Questions and Answers
What is a defining characteristic of unipolar depression?
Which neurotransmitter is NOT typically associated with major depression symptoms?
What is a common trigger for depression in some individuals?
What must individuals experience to meet the DSM V criteria for major depression?
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Which of the following groups has a higher lifetime rate of depression compared to men?
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Which statement accurately describes bipolar disorder?
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What is one of the first steps in identifying depressive symptoms associated with substance use?
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Which population exhibits the highest rates of major depression?
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Which medication is contraindicated in patients with QT prolongation?
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What is a common adverse effect associated with Trazodone?
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Which antidepressant requires monitoring for liver function due to a risk of hepatotoxicity?
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What should patients taking MAOIs avoid to prevent hypertensive crises?
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What distinguishes Mirtazapine from other antidepressants discussed?
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What is a serious consequence of combining MAOIs with tyramine-rich foods?
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What is the initial dose of Phenelzine?
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Which of the following symptoms is NOT associated with serotonin syndrome?
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When switching to an MAOI from another antidepressant, what is the required washout period for most antidepressants?
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Which is a prominent adverse effect of Bupropion?
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Why is Nefazodone rarely used in treatment today?
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What effect does ɑ2-adrenergic receptor antagonism have in Mirtazapine?
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What is the highest generally recommended dose range for Trazodone?
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What is considered a score indicative of moderate-severe depression on the Hamilton Rating Scale for Depression (HAM-D)?
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In the context of the Montgomery-Asberg Depression Rating Scale (MADRS), what does this scale primarily evaluate?
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What does a 'response' to treatment generally signify when using the HAM-D scale?
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Which patient health questionnaire is based on DSM-5 diagnostic criteria for major depression?
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What is the goal of the acute phase of treatment for depression?
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What risk factor would most likely necessitate lifelong maintenance therapy for depression?
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What is the purpose of educating the patient and their support system during treatment for depression?
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What is the definition of 'remission' in the context of the HAM-D scale?
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What is the recommendation for psychotherapy as a treatment for severe major depressive disorder?
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What is a significant concern regarding St. John's Wort?
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Which statement about Electroconvulsive Therapy (ECT) is accurate?
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When is maintenance psychotherapy recommended?
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What is a common adverse effect of Electroconvulsive Therapy (ECT)?
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Which patient is most likely to be a candidate for ECT?
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Which statement about the frequency of ECT treatments is true?
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What issue may occur if antidepressants are not prescribed after ECT?
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What is a key emotional symptom of major depressive disorder?
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Which option describes a common physical symptom associated with major depressive disorder?
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Which of the following factors is NOT associated with increased suicide risk?
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What type of psychomotor disturbance is characterized by purposeless, restless motion?
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What cognitive symptom is commonly noted in patients with major depressive disorder?
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What is a notable characteristic of patients at risk for suicide?
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Which statement regarding the myths of suicide is true?
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When evaluating a patient for major depressive disorder, which symptom is indicative of psychotic features?
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What is a common misconception regarding suicide risk factors?
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Which chronic symptom often leads patients to seek medical attention?
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Study Notes
Definition of Depression
- A mental state marked by persistent sadness, frustration, and hopelessness.
- Key characteristics include misery, guilt, low self-esteem, lack of motivation, and absence of drive.
- Unipolar depression involves depressive episodes only, while bipolar disorder includes alternating episodes of depression and mania.
Mania
- Defined by increased impulsivity and hyper-excitability, lasting months.
- Symptoms include opposite effects of depression due to neurotransmitter overproduction.
- May involve hallucinations and significant mood swings.
Epidemiology and Risk Factors
- Depression contributes to functional disability, increased morbidity, and mortality.
- New antidepressants are generally more effective and better tolerated than older options.
- Women face a higher lifetime risk, estimated at 1.7 to 2.7 times greater than men, particularly from early adolescence to mid-50s.
- Young adults (18-29 years) report the highest rates of major depression.
Clinical Presentation
- Withdrawal from substances like cocaine may induce depressive symptoms.
- Essential to rule out medical conditions and review medications through lab tests and mental status examinations.
- Life stressors can trigger depression; patients may experience recurrent episodes.
- Medical and substance use disorders often coincide with depressive symptoms.
DSM V Criteria for Major Depression
- Diagnosis requires five or more symptoms over a two-week period, with at least one being either depressed mood or loss of interest.
- Symptoms must markedly impair social or occupational functions and not stem from substance abuse or medical conditions.
Emotional Symptoms
- Persistent inability to experience pleasure and loss of interest in daily activities.
- Patients appear sad, often holding pessimistic beliefs about recovery.
- Unrealistic feelings of guilt can exhibit delusional qualities.
- Approximately 90% of major depressive disorder patients also exhibit anxiety symptoms.
Physical Symptoms
- Chronic fatigue, especially pronounced in the morning, often with pain or headaches.
- Sleep disturbances include early awakenings, difficulty falling asleep, and hypersomnia.
- Appetite changes can lead to significant weight loss or gain, particularly in older adults.
