Chapter 8 Flashcards
(227 cards)
1
Q
What is the minimum number of symptoms required for a diagnosis of Major Depressive Disorder?
A
≥5 symptoms present nearly every day in the same 2-week period
Symptoms must represent a change from previous functioning.
2
Q
Which two symptoms must be included for a diagnosis of Major Depressive Disorder?
A
Depressed mood or loss of interest or pleasure
One of these symptoms must be present.
3
Q
What does the ‘S’ in SIGECAPS stand for?
A
Sleep
Refers to insomnia or hypersomnia, and staying asleep being problematic.
4
Q
What does the ‘I’ in SIGECAPS signify?
A
Interest
Loss of interest or pleasure is a key symptom.
5
Q
What feelings are represented by the ‘G’ in SIGECAPS?
A
Guilt
Feelings of worthlessness or excessive/inappropriate guilt.
6
Q
What does the ‘E’ in SIGECAPS refer to?
A
Energy
Related to fatigue and diminished ability to think clearly.
7
Q
What does the ‘C’ in SIGECAPS stand for?
A
Concentration
Diminished ability to think clearly or make decisions.
8
Q
What does the ‘A’ in SIGECAPS represent?
A
Appetite
Weight change (increase or decrease) and loss of food enjoyment.
9
Q
What does the ‘P’ in SIGECAPS indicate?
A
Psychomotor
Psychomotor retardation or agitation.
10
Q
What does the ‘S’ at the end of SIGECAPS refer to?
A
Suicide
Recurrent thoughts of death, including passive thoughts without a plan.
11
Q
What type of functioning must be interfered with for a Major Depressive Disorder diagnosis?
A
Social, occupational, or interpersonal functioning
This interference is a criterion for diagnosis.
12
Q
What must not be present in order to diagnose Major Depressive Disorder?
A
Past manic, hypomanic, or mixed episodes
This is important to differentiate from bipolar disorder.
13
Q
What must be ruled out to diagnose Major Depressive Disorder?
A
Physiologic effect of a substance or general medical condition
This ensures the symptoms are not due to other causes.
14
Q
List the severity/course specifiers for Major Depressive Disorder.
A
- Mild
- Moderate
- Severe
- With psychotic features
- In partial remission
- In full remission
- Unspecified
These specifiers help to classify the severity and course of the disorder.
15
Q
What does a score of 15 indicate on the PHQ-9?
A
Mild depression
The PHQ-9 is a tool used for assessing the severity of depression.
16
Q
What score range corresponds to Minimal depression?
A
1-4
The scoring system helps categorize the severity of depression.
17
Q
What is the score range for Moderate depression according to the PHQ-9?
A
10-14
Understanding these ranges aids in determining treatment needs.
18
Q
How is Severe depression defined in the PHQ-9 scoring?
A
> 20
This indicates a high level of depressive symptoms requiring immediate attention.
19
Q
What score on the PHQ-9 indicates a person has recovered?
A
7
A score of 7 or lower suggests significant improvement in depressive symptoms.
20
Q
What score range indicates Moderately severe depression?
A
15-19
This category reflects a serious level of depression that may require intervention.
21
Q
How many questions are included in the PHQ-9?
A
9 questions
These questions assess various aspects of depression.
22
Q
Fill in the blank: A score of 1-9 on the PHQ-9 indicates _______.
A
Mild depression
23
Q
True or False: A score of 10-19 on the PHQ-9 indicates Mild depression.
A
False
This score range indicates Moderate to Moderately severe depression.
24
Q
What is the scoring range for the Zung Depression Scale?
A
20 to 80
The Zung Depression Scale consists of 20 items.
25
What score range on the Zung Depression Scale indicates normal range?
20-49
26
What score range on the Zung Depression Scale indicates mild depression?
50-59
27
What score range on the Zung Depression Scale indicates moderate depression?
60-69
28
What score on the Zung Depression Scale indicates severe depression?
≥70
29
How many questions are on the Hamilton Depression Rating Scale (Ham D)?
17-21 questions
30
What is the normal score range on the Hamilton Depression Rating Scale?
0-7
31
What score on the Hamilton Depression Rating Scale indicates moderately severe depression?
≥20
32
How many questions are on the Beck Depression Inventory (BDI)?
