 39

All of the following can be part of treating serotonin syndrome except: a. discontinue offending agent b. cyproheptadine c. anticonvulsants e. phenelzine d. autonomic support

Answer 39

e. phenelzine

Question 40

Significant side effects of MAOIs include all of the following except: a. hypotension b. insomnia c. weight gain d. anticholinergic side effects d. lightheaded and dizzy e. sexual dysfunction

Answer 40

a. hypotension, instead could cause hypertensive crisis

Question 41

True or False: NT theory of how ECT works suggests increase in dopamine, serotonin, and norepinephrine

Answer 41

True

Question 42

Which theory suggests that ECT works by releasing hormones such as prolactin, TSH, pituitary hormones, endorphins, and adrenocorticotropic hormone: a. NT theory b. neuroendocrine theory c. anticonvulsant theory d. cognitive theory

Answer 42

b. neuroendocrine theory

Question 43

Which theory suggest that ECT works by exerting an anticonvulsant effect, which then produces an antidepressant effect: a. NT theory b. neuroendocrine theory c. anticonvulsant theory d. cognitive theory

Answer 43

c. anticonvulsant theory

Question 44

Contradiction to ECT include all of the following except: a. cardiac disease b. compromised pulmonary status b. hx of brain injury/tumor c. hx of SJS d. anesthesia medical complications

Answer 44

c. history of SJS

Question 45

Which of these involves inducing a grand mal seizure induced in an anesthetized person: a. ECT b. TMS c. VNS d. Phototherapy

Answer 45

a. ECT, electroconvulsive therapy -usual course 6 to 12 tx

Question 46

Which of these involves placement of a small wire coil on the scalp to conduct electrical current, creating a magnetic field, through the tissues of the head: a. ECT b. TMS c. VNS d. Phototherapy

Answer 46

b. TMS transcranial magnetic stimulation -performed without anesthesia, office setting -usually 40 min session, 5x/wk for 6 weeks

Question 47

Which of these involves a pacemaker-like device implanted in the left side of the chest to simulate left branch of nerve: a. ECT b. TMS c. VNS d. Phototherapy

Answer 47

c. VNS -can be outpatient but anesthesia required

Question 48

Which of these involves 2,500 to 10,000 lux light for 30 min up to 2 hrs, 1 to 2x daily: a. ECT b. TMS c. VNS d. Phototherapy

Answer 48

d. phototherapy

Question 49

All of the following are risk factors for suicide except: a. 45 or older if male b. 55 or older if female c. divorced/single d. white e. female gender

Answer 49

e. female, males are at greater risk for suicide other risk factors include living alone, psych disorder, physical illness, substance abuse, previous suicide attempt, family hx of suicide, recent loss

Question 50

All of the following symptoms are more pronounced in children with MDD except: a. irritability b. motor retardation c. somatic complaints d. social withdrawal

Answer 50

b. motor retardation, this is less common before the onset of puberty, along with: -psychosis -hypersomnia -increase appetite

Question 51

True or False: MDD has a strong separation anxiety component in children

Answer 51

True

Question 52

Drug combinations that can cause serotonin syndrome include all of these except: a. SSRIs and MAOIs b. SSRIs and mood stabilizers c. drug and herbal interactions d. SSRIs and St. John's wort

Answer 52

b. SSRIs and mood stabilizers

Question 53

symptoms of discontinuation syndrome include all of the following except: a. flu-like symptoms b. increased concentration c. fatigue d. myalgia e. nausea and vomiting f. impaired memory g. vertigo

Answer 53

b. increased concentration, instead decreased concentration other symptoms include: lethargy, paresthesia's, irritability, anxiety, insomnia, crying without w/out provocation, and dizzyness

Question 54

Evidence indicates clients should take an antidepressant agent for at least _____ months after remission of symptoms: a. 3 months b. 8 months c. 9 months d. 12 months

Answer 54

d. 12 months

Question 55

True or False: dysthymia is similar to MDD but has less severe symptoms, and no psychotic symptoms

Answer 55

True, also vegetative symptoms are less likely with dysthymia

Question 56

True or False: women are 2-3 times more likely to develop dysthymia

Answer 56

True

Question 57

Dysthymia is characterized by a chronically depressed mood that occurs for most of the day, more days than not, for at least ____ (how long?)

Answer 57

2 years -also prominent: low self-esteem, self-criticism, and a perception of general incompetence compared to others

Question 58

True or False: it can be considered grief/bereavement when symptoms develop within 3 months of the stressor

Answer 58

True