Mood Disorders Exam (Actual Exam Given 1998) 1) If you went door to door and interviewed a representative sample of the population, you would find that the number of individuals who met DSM-IV criteria for Major Depression over the last 12 months was: A. 1% B. 3% C. 5% D. 10% E. 20% Answer 2) The number of patients who met criteria for manic depressive illness in the same 12 month period would be: A. .5% B. 1.5% C. 5% D. 5.5% E 10% Answer 3) One of the two criteria that a patient must meet for at least two weeks in order to be diagnosed with Major Depression is: A. Suicidal thoughts B. Poor concentration C. Hopelessness D. Irritability E. Loss of interest and pleasure Answer 4) The cohort studies of the age of onset of Major Depression show that: A. Subjects born in the 1950's have a higher lifetime rate of depression than patients born in the 1980's B. Subjects born in the 1950's have the same lifetime rate of depression as patients born in the 1980's C. Subjects born in the 1950's have a lower lifetime rate of depression than patients born in the 1980's Answer 5) A majority of patients treated for Major Depression will be treated by: A. Psychiatrists B. Family Physicians C. Gynecologists D. Cardiologists E. Oncologists Answer 6) A patient presents with Major Depression over the last month. You diagnose her with depression and tell her you would like to begin treatment with an antidepressant. She refuses and returns to see you a year later. At that time you would expect that she has a greater than 50/o chance of the following: A. The depressive episode is fully resolved with no depressive symptoms B. She would still have some depressive symptoms and would meet criteria for Dysthymia or Major Depression C. She would meet criteria for Major Depression Answer 7) Another patient comes to see you and has symptoms that meet criteria for Major Depression. In taking her history, she has three previous episodes of depression, one when she was 15 that lasted 2 years, one when she was 20 that lasted one year and one when she was 25 that lasted 6 months. She is now 45 years old. She agrees to treatment with fluoxetine (Prozac) and has a full remission of symptoms. You see her for her one year follow-up: A. You tell her the length of the episodes appears to be decreasing, that she can taper off the Prozac, watch for any signs of a recurrence of depressive symptoms and call you immediately if they recur so that the medication can be restarted. B. You tell her that she has a very high probability of having a fifth episode and insist that she continue the Prozac indefinitely. Answer 8) The treatment of depression in a patient who is grieving the loss of a spouse is difficult. Many patients meet criteria for Major Depression but to some extent this may be expected given the relationship of the patient with their spouse. The available research indicates however that approximately 15% of patients develop chronic symptoms of depression, while in the majority of patients the symptoms resolve gradually. At what point in time do the symptoms of depression level off to this level of 15% and become chronic: A. 2 months B. 6 months C. one year D. two years E. five years Answer 9) Which of the following is not a tricyclic antidepressant and has no therapeutic blood level associated with the onset of the therapeutic effect: A. desipramine B. nortriptyline C. mirtazapme D. clomipramine E. amitriptyline Answer 10) The patient with the highest rate of completed suicide is: A. Twenty year old woman with borderline personality disorders who is recently married B. Forty-five year old Catholic man with a high stress corporate job C. Seventy year old divorced hispanic male with chronic coronary artery disease Answer 11) The type of personality disorders that are most subject to episodes of depression are: A. Schizotypal B. Borderline C. Paranoid D. Avoidant E. Antisocial Answer 12) A patient has failed an adequate trial of sertraline. You believe he was compliant with the medication and discuss choosing a second antidepressant with him. You want to choose a medication that is in a different class, as Dr. Kelsey discussed in his lecture. You might chose all of the following except: A. Fluoxetine B. Bupropion C. Nortriptyline D. Phenelzine Answer 13)A patient who has a depressed mood for 3 months could potentially meet criteria for: A. Major Depression alone B. Dysthymia alone C. Both Major Depression and Dysthymia D. Neither disorders Answer 14) Feelings of inadequacy and low self esteem are diagnostic criteria for: A. Major Depression alone B. Dysthymia alone C. Both Major Depression and Dysthymia D. Neither disorders Answer 15) A patient with fatigue or loss of energy during a depressive episode potentially meets criteria for: A. Major Depression alone B. Atypical Depression alone C. Dysthymia alone D. All three disorders E. None of the disorders Answer 16) Which of the following patients would not be predisposed to develop Dysthymia: A. A patient with childhood onset diabetes B. A patient with an narcissistic personality disorder C. A patient who was treated for a Major Depression D. All of the patients above have the potential for developing Dysthymia greater than would be expected in the general population Answer 17) The findings from sleep studies of depressed patients include: A. Increased secretion of melatonin B. Shortened REM