21 questions
33
What is the scoring range for the Beck Depression Inventory?
0 to 63 points
34
What score range on the BDI indicates minimal depression?
0-13
35
What score range on the BDI indicates mild depression?
14-19
36
What score range on the BDI indicates moderate depression?
20-28
37
What score range on the BDI indicates severe depression?
29-63
38
How many questions are on the Montgomery-Asberg Depression Rating Scale (MADRS)?
10 questions
39
What score on the MADRS indicates very severe depression?
44
40
What score on the MADRS indicates severe depression?
31
41
What score on the MADRS indicates moderate depression?
25
42
What score on the MADRS indicates mild depression?
15
43
What score on the MADRS indicates recovery?
7
44
What is Major Depressive Disorder (MDD)?
The presence of a single major depressive episode.
45
What characterizes recurrent Major Depressive Disorder (MDD)?
2 or more episodes of MDD, split by a 2-month interval.
46
Define Persistent Depressive Disorder (Dysthymia).
Depressed mood plus at least two other MDD criteria present for at least 2 years (1 year for children and adolescents) and has not been symptom-free for more than 2 months.
47
What happens if a Major Depressive Disorder episode occurs during Persistent Depressive Disorder?
A separate MDD diagnosis is made.
48
What is Other Specified Depressive Disorder?
Depressive symptoms but do not meet criteria for major depressive disorder (e.g., recurrent brief depression, short-duration depression, depressive episode with insufficient symptoms).
49
What defines Unspecified Depressive Disorder?
Depressive symptoms are present but do not meet the full criteria.
50
What characterizes Adjustment Disorder with Depressed Mood?
Psychological symptoms present within 3 months of the stressor and do not meet the diagnostic criteria for other depressive disorders.
51
What symptoms are associated with Premenstrual Dysphoric Disorder?
One or more of the following: * Affective lability * Marked mood swings * Sensitivity to rejection * Significant irritability/conflicts * Depressed/hopelessness * Anxious symptoms and other depressive symptoms (e.g., appetite, fatigue, concentration) that are present repeatedly before menses and end at or around the start of menses.
52
What is Substance/Medication-Induced Depressive Disorder?
Depressive symptoms associated with the use of a substance and extend beyond the expected length of the physiological effects of the substance.
53
How long do symptoms usually remit after substance cessation in Substance/Medication-Induced Depressive Disorder?
Usually remit within 1 month of substance cessation.
54
What is Depressive Disorder caused by another medical condition?
Depressive symptoms thought to be related to the direct effects of another medical condition.
55
What is a potential onset time for depression following a cerebrovascular accident (CVA)?
Onset may be weeks to months following CVA.
56
Can depression precede motor impairments in Parkinson's and Huntington's diseases?
Yes, depression may precede motor impairments.
57
Which of the following is false regarding the diagnosis of major depression?
A. More likely to occur in men than women
B. Higher prevalence in whites than blacks
C. Lifetime prevalence is 12%
D. Risk factors include genetics and low education
A. More likely to occur in men than women.
58
A 48 year old woman presents for concerns of irritability. She scores a 17 on her PHQ-9. With this score, what type of depression does she have?
Moderately severe depression
59
What does the DIGFAST mnemonic stand for in the context of a manic episode?
D - Distractibility, I - Indiscretion, G - Grandiosity, F - Flight of ideas, A - Activities increase, S - Sleep deficit, T - Talkativeness
## Footnote
Each component represents a symptom associated with a manic episode.
60
What is the minimum duration for symptoms to be considered for a manic episode?
At least 1 week
## Footnote
This applies unless the mood is only irritable, in which case 4 symptoms are required.
61
What is a key characteristic of mood during a manic episode?
Abnormal, persistently elevated, expansive or irritable mood
## Footnote
This is coupled with increased goal-directed activity or energy.
62
What is the significance of distractibility in a manic episode?
Attention easily drawn to irrelevant outside stimuli
## Footnote
This symptom reflects a lack of focus, common in manic episodes.
63
Define indiscretion in the context of a manic episode.
Overinvolvement in pleasurable activities that can result in painful consequences
## Footnote
This can lead to risky behaviors or decisions.
64
What does grandiosity refer to in a manic episode?
