Deck 13: Depressive Disorders

Question 1

The patient says that for the last 5 years, she has begun to feel depressed around the time the golf season ends in November and begins to feel better when she is able to get outdoors to play again in April. When she is depressed, she craves carbohydrates, overeats, and gains weight. She has no energy and wants to sleep all the time and she is irritable and snaps at people. The psychiatric advanced practice nurse considers which of the following diagnoses?

A) Dysthymia
B) Major depressive disorder with seasonal pattern
C) Adjustment disorder with depressed mood
D) Major depressive disorder with atypical features

Answer 1

Major depressive disorder with seasonal pattern

Question 2

A young adult who works as a court reporter describes herself as being depressed most of the time and says she has been that way since her teens. She denies any weight loss or sleep disturbances. She describes problems with concentration, difficulty making decisions, and lack of energy that are causing her problems at work. Which of the following is the most likely diagnosis?

A) Dysthymia
B) Major depressive disorder with seasonal pattern
C) Major depressive disorder with atypical features
D) Major depressive disorder with melancholic features

Answer 2

Dysthymia

Question 3

The patient says that she has been feeling sad and having difficulty sleeping over the past 6 weeks. She says she has lost her appetite and has lost about 10 lb. This is the first time she has felt this way and she cannot recall any specific unsetting event. Given this minimal information, an initial diagnosis might be

A) Adjustment disorder with depression
B) Seasonal affective disorder
C) Major depression, single episode
D) Major depression with catatonic features

Answer 3

Major depression, single episode

Question 4

A patient says that she has been becoming increasingly depressed following the birth of her first child 4 months ago. She had an episode of depression in her 20s but recovered. Now, she is becoming more despondent, crying, and sleeping a lot. She fears that she may hurt the baby if she does not get treatment. A possible diagnosis is

A) Major depressive disorder with melancholic features
B) Major depressive disorder with psychotic features
C) Dysthymia with superimposed major depression (double depression)
D) Major depressive disorder with postpartum onset

Question 5

Electroconvulsive therapy has been found to be effective in which of the following conditions?

A) Depression with melancholic features
B) Dysthymia
C) Seasonal affective disorder
D) Atypical depression

Question 6

Core symptoms of complicated grief include experiencing which of the following symptoms more than 6 months after the death?

A) Feeling that life has no meaning without the deceased
B) Prominent self-blaming thoughts for not having prevented the death
C) Dissociative states in which the deceased is believed to be present
D) All of the above

Question 7

A patient who has been taking venlafaxine (Effexor) for major depressive disorder with melancholic features says that suddenly he can't sleep and spends hours writing to his congressman with his ideas of how to reduce the national debt. The psychiatric advanced practice nurse considers all of the following but selects which one as the most likely explanation for the change in his clinical presentation:

A) Nonadherence with venlafaxine
B) Emergence of symptoms of hypomania
C) Emergence of symptoms of a personality disorder
D) Increasing severity of symptoms of depression

Question 8

Post's theory of depression states that early experience may make the brain more sensitive to future stressors and to recurrence of depressive episodes. This theory is often referred to as

A) Kindling theory
B) Dysregulation theory
C) Anger turned inward theory
D) Learned helplessness theory

Question 9

Which one of the following somatic therapies is no longer used to treat depression?

A) Transcranial magnetic stimulation
B) Electroconvulsive therapy
C) Insulin shock therapy
D) Phototherapy (light therapy)

Question 10

In teaching about the management of the care of a patient with major depressive disorder who has expressed thoughts of suicide, the psychiatric advanced practice nurse emphasizes that the risk is greatest

A) When the depression most severe
B) Before any kind of somatic treatment is started
C) When the patient expresses feelings of sadness or is tearful
D) When the patient begins to feel more energetic

Question 11

Which of the following is a frontline treatment for insomnia in depressed elderly individuals?

A) Sleep hygiene
B) Benzodiazepines
C) Zolpidem
D) Trazodone

Question 12

Compared with unipolar depression, the depressed phase of bipolar disorder

A) Has a later onset
B) Has a more gradual onset
C) Carries a greater risk for suicide
D) Is less frequently accompanied by psychotic symptoms in younger patients