latency C. Increased REM in the later parts of the night D. Increased stage 3 and 4 (Delta) sleep or deep sleep E. Improved sleep efficiency Answer 18) The key criteria determining the distinction between mania and hypomania are: A. Functional disability (whether the patient is hospitalized) B. Psychosis C. Both D. Neither Answer 19) Over time, this cycle length of bipolar episodes: A. Is shorter B. Is longer C. Is about the same Answer 20) Schizophrenia and Bipolar Disorder are distinguished by: A. The number of Americans who have each disease B. The number of females who have each disease C. The socioeconomic status of individuals with each disease D. All of the above E. None of the above Answer 21) The differential diagnosis of a hypomanic episode (e.g., the disorders you would consider in addition to hypomania) includes all of the following except: A. An idealized norm B. Schizophrenia C. Substance Abuse D. Personality disorders such as Histrionic Personality Disorder Answer 22) Patients with Bipolar Disorder have a predominance of: A. Mood congruent delusions B. Mood incongruent delusions C. Do not have delusions Answer 23) Patients with cyclothymia: A. May meet criteria for Major Depression B. May have episodes of psychosis C. May have a personality disorder Answer 24) Which neurotransmitter has the most research evidence supporting an involvement in Major Depression: A. Norepinepherine B. Serotonin C. Dopamine D. Acetylcholine Answer 25) Which neurotransmitter has the most research evidence supporting a role in violent behavior such as that seen in suicide and antisocial personality disorders: A. Norepinepherine B. Serotonin C. Dopamine D. Acetylcholine Answer 26) The early observations from the effects of drugs such as isoniazid and reserpine led to the hypothesis that: A. High levels of the neurotransmiters such as norepinephrine(NE) are associated with depression B. Low levels of the neurotransmiters such as NE are associated with depression C. Neither A or B Answer 27) The limbic system is integral to the development of mood disorders. There are many projections within the limbic system but the core components are: A. Locus ceruleus, median raphe, basal ganglia and neocortex B. Locus ceruleus, median raphe, hippocampus and hypothalamus C. Cingulate gyrus, hippocampus, hypothalamus and medial thalamic gyrus D. Basal ganglia, thalamus, cingulate gyrus and medial thalamic nuclei E. None of the above Answer 28) Compared to controls, a patient with Major Depression would be expected to have: A. An decrease in the level 5-Hydroxy Indoleacetic Acid ( 5-HIAA) in the spinal fluid B. An increased urinary Methoxy-4-Hydroxyphenylglycol (MHPG) C. A decrease in the number of post synaptic Hydroxytryptamine (5-HT) binding sites D. An increase in the amount of growth hormone released when a patient was given a challenge dose of the alpha 2 agonist clonidine E. None of the above Answer 29) When the amount of serotonin or norepinephrine decreases in the synaptic cleft, the post synaptic receptor: A. Increases the number of binding sites although functionally these sites may not be as efficient in sending the signal and result in a decrease in synaptic transmission B. Increases the number of binding sites and increases the rate of synaptic transmission C. Deceases the number of binding sites and thereby decreases the synaptic transmission D. Decreases the number of binding sites but transmits the signal more efficiently E. None of the above Answer 30) A patient who has a marked decrease in their symptoms after only three days on an antidepressant is probably a: A. Quick responder B. Schizophrenic C. Immediate responder D. Placebo responder E. All of the above Answer 31) An example of data which supports the "permissive hypothesis" include: A. Antidepressant drugs which are effective and selectively block the reuptake ofNE only B. Antidepressant drugs which are effective and selectively block the reuptake of 5-HT only C. All of the above D. None of the above Answer 32) Central to the effectiveness of antidepressant medication is: A. Up regulation of post synaptic serotonin receptors B. Up regulation ofpre synaptic serotonin receptors C. Improved efficiency of the coupling of the G protein complex to serotonin receptors D. None of the above E. All of the above Answer 33) Which of the following is not a risk factor for the development of depression: A. Sexual abuse B. Previous episode of depression C. Parkinson's Disease D. Male gender E. Family history of depression Answer 34) Which of the following is true: A. Cortisol from the adrenal medulla create a negative feedback loop on Corticotropin Releasing Factor (CRF) cells in the anterior pituitary and hypothalamus. B. Cortisol from the adrenal medulla create a negative feedback loop on CRF cells in the anterior pituitary only. ' C. Cortisol from the adrenal cortex create a negative feedback loop on CRF cells in the anterior pituitary and hypothalamus. D. Cortisol from the adrenal cortex create a negative feedback loop on CRF cells in the anterior pituitary only. Answer 35) Cortisol secretion in depressed patients compared to normal controls demonstrate all of the following except: A. Increased secretion of cortisol in depressed patients compared to controls at every time point. B. Loss of the typical circandian rhythm in depressed patients compared to controls