RECALL: Depression + Suicide + Trauma + Bipolar + OCD Flashcards
(41 cards)
“111. Depressive symptoms are similar in adolescents and adults, except:
a. Change in concentration
b. Suicide
c. Depressed mood
d. Melancholy”
“D) Melancholy = FALSE
A) TRUE
B) TRUE
C) TRUE
D) FALSE. Less melancholic features. Usually hypersomnia, hyperphagia [DSM5, p.166. top]”
“Some symptom differences exist, though, such that hypersomnia and hyperphagia are more likely in younger individuals, and melancholic symptoms, particularly psychomotor disturbances, are more common in older individuals.” - DSM5
“125. Dysthymia, which is true?
a. Majority has an insidious onset before age 25 (50%)
b. Specifier at early start is before age 21
c. There may have been a hypomanic episode prior to diagnosis
d. If late start, is likely to develop a bipolar disorder”
“B) Specifier at early start is before age 21 = TRUE
Straight from DSM5 p.169.
A also true per below, so likely a recall issue, but DSM > KS concise for priority
A) TRUE, but not DSM
- DSM p170 - ““often has early and insidious onset””, but age 25 not mentioned.
- KS CONCISE textbook: ““About 50 percent of patients with dysthymia experience an insidious onset of symptoms before 25 years of age.”” p85
B) TRUE.
C) FALSE. Exclusion.
D) FALSE. If early, more likely bipolar. (B19); or at least early depression often bipolar”
“126. Site to target for DBS in depression?
a. Sub-callous cingulum (subcallosum cingulate)
b. Cortex DLPF
c. Broca’s Area 25
d. Tonsil”
“A) Subcallosum cingulate = TRUE
NB. BRODMANN area 25 is SCC.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3984894/
A) SCC first site investigated. Ongoing research into nucleus accumbens, ventral capsule and ventral striatum.
B) FALSE
C) FALSE
D) FALSE”
“132. Female with MDD with three (4?) previous episodes in 5 years, minimum duration of recommended antidepressant treatment:
a. 2 years
b. 5 years”
“A) 2 years = TRUE
Frequent recurrent depresison is risk factor for consideration for at least 2 years of antidepressant treatment. High risk of relapse if stopped before 6 months. Depends on wording.
A) TRUE
B) FALSE”
how many episodes of depression must someone have before the recommendation is to continue antidepressants for 2 years after recovery
3+
“15) Middle aged man with depression. Effexor and SSRI gave him sexual dysfunction. Mirtazapine and Wellbutrin didn’t work. Next choice?
a) duloxetine
b) desipramine
c) aripiprazole
d) selegeline”
“D) Selegeline - IMAO-B
““Agomelatine, bupropion, mirtazapine, moclobemide, and selegiline transdermal exhibit placebo-level rates of sexual
dysfunction.”” <2% Sexual SE
A) FALSE. SNRI have higher rates of sexual dysfunction.
B) FALSE. TCAs have higher rates of sexual dysfunction.
C) FALSE. Aripiprazole is not monotherapy recommendation.
D) TRUE”
“156. Man in his 60’s with symptoms of depression. Which of the following would be most specific to his diagnosis?
a. Psychomotor retardation
b. Suicidality
c. Poor concentration
d. Poor energy “
“B) Suicidality
Other symptoms may be seen in cognitive decline or organic etiology or psychotic features.
A) FALSE -> NS
B) Most specific for MDD
C) FALSE -> NS
D) FALSE -> NS”
“16. Atypical depression in a 50-ish woman. She had a history of a prior GI bleed, HTN, and was on an NSAID, a PPI and Metoprolol. What do you chose to treat with?
a) Moclobemide
b) paroxetine
c) venlafaxine
d) phenelzine”
“A) Moclobemide = TRUE
If history of GI bleed, would NOT use SSRI. MAOIs and SNRI not associated as strongly with GI bleed. Mirtazapine and bupropion have low risk of GI bleed.
Stahl’s prescriber’s guide 6e, p.487-488 can support A and C.
- moclobemide has ““potential advantage”” for atypical depression
- ““use cautiously”” in HTN pts
A) TRUE
B) FALSE. SSRI risk of GI bleed
C) FALSE. SNRI still risk of GI bleed + HTN risk
D) FALSE. MAOI lower risk of GI bleed, but phenelzine has lower recommendation for depression.
