Deck 53: Depression

Question 1

The lifetime prevalence of major depressive disorder in U.S. adults is estimated to be:

A) 7%
B) 10%
C) 17%
D) 24%

Answer 1

C

Question 2

Which symptom of depression is assessed by the question, "Over the past 2 weeks, have you felt little interest or pleasure in doing things?"

A) Depressed mood
B) Anhedonia
C) Fatigue
D) Impaired concentration

Answer 2

B

Question 3

In reviewing your patient Paula Flynn's history of depressive symptoms, she describes an initial episode of depression at age 16 after her father unexpectedly died of a heart attack. This episode was characterized by depressed mood, anhedonia, feelings of guilt, difficulty sleeping, and lack of energy. Although she withdrew from friends and family, she continued to work part time and her school performance did not suffer. She was not diagnosed with depression at this time and the episode resolved without treatment "probably in about 4 months."
Paula experienced another episode of depression at age 24 when she was in her second semester of graduate school. Her symptoms were similar to those of the first episode, with the addition of impaired concentration and frequent thoughts that she would be better off dead. Her problems with concentration and memory and anxiety around other people were severe enough that she took a leave of absence from school. After being depressed for several months, she began seeing a therapist at the insistence of her mother and "I got back to myself, but it took about a year."
Paula is currently 27 years old and "the depression is the worst it's ever been." There was no obvious precipitant ("It just came over me like a black cloud"). She has taken a leave from her job because "I just can't get out of bed in the morning." She has not been able to successfully utilize coping skills learned in previous treatment. She thinks frequently about suicide and tells you that she has thought about jumping from a 10-story building.
-When documenting Paula's mental status, which of these choices is the best description of her mood?

A) Depressed and irritable
B) Psychomotor retardation
C) Tearful
D) "Despondent. It feels like this misery will never go away."

Answer 3

D

Question 4

In reviewing your patient Paula Flynn's history of depressive symptoms, she describes an initial episode of depression at age 16 after her father unexpectedly died of a heart attack. This episode was characterized by depressed mood, anhedonia, feelings of guilt, difficulty sleeping, and lack of energy. Although she withdrew from friends and family, she continued to work part time and her school performance did not suffer. She was not diagnosed with depression at this time and the episode resolved without treatment "probably in about 4 months."
Paula experienced another episode of depression at age 24 when she was in her second semester of graduate school. Her symptoms were similar to those of the first episode, with the addition of impaired concentration and frequent thoughts that she would be better off dead. Her problems with concentration and memory and anxiety around other people were severe enough that she took a leave of absence from school. After being depressed for several months, she began seeing a therapist at the insistence of her mother and "I got back to myself, but it took about a year."
Paula is currently 27 years old and "the depression is the worst it's ever been." There was no obvious precipitant ("It just came over me like a black cloud"). She has taken a leave from her job because "I just can't get out of bed in the morning." She has not been able to successfully utilize coping skills learned in previous treatment. She thinks frequently about suicide and tells you that she has thought about jumping from a 10-story building.
-Paula's history illustrates which of the risks of inadequately treated depression?

A) Bipolar disorder
B) Kindling
C) Persistent depressive disorder
D) Social isolation

Question 5

In reviewing your patient Paula Flynn's history of depressive symptoms, she describes an initial episode of depression at age 16 after her father unexpectedly died of a heart attack. This episode was characterized by depressed mood, anhedonia, feelings of guilt, difficulty sleeping, and lack of energy. Although she withdrew from friends and family, she continued to work part time and her school performance did not suffer. She was not diagnosed with depression at this time and the episode resolved without treatment "probably in about 4 months."
Paula experienced another episode of depression at age 24 when she was in her second semester of graduate school. Her symptoms were similar to those of the first episode, with the addition of impaired concentration and frequent thoughts that she would be better off dead. Her problems with concentration and memory and anxiety around other people were severe enough that she took a leave of absence from school. After being depressed for several months, she began seeing a therapist at the insistence of her mother and "I got back to myself, but it took about a year."
Paula is currently 27 years old and "the depression is the worst it's ever been." There was no obvious precipitant ("It just came over me like a black cloud"). She has taken a leave from her job because "I just can't get out of bed in the morning." She has not been able to successfully utilize coping skills learned in previous treatment. She thinks frequently about suicide and tells you that she has thought about jumping from a 10-story building.
-Paula's current score on the Patient Health Questionnaire (PHQ-9) is 20. What level of depression severity would be indicated by this score?

