Mood Disorders

mood-disorders

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Depression and mania share which of the following symptoms?

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The person least likely to develop major depressive disorder in his or her lifetime is

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Explanation

The 19-year-old rape victim is more likely to develop a variation of posttraumatic stress disorder, which is highest among vic- tims of rape, military combat veterans, and survivors of torture. Childhood onset of dysthymia similarly presages extremely high rates of depression and bipolar disorder in adulthood. Monozy- gotic twins have been shown to have a two- to fourfold in- crease in concordance rates for mood disorders over dizygotic twins, compelling data for the role of genetic factors in mood disorders. Parental loss before adolescence is also a well-documented risk factor for adult-onset depression. Medical problems of many types, such as cancer of the pancreas, multiple sclerosis, and space-occupying lesions of the brain, can produce depression.

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A hypomanic episode differs from a manic episode in that a hypomanic episode

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Explanation

A hypomanic episode lacks psychotic features, which can some- times be associated with mania. A manic episode is a distinct period of an abnormally and persistent elevated, expansive, or irritable mood lasting for at least 1 week or less if a patient must be hospitalized. A hypomanic episode lasts at least 4 days and is similar to a manic episode except that it is not sufficiently se- vere to cause impairment in social or occupational functioning. Patients often believe that they benefit from the energy and con- fidence of hypomania. Diagnostically, history of hypomania is preferably obtained from significant others who have the patient; the experience is often pleasant, and the subject may be unaware of it or may tend to deny it. Both mania and hypo- mania are associated with inflated self-esteem, decreased need for sleep, distractibility, great physical and mental activity, and overinvolvement in pleasurable behavior.

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The defense mechanism most commonly used indepression is

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Explanation

In Sigmund Freud’s structural theory, introjection of the lost object into the ego leads to the typical depressive symptoms of a lack of energy available to the ego. The superego, which is unable to retaliate against the lost object externally, flails out at the psychic representation of the lost object, now internalized in the ego as an introject. When the ego overcomes or merges with the superego, energy previously bound in the depressive symptoms is released, and mania supervenes with the typical symptoms of excess. Projection is the unconscious defense mechanism in which a person attributes to another person those generally unconscious ideas, thoughts, feelings, and impulses that are personally unde- sirable or unacceptable. Sublimation is an unconscious defense mechanism in which the energy associated with unacceptable impulses or drives is diverted into personally and socially ac- ceptable channels. Undoing is an unconscious defense mechanism by which a person symbolically acts out to reverse something unacceptable that has already been done or against which the ego must defend itself. Altruism is regard for and dedication to the welfare of others.

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Which of the following is not part of the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria for diagnosing atypical depression?

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Explanation

Nearly two-thirds of patients with depressive disorders, whether experiencing typical or atypical symptoms, exhibit marked shortening of rapid eye movement (REM) latency, the period from sleep onset to the first REM period. This fact is not specific to atypical depression as are the other choices listed. Mood reactivity is characterized by mood elevation in response to something good happening. Leaden paralysis (a heavy, leaden feelings in one’s arms and legs), hypersomnia, increased appetite, and significant weight gain are also among the features of atypical depression.

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l-Tryptophan

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Explanation

l-Tryptophan, the amino acid precursor to serotonin, has been used as an adjuvant to both antidepressants and lithium in the treatment of bipolar I disorder. Tyrosine is the amino acid precur- sor to dopamine. l-Tryptophan has also been used alone as a hyp- notic and an antidepressant. l-Tryptophan and l-tryptophan– containing products have been recalled in the United States because l-tryptophan has been associated with eosinophilia- myalgia syndrome. The symptoms include fatigue, myalgia, shortness of breath, rashes, and swelling of the extremities. Con- gestive heart failure and death can also occur. Although several studies have shown that l-tryptophan is an efficacious adjuvant in the treatment of mood disorders, it should not be used for any purpose until the problem with eosinophilia- myalgia syndrome is resolved. Current evidence points to a contaminant in the manufacturing process.

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Which of the following is not an indicator of a good prognosis for major depressive disorder?