C. Higher peak cortisol secretions in depressed patients compared to controls D. Peak cortisol levels at the start of the day (6am to Sam) when the patient wakes up in depressed patients but not controls E. Normalization of the circadian rhythm in patients who respond to treatment with antidepressants Answer 36) Findings from studies of patients with depression show that: A. The adrenal medulla is hypertrophied B. The pituitary is hypertrophied C. Both of the above D. None of the above Answer 37) Studies of rats have shown that early stress (being taken away from your mother at an early age) demonstrate that childhood trauma may lead to: A. A decrease in the output of the Hypothalamic Pituitary Axis (HPA) axis (e.g., corticosterone) when the animal is injected with a saline solution. B. An increase corticosterone when the animal is injected with a saline solution. C. No change in the levels of corticosterone when the animal is injected with a saline solution. Answer 38) The changes in the amount of corticosterone that occur when an animal that is stressed support the theory that: A. Animals that have been stressed early in life are more likely to develop an adaptive response to stress that occurs as adults. B. Animals that have been stressed early in life are more likely to develop Major Depression as adults. C. Both of the above. Answer 39) The development of an antidepressant that antagonizes CRF is based on the following important finding: A. The injection of CRF into the CSF of normal controls induces depressive symptoms. B. The injection ofACTH into the CSF of normal controls induces depressive symptoms. C. The injection ofcortisol into the CSF of normal controls induces depressive symptoms. D. None of the above E. All of the above Answer 40) Studies of patients who have suffered child abuse have: A. Demonstrated that a history of child abuse is present in 50% of patients with Major Depression. B. Shown that epidemiologic studies of child abuse have clearly demonstrated an increase in the prevalence of child abuse over the last decade. C. Demonstrated that child abuse may predispose a patient to later development of Major Depression. D. All of the above. Answer 41) Studies of rat pups who have been stressed then treated with antidepressants support the use of antidepressants in patients with child abuse for: A. A limited amount of time, usually 6 months to one year. B. The prophylactic use of antidepressants for the patient's lifetime (i.e., start them on an antidepressant and leave them on it for their entire life) Answer 42) A patient presents to you with five episodes of mania and depression over the last year. She has a euphoric mood, is grandiose and thinks that she is related to Abraham and has recently spent $50,000 on a pink Gremlin because she liked the color. Her husband says he has reached his limit and is going to divorce her and is going to divorce her if she doesn't "show some sense". He says she recently tried to sell her children to their church to become slaves of God and earlier in the year had slit her wrist because she thought the Devil was taking over her soul. Research indicates that she would most likely respond to: A. Lithium carbonate B. Fluoxetine C. Phenelzine D. Carbamazepine E. Valproic acid Answer 43) Patients on lithium carbonate may experience which of the following when taking the medication: A. Polyuria B. Tremor C. Weight gain D. A and B only E. All of the above Answer 44) Autoinduction is a common occurrence in patients treated with carbamazepine. The consequence of this process in clinical practice is: A. The tendency for the serum drug level of carbamazepine to decrease in the first few weeks of treatment in a patient who is taking the recommended dose of medication B. The increase in the serum drug level when carbamazepine is given with valproic acid C. The increase in the serum blood levels of steroids (such as birth control pills) when patients take carbamazepine D. The tendency of manic patients to buy cars Answer 45) Which of the following drugs are approved by the PDA for the acute treatment of mania: A. Lithium carbonate B. Carbamazepine C. Valproic Acid D. Gabapentin E AandC Answer 46) The tricyclic antidepressant which has the most serotonergic activity is: A. Phenelzine B. Desipramine C. Clomipramine D. Fluoxetine E. Imipramine Answer 47) All of the following are common potential side effects of the tricyclic antidepressants except: A. Constipation B. Agitation C. Weight gain D. Orthostatic hypotension E. Confusion Answer 48) The most common side effect of the serotonin reuptake inhibitors is: A. Hair loss due to brittle hair and treated with selinium B. Weight gain C. Hypersomnia (increased fatigue and sleeplessness) D. Decreased libido (sexual appetite) E. Dry mouth Answer 49) The monoamine oxidase inhibitors are not being prescribed as much by psychiatrists because: A. They are not as effective as the newer agents B. The potential for a hypotensive crisis (e.g., the rapid drop in the patient's blood pressure when a patient eats food with high amounts oftyramine) C. Both A and B D. Neither A or B Answer 50) An antidepressant which exerts it's antidepressant effect through reuptake blockade of both serotonin and norepinepherine without anticholinergic side effects is: A. Fluoxetine B. Paroxetine C. Sertraline D. Venlafaxine E. Amitriptyline Answer