Inflated self-esteem
## Footnote
This symptom can manifest as an exaggerated sense of one’s abilities or importance.
65
What does 'flight of ideas' mean in the context of mania?
Subjective idea that thoughts are racing
## Footnote
This can lead to rapid speech and difficulty in maintaining a coherent conversation.
66
What is meant by 'activities increase' in a manic episode?
Increase in goal-directed activities at work, school; psychomotor agitation
## Footnote
This indicates heightened energy and productivity, often to an excessive degree.
67
What is a symptom related to sleep in a manic episode?
Decreased need for sleep
## Footnote
Individuals may feel rested after only a few hours of sleep.
68
What does talkativeness indicate in a manic episode?
Increased talking or pressure to keep talking
## Footnote
This symptom may reflect a rapid flow of ideas or thoughts.
69
What are the consequences of a manic episode?
Marked impairment in occupational function, relationships, necessitates hospitalization or has psychotic features
## Footnote
This highlights the severe impact of mania on daily life.
70
What conditions must be ruled out for a diagnosis of a manic episode?
Not caused by substances, medical condition, antidepressant treatment (medications or electroconvulsive therapy [ECT])
## Footnote
This ensures that the symptoms are not attributable to external factors.
71
How does a bipolar 1 diagnosis relate to antidepressant treatment?
If full manic criteria emerge during treatment but persists beyond expected effects
## Footnote
This indicates that the individual may have an underlying bipolar disorder.
72
What is the equivalent mood in children for a manic episode?
Happiness or silliness, distinctly increased from child's baseline
## Footnote
This should be coupled with persistently increased activity or energy levels.
73
What is the minimum duration for a hypomanic episode?
4 days
## Footnote
This is shorter than the duration required for a manic episode.
74
What distinguishes a manic episode from a hypomanic episode?
A manic episode is abnormal, persistent, and lasts at least 1 week
## Footnote
Hypomanic episodes are less severe and shorter.
75
What is the DIGFAST mnemonic used for?
Criteria for Hypomanic Episode
76
What are the mood characteristics required for a hypomanic episode?
Persistently elevated, expansive, or irritable mood and increased goal-directed activity or energy
77
How many symptoms must be present for at least 4 days to qualify as a hypomanic episode?
≥3 symptoms (4 if mood is only irritable)
78
What does 'Distractibility' refer to in the context of hypomanic episodes?
Attention easily drawn to irrelevant outside stimuli
79
Define 'Indiscretion' in relation to hypomanic episodes.
Overinvolvement in pleasurable activities that can result in painful consequences
80
What does 'Grandiosity' mean in the context of a hypomanic episode?
Inflated self-esteem
81
What is meant by 'Flight of ideas'?
Subjective idea that thoughts are racing
82
What does 'Activities increase' indicate during a hypomanic episode?
Increase in goal-directed activities at work, school; psychomotor agitation
83
What does 'Sleep deficit' refer to in hypomanic episodes?
Decreased need for sleep
84
What does 'Talkativeness' signify in the context of hypomanic episodes?
Increased talking or pressure to keep talking
85
What is a key characteristic of mood changes in hypomanic episodes?
Causes unequivocal change in mood and functioning that others notice
86
Is a hypomanic episode severe enough to cause marked impairment in social or occupational functioning?
No
87
What is not required during a hypomanic episode?
Hospitalization, psychotic features
88
What must not cause a hypomanic episode?
Substances, medical condition, antidepressant treatment
89
What characterizes Bipolar I Disorder?
One or more manic episodes or mixed episodes; often one or more MDD episodes
90
What is required for a diagnosis of Bipolar II Disorder?
At least one episode of major depression and the presence or history of at least one hypomanic episode
91
Define Cyclothymic Disorder.
Chronic mood disorder with periods of hypomanic symptoms and depressive symptoms for at least half the time over 2 years for adults, 1 year for children and adolescents
92
What characterizes Substance/Medication-induced Bipolar Disorder?
Manic mood and activity/energy symptoms that developed during or soon after substance intoxication, withdrawal, or exposure
93
What is the cause of symptoms in Bipolar and Related Disorder Caused by Another Medical Condition?
Direct pathophysiological consequence of another medical condition
94
What are Other Specified Bipolar and Related Disorders?
