depression

Question 1

What is the most common clinical mistake leading to an unsuccessful trial of an antidepressant drug?

Answer 1

Use of too low a dosage for too short a time

Dosage should be raised to the maximum recommended level and maintained for at least 4 or 5 weeks.

Question 2

How long should an antidepressant be maintained at the maximum recommended level before considering a trial unsuccessful?

Answer 2

At least 4 or 5 weeks

This duration is crucial unless adverse events prevent dosage increase.

Question 3

What should be done if a patient is improving clinically on a low dosage of an antidepressant?

Answer 3

Do not raise the dosage unless clinical improvement stops

This approach helps in obtaining maximal benefit.

Question 4

What action may clinicians take if a patient does not respond to appropriate dosages of an antidepressant after 2 or 3 weeks?

Answer 4

Obtain a plasma concentration of the drug

This test may indicate noncompliance or unusual pharmacokinetic disposition.

Question 5

Do available antidepressants differ in overall efficacy, speed of response, or long-term effectiveness?

Answer 5

No

They differ in pharmacology, drug–drug interactions, side effects, and ease of dose adjustment.

Question 6

How long should antidepressant treatment be maintained?

Answer 6

At least 6 months or the length of a previous episode, whichever is greater

This duration is recommended to ensure effective management of depressive episodes.

Question 7

When discontinuing antidepressant treatment, how should the drug dose be adjusted?

Answer 7

Tapered gradually over 1 to 2 weeks

The tapering period depends on the half-life of the particular compound.

Question 8

What is the effectiveness of prophylactic treatment with antidepressants?

Answer 8

Effective in reducing the number and severity of recurrences

Prophylactic treatment is recommended for patients with a history of recurrent depressive episodes.

Question 9

When should prophylactic treatment be recommended according to one study?

Answer 9

When episodes are less than 21/2 years apart

This recommendation is based on the frequency of depressive episodes.

Question 10

What factors suggest the need for prophylactic treatment?

Answer 10

• Seriousness of previous depressive episodes
• Significant suicidal ideation
• Impairment of psychosocial functioning

These factors indicate a considerable risk if treatment is stopped.

Question 11

What is the aim of the maintenance phase of treatment?

Answer 11

Prevention of new mood episodes (i.e., recurrences)

This phase is crucial for patients with recurrent or chronic depressions.

Question 12

Who are candidates for maintenance treatment?

Answer 12

Patients with recurrent or chronic depressions

Maintenance treatment is specifically designed for these patient groups.

Question 13

What do several studies indicate about maintenance antidepressant medication?

Answer 13

Appears to be safe and effective for the treatment of chronic depression

This finding supports the continued use of antidepressants in chronic cases.

Question 14

True or false?

In general, the nonmood disorder dictates the choice of
treatment in comorbid states.

Answer 14

True

Question 15

Suicide impulse is related to low levels of what neurotransmitter?

Answer 15

Serotonin

Question 17

What are the most common precipitating factors in younger adolescent suicide completers?

Answer 17

• Impending disciplinary actions
• Impulsive behavioral histories
• Access to loaded guns, particularly in the home

These factors highlight the risks associated with adolescent mental health and safety.

Question 18

What is the definition of remission in the context of major depressive disorder?

Answer 18

A period of 2 or more months with no symptoms, or only one or two symptoms to no more than a mild degree

The course of major depressive disorder is variable, with some individuals rarely experiencing remission.

Question 19

What factors may reflect the course of depression?

Answer 19

• Social-structural adversity
• Poverty
• Racism
• Marginalization

These factors can influence the variability in the course of major depressive disorder.

Question 20

What is the significance of identifying the last period of at least 2 months free of depressive symptoms?

Answer 20

It helps distinguish chronic depressive illness from recent onset

Chronicity of depressive symptoms increases the likelihood of underlying disorders and decreases the likelihood of full symptom resolution.

Question 21

What percentage of individuals with major depression begin recovery within 3 months of onset?

Answer 21

40%

Recovery rates increase to 80% within 1 year.

Question 22

What features are associated with lower recovery rates from major depressive episodes?

Answer 22

• Psychotic features
• Prominent anxiety
• Personality disorders
• Symptom severity

Current episode duration is also a significant factor in recovery rates.

Question 23

How does the risk of recurrence change over time?

Answer 23

It becomes progressively lower as the duration of remission increases

The risk is higher in individuals with severe preceding episodes, younger individuals, and those with multiple episodes.

Question 24

What is a powerful predictor of recurrence in major depressive disorder?

Answer 24

Persistence of even mild depressive symptoms during remission

This indicates a higher likelihood of future depressive episodes.

Question 25

What proportion of individuals with major depressive disorder may actually have a **bipolar disorder**?

