Depression

Depression US Medical PG Question 1: A 52-year-old man presents with a 1-month history of a depressed mood. He says that he has been “feeling low” on most days of the week. He also says he has been having difficulty sleeping, feelings of being worthless, difficulty performing at work, and decreased interest in reading books (his hobby). He has no significant past medical history. The patient denies any history of smoking, alcohol use, or recreational drug use. A review of systems is significant for a 7% unintentional weight gain over the past month. The patient is afebrile and his vital signs are within normal limits. A physical examination is unremarkable. The patient is prescribed sertraline 50 mg daily. On follow-up 4 weeks later, the patient says he is slightly improved but is still not feeling 100%. Which of the following is the best next step in the management of this patient?

• A. Switch to a different SSRI
• B. Continue sertraline (Correct Answer)
• C. Add buspirone
• D. Switch to an MAOI
• E. Add aripiprazole

Depression Explanation: ***Continue sertraline*** - Many antidepressants, including SSRIs like sertraline, require **4-6 weeks at a therapeutic dose** to achieve their full effect. Since the patient reports slight improvement after 4 weeks, continuing the current medication allows more time for optimal response. - The goal is for the patient to feel "100%", which often takes longer than one month. **Gradual improvement** after initial therapy suggests the medication is working, but needs more time. *Switch to a different SSRI* - Switching to another SSRI is typically considered if there is **no improvement or significant intolerance** after an adequate trial (at least 4-6 weeks) at a therapeutic dose of the initial SSRI. - This patient has shown *slight improvement*, indicating that sertraline may still be effective with more time. *Add buspirone* - Buspirone is an **anxiolytic medication** sometimes used as an augmentation strategy for depression, particularly if anxiety is a prominent symptom. - However, it's generally added *after* an initial antidepressant has failed to achieve a full response, and typically *after* optimizing the dose and duration of the primary antidepressant. *Switch to an MAOI* - **Monoamine oxidase inhibitors (MAOIs)** are older antidepressants with a more challenging side effect profile and significant drug-drug and drug-food interactions. - They are typically reserved for patients who have **failed multiple trials of other antidepressants** due to their safety concerns. *Add aripiprazole* - Aripiprazole, an **atypical antipsychotic**, is sometimes used as an augmentation strategy for **treatment-resistant depression**. - This approach is usually considered when trials of several different antidepressant classes have failed or when the depression has not responded adequately to optimized antidepressant therapy.

Depression US Medical PG Question 2: A 27-year-old man presents to his physician for a checkup. At presentation, he complains of anxiety and persistent mood changes. The patient's comorbidities include chronic gastritis treated with Helicobacter pylori eradication therapy, and chronic pyelonephritis with stage 1 chronic kidney disease. His grandfather who was a heavy smoker just passed away due to metastatic lung cancer. The patient has an 8-year-history of smoking, and he is concerned about consequences of his habit. He says that he tried to quit several times with nicotine patches, but he is unsuccessful because of the unpleasant symptoms and returning anxiety. Moreover, his tobacco use increased for the past 12 months due to increased anxiety due to his job and family problems, which could not be relieved by previous consumption levels. He still wants to stop smoking due to the health concerns. The patient's vital signs and physical examination are unremarkable. The physician considers prescribing the patient a partial nicotine agonist, and conducts a further testing to see whether the patient is eligible for this medication. Which of the following tests is required to be performed prior to prescribing this medication to the presented patient?

• A. Echocardiography
• B. Creatinine assessment
• C. Esophagogastroduodenoscopy
• D. Mini mental state examination
• E. 9-item patient health questionnaire (Correct Answer)