A) Mild depression
B) Moderate depression
C) Moderately severe depression
D) Severe depression

Question 6

In reviewing your patient Paula Flynn's history of depressive symptoms, she describes an initial episode of depression at age 16 after her father unexpectedly died of a heart attack. This episode was characterized by depressed mood, anhedonia, feelings of guilt, difficulty sleeping, and lack of energy. Although she withdrew from friends and family, she continued to work part time and her school performance did not suffer. She was not diagnosed with depression at this time and the episode resolved without treatment "probably in about 4 months."
Paula experienced another episode of depression at age 24 when she was in her second semester of graduate school. Her symptoms were similar to those of the first episode, with the addition of impaired concentration and frequent thoughts that she would be better off dead. Her problems with concentration and memory and anxiety around other people were severe enough that she took a leave of absence from school. After being depressed for several months, she began seeing a therapist at the insistence of her mother and "I got back to myself, but it took about a year."
Paula is currently 27 years old and "the depression is the worst it's ever been." There was no obvious precipitant ("It just came over me like a black cloud"). She has taken a leave from her job because "I just can't get out of bed in the morning." She has not been able to successfully utilize coping skills learned in previous treatment. She thinks frequently about suicide and tells you that she has thought about jumping from a 10-story building.
-When assessing Paula's risk of suicide, which of these behaviors would be a particular cause for concern?

A) Excessive alcohol consumption
B) Spending sprees
C) Fighting with her spouse
D) Making a large donation to charity

Question 7

In reviewing your patient Paula Flynn's history of depressive symptoms, she describes an initial episode of depression at age 16 after her father unexpectedly died of a heart attack. This episode was characterized by depressed mood, anhedonia, feelings of guilt, difficulty sleeping, and lack of energy. Although she withdrew from friends and family, she continued to work part time and her school performance did not suffer. She was not diagnosed with depression at this time and the episode resolved without treatment "probably in about 4 months."
Paula experienced another episode of depression at age 24 when she was in her second semester of graduate school. Her symptoms were similar to those of the first episode, with the addition of impaired concentration and frequent thoughts that she would be better off dead. Her problems with concentration and memory and anxiety around other people were severe enough that she took a leave of absence from school. After being depressed for several months, she began seeing a therapist at the insistence of her mother and "I got back to myself, but it took about a year."
Paula is currently 27 years old and "the depression is the worst it's ever been." There was no obvious precipitant ("It just came over me like a black cloud"). She has taken a leave from her job because "I just can't get out of bed in the morning." She has not been able to successfully utilize coping skills learned in previous treatment. She thinks frequently about suicide and tells you that she has thought about jumping from a 10-story building.
-Given the severity of Paula's symptoms, what would be an evidence-based treatment recommendation?

A) Her depression is too severe to be treated with psychotherapy and she should be treated with antidepressant medication.
B) Her increasing suicidality is an indication for electroconvulsive therapy (ECT).
C) She should immediately begin a program of daily aerobic exercise.
D) Combined treatment with psychotherapy and medication is likely to produce greater improvement in depressive symptoms than either treatment modality alone.

Question 8

In reviewing your patient Paula Flynn's history of depressive symptoms, she describes an initial episode of depression at age 16 after her father unexpectedly died of a heart attack. This episode was characterized by depressed mood, anhedonia, feelings of guilt, difficulty sleeping, and lack of energy. Although she withdrew from friends and family, she continued to work part time and her school performance did not suffer. She was not diagnosed with depression at this time and the episode resolved without treatment "probably in about 4 months."
Paula experienced another episode of depression at age 24 when she was in her second semester of graduate school. Her symptoms were similar to those of the first episode, with the addition of impaired concentration and frequent thoughts that she would be better off dead. Her problems with concentration and memory and anxiety around other people were severe enough that she took a leave of absence from school. After being depressed for several months, she began seeing a therapist at the insistence of her mother and "I got back to myself, but it took about a year."
Paula is currently 27 years old and "the depression is the worst it's ever been." There was no obvious precipitant ("It just came over me like a black cloud"). She has taken a leave from her job because "I just can't get out of bed in the morning." She has not been able to successfully utilize coping skills learned in previous treatment. She thinks frequently about suicide and tells you that she has thought about jumping from a 10-story building.
-After discussing treatment options with Paula, you prescribe a selective serotonin reuptake inhibitor (SSRI). How frequently should you monitor her response during the first few months of treatment?