Answer 25

A substantial proportion ## Footnote This is more likely in individuals with adolescent onset, psychotic features, and a family history of bipolar illness.

Question 26

What symptom differences exist between younger and older individuals with major depressive disorder?

Answer 26

* Hypersomnia and hyperphagia are more likely in younger individuals * Melancholic symptoms, particularly psychomotor disturbances, are more common in older individuals ## Footnote These differences do not generally affect the course of major depressive disorder.

Question 27

What are the **course modifiers** of major depressive disorder?

Answer 27

* Temperamental * Environmental * Genetic and physiological ## Footnote These modifiers can influence the course and treatment response of major depressive disorder.

Question 28

What is the **chance of recurrence** after the **first episode of MDD**?

Answer 28

50% ## Footnote The likelihood of recurrence increases with each subsequent episode.

Question 29

What is the **chance of recurrence** after the **second episode of MDD**?

Answer 29

70% ## Footnote This indicates a significant increase in likelihood compared to the first episode.

Question 30

What is the **chance of recurrence** after the **third episode of MDD**?

Answer 30

90% ## Footnote This shows a very high likelihood of recurrence after multiple episodes.

Question 31

Fill in the blank: The likelihood of recurrence increases significantly with each episode, reaching a **______** chance after the first episode.

Answer 31

50% ## Footnote This statistic highlights the increasing risk associated with repeated episodes.

Question 32

Diagnostic criteria for MDD with atypical features

Answer 32

** Mood reactivity** (Brightens to actual or potential positive events) + 2 or more * weight gain, increased app * Hypersomnia * Leaden paralysis (heavy feeling in arms/legs) * longstanding pattern of interpersonal rejection sensivity (occurs even when not depressed) | Cant co-occur with melancholic features or catatonia in the same episode

Question 33

Diagnostic criteria for MDD with psychotic features

Answer 33

MDD criteria + delusions or hallucinations present at any time during the episode. | Specify if psychotic features are mood congruent or incongruent

Question 34

What are mood congruent psychotic features in relation to MDD?

Answer 34

Content of hallucinations & delusions are consistent with typical themes of personal inadequacy, guilt, disease, death, nihiligm, and deserved punishment.

Question 35

What are **mood incongruent **features in relation to MDD?

Answer 35

Content of delusions/ hallucinations does not contain typical depressive themes or is a mixture of mood- incongruent or mood congruent themes.

Question 36

The risk of **postpartum episodes with psychotic features** is particularly increased for women with what type of prior episodes?

Answer 36

Prior postpartum psychotic mood episodes ## Footnote This risk is notably higher for women who have experienced these episodes previously.

Question 37

True or false: Women with a **prior history of depressive or bipolar disorder** have an elevated risk of postpartum episodes with psychotic features.

Answer 37

TRUE ## Footnote This includes especially those with bipolar I disorder.

Question 38

What family history increases the risk of **postpartum episodes with psychotic features**?

Answer 38

Family history of bipolar disorders ## Footnote A family history of bipolar disorders can elevate the risk for postpartum psychotic episodes.

Question 39

What is the risk of **recurrence** of postpartum episodes with psychotic features after a subsequent delivery?

Answer 39

30% to 50% ## Footnote This statistic highlights the significant risk associated with postpartum psychosis.

Question 40

Postpartum episodes must be differentiated from **delirium** occurring in the postpartum period. What is a key distinguishing feature of delirium?

Answer 40

Fluctuating level of awareness or attention ## Footnote This characteristic helps in identifying delirium as distinct from postpartum episodes.

Question 41

What defines MDD **with a seasonal pattern**?

Answer 41

* Regular temporal relationship between the onset of MDD and particular time of the year (usually fall or winter). *Full remissions also occur at a characteristic time of the year (e.g., depression disappears in the spring). * 2 consecutive years of this pattern with no non-seasonal MDD

Question 42

Risk factors for seasonal depression

Answer 42

* higher latitude * Younger persons (winter depression)

Question 43

In MDD, what differentiates partial from full remission?

Answer 43

**Partial:** Some sx still present but not enough to meet dx criteria or no sx present but < 2 months **Full:** No significant signs or symptoms for **2 months**

Question 44

What determines severity of MDD?

Answer 44

1. # of sx 2. severity of sx 3. degree of functional impairment

Question 45

Diagnostic criteria for ** Persistent depressive disorder**

Answer 45

2+ years of depression + atleast 2 of the following: * Appetite change * Concentration probs * Hopelessness * Energy deficit * Worthlessness (low self esteem) * Sleep disorder | ACHEWS

Question 46

atypical depression responds particularly well to ________

Answer 46

MAOIs