Depression Explanation: ***9-item patient health questionnaire*** - This patient is on a **partial nicotine agonist** (likely **varenicline**) and has a history of anxiety, mood changes, and chronic kidney disease, which requires a psychiatric assessment. - Varenicline has been associated with **neuropsychiatric effects**, including mood changes and suicidal ideation, making baseline assessment of mental health crucial. *Echocardiography* - This test is primarily used to assess **cardiac function** and structure. - Although smoking is a risk factor for cardiovascular disease, there is no indication for an echocardiogram based on the patient's current symptoms or the intended medication. *Creatinine assessment* - While the patient has **stage 1 chronic kidney disease**, the medication in question (varenicline) is primarily renally cleared. A **creatinine assessment** would be relevant for dose adjustment, but it is not typically a prerequisite for *eligibility* itself since the medication can be used in patients with kidney disease with dose modification. - The medication can be used but usually needs **dose adjustments** for patients with kidney impairment (creatinine clearance below 30 mL/min); therefore, it is often done, but mainly for dose modification, not for eligibility given stage 1 CKD. *Esophagogastroduodenoscopy* - This procedure is relevant for evaluating the upper gastrointestinal tract and is indicated for conditions like **chronic gastritis** or suspected peptic ulcer disease. - While the patient has a history of chronic gastritis, there is no current indication for an EGD related to the intended **smoking cessation medication.** *Mini mental state examination* - The **MMSE** assesses **global cognitive function** and screens for conditions like dementia. - The patient's symptoms of anxiety and mood changes do not primarily suggest cognitive impairment, and a psychiatric questionnaire is more appropriate for evaluating his specific mental health concerns.

Depression US Medical PG Question 3: A 50-year-old woman presents to her family physician 6 months after the death of her husband, who died following a car accident. She is crying inconsolably and reports that she no longer enjoys doing the things she and her husband once did together. She feels guilty for the time she wasted arguing with him in the past. She finds herself sleeping on most mornings, but still lacks the energy and concentration needed at work. The physical examination is normal. Based on a well-known hypothesis, which of the following combinations of neurotransmitter abnormalities most likely exist in this patient?

• A. ↑ Norepinephrine, ↑ Serotonin, ↑ Dopamine
• B. ↓ Norepinephrine, ↓ Serotonin, ↓ Dopamine (Correct Answer)
• C. Normal Norepinephrine, ↓ Serotonin, Normal Dopamine
• D. Normal Norepinephrine, Normal Serotonin, ↑ Dopamine
• E. Normal Norepinephrine, Normal Serotonin, ↓ Dopamine

Depression Explanation: ***↓ Norepinephrine, ↓ Serotonin, ↓ Dopamine*** - The patient's symptoms (anhedonia, guilt, fatigue, poor concentration, sleep disturbance) are classic for **major depressive disorder**. - According to the **monoamine hypothesis of depression**, an imbalance of monoamine neurotransmitters (norepinephrine, serotonin, and dopamine) is implicated, with a **decrease** in their levels or activity leading to depressive symptoms. *↑ Norepinephrine, ↑ Serotonin, ↑ Dopamine* - **Elevated levels** of these neurotransmitters are typically associated with conditions like **mania** or **anxiety disorders**, not depression. - This pattern would lead to increased energy, euphoria, or agitation, which are contrary to the patient's presentation. *Normal Norepinephrine, ↓ Serotonin, Normal Dopamine* - While **decreased serotonin** is a key component of the monoamine hypothesis of depression and often targeted by SSRIs, depression typically involves a broader dysregulation of monoamines. - The patient's significant symptoms of fatigue and lack of concentration also suggest involvement of **norepinephrine** and **dopamine** deficiencies. *Normal Norepinephrine, Normal Serotonin, ↑ Dopamine* - An **increase in dopamine** is generally associated with conditions like **psychosis** or **reward-seeking behavior**, and would not explain the patient's anhedonia and low energy. - Normal levels of serotonin and norepinephrine would also not fully account for the scope of the patient's depressive symptoms. *Normal Norepinephrine, Normal Serotonin, ↓ Dopamine* - While **decreased dopamine** can contribute to anhedonia and lack of motivation, a diagnosis of major depressive disorder, especially with guilt and severe fatigue, is typically linked to a more widespread deficiency in *all three monoamines*. - Normal levels of norepinephrine and serotonin would be unlikely given the severity and range of the patient's depressive symptoms.