Intellectual and Cognitive Symptoms
- Signs include decreased concentration, slowness in thought and processing, confusion, and poor memory.
- Cognitive symptoms in elderly people may indicate depression.
Psychomotor Disturbances
- Psychomotor retardation can lead to noticeably slowed movements and thought processes.
- Psychomotor agitation manifests as purposeless and restless activity.
Suicide Risk Evaluation and Management
- Suicide is the third leading cause of death in individuals aged 15-24 and second for ages 25-34.
- Common myths about suicide include misconceptions about those who express suicidal thoughts.
- Factors intensifying risk encompass previous suicide attempts, male gender, social isolation, and hopelessness.
- Hints of suicidal ideation may indicate severity, such as personality change or preparation to make a will.
Clinician Rating Scales
- Hamilton Rating Scale for Depression (HAM-D) is used for clinical trials.
- Clinical Global Impression (CGI) assesses overall severity and patient improvement.
- Montgomery-Asberg Depression Rating Scale (MADRS) measures depressive symptoms.
Patient Rating Scales
- Patient Health Questionnaire-9 (PHQ-9) aligns with DSM-5 criteria for screening depression.
- Beck Depression Inventory and Quick Inventory of Depressive Symptoms (Self-Rated) also evaluate depression.
Therapeutic Options
- Treatment aims to reduce acute symptoms, restore functioning, and prevent future episodes.
- Hospitalization is based on suicide risk, overall health, support systems, and severity of symptoms.
Phases of Treatment
- Acute phase (6 to 10 weeks) focuses on achieving remission.
- Continuation phase (4 to 9 months) aims to eliminate residual symptoms.
- Maintenance phase (more than 12 to 36 months) works to prevent recurrence, especially for those at high risk.
Education and Non-Pharmacological Approaches
- Patients and families need guidance on treatment expectations, adherence, and managing delayed antidepressant effects.
- Emphasize the importance of a supportive network in recovery.### Psychotherapy and its Efficacy
- Interpersonal psychotherapy and cognitive behavioral therapy are common types of psychotherapy.
- Effectiveness of psychotherapy is often observed over a longer duration compared to pharmacotherapy, which enhances its effectiveness.
- For mild to moderate depressive episodes, psychotherapy can be the first-line therapy.
- Severe or psychotic major depressive disorders do not recommend psychotherapy alone for acute treatment.
- Maintenance psychotherapy is not advised as the sole strategy for preventing depressive recurrence.
St. John's Wort
- Not regulated by the FDA; manufacturers do not need to prove safety or efficacy.
- Single-source products from reputable manufacturers are recommended.
- Significant interactions observed with commonly prescribed medications.
Electroconvulsive Therapy (ECT)
- ECT is a safe and effective treatment for various mental illnesses, particularly major depressive disorder.
- Candidates for ECT include those needing rapid response or with a history of poor antidepressant response.
- Recommended if depression symptoms are severe or life-threatening.
- Standard ECT course entails 6 to 12 treatments, delivered 2-3 times a week, with a quick therapeutic response (10-14 days).
- Increased risks associated with certain conditions, including increased intracranial pressure and recent myocardial infarction.
- Anesthetics and neuromuscular blockers can reduce ECT-related morbidity.
- Possible adverse effects include cognitive dysfunction, memory disturbances, cardiovascular dysfunction, and prolonged apnea.
Antidepressants: Secondary Amines
- Patients with QT prolongation are treated cautiously with medications like citalopram.
- Desipramine and nortriptyline doses vary and are dependent on clinical needs.
- Combined imipramine and desipramine concentrations must be monitored for therapeutic efficacy.
Triazolopyridines and Aminoketone Antidepressants
- Trazodone and nefazodone act through dual mechanisms on serotonergic neurons.
- Bupropion has minimal effect on 5-HT reuptake but inhibits dopamine and norepinephrine reuptake.
- Mirtazapine enhances norepinephrine and serotonin activity while antagonizing various receptors, thus reducing side effects.
- Common adverse effects include sedation, weight gain, dry mouth, and cognitive slowing.
Monoamine Oxidase Inhibitors (MAOIs)
- Types of MAOIs include phenelzine and tranylcypromine, known for blocking the breakdown of neurotransmitters.
- Patients on MAOIs must avoid tyramine-rich foods to prevent hypertensive crises.
- Symptoms of hypertensive crises include severe headaches, stiff neck, nausea, sweating, and dangerously high blood pressure.
- MAOIs can alter receptor sensitivity over time, leading to various side effects like weight gain and sexual dysfunction.
Signs of Serotonin Syndrome
- Cognitive dysfunction: confusion, agitation, hypomania.
- Autonomic dysfunction: shivering, fever, diarrhea, diaphoresis.
- Neuromuscular dysfunction: myoclonus, hyperreflexia, tremor.
- Severe cases can lead to seizures or even death.
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Description
Explore the complex topic of depression in this quiz, covering definitions, symptoms, and classifications such as unipolar and bipolar disorders. Understand the implications of depressive moods and how they relate to mental health.