Mood disorders that do not meet criteria for specific bipolar disorder
95
What does 'With rapid cycling' mean in bipolar disorders?
It refers to 4 or more major mood episodes (major depressive, manic, or hypomanic) occurring in the previous 12 months.
96
What does 'With mixed features' mean in bipolar disorders?
It means meeting criteria for both a manic and depressive episode while having either manic, hypomanic, or depressive episodes.
97
What is the Mood Disorder Questionnaire (MDQ)?
A self-report screening tool for bipolar disorders that includes 13 items related to manic symptoms, a timing question, and a severity question.
98
What is the Young Mania Rating Scale (YMRS)?
A clinician-administered tool used to assess mania severity, consisting of 11 questions with 4 items graded on a 0-8 scale and 7 items graded on a 0-4 scale.
99
What is the score range for the Young Mania Rating Scale (YMRS)?
The score range is 0-60.
100
What is the Bipolar Spectrum Disorder Scale (BSDS)?
A 19-item self-administered questionnaire that rates the likelihood of bipolar disorder.
101
What are the risk categories based on the BSDS total score?
0-6: highly unlikely, 7-12: low risk, 13-19: moderate risk, 20-25: highly likely.
102
Jeremy, a 36 year old married attorney, was referred by his primary care provider for a consultation regarding his depression. He relates problems with what he would call "minor" depression and "mood swings " for at least 15 years. He denies ever having any suicidal ideation, hospitalization, or legal difficulty. On the MDQ checks 4 items positive and 3 as "possibly positive." Which disorder most likely fits his symptoms?
Cyclothymic disorder
103
The patient with bipolar disorder who is most likely to be misdiagnosed as having unipolar depression most likely has:
Bipolar II
104
What is the PHQ-9 score that indicates severe major depressive disorder (MDD)?
PHQ 9 ≥20
105
What duration defines chronic major depressive disorder?
Duration >2 years
106
How many episodes characterize recurrent major depressive disorder?
3 or more episodes
107
What is the treatment approach for severe MDD without psychotic features?
Medication and psychotherapy
108
What is the treatment approach for severe MDD with psychotic features?
Antidepressant and antipsychotic
109
When is Electro-Convulsive Therapy (ECT) considered for MDD?
Yes, certain patients
110
What factors guide the choice of medication for MDD?
* Prior positive response
* Moderate to severe symptoms
* Significant sleep or appetite disturbances
* Anticipated need for maintenance therapy
* Patient preference
* Availability
111
What psychological factors are considered when choosing psychotherapy for MDD?
* Significant psychological factors
* Stressors
* Interpersonal issues
* Co-occurring personality disorders
112
What severity of illness is psychotherapy preferred for?
Mild to moderate severity of illness
113
What are some complementary therapies for MDD with sparse evidence?
* Omega-3 fatty acids
* St. John's wort
* S-adenosyl-L-methionine (SAMe)
* Folate
* Bright light therapy
* Acupuncture
* Exercise
* Vitamin D
114
Fill in the blank: The severity of major depressive disorder is classified as _____, _____, and _____ without psychotic features.
mild, moderate, severe
115
True or False: Patient preference is an important factor in both medication and psychotherapy treatment options for MDD.
True
116
What should be considered for pregnant patients with MDD?
Patient preference
117
What factors influence the choice of pharmacotherapy in Major Depressive Disorder?
* Effectiveness comparison between and within classes
* Patient preference
* Prior response to medication
* Safety, tolerability, and anticipated adverse effects
* Co-occurring psychiatric or general medical conditions
* Pharmacological properties of medications
* Cost
## Footnote
Includes drug half-life, P450 enzyme action, and drug interactions.
118
What is the baseline risk of birth defects in pregnancy?
3-5%
## Footnote
This is the general risk for all pregnancies.
119
What percentage of pregnant women experience depression?
10-14%
## Footnote
This statistic highlights the prevalence of depression during pregnancy.
120
What percentage of women used an antidepressant during their pregnancy according to a recent study?
Up to 7%
## Footnote
This indicates a significant number of women may require antidepressant treatment.
121
Why are prescribing decisions for medications during pregnancy limited?
Incomplete data
## Footnote
Information on medications changes constantly, impacting the safety of prescribing.