Depression US Medical PG Question 4: A 43-year-old woman is brought to the physician by her daughter because she has been intermittently crying for 6 hours and does not want to get out of bed. Her symptoms started after she was fired yesterday from her job of 20 years. She says she feels sad and does not understand what she will do with her life now. She uses an over-the-counter inhaler as needed for exercise-induced asthma, and recently started oral isotretinoin for acne. She used to smoke a pack of cigarettes per day, but for the last year she has decreased to 2 cigarettes daily. She appears sad and very upset. Her temperature is 37°C (98.6°F), pulse is 110/min, respirations are 20/min, and blood pressure is 140/80 mm Hg. Physical examination shows no other abnormalities. On mental status examination, she is oriented to person, place, and time. She maintains eye contact and follows instructions. She denies suicidal ideation. Which of the following is the most likely explanation for this finding?

• A. Drug-related depression
• B. Acute stress disorder
• C. Adjustment disorder
• D. Major depressive disorder
• E. Normal stress reaction (Correct Answer)

Depression Explanation: ***Normal stress reaction*** - The patient's symptoms (crying, sadness, not wanting to get out of bed) are a direct, understandable emotional response to a significant recent stressor (being fired from a 20-year job). This type of reaction is **expected and transient** in response to acute life changes. - The duration of symptoms is short (6 hours), and there is **no evidence of significant functional impairment** beyond the initial emotional distress, nor does she meet criteria for a mental disorder. *Drug-related depression* - While **isotretinoin has been associated with mood changes**, including depression, the acute onset and direct temporal relationship to a significant psychosocial stressor make a drug-related cause less likely as the primary explanation. - There are no other features pointing to drug-induced etiology, and her symptoms are clearly linked to the job loss. *Acute stress disorder* - Acute stress disorder symptoms (e.g., intrusive thoughts, negative mood, dissociation, avoidance, arousal) typically involve exposure to an **actual or threatened traumatic event**, such as death or serious injury, which is not the case here. - The symptom duration for acute stress disorder is also typically 3 days to 1 month, and the patient's symptoms are of much shorter duration and less severe. *Adjustment disorder* - Adjustment disorder involves significant emotional or behavioral symptoms in response to an identifiable stressor, but these symptoms must cause **marked distress in excess of what would be expected** or significant impairment in social or occupational functioning. - Given the magnitude of the stressor (losing a 20-year job), the patient's reaction is within the range of a normal and expected emotional response, rather than excessive or impairing functionality long-term. *Major depressive disorder* - Major depressive disorder requires a cluster of specific symptoms (e.g., anhedonia, sleep disturbance, appetite changes, low energy, feelings of worthlessness) lasting for at least **two weeks**, causing clinically significant distress or impairment. - The patient's symptoms are acute (6 hours), directly linked to an external event, and do not yet meet the duration or full criteria for a major depressive episode.

Depression US Medical PG Question 5: A 22-year-old female presents to your clinic for evaluation of "skin problems." She complains of severe acne and "spots" all over her face that have persisted for the last 8 years, despite innumerable creams and lotions. She reports spending several hours every morning using make-up just to go outside. She wishes to learn about cosmetic procedures or surgeries that could solve her problem. While you perceive her concern for her skin to be genuine, upon examination, you note a healthy-appearing, well-nourished female with a normal complexion, minimal acne and sparse freckles on the nasal bridge. You calculate her BMI to be 21. In addition to making a diagnosis, this patient should be screened for which other disorder?

• A. Major depressive disorder (Correct Answer)
• B. Anorexia
• C. Malingering
• D. Munchausen's syndrome
• E. Trichotillomania

Depression Explanation: **Major depressive disorder** * This patient's symptoms are suggestive of **body dysmorphic disorder (BDD)**, which has a high comorbidity with major depressive disorder. * **Depressive symptoms** like poor self-esteem, social isolation due to perceived flaws, and a focus on physical appearance often co-occur with BDD. *Anorexia* * **Anorexia** involves an extreme preoccupation with body weight and shape, leading to severe calorie restriction and a significantly low body weight (BMI < 17.5). * This patient has a normal BMI of 21 and her primary preoccupation is with perceived skin flaws rather than weight. *Malingering* * **Malingering** is the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding work or obtaining financial compensation. * The patient genuinely believes in her severe skin problems and is seeking treatment for them, not external gain. *Munchausen's syndrome* * **Munchausen's syndrome** (Factitious Disorder Imposed on Self) involves intentionally feigning or inducing illness to assume the sick role, without obvious external incentives. * While the patient's perception of her skin problems is distorted, she is not intentionally creating symptoms or fabricating illness for attention. *Trichotillomania* * **Trichotillomania** is an impulse control disorder characterized by recurrent, irresistible urges to pull out one's own hair. * This patient's primary complaint is severe acne and "spots" on her face, with no mention of hair pulling.