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Explanation

A history of more than one previous depressive episode is not an indicator of a good prognosis for major depressive disorder. Rather, it increases the possibility for a poor prognosis. Other indicators of a poor prognosis include coexisting dysthymic dis- order, abuse of alcohol and other substances, and anxiety disor- der symptoms. Men are more likely than women to experience a chronically impaired course. Mild episodes, the absence of psychotic symptoms, and a short hospital stay are good prognostic indicators. Psychosocial indicators of a good course include a history of solid friend- ships during adolescence, stable family functioning, and gener- ally sound social functioning for the 5 years preceding the illness. Additional good prognostic signs are the absence of a comorbid psychiatric disorder and of a personality disorder, no more than one previous hospitalization for major depressive disorder, and an advanced age of onset.

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Reactive depression can best be compared to

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Which of the following statements regarding rapid cycling bipolar disorder is true?

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Explanation

Among the factors favoring the occurrence of rapid cycling bipo- lar disorder are alcohol, stimulant, and caffeine use. Other fac- tors include female gender because this subtype is much more common in women than men. Most antidepressants readily in- duce excited episodes and thus aggravate the rapid cycling pat- tern. Rapid cycling is defined as the occurrence of at least four episodes of depression and hypomania or mania per year (not per month). Hospitalization of these patients is often frequent to stabilize medication and achieve compliance.

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All of the following are common causes of misdiagnosis of mood disorder as schizophrenia except

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Explanation

Reliance on the cross-sectional rather than longitudinal picture (not vice versa) may cause a misdiagnosis of mood disorder as schizophrenia. Cross-sectionally, young patients with bipo- lar disorder might seem psychotic and disorganized and thus schizophrenic. Their thought processes are so rapid that they may seem loose, but unlike patients with schizophrenia, display an expansive and elated affect, which is often conta- gious. By contrast, a severely retarded bipolar depressive person, whose affect may superficially seem flat, almost never exhibits major fragmentation of thought. The clinician should therefore place greater emphasis on the pattern of symptoms than on in- dividual symptoms in the differential diagnosis of mood and schizophrenic psychosis. Table 15.1 lists the most common pitfalls in diagnosis.

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Mild, non psychotic depression with predominant anxiety is called

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Explanation

Dysthymia is defined as a reactive nonpsychotic depression of mild to moderate intensity with predominant anxiety. It is char- acterized by the presence of a depressed mood that lasts most of the day and is present almost continuously. Patients complain that they have always been depressed. It is not a sequela to a major depressive episode as with chronic depression. There are associated feelings of inadequacy, guilt, irritability, and anger; withdrawal from society; loss of interest; and inactivity and lack of productivity. Most cases are of early onset, beginning in child- hood or adolescence and certainly by the time patients reach their 20s. The overall prognosis for dysthymia is good with treatment; however, 25 percent of dysthymic patients never attain complete recovery. Bipolar disorder is defined as a mood disorder in which the patient exhibits both manic and depressive episodes. The criteriafor a manic episode require the presence of a distinct period of abnormal mood lasting at least 1 week. Typically beginning in the teenage years, the 20s, or the 30s, the first episode of bipolar I disorder could be manic, depressive, or mixed. On average, manic episodes predominate in youth, and depressive episodes predominate in later years. Although the overall sex ratio is 1:1, men, on average, undergo more manic episodes, and women experience more mixed and depressive episodes. Endogenomorphic depression is a term used to describe in- hibition of the pleasure or reward system to such an extent that the patient no longer has the capacity for enjoyment. There may or may not be an apparent environmental precipitant or stress. In most cases, patients show dramatic abnormalities in psychomo- tor activity and somatic rhythms (i.e., sleep, appetite, libido). Such patients may also be delusional. The symptom profile in chronic depression usually displays low-grade intensity. Full criteria for a major depressive episode must have been met con- tinuously for at least the past 2 years. Instead of the customary remission within 1 year, patients are ill for years. Anxiety disorders are disorders in which anxiety is the most prominent disturbance or in which patients experience anxiety if they resist giving in to their symptoms. They are among the most prevalent mental disorders in the general population. Women are affected nearly twice as frequently as men. They are associated with significant morbidity and often are chronic and resistant to treatment. They include (1) panic disorder with or without agoraphobia, (2) agoraphobia with or without panic disorder, (3) specific phobia, (4) social phobia, (5) obsessive-compulsive disorder (OCD), (6) posttraumatic stress disorder (PTSD), (7) acute stress disorder, and (8) generalized anxiety disorder.

