Mood disorders

Question 1

What psychiatric symptoms are associated with Lyme disease?

Answer 1

Difficulty concentrating, irritability, and depression - often associated with a flulike illness

Question 2

Within what time period is depressed mood following a death considered normal bereavement?

Answer 2

Less than 2 months

Question 3

How common is postpartum blues?

Answer 3

30-75% of women

Question 4

How long after a stroke is a patient most likely to develop post-stroke depression?

Answer 4

6 months

Question 5

Is anhedonia a feature of postpartum blues or postpartum depression?

Answer 5

Postpartum depression

Question 6

What are common features of depressive disorder with a seasonal pattern?

Answer 6

Hypersomnia and hyperphagia

Question 7

What are the treatments for depressive disorder with a seasonal pattern?

Answer 7

Light therapy and serotonergic agents (usually an SSRI)

Question 8

What are features of cyclothymic disorder?

Answer 8

Recurrent periods of mild depression alternating with periods of hypomania. This pattern must be present for at least 2 years. Symptom free intervals should not be longer than 2 months.

Question 9

What are the most common complaints after ECT?

Answer 9

Headache, nausea, and muscle soreness

Question 10

What is the time requirement of symptoms for persistent depressive (dysthymic) disorder in adults and adolescents?

Answer 10

Adults: 2 years
Adolescents: 1 year

Question 11

What are the relative contraindications to ECT therapy?

Answer 11

Very safe procedure with very few relative contraindications - increased intracranial pressure, MI in the past 4 weeks, aneurysm, bleeding disorder, and any disorders that disrupt the blood brain barrier. *Safe in pregnant women.

Question 12

How is REM sleep affected by depression?

Answer 12

Shortened REM

Question 13

What brain imaging study is characteristic of depression?

Answer 13

Decreased blood flow and metabolism in the frontal lobes on PET scan

Question 14

What feature of depression is one of the most accurate predictors of suicide?

Answer 14

Hopelessness

Question 15

What are the features of major depressive disorder with melancholic features?

Answer 15

Anhedonia, lack of reactivity (nothing can make patient feel better), intense guilt, significant weight loss, early morning awakening, and psychomotor retardation.

Question 16

What is double depression?

Answer 16

When a major depressive episode develops in a patient with dysthymic disorder

Question 17

What are the characteristics of MDD with atypical features?

Answer 17

Mood reactivity (pleasurable events may temporarily improve mood), self-pity, excessive sensitivity to rejection, reversed diurnal mood fluctuations ( patients feel better in the morning), and reversed vegetative symptoms (increased appetite and increased sleep).

Question 18

What months of the year is a manic episode more likely to present?

Answer 18

Summer months - associated with increased sunlight

Question 19

How is REM sleep affected in major depressive disorder?

Answer 19

See decreased latency of REM

Question 20

What proportion of school aged children with major depression demonstrate psychotic symptoms?

Answer 20

1/3

Question 21

What somatic illness should be considered in a middle-aged patient with depression and abdominal pain?

Answer 21

Pancreatic cancer - presents with weight loss, abdominal pain, apathy, decreased energy, lethargy, anhedonia, and depression. Psychiatric symptoms often present before any somatic symptoms so pancreatic cancer should always be considered in middle-aged patients with new onset depression.

Question 22

What is the relative risk of suicide of a female physician compared with the general female population?

Answer 22

Increased

Question 23

How long should a patient continue an antidepressant if they respond well after a single major depressive episode?

Answer 23

An additional 4-9 months to prevent relapse