Depression US Medical PG Question 6: A 69-year-old woman presents to the clinic with one week of suicidal ideation. She has a history of depression that began after her husband passed away from a motor vehicle accident seven years ago. At the time, she attempted to overdose on over-the-counter pills, but was able to recover completely. Her depression had been adequately controlled on sertraline until this past week. Aside from her depression, she has a history of hypertension, which is controlled with hydrochlorothiazide. The patient is retired and lives alone. She spends her time gardening and is involved with her local community center. On further questioning, the patient states that she does not have an organized plan, but reveals that she did purchase a gun two years ago. She denies tobacco, alcohol, or illicit substances. Which of the following is this patient’s most significant risk factor for completed suicide?

• A. Female sex
• B. Elderly age
• C. Previous attempt (Correct Answer)
• D. Firearm possession
• E. No spouse

Depression Explanation: ***Previous attempt*** - A **prior suicide attempt** is the strongest single predictor of completed suicide, increasing the risk 5-6 fold. - This patient has a history of an **overdose attempt**, indicating a higher baseline risk for future attempts. *Female sex* - While women are more likely to attempt suicide, **men are more likely to complete suicide** due to using more lethal means. - Therefore, female sex alone is not the most significant risk factor for completed suicide. *Elderly age* - The risk of suicide generally **increases with age**, particularly in elderly men; however, a prior attempt is a stronger predictor across all age groups. - While being **elderly** is a risk factor, it is less significant than a previous attempt. *Firearm possession* - The presence of a **firearm in the home increases the risk of suicide completion**, as it provides a highly lethal means. - However, for this patient, the **prior attempt** is still considered a more significant and direct risk factor for completed suicide. *No spouse* - **Social isolation** and lack of a marital partner are risk factors for suicide, as they can contribute to feelings of loneliness and lack of support. - While relevant, it is generally considered less impactful than a **previous suicide attempt** in predicting future completion.

Depression US Medical PG Question 7: A 22-year-old college student comes to the physician because of depressed mood and fatigue for the past 5 weeks. He has been feeling sad and unmotivated to attend his college classes. He finds it particularly difficult to get out of bed in the morning. He has difficulty concentrating during lectures and often feels that he is less intelligent compared to his classmates. In elementary school, he was diagnosed with attention deficit hyperactivity disorder and treated with methylphenidate; he stopped taking this medication 4 years ago because his symptoms had improved during high school. He has smoked two packs of cigarettes daily for 8 years; he feels guilty that he has been unable to quit despite numerous attempts. During his last attempt 3 weeks ago, he experienced increased appetite and subsequently gained 3 kg (6 lb 10 oz) in a week. Mental status examination shows psychomotor retardation and restricted affect. There is no evidence of suicidal ideation. Which of the following is the most appropriate pharmacotherapy?

• A. Amitriptyline
• B. Bupropion (Correct Answer)
• C. Lithium carbonate
• D. Fluoxetine
• E. Valproic acid