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The most consistent computer tomography (CT) and magnetic resonance imaging (MRI) abnormality observed in depressive disorders is

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Explanation

Computed tomography (CT) and magnetic resonance imaging (MRI) scans provide sensitive, noninvasive methods to assess the brain, including cortical and subcortical tracts, as well as white matter lesions. The most consistent abnormality observed in the depressive disorders is increased frequency of abnormal hyper- intensities in subcortical regions, especially the periventricular area, basal ganglia, and thalamus (Figure 15.2). More common in bipolar I disorder and among the elderly, these hyperinten- sities appear to reflect the deleterious neurodegenerative effects of recurrent mood episodes. Ventricular enlargement, cortical atrophy, and sulcal widening have also been reported in patients with mood disorders compared with normal control subjects. In addition to age and illness duration, structural abnormali- ties are associated with increased illness severity, bipolar status, and increased cortisol levels. Some depressed patients also may have reduced caudate nucleus volumes, suggesting a defect in the mesocorticolimbic system. Cerebrovascular factors often in- volve subcortical frontal and basal ganglia structures and appear particularly relevant to late-life depression.

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The following situations call for a break in doctor–patient confidentiality except

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Explanation

Confidentiality refers to the therapist’s responsibility to not release information learned in the course of treatment to third par- ties. Confidentiality is an essential ingredient of psychiatric care because it is a prerequisite for patients to be willing to speak freely to therapists. People would be less likely to go for help and would tend to withhold crucial information if confidentialityare more common in women, more men than women die of suicide because of more lethal methods chosen.

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A 27-year-old patient has been diagnosed with bipo- lar disorder. Before starting this patient on lithium for mood stabilization, which of the following laboratory tests should be obtained?

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Which of the following statements regarding mood disorders is false?

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Explanation

Three (not one) out of four patients with acute depression will experience recurrences, with varying degrees of residual symp- toms between episodes. Of note, although depressive are more common in women, more men than women die of suicide because of more lethal methods chosen.

Mood Disorders

Question 1 of 1

Time Left

Depression and mania share which of the following symptoms?

Select the correct answer(s).

(0/0)

The person least likely to develop major depressive disorder in his or her lifetime is

Select the correct answer(s).

(0/0)

Explanation

A hypomanic episode differs from a manic episode in that a hypomanic episode

Select the correct answer(s).

(0/0)

Explanation

The defense mechanism most commonly used indepression is

Select the correct answer(s).

(0/0)

Explanation

Which of the following is not part of the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria for diagnosing atypical depression?

Select the correct answer(s).

(0/0)

Explanation

l-Tryptophan

Select the correct answer(s).

(0/0)

Explanation

Which of the following is not an indicator of a good prognosis for major depressive disorder?

Select the correct answer(s).

(0/0)

Explanation

Reactive depression can best be compared to

Select the correct answer(s).

(0/0)

Which of the following statements regarding rapid cycling bipolar disorder is true?

Select the correct answer(s).

(0/0)

Explanation

All of the following are common causes of misdiagnosis of mood disorder as schizophrenia except

Select the correct answer(s).

(0/0)

Explanation

Mild, non psychotic depression with predominant anxiety is called

Select the correct answer(s).

(0/0)

Explanation

The most consistent computer tomography (CT) and magnetic resonance imaging (MRI) abnormality observed in depressive disorders is

Select the correct answer(s).

(0/0)

Explanation

The following situations call for a break in doctor–patient confidentiality except

Select the correct answer(s).

(0/0)

Explanation

A 27-year-old patient has been diagnosed with bipo- lar disorder. Before starting this patient on lithium for mood stabilization, which of the following laboratory tests should be obtained?

Select the correct answer(s).

(0/0)

Which of the following statements regarding mood disorders is false?

Select the correct answer(s).

(0/0)

Explanation

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