122
What should healthcare providers provide to pregnant patients about medication risks?
Up-to-date information on possible risks and complications of medication and untreated illness
## Footnote
Emphasizes informed decision-making for the patient.
123
What is important to emphasize to women making medication decisions during pregnancy?
The final decision is theirs
## Footnote
Support their choice and focus on the positive aspects.
124
Which resources are available for pregnancy and lactation support?
* Mothertobaby.org
* Womensmentalhealth.org
* www.postpartum.net
## Footnote
These resources provide valuable information for women during pregnancy.
125
Which class of medications has been most studied regarding pregnancy?
SSRI medications (with the exception of fluvoxamine)
## Footnote
SSRIs are commonly prescribed for depression.
126
What medication is associated with higher rates of cardiovascular defects?
Paroxetine
## Footnote
This highlights the risks associated with certain psychotropic medications.
127
What is lithium associated with during pregnancy?
Cardiovascular malformations
## Footnote
The risk increases with higher dosing (>900 mg per day).
128
What are benzodiazepines linked to in terms of birth defects?
Cleft lip and palate (weak association)
## Footnote
This indicates potential risks of using benzodiazepines during pregnancy.
129
What is valproic acid associated with during pregnancy?
* Neural tube defects
* Neurodevelopmental disorders
* ASD
* Decreased IQ scores
## Footnote
These risks underline the importance of careful medication management in pregnant women.
130
What is carbamazepine associated with?
Neural tube defects
## Footnote
This medication poses risks during pregnancy.
131
What are the associations of topiramate during pregnancy?
Neurodevelopmental disorders
## Footnote
This highlights the risks of certain anticonvulsants in pregnancy.
132
What types of medications should be avoided during pregnancy?
* Monoamine oxidase inhibitors (MAOIs)
* Tricyclic antidepressants
## Footnote
These classes have significant risks associated with their use in pregnant women.
133
What are some safe and effective alternatives to medication for managing mood disorders during pregnancy?
* ECT
* Transcranial magnetic stimulation (TMS)
* Therapy
## Footnote
These options can provide relief without the risks associated with medications.
134
What nutritional supplements should be maximized during pregnancy?
* Omega fatty acids
* Folate
## Footnote
These nutrients are important for fetal development and maternal health.
135
What is the class of medication for Citalopram?
Selective Serotonin Reuptake Inhibitor (SSRI)
## Footnote
Citalopram is used to treat mood disorders.
136
What are common adverse effects of SSRIs?
* Nausea
* Headache
* Fatigue
* Agitation
* Sexual adverse effects (e.g., delayed orgasm, anorgasmia, decreased libido, erectile dysfunction)
## Footnote
These effects can be significant, with some being chronic in nature.
137
What is the maximum recommended dose of Citalopram for individuals over 60 years of age?
20 mg
## Footnote
The usual limit is 40 mg, but it is reduced for older adults due to prolonged QT adverse effects.
138
What is a boxed warning associated with SSRIs?
Increased suicidal ideation in adolescents and young adults
## Footnote
This warning highlights the risks of SSRIs in certain age groups.
139
What should be done when discontinuing SSRIs?
Taper the dosage to avoid withdrawal symptoms
## Footnote
Fluoxetine is an exception due to its long half-life.
140
What are the symptoms of serotonin syndrome?
* Diarrhea
* Restlessness
* Extreme agitation
* Autonomic instability
* Hyperthermia
* Rigidity
* Coma
* Death
## Footnote
Symptoms appear in a specific order and can be life-threatening.
141
True or False: Paroxetine is contraindicated during pregnancy.
True
## Footnote
This medication poses risks to both the mother and fetus.
142
Which SSRIs are classified as L2 for lactation?
* Sertraline
* Paroxetine
## Footnote
L2 indicates that these medications are considered relatively safe during breastfeeding.
143
Fill in the blank: The potential for SSRI withdrawal symptoms exists in _______.
newborns
## Footnote
This risk is particularly associated with the use of SSRIs during pregnancy.
144
What is the effect of combining SSRIs with MAOIs or other interacting medications?
Increased risk of serotonin syndrome
## Footnote
This combination can lead to dangerously high serotonin levels.