Depression Explanation: ***Bupropion*** - Bupropion is an antidepressant that works as a **norepinephrine-dopamine reuptake inhibitor**. It is particularly effective for patients with **depressed mood, fatigue, and difficulty concentrating**, as seen in this patient. - It is also beneficial for **nicotine cessation**, which aligns well with the patient's history of heavy smoking and failed attempts to quit. *Amitriptyline* - Amitriptyline is a **tricyclic antidepressant (TCA)** that can be sedating and has significant anticholinergic side effects, which might worsen the patient's fatigue and concentration difficulties. - TCAs are generally **not first-line** due to their side effect profile and risk in overdose compared to newer antidepressants. *Lithium carbonate* - Lithium is primarily used as a **mood stabilizer** for **bipolar disorder** and is not a first-line treatment for major depressive disorder without manic or hypomanic symptoms. - This patient's symptoms are indicative of depression, not bipolar illness. *Fluoxetine* - Fluoxetine is a **selective serotonin reuptake inhibitor (SSRI)**, a common first-line treatment for depression, but it might not be the most appropriate choice given this patient's specific presentation. - SSRIs can sometimes cause **fatigue or sexual dysfunction**, and they don't offer the added benefit for smoking cessation that bupropion does. *Valproic acid* - Valproic acid is an **anticonvulsant** primarily used as a **mood stabilizer** for bipolar disorder or for seizure control, not as a primary antidepressant in unipolar depression. - There is no indication in the patient's history or presentation to suggest bipolar disorder or a seizure disorder.

Depression US Medical PG Question 8: A 42-year-old female presents to her primary care provider for an annual checkup. She reports feeling sad over the past few months for no apparent reason. She has lost interest in swimming, which she previously found enjoyable. Additionally, she has had trouble getting a full night’s sleep and has had trouble concentrating during the day. She has lost 15 pounds since her last visit one year prior. Which of the following sets of neurotransmitter levels is associated with this patient’s condition?

• A. Decreased acetylcholine, normal serotonin, normal dopamine
• B. Decreased norepinephrine, decreased serotonin, decreased dopamine (Correct Answer)
• C. Decreased GABA, decreased acetylcholine, increased dopamine
• D. Increased norepinephrine, decreased serotonin, decreased GABA
• E. Increased acetylcholine, increased serotonin, decreased dopamine

Depression Explanation: ***Decreased norepinephrine, decreased serotonin, decreased dopamine*** - The patient's symptoms of **sadness**, loss of interest (**anhedonia**), **insomnia**, **difficulty concentrating**, and **weight loss** are classic for **major depressive disorder**. - **Depression** is strongly associated with deficiencies in **monoamine neurotransmitters**: **norepinephrine**, **serotonin**, and **dopamine**. *Decreased acetylcholine, normal serotonin, normal dopamine* - While **acetylcholine** is involved in mood regulation, its isolated decrease with normal serotonin and dopamine levels is not characteristic of generalized depression. - More prominent roles for **acetylcholine dysfunction** are seen in conditions like **Alzheimer's disease** or **myasthenia gravis**. *Decreased GABA, decreased acetylcholine, increased dopamine* - **Decreased GABA** is often associated with **anxiety disorders** and seizures, not the primary presentation of depression here. - **Increased dopamine** is more characteristic of conditions like **schizophrenia** or **mania**, which contrasts with the patient's depressive symptoms. *Increased norepinephrine, decreased serotonin, decreased GABA* - **Increased norepinephrine** is typically associated with **anxiety**, **stress**, or sometimes **mania**, which is inconsistent with this patient's depressive state. - While **decreased serotonin** is correct for depression, the combination with increased norepinephrine and decreased GABA does not fit the typical neurotransmitter profile. *Increased acetylcholine, increased serotonin, decreased dopamine* - **Increased acetylcholine** is generally not associated with the full spectrum of depressive symptoms described. - **Increased serotonin** is often the goal of antidepressant treatments (SSRIs), making an endogenous increase unlikely to cause depression.

Depression US Medical PG Question 9: A 35-year-old banker is brought to a medical clinic by his concerned wife. For the past 3 weeks, he has not been eating well and has had a 10 kg (22 lb) weight loss. He wakes up very early in the mornings and feels extremely despondent. He no longer goes out on the weekends to hang out with his close friends nor does he go on date nights with his wife. He feels guilty for letting his friends and family down recently. He additionally has a history of fibromyalgia and deals with daily pain. What would be the most appropriate treatment plan for this patient?

