Deck 5: Depressive Disorders

Question 1

Claire Gilliam is a 23 year-old single young woman who makes an appointment with her internist complaining that lately she has been experiencing "crying jags" for no apparent reason. She adds, "I feel like I'm living in a fog. You know, there but not really." Claire also reports fatigue, and a loss of interest in just about everything. She has a poor appetite, and has begun to lose weight. Overall, Claire feels irritable and overwhelmed. She is concerned about her work performance since she's finding it harder and harder to concentrate. Further, her boyfriend is started to complain about their relationship. Reluctantly, Claire admits to a loss of interest in sex. She has never been nor is currently) pregnant. Her physician suggested blood work and the test confirmed 12.hyperthyroidism. Claire was referred to an endocrinologist who put her on the beta-blocker Toprol XL as well as Tapazole, an anti-thyroid medication that prevents the thyroid gland from over-producing thyroid hormone. What is the most likely diagnosis for Claire?

A)Major depressive disorder
B)Persistent depressive disorder dysthymia)
C)Depressive disorder due to another medical condition
D)Substance/medication -induced depressive disorder
True/False:

Answer 1

C

Question 2

One major complication commonly associated with persons who are clinically depressed is the presence of suicidal ideation.

Answer 2

True

Question 3

The diagnostic criteria for a major depressive disorder includes all of the following except:

A)It is not due to the use of a substance or a general medical condition
B)At least five symptoms - one of the symptoms must be either a depressed mood, loss of interest or pleasure - differing from previous functioning, which presents during a two-week period
C)It is not due to bereavement
D)The amount of time between episodes often increases

Answer 3

D

Question 4

There is growing empirical evidence that genetics does not play a role in the etiology of mood disorders.

Question 5

George Langwasser is a 45 year-old gentleman whose case history describes classic features of schizophrenia but the social worker notices in his chart that he has always experienced co-occurring symptoms of depression - that is, feeling "down in the dumps," poor appetite, feelings of hopelessness and insomnia - during his episodes of active psychosis and only during the 2-year period of the active symptoms of schizophrenia. Currently, his psychotic episodes are successfully controlled by medication and his chart reflects no further symptoms of depression. In fact, Mr. Langwasser has never met full diagnostic criteria for major depressive disorder at any time. Should his diagnosis of schizophrenia be changed?

A)No, the diagnosis of schizophrenia is correct
B)Yes, the diagnosis should be changed to persistent depressive disorder dysthymia)
C)Yes, the diagnosis should be changed to schizoaffective disorder
D)Yes, the diagnosis should be changed to schizophrenia and persistent depressive disorder dysthymia)

Question 6

Danny Flynn is a 6 and a half year-old boy who lives with his parents, and younger sister. Mrs. Flynn began, "To look at my Danny, you would never know why we brought him to the mental health clinic. He looks like an angel… those greenish-blue eyes, and that curly blonde hair of his. But to live with him, he's more like the devil reincarnated. Don't get me wrong. I love my son but the problems we're having with him are just not normal." The reason the Laughlin's are seeking counseling is for John's history of severe temper outbursts, both verbal and behavioral, and usually when "things don't go his way" which is just about all the time. "And when he's not having a tantrum, Danny is just plain old angry," adds Mr. Flynn. Danny's most likely diagnosis is:

A)Major depressive disorder
B)Disruptive mood dysregulation disorder
C)Attention-deficit/hyperactivity disorder
D)Persistent depressive disorder dysthymia)

Question 7

Which of the following cities would be expected to have the lowest prevalence of recurrent major depressive disorder with a seasonal pattern?

A)Billings, Montana
B)Nome, Alaska
C)The North Pole
D)Miami, Florida

Question 8

Of the following features, what differentiates disruptive mood dysregulation disorder from bipolar disorder in children?

A)Severity
B)Irritability
C)Age at onset
D)Chronicity

Question 9

Complications with major depression typically center on interpersonal difficulties related to employment, relationships with others, marital discord, and/or substance abuse.

Question 10

Kevin Stover is a 14 year-old boy who was referred to the school social worker for problems focusing on his studies. Kevin admits to difficulties concentrating and confides that he has been feeling "down" all the time for the past school year. He remembers the only time this feeling went away was, "only for a coupla weeks last summer when I went to visit my Uncle Mark. He's really cool. But then that down feeling came back as soon as I got home," states Kevin. He denies any suicidal thoughts but admits to feelings of hopelessness, and low self-esteem. What is the most likely diagnosis for Kevin?