145
What is a common treatment regimen for chronic pain depression?
150 mg Sertraline + Buspirone + Amitriptyline or Nortriptyline
## Footnote
This combination is used to manage both depression and chronic pain effectively.
146
What is the class of medications that includes Venlafaxine, Duloxetine, and Desvenlafaxine?
Serotonin and Norepinephrine Reuptake Inhibitors (SNRI)
## Footnote
SNRIs are used to treat mood disorders by increasing serotonin and norepinephrine levels in the synapse.
147
List some common adverse effects of SNRIs.
* Nausea
* Bowel changes
* Dizziness
* Dry mouth
* Fatigue
* Agitation
* Sexual adverse effects (e.g., delayed orgasm, anorgasmia)
## Footnote
Sexual adverse effects can have an incidence rate of up to 75%.
148
What should be monitored before starting and periodically while taking SNRIs?
Blood pressure
## Footnote
Monitoring is crucial due to potential increases in blood pressure from SNRIs.
149
What is a significant risk associated with tapering Venlafaxine too quickly?
Discontinuation syndrome
## Footnote
Symptoms of discontinuation syndrome include dizziness, anxiety, nausea, sleep disturbances, and paresthesias.
150
What medication is contraindicated within 14 days of taking a MAOI?
SNRIs
## Footnote
MAOIs and SNRIs can lead to serious interactions.
151
What class of medication does Bupropion belong to?
Norepinephrine and Dopamine Reuptake Inhibitor
## Footnote
Bupropion is also used in smoking cessation and attention-deficit/hyperactivity disorder.
152
What are some adverse effects of Tricyclic Antidepressants (TCA)?
* Headache
* Insomnia
* Dry mouth
* Tremor
* Nausea
* Restlessness
* Agitation
* Irritability
## Footnote
TCAs can have various side effects, including anticholinergic effects.
153
What is a risk associated with doses greater than 450 mg of Bupropion?
Lower seizure threshold
## Footnote
Rapid dose escalations can also increase this risk.
154
What are some common anticholinergic side effects of TCAs?
* Dry mouth
* Constipation
* Blurred vision
* Delirium
* Urinary retention
## Footnote
Anticholinergic effects are significant considerations when prescribing TCAs.
155
What cardiac effects can be caused by Tricyclic Antidepressants?
* Tachycardia
* Flattened T waves
* Prolonged QT intervals
* Depressed ST segments
## Footnote
Monitoring of cardiac function is crucial when using TCAs.
156
What is recommended before starting a TCA in children and adolescents?
Baseline electrocardiogram
## Footnote
This is to assess any pre-existing cardiac conditions.
157
True or False: Overdose of TCAs can be fatal.
True
## Footnote
Due to their toxicity, overdose management is critical.
158
Fill in the blank: SSRIs or other newer antidepressants are usually started first due to the _______ of TCAs.
adverse effects
## Footnote
The side effects of TCAs can be more severe compared to SSRIs.
159
What are the common adverse effects of Mirtazapine?
Somnolence, increased appetite
## Footnote
Mirtazapine is also noted for having no sexual adverse effects.
160
What type of medication is Trazodone?
Antidepressant
## Footnote
Trazodone is primarily known for causing somnolence.
161
What is the mechanism of action of Vilazodone?
SSRI and 5-HT1A receptor partial agonist
## Footnote
This dual action contributes to its antidepressant effects.
162
What is Vortioxetine classified as?
Serotonin modulator and stimulator
## Footnote
Vortioxetine has a unique mechanism affecting serotonin receptors.
163
What is a notable side effect of Ketamine?
Dissociative symptoms, hallucinations
## Footnote
Ketamine also inhibits postsynaptic glutamate-binding protein NMDA receptor.
164
What common adverse effects are associated with Ketamine?
Nausea, diarrhea, dizziness, headache, poor coordination
## Footnote
These effects are usually transitory.
165
What is Brexanolone used for?
Postpartum depression
## Footnote
It is administered through a restricted program and requires clinical supervision.
166
What are the adverse effects of Brexanolone?
Sleepiness, dry mouth, loss of consciousness, flushing
## Footnote
Brexanolone functions as an allosteric moderator of GABA.
167
What is a unique characteristic of Esketamine compared to other medications?