A) Weekly for first month, then monthly
B) Monthly
C) Twice in the first week, then weekly
D) Every 2 months

Question 9

In reviewing your patient Paula Flynn's history of depressive symptoms, she describes an initial episode of depression at age 16 after her father unexpectedly died of a heart attack. This episode was characterized by depressed mood, anhedonia, feelings of guilt, difficulty sleeping, and lack of energy. Although she withdrew from friends and family, she continued to work part time and her school performance did not suffer. She was not diagnosed with depression at this time and the episode resolved without treatment "probably in about 4 months."
Paula experienced another episode of depression at age 24 when she was in her second semester of graduate school. Her symptoms were similar to those of the first episode, with the addition of impaired concentration and frequent thoughts that she would be better off dead. Her problems with concentration and memory and anxiety around other people were severe enough that she took a leave of absence from school. After being depressed for several months, she began seeing a therapist at the insistence of her mother and "I got back to myself, but it took about a year."
Paula is currently 27 years old and "the depression is the worst it's ever been." There was no obvious precipitant ("It just came over me like a black cloud"). She has taken a leave from her job because "I just can't get out of bed in the morning." She has not been able to successfully utilize coping skills learned in previous treatment. She thinks frequently about suicide and tells you that she has thought about jumping from a 10-story building.
-What is a key point to be included in patient education when starting a patient on a SSRI?

A) Presence of GI side effects such as nausea and diarrhea is an indication that medication dosage should be reduced.
B) Early side effects of SSRI treatment such as decreased appetite, nausea, and headache are usually time limited and do not indicate a need to discontinue the medication.
C) Full remission of depressive symptoms should be expected within the first 2 weeks of treatment.
D) A 50% reduction in depressive symptoms is considered full remission.

Question 10

In reviewing your patient Paula Flynn's history of depressive symptoms, she describes an initial episode of depression at age 16 after her father unexpectedly died of a heart attack. This episode was characterized by depressed mood, anhedonia, feelings of guilt, difficulty sleeping, and lack of energy. Although she withdrew from friends and family, she continued to work part time and her school performance did not suffer. She was not diagnosed with depression at this time and the episode resolved without treatment "probably in about 4 months."
Paula experienced another episode of depression at age 24 when she was in her second semester of graduate school. Her symptoms were similar to those of the first episode, with the addition of impaired concentration and frequent thoughts that she would be better off dead. Her problems with concentration and memory and anxiety around other people were severe enough that she took a leave of absence from school. After being depressed for several months, she began seeing a therapist at the insistence of her mother and "I got back to myself, but it took about a year."
Paula is currently 27 years old and "the depression is the worst it's ever been." There was no obvious precipitant ("It just came over me like a black cloud"). She has taken a leave from her job because "I just can't get out of bed in the morning." She has not been able to successfully utilize coping skills learned in previous treatment. She thinks frequently about suicide and tells you that she has thought about jumping from a 10-story building.
-Paula has remained on SSRI treatment for 15 months and has now been symptom free for 6 months. She wants to get pregnant and would like to discontinue medication. What would be your treatment recommendation to Paula?

A) She should continue taking her medication while trying to conceive because SSRIs are safe in pregnancy.
B) She should discontinue her SSRI because she is no longer at risk of relapse.
C) She should continue to be monitored for several months after discontinuing her medication because risk of relapse is highest in the first 2 months after discontinuing treatment.
D) She should not try to conceive since pregnancy is risky for women with major depressive disorder.