Relates to 5HT boosting. Risk .:
- HIGH = SSRI, clomipramine
- MED = SNRI, 3o TCA
- LOW = Bup, Mirtaz, Moclobemide, desimpramine
[LR2020]
”
“21. How is remission of depression defined re: HAM-D score?
a) 50% score reduction
b) 25% score reduction
c) Score of 12 or less
d) Score of 7 or less”
“D) Score of 7 or less
Response (reduction from baseline of ≥ 50% in the total score)
Remission (total HAMD-17 score ≤ 7)
[https://www.ncbi.nlm.nih.gov/pubmed/23357658]
Remission scores for various scales:
PHQ9: 5
QIDS: 5
HAMD: 7
MADRS: 10”
“51. All of these statements about major depression are true, except?
a. About 50% of people with a first episode of MDE will have a second one
b. Psychosocial stressors have similar impact across all stages of MDD
c. People with dysthymia and superimposed depression have less interepisode recovery”
“B) Psychosocial stressors have similar impact across of all stages of MDD = FALSE
A) TRUE.
““Many patients are at substantial risk of later recurrence, with 60% lifetime risk of recurrence after the first major depressive episode. As many as 70% of those with 2 MDEs have recurrences throughout their life, and 90% of those with three or more episodes will experience further recurrent episode”“(2020, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0230363;
"”A single episode of MDD is associated with a 50% lifetime risk of recurrence; two episodes are associated with a 70% lifetime recurrence risk, and three or more episodes are associated with a 90% lifetime recurrence risk”” (2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3057717/ )
B) FALSE. Less impact with age
KS (synopsis) p.354, first stressor may have longlasting changes that alter brain .: high risk of subsequent episodes even without external stressor
KS FULL pdf p. 4147: ““association of acute stressors and onset of illness become progressively weaker with increasing number of previous episodes… and patients at high genetic risk commonly experience episodes without any negative life event””
C) TRUE
-DSM: dysthymia is harder to treat than MDD (from p.170 ““depressive symptoms are much less likely to resolve in a given period of time in the context of persistnet depressive disorder than they are in a major depressive episode””)”
“55. What comorbidity best predicts tx resistance in kids with MDD
a. ADHD
b. ODD
c. OCD”
“C) OCD
Dr. Yew in Surrey said put OCD
TR2021
Can’t find formal source
Everywhere says ““comorbidities can worsen treatment outcome””. CANMAT says ““limited evidence supports fluoxetine in oppositional symptoms””, TORDIA (study about AFTER they are treatment resistant) says ADHD and anxiety and oppositional symptoms all improved somewhat. ADHD sx actually had a slight non-significant trend toward having a greater response rate. All the treatment resistant depression in kids papers send me down a rabbit hole of circular citing.
“
“60. Regarding MDD and relapse:
a. IPT plus medications is the more effective at preventing relapse as IPT alone
b. There have not been studies examining the combination of IPT and medications for preventing relapse
c. No psychotherapy has been shown to be effective for relapse prevention
d. Something about dropout rates”
“A) IPT plus meds is MORE effective at preventing relapse that IPT alone
In CANMAT, Combo > either alone
A) TRUE. IPT + meds BETTER than meds alone (CANMAT 2016)
B) FALSE
C) FALSE”
“62. Most replicated finding on neuroimaging for MDD
a. PFC hyperreactivity
b. amygdala hyperactivity
c. caudate”
“B) Amygdala hyperactivity
A) FALSE. PFC HYPOreactivity
B) TRUE
C) FALSE. Caudate HYPOreactivity [KS synpsosis, p.361]”
“76. Guy in his 30s, presenting with symptoms of depression (no neurological symptoms mentionned), taking Vitamin D supplements. Vegan. Which deficiency?
A) Calcium
B) Magnesium
C) Vitamin B12
D) Vitamin D”
“C) VItamin B12 = TRUE
Vit B12 is found in dairy and meets. Vit B12 def can cause depressed mood, poor concentration and fatigue.
