Depression — MCQs

A 17-year-old girl is brought to the physician by her mother for evaluation of mild acne. Six months ago, the girl developed papules over her back and shoulders. Her mother reports that her daughter has only been wearing clothes that cover her complete back and shoulders recently and that she spends a lot of time checking her skin in the mirror. She spends three hours a day scratching and squeezing the comedones. After reading an article that suggested sugar was a possible cause of acne, she tried a low-carb diet, which resulted in a weight loss 5.2-kg (11.5-lb) but no change in her skin condition. The patient describes herself as “ugly.” Over the past 6 months, she quit the swim team, stopped swim training, and stayed home from school on several occasions. She appears sad and distressed. She is 170 cm (5 ft 7 in) tall and weighs 62 kg (136.7 lb); BMI is 21.4 kg/m2. Vital signs are within normal limits. Physical examination shows a few small papules but numerous, widespread scratch marks over the neck, back, and buttocks. On mental status examination, she is depressed and irritable. There is no evidence of suicidal ideation. After establishing a therapeutic alliance, which of the following is the most appropriate next step in management?

A 67-year-old woman presents to her primary care physician for memory difficulty. She states that for the past couple months she has had trouble with her memory including forgetting simple things like bills she needs to pay or locking doors. She was previously fully functional and did not make these types of mistakes. The patient has not been ill lately but came in because her daughter was concerned about her memory. She makes her own food and eats a varied diet. Review of systems is notable for a decrease in the patient’s mood for the past 2 months since her husband died and a sensation that her limbs are heavy making it difficult for her to do anything. Her temperature is 99.3°F (37.4°C), blood pressure is 112/68 mmHg, pulse is 71/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for an elderly woman. Her neurological exam is unremarkable; however, the patient struggles to recall 3 objects after a short period of time and can only recall 2 of them. The patient’s weight is unchanged from her previous visit and cardiac, pulmonary, and dermatologic exams are within normal limits. Which of the following is the most likely diagnosis?

A 24-year-old male comes into the psychiatric clinic complaining of consistent sadness. He endorses feelings of worthlessness, anxiety, and anhedonia for the past couple months but denies feeling suicidal. He further denies any past episodes of feeling overly energetic with racing thoughts. Confident of the diagnosis, you recommend frequent talk therapy along with a long-term prescription of a known first-line medication for this disorder. What is the drug and what are some of the most frequently encountered side effects?

An 82-year-old woman comes to the physician because of difficulty sleeping and increasing fatigue. Over the past 3 months she has been waking up early and having trouble falling asleep at night. During this period, she has had a decreased appetite and a 3.2-kg (7-lb) weight loss. Since the death of her husband one year ago, she has been living with her son and his wife. She is worried and feels guilty because she does not want to impose on them. She has stopped going to meetings at the senior center because she does not enjoy them anymore and also because she feels uncomfortable asking her son to give her a ride, especially since her son has had a great deal of stress lately. She is 155 cm (5 ft 1 in) tall and weighs 51 kg (110 lb); BMI is 21 kg/m2. Vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tired and has a flattened affect. Cognition is intact. Which of the following is the most appropriate initial step in management?

An 84-year-old woman is brought to the physician by her son after he found her trying to hang herself from the ceiling because she felt that she was a burden to her family. Her family says that for the past 2 months she has had no energy to leave her room, has been sleeping most of the day, has lost 10 kg (22 lb), and cries every day. She was diagnosed with breast cancer that has metastasized to the liver 4 months ago. She moved in with her son and daughter-in-law shortly after the diagnosis. She initially underwent chemotherapy but discontinued the treatment when the metastases spread to the spine and brain. Her life expectancy is 1–2 weeks and she is currently receiving home-hospice care. Her only current medication is a fentanyl patch. She is 160 cm (5 ft 3 in) tall and weighs 46 kg (101.4 lb); BMI is 18 kg/m2. Her vital signs are within normal limits. Examination shows slow speech, a flat affect, and depressed mood. Which of the following treatments is initially most likely to provide the greatest benefit for this patient?

A 40-year-old man with a past medical history of major depression presents to the clinic. He is interested in joining a research study on depression-related sleep disturbances. He had 2 episodes of major depression within the last 2 years, occurring once during the summer and then during the winter of the other year. He has been non-compliant with medication and has a strong desire to treat his condition with non-pharmacological methods. He would like to be enrolled in this study that utilizes polysomnography to record sleep-wave patterns. Which of the following findings is likely associated with this patient’s psychiatric condition?

A 24-year-old woman presents to her primary care physician for a wellness exam. She currently has no acute concerns but has been feeling hopeless, has a poor appetite, difficulty with concentration, and trouble with sleep. She says that she has poor self-esteem and that her symptoms have been occurring for the past 3 years. She has had moments where she felt better, but it lasted a few weeks out of the year. She currently lives alone and does not pursue romantic relationships because she feels she is not attractive. She has a past medical history of asthma. Her mother is alive and healthy. Her father committed suicide and suffered from major depressive disorder. On physical exam, the patient has a gloomy demeanor and appears restless and anxious. Which of the following is the most likely diagnosis?

A 29-year-old man with post-traumatic stress disorder is admitted to the hospital following an intentional opioid overdose. He is a soldier who returned from a deployment in Afghanistan 3 months ago. He is divorced and lives alone. His mother died by suicide when he was 8 years of age. He states that he intended to end his life as painlessly as possible and has also contemplated using his service firearm to end his life. He asks the physician if assisted suicide is legal in his state. He does not smoke or drink alcohol but uses medical marijuana daily. Mental status examination shows a depressed mood and constricted affect. Which of the following is the strongest risk factor for suicide in this patient?

A mental health volunteer is interviewing locals as part of a community outreach program. A 46-year-old man discloses that he has felt sad for as long as he can remember. He feels as though his life is cursed and if something terrible can happen to him, it usually will. He has difficulty making decisions and feels hopeless. He also feels that he has had worsening suicidal ideations, guilt from past problems, decreased energy, and poor concentration over the past 2 weeks. He is otherwise getting enough sleep and able to hold a job. Which of the following statement best describes this patient's condition?

A 33-year-old man visits his psychiatrist with feelings of sadness on most days of the week for the past 4 weeks. He says that he is unable to participate in his daily activities and finds it hard to get out of bed on most days. If he has nothing scheduled for the day, he sometimes sleeps for 10–12 hours at a stretch. He has also noticed that on certain days, his legs feel heavy and he finds it difficult to walk, as though there are bricks tied to his feet. However, he is still able to attend social events and also enjoys playing with his children when he comes home from work. Other than these simple pleasures, he has lost interest in most of the activities he previously enjoyed. Another troubling fact is that he had gained weight over the past month, mainly because he eats so much when overcome by these feelings of depression. His is prescribed a medication to treat his symptoms. Which of the following is the mechanism of action of the drug he was most likely prescribed?