Nasal spray availability
## Footnote
Esketamine is available through a restricted distribution system.
168
What is the response time for Ketamine treatment?
Response seen within 24 hours
## Footnote
However, the effect seems to be short-lived.
169
Fill in the blank: The common adverse effects of antidepressants include _______.
Dizziness, headache, poor coordination
## Footnote
These are typically transitory effects.
170
True or False: Brexanolone has a high incidence of sexual adverse effects.
False
## Footnote
It is noted that Brexanolone might not have as high an incidence of sexual adverse effects compared to other antidepressants.
171
What is a risk associated with Trazodone?
Priapism
## Footnote
This is a rare but serious side effect.
172
What is the primary use of Mirtazapine in patients with depression?
Useful with depression with insomnia, weight loss, and agitation
## Footnote
Mirtazapine is also effective against nausea.
173
What is the importance of taking Ketamine with food?
To reduce gastrointestinal side effects
## Footnote
Taking it with food may help mitigate nausea.
174
What are the ongoing studies concerning Esketamine focused on?
Oral version in Phase 3 trials
## Footnote
These trials aim to enhance accessibility and administration methods.
175
What are Monoamine Oxidase Inhibitors (MAOIs)?
A class of antidepressant medications that inhibit the activity of monoamine oxidase enzymes.
176
List four examples of Monoamine Oxidase Inhibitors.
* Phenelzine
* Selegiline
* Tranylcypromine
* Isocarboxazid
177
What caution should be taken when combining MAOIs with other medications?
Use caution when combining MAOIs with anything that increases norepinephrine as it can raise blood pressure.
178
What should be avoided to prevent hypertensive crisis when taking MAOIs?
Avoid dried, aged, smoked, fermented meats, poultry, and fish.
179
What foods should be avoided due to high tyramine content when on MAOIs?
* Aged cheeses
* Tap and unpasteurized beer
* Sauerkraut
* Kimchee
180
How long must a patient be off Tricyclics before starting MAOIs?
At least 2 weeks.
181
What is the half-life of Paroxetine (Paxil®)?
21 hours.
182
What is the half-life of Sertraline (Zoloft®)?
26 hours.
183
What is the half-life of Escitalopram (Lexapro®)?
27-32 hours.
184
What is the half-life of Citalopram (Celexa®)?
84 hours, with a metabolite half-life of 7-15 days.
185
What is the half-life of Fluoxetine (Prozac®)?
Long half-life due to active metabolites.
186
Which CYP450 isoenzymes are affected by Escitalopram?
Does not significantly inhibit any CYP450 isoenzymes.
187
Which CYP450 isoenzymes does Paroxetine affect?
* 1A2: +
* 2C9: +
* 2C19: +
* 2D6: +++
* 3A4: +
188
Which SSRI has the highest risk for drug interactions?
Paroxetine.
189
True or False: Sertraline has no significant effect on CYP450 2D6.
False.
190
Fill in the blank: The half-life of Citalopram is ______ hours.
84
191
Which two SSRI's have the highest chance of interacting?
Fluoxetine and fluoxetine due to the 2D6
192
What is the main strategy to avoid Antidepressant Discontinuation Syndrome?
Medication taper over ~6 weeks
## Footnote
Gradual reduction of the medication dosage helps prevent withdrawal symptoms.
193
When does Antidepressant Discontinuation Syndrome typically occur?
When SSRI, SNRI, TCA taken for ≥6 weeks then rapidly discontinued
## Footnote
Rapid discontinuation after prolonged use can lead to withdrawal symptoms.
194
What is the typical duration of Antidepressant Discontinuation Syndrome?
Typically lasts <7 days
## Footnote
Symptoms usually resolve within a week.
195
Is Antidepressant Discontinuation Syndrome life-threatening?
No, it is bothersome but not life-threatening
## Footnote
Symptoms can cause discomfort but are not harmful.
196
What are some common symptoms of Antidepressant Discontinuation Syndrome?
Flu-like symptoms, Insomnia, Nausea, Imbalance, Sensory disturbances, Hyperarousal, Headache
## Footnote
These symptoms can vary in intensity and combination.
197
Who is the best candidate for fluoxetine (Prozac®) therapy?