A) FALSE calcium def results in cramps and pain
B) FALSE magnesium found in plants
D) FALSE He is taking Vit D supplement
“
“88. Post MI with depression. Poor sleep, low appetite, low interest. Best treatment?
a. Mirtazapine
b. Sertraline”
“B) Sertraline
SADHART, CREATE
SSRIs, specifically sertraline or citalopram are first line for depression + ACS/MI/CAD
A) FALSE
B) TRUE”
does being LGBTQ affect suicide risk in teens
“LGBTQ2S Canadians: Evidence is mixed; but very likely higher rates of suicidal behaviour and death by suicide, especially at younger ages”
what is the most common method of suicide in adolescent canadians
hanging
(its firearms in US teens)
“112. Which factor most decreases suicide rates on inpatient unit?
a. risk assessment before patient goes out on passes
b. removing ligature points from wards
c. Accounting for sharps and medications
d. 1:1 observation of high risk patients”
“B) Removing ligature points from wards
[CJP 2014, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4079240/]
““In the case audits authorized by TJC known as root cause analyses, the physical environment of the inpatient unit was incriminated in 84% of reported suicides, 15 clearly the most important factor in inpatient suicide.””
TR2020 also confirms this. Addressing physical env is most effective way to reduce suicide rate in hospital, especially anchor points”
“35) What initiative has lowered the suicide rates the most?
a) increasing ratios of psychiatrists to patients
b) 24 hr crisis response
c) improving access to mental health inpatient services
- What system intervention decreases suicide?
a) increase psychiatrists in system to improve access
b) having 24 hr crisis support
c) more access to inpatient beds
d) increase media coverage of suicides
“
“B) Having 24 hr crisis support?
Reducing lethal means in other versions, which is very effective.
A) ? [Crisis 2004, small impact, https://www.ncbi.nlm.nih.gov/pubmed/15387212?dopt=Abstract]
B) TRUE
C) ? No association with increasing physician density
D) Increasing media has bidirectional effect
https://www.sciencedirect.com/science/article/pii/S0398762013002885 (2013)
- ““three most efficient categories of intervention seem to be the limitation of access to lethal means, the preservation of contact with the patients hospitalized for a suicide attempt after hospitalization, and the implementation of emergency call centers. The four other categories of intervention examined in this study — the training of general practitioners, the reorganization of care, programs in schools, and information campaigns — have not yet shown sufficient proof of their efficacy.””
https://www.cdc.gov/violenceprevention/pdf/suicideTechnicalPackage.pdf
- this seems like a good resource but hard to get comparables
“
in PTSD, what brain area is ACTIVATED during flashbacks
amygdala on the right
in PTSD, what areas show DECREASED activity during flashbacks
brocas and prefrontal cortex
what does up to date advise for treatment of acute stress disorder
If was Acute Stress Disorder, UTD says:
- Wait 2 weeks after trauma before starting
- then TF-CBT (which includes psychoed and exposure)
- benzos for TEMP relief of acute sx IF NEEDED
- no evidence for SSRIs
“77. 16 year old girl, witnessed someone getting shot at school last year. She has had 2 months of being out of school, having nightmares, and difficulty sleeping. What do you do?
a) supportive psychotherapy
b) sertraline
c) tell family that it will pass
d) trazadone”
“A) Supportive psychotherapy
(1) What are we treating?
(2) What is indicated per dx?
PTSD?
NOT setraline.
- CPG 2014 p41 re: CAP PTSD = ““pediatric PTSD, sertraline alone or as an adjunct to CBT was not more effective than placebo or CBT (both Level 2, negative) and CANNOT be recommended at this time””
- KSFull 10e P.3706 = “” Although several selective serotonin reuptake inhibitors (SSRIs) have been shown to effectively treat adult PTSD symptoms, two RCTs have failed to show superiority to placebo in traumatized children. Similarly, although open trials of adrenergic agents have had promising results, two RCTs have failed to show superiority of propranolol to placebo in treating pediatric PTSD.””
SLEEP?
Meds NOT first line. And usually antihistamines or melatonin. https://www.uptodate.com/contents/pharmacotherapy-for-insomnia-in-children-and-adolescents-a-rational-approach
WILL IT PASS IF IT IS PTSD?
50% do in 3 months. but she’s pretty impaired so you’d at LEAST do supportive psychotherapy”
are meds indicated in pediatric PTSD
so far, SSRIs have failed to show superiority over placebo for treatment of traumatized children despite evidence for efficacy in adults