• A. Amitriptyline
• B. Phenelzine
• C. Venlafaxine (Correct Answer)
• D. Electroconvulsive therapy
• E. Fluoxetine

Depression Explanation: ***Venlafaxine*** - This patient presents with symptoms highly suggestive of **major depressive disorder**, including **anhedonia**, significant **weight loss**, **early morning awakening**, and **feelings of guilt**. His co-occurring **fibromyalgia** makes a **serotonin-norepinephrine reuptake inhibitor (SNRI)** like venlafaxine an excellent choice. - SNRIs are effective for both depression and chronic pain conditions such as fibromyalgia, as they modulate both **serotonin** and **norepinephrine** pathways, which are implicated in both mood and pain perception. *Amitriptyline* - **Amitriptyline** is a **tricyclic antidepressant (TCA)** that can be used for both depression and chronic pain, including fibromyalgia. - However, TCAs generally have a less favorable side effect profile (e.g., **anticholinergic effects**, **cardiac toxicity in overdose**) compared to SNRIs and SSRIs, making them less of a first-line choice unless other options fail or specific indications are present. *Phenelzine* - **Phenelzine** is a **monoamine oxidase inhibitor (MAOI)**, typically reserved for **atypical depression** or treatment-resistant depression due to its significant **food and drug interactions** (e.g., **hypertensive crisis** with tyramine-rich foods or sympathomimetics). - Given this is likely a first-line treatment scenario, an MAOI would not be the most appropriate initial choice. *Electroconvulsive therapy* - **Electroconvulsive therapy (ECT)** is a highly effective treatment for severe depression, especially with **psychotic features**, **catatonia**, or **severe suicidality**, or in cases of **treatment resistance** where other modalities have failed. - While the patient has significant symptoms of depression, there is no indication of immediate life-threatening severity (e.g., active suicidal intent with a plan) or treatment resistance to warrant ECT as a first-line option. *Fluoxetine* - **Fluoxetine** is a **selective serotonin reuptake inhibitor (SSRI)** and a common first-line treatment for major depressive disorder. - While it would be effective for the patient's depression, it does not offer the additional specific benefit for **fibromyalgia pain** that an SNRI like venlafaxine provides through dual serotonin and norepinephrine reuptake inhibition.

Depression US Medical PG Question 10: A 28-year-old woman presents with depressed mood lasting for most days of the week for the past month. She also mentions that she has lost her appetite for the past 3 weeks. She adds that her job performance has significantly deteriorated because of these symptoms, and she feels like she will have to quit her job soon. Upon asking about her hobbies, she says that she used to enjoy dancing and music but does not have any desire to do them anymore. The patient’s husband says that she has had many sleepless nights last month. The patient denies any history of smoking, alcohol intake, or use of illicit substances. No significant past medical history. Physical examination is unremarkable. Routine laboratory tests are all within normal limits. Which of the following clinical features must be present, in addition to this patient’s current symptoms, to confirm the diagnosis of a major depressive episode?

• A. Intense fear of losing control
• B. Lack of concentration (Correct Answer)
• C. Weight loss
• D. Anterograde amnesia
• E. Nightmares

Depression Explanation: ***Lack of concentration*** - The diagnostic criteria for a **major depressive episode** (DSM-5) require at least **5 out of 9 cardinal symptoms** present for at least 2 weeks, with at least one being either **depressed mood** or **anhedonia**. - This patient currently has **4 symptoms**: (1) depressed mood, (2) anhedonia (loss of interest in dancing/music), (3) appetite disturbance (loss of appetite), and (4) sleep disturbance (insomnia). - To meet diagnostic criteria, she needs **one more symptom** from the remaining options: fatigue, feelings of worthlessness/guilt, **diminished ability to concentrate or indecisiveness**, psychomotor changes, or suicidal ideation. - **Lack of concentration** is one of the DSM-5 diagnostic criteria and would bring her total to 5 symptoms, confirming the diagnosis. *Intense fear of losing control* - This symptom is characteristic of **panic disorder** or anxiety disorders, where individuals experience sudden, intense episodes of fear with accompanying physical and cognitive symptoms. - While anxiety can co-occur with depression, intense fear of losing control is **not a DSM-5 diagnostic criterion** for major depressive episode. *Weight loss* - The patient already has **loss of appetite**, which satisfies the weight/appetite criterion for major depressive episode. - **Weight loss and appetite changes are part of the same diagnostic criterion**, not separate ones. Therefore, weight loss would not add an additional criterion to reach the required 5 symptoms. - While clinically significant weight loss can occur in depression, it would not provide the "additional" criterion needed in this case. *Anterograde amnesia* - **Anterograde amnesia** (inability to form new memories) is associated with neurological conditions such as **hippocampal damage**, **Korsakoff syndrome**, or **traumatic brain injury**. - It is **not a DSM-5 diagnostic criterion** for major depressive episode, though some cognitive impairment (concentration difficulties) may occur. *Nightmares* - The patient already has **insomnia** (sleep disturbance), which is one of the DSM-5 diagnostic criteria. - While nightmares may occur in depression, they are not a separate diagnostic criterion and would not add to the symptom count since sleep disturbance is already present.