C. A 28-year-old woman who occasionally 'skips a dose' of her prescribed medication
## Footnote
This patient’s profile suggests she may benefit from fluoxetine despite non-compliance.
198
Fill in the blank: Antidepressant Discontinuation Syndrome is typically noted when ________.
SSRI, SNRI, TCA taken for ≥6 weeks then rapidly discontinued
199
True or False: Antidepressant Discontinuation Syndrome is always life-threatening.
False
## Footnote
While symptoms can be distressing, they are not dangerous.
200
A 26-year-old married woman with a two-year-old daughter presents for evaluation of depression that she believes began after the birth of her daughter. She has a BDI score of 23. She relates that she is overall healthy and that she is 16 weeks pregnant. Which of the following would not be an appropriate course of action?
A. Advise no medication or psychotherapy at this time.
B. Refer for weekly interpersonal psychotherapy.
C. Initiate therapy with a therapeutic dose of Citalopram
D. Prescribe a therapeutic dose of bupropion.
A. Advise no medication or psychotherapy at this time.
201
There is positive evidence that the use of lithium by a breast-feeding woman compose a risk to the infant. This medication meets, which hail lactation risk category?
A. L1.
B. L2
C. L3
D. L4
D. L4
202
An overdose of which of the following medications is most likely to be fatal?
A. Amitriptyline.
B. Duloxetine.
C. Fluoxetine.
D. Bupropion.
AMITRIPTYLINE
203
SSRI WITHDRAWAL SYNDROME IS BEST CHARACTERIZED BY:
A. Potentially life threatening
B. Bothersome but not life threatening
C. Most often seen with medications with a longer T1/2
D. Associated with seizure risk
B. Bothersome but not life threatening C
204
A 56 year-old woman is seen in the emergency department with headache, dizziness and Mark hypertension blood pressure 205/145. She is taking some medication for a psychiatric condition, but cannot remember the name. She reports that she felt fine the previous night as she celebrated her wedding anniversary with a wonderful dinner out a local German restaurant she is most likely taking which of the following medication's?
A. Sertraline
B. Phenalzine
C. Fluoxetine
D. Lithium
B. Phenalizine
205
206
What should be assessed and addressed in the psychiatric management of bipolar disorder?
Alcohol or substance use disorders
## Footnote
This is a cornerstone of care.
207
What neurological condition should be assessed for its association with secondary mania?
Multiple sclerosis
208
What specific episodes should mood dysregulation be assessed for in bipolar disorder?
Manic or hypomanic episodes
209
Why is it important to consider collateral sources in managing bipolar disorder?
To gather comprehensive information
210
What is a crucial aspect to ensure in the management of bipolar disorder?
Safety
211
What is the chance of relapse in the first 5 months after discontinuing lithium?
50%
212
What should be minimized during the manic phase of bipolar disorder?
Risk (e.g., limited access to bank accounts)
213
What is essential to promote throughout the care of a patient with bipolar disorder?
A positive recovery message
214
What should be regularly assessed in patients with bipolar disorder?
Psychiatric status
215
What type of contact should be maintained with patients in bipolar disorder management?
Regular visits and phone contact when needed
216
What should be done to educate in the management of bipolar disorder?
Educate patient and family
217
What problems should be anticipated with treatment adherence in bipolar disorder?
Problems with treatment adherence
218
What should be promoted to help manage bipolar disorder effectively?
Awareness of stressors and regular sleep-activity patterns
219
What type of psychotherapy should be targeted in bipolar disorder management?
Understanding the biologic/medical aspect of illness
220
What should be worked on with the patient to help manage bipolar disorder?
Anticipate signs of relapse
221
What is a strategy to prepare for mania re-occurrence?
'Fire drill' for mania re-occurrence
222
What should be evaluated and managed in patients with bipolar disorder?
Functional impairments
223
True or False? Problems with treatment adherence in bipolar disorder can be addressed by acknowledging patient ambivalence.
True
224
True or False? Patients with bipolar disorder are more likely to attempt suicide during manic episodes.
True
225
True or False? Patients rarely volunteer information about manic or hypomanic symptoms.
True
226
True or False? Patients usually exhibit limited insight during a manic phase.
True
227
What technique can be used to help improve medication adherence in bipolar disorder?
Motivational interviewing