A)Major depressive disorder
B)Schizoaffective disorder
C)Persistent depressive disorder dysthymia), with early onset
D)Disruptive mood dysregulation disorder

Question 11

Jeff Coggins is a 12 year-old youngster who has always been seen by his teachers as "hard to manage." Recently, he started to have new episodes of temper outbursts that are clearly out of proportion to the situation. Which of the following diagnoses is not a possibility?

A)Bipolar disorder
B)Disruptive mood dysregulation disorder
C)Attention-deficit/hyperactivity disorder
D)Conduct disorder

Question 12

Disruptive mood dysregulation disorder, premenstrual dysphoric disorder, and persistent depressive disorder dysthymia) are new depressive disorder diagnoses in the DSM-5. True

Question 13

The DSM-5 has made changes in the classification system for mood disorders as compared to the DSM-IV-TR organization. The following statement best represents the changes to the DSM-5.

A)Consolidates the mood disorders into one section
B)Places the depressive and bipolar mood disorders into separate sections
C)Consolidates mood and anxiety disorders into one section
D)Places mood disorders with psychotic features in a separate section

Question 14

This disorder was previously called "depressive neurosis" and considered less severe than major depressive disorder. The onset is insidious and occurs more often in persons who have a history of long-term stress. Symptoms should include at least two of the following: poor appetite or overeating, sleep problems, fatigue, low self-esteem, difficulty concentrating and/or feeling hopeless. This disorder often coexists with other psychiatric disorders, e.g., substance abuse, personality disorders, and obsessive compulsive disorder. What is the most likely diagnosis?

A)Chronic major depressive episode
B)Pseudomentia
C)Persistent depressive disorder dysthymia)
D)Disruptive mood dysregulation disorder

Question 15

Vegetative features are not important to consider as part of the competency-based assessment of mood disorders.

Question 16

Premenstrual dysphoric disorder PMDD) is included in the DSM-5 but the name of the diagnosis has been changed from how it was listed in the DSM-IV-TR.

Question 17

According to the DSM-5 criteria for a major depressive episode, feelings of worthlessness and self-loathing are common in grief, but self-esteem is generally preserved.

Question 18

In order to meet the diagnostic criteria for a major depressive mood disorder, the symptoms must be present for at least a one-week period of time.

Question 19

Scott Manhattan has been prescribed an anti-depressant medication. His physician, Dr. Andre Hitchcock, instructs him to avoid tyramine rich foods such as aged cheeses, organ meats, red wine, canned figs, and beer while he is on the medication. Scott is most likely taking:

A)Lithium
B)A Mao Inhibitor
C)A Benzodiazepine
D)A serotonin specific reuptake inhibitor SSRI)

Question 20

Children with disruptive mood dysregulation disorder often meet criteria for oppositional defiant disorder.

Question 21

Match each term with the appropriate definition:
$\begin{array}{|l|l|}\hline\text { Term: } & \text { Definition: } \\\hline \text { a) Depressive disorders } &\_\_\_\text { Relatively low-grade, but chronic depression }\\&\text { often lasting for years }\\\hline\text { b) Persistent depressive } &\_\_\_ \text { Use of substances of abuse and several medical } \\\text { disorder (dysthymia) } & \text { conditions associated with depression-like }\\&\text { phenomena }\\\hline \text { c) Disruptive mood } & \_\_\_\text { Symptoms for this disorder must be a } \\\text { dysregulation disorder } & \text { depressed mood present for most of the day in }\\&\text { addition to being present nearly ev ery day }\\\hline \text { d) Mixed episode }&\begin{array}{ll}\_\_\_\text { Refers to the presence of sadness, emptiness }\\\text { or irritable mood accompanied by somatic and }\\\text { cognitive changes significantly affecting functioning }\end{array}\\\hline \begin{array}{ll}\text { e) Substance/medication- }\\\text { induced depressive }\\\text { disorder }\end{array}&\begin{array}{ll}\_\_\_\text { At least } 3 \text { of a combination of manic and }\\\text { depressive symptoms present during the majority of }\\\text { days of a major depressive episode }\end{array}\\\hline \text { f) Major depressive disorder }&\begin{array}{ll}\_\_\_\text { Refers to the presentation in children with }\\\text { persistent irritability and frequent episodes of }\\\text { extreme behavioral dyscontrol }\end{array}\\\hline\end{array}$
$\quad$