Depression Flashcard 1 of 10

Question: depression

Answer:

Extra Information: early morning awakening incompletedecreased: NE, dopamine, serotonin

Depression Flashcard 2 of 10

Question: serotonin

Answer: raphe nucleus

Depression Flashcard 3 of 10

Question: A woman status post mastectomy says she feels ugly when she undresses.

Answer: Find out why the patient feels that way. Do not offer false reassurance or anything that could be interpreted as flirtation. (e.g. You still look great!)

Depression Flashcard 4 of 10

Question: What changes in sleep patterns are often seen in depressed patients?

Answer: 1. less delta-wave sleep 2. more REM sleep 3. more/earlier awakenings (decreased delta-wave sleep (stage N3) decreased REM latency increased REM early in sleep cycle increased total time in REM repeated nighttime awakenings early-morning awakening)

Depression Flashcard 5 of 10

Question: Major depressive disorder with seasonal pattern is most associated with what season? _____

Answer: Winter

Extra Information:  https://onlinemeded.org/spa/psychiatry/mood-disorders/acquire?ref=anki 

Depression Flashcard 6 of 10

Question: Huntington disease presents with chorea that can progress to _____ and dementia; also may have aggression

Answer: depression

Extra Information:   Watch Creutzfeldt Jakob Disease, Parkinsons Disease & Huntingtons Disease [https://dashboard.sketchy.com/study/medical/courses/medical-pathophysiology/units/medical-pathophysiology-neuro/videos/medical-pathophysiology-neuro-neurodegenerative-creutzfeldt-jakob-disease-parkinsons-disease-and-huntingtons-disease?utm_source=anki&utm_medium=partnership&utm_campaign=february_update&utm_content=medical]Watch associated Bootcamp video [https://app.bootcamp.com/med-school/neurology/videos/dementia?index=8] https://onlinemeded.org/spa/genetics?ref=anki Atlas: 

Depression Flashcard 7 of 10

Question: Primary hyperparathyroidism may lead to CNS disturbances, such as _____ and seizures

Answer: depression

Extra Information:   https://onlinemeded.org/spa/endocrinology?ref=anki 

Depression Flashcard 8 of 10

Question: Depression is characterized by _____ dopamine

Answer: decreased

Extra Information:  Watch associated Bootcamp video [https://app.bootcamp.com/med-school/neurology/videos/neurotransmitter-activity-in-psychiatric-disease?index=2] https://onlinemeded.org/spa/dna-to-protein/amino-acids/acquire?ref=anki 

Depression Flashcard 9 of 10

Question: Major depressive disorder episodes are characterized by depressed mood or anhedonia and at least four other "SIG E CAPS" symptoms lasting > 2 weeks S: _____ I: Interest decreases (anhedonia) G: Guilt or feelings of worthlessness E: Energy loss or fatigue C: Concentration problems A: Appetite/weight changes P: Psychomotor retardation or agitation S: Suicidal ideations

Answer: Sleep changes

Extra Information:   https://onlinemeded.org/spa/psychiatry/mood-disorders/acquire?ref=anki 

Depression Flashcard 10 of 10

Question: What is noticably absent in patients with major depressive disorder with seasonal pattern? _____

Answer: Nonseasonal depressive episodes

Extra Information: Watch associated Bootcamp video [https://app.bootcamp.com/med-school/psychiatry/videos/psychotic-and-mood-disorders?index=4] https://onlinemeded.org/spa/psychiatry/mood-disorders/acquire?ref=anki