CMN 552 Exam 1
What two neurotransmitters are most implicated in the pathophysiology of mood
disorders? - correct answer norepinephrine and serotonin
How are dopamine levels affected in depression and mania? - correct answer
Dopamine activity may be reduced in depression and increased in mania
How does depression affect sleep neurophysiology? - correct answer Loss of deep
(slow-wave) sleep
Increase in nocturnal arousal.
The latter is reflected by four types of disturbance: (1) an increase in nocturnal
awakenings, (2) a reduction in total sleep time, (3) increased phasic rapid eye
movement (REM) sleep, and (4) increased core body temperature. T
What is the most common abnormality found in structural and functional brain imaging
in depressive disorders? - correct answer Increased frequency of abnormal
hyperintensities in subcortical regions, such as periventricular regions, the basal
ganglia, and the thalamus
What cognitive distortions are commonly seen in depressed patients? - correct answer
(1) views about the self —a negative self-precept, (2) about the environment—a
tendency to experience the world as hostile and demanding, and (3) about the future—
the expectation of suffering and failure
What is learned helplessness? - correct answer the hopelessness and passive
resignation an animal or human learns when unable to avoid repeated aversive events
What "specifiers" are used to describe patients with various mood disorders? - correct
answer Table 8.1-7
What factors are associated with a poor prognosis for patients with mood disorders? -
correct answer MDD: The percentage of patients recovering after repeated
hospitalization decreases with passing time. Generally, as a patient experiences more
and more depressive episodes, the time between the episodes decreases, and the
severity of each episode increases.
Bipolar I: Have a poorer prognosis than do patients with major depressive disorder.
About 40 to 50 percent of patients with bipolar I disorder may have a second manic
episode within 2 years of the first episode. poor occupational status, alcohol
dependence, psychotic features, depressive features, interepisode depressive features,
and male gender were all factors that contributed a poor prognosis. Short duration of
manic episodes, advanced age of onset, few suicidal thoughts, and few coexisting
psychiatric or medical problems predict a better outcome.
,Bipolar II: The course and prognosis of bipolar II disorder indicate that the diagnosis is
stable because there is a high likelihood that patients with bipolar II disorder will have
the same diagnosis up to 5 years later. Bipolar II disorder is a chronic disease that
warrants long-term treatment strategies.
What is endogenous depression? - correct answer depression with no apparent cause
What characteristics would the clinician see if a patient presented with atypical features
in a depressed patient? - correct answer Catatonic features
Postpartum onset
Rapid cycling
Seasonal features
Significant weight gain
Hypersomnia
Leaden paralysis
What diagnostic criteria are required for a patient to receive a diagnosis of Major
Depressive Disorder? - correct answer *Five (or more) of the following symptoms
have been present during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either (1) depressed mood or (2)
loss of interest or pleasure.
Depressed most of the day, nearly every day as indicated by subjective report (e.g.,
feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)
Markedly diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day (as indicated by subjective account or observation)
Significant weight loss when not dieting or weight gain (e.g., change of more than 5% of
body weight in a month), or decrease or increase in appetite nearly every day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others, not merely
subjective feelings of restlessness or being slowed down)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others)
, Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing suicide
The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to another
medical condition.
The occurrence of the major depressive episode is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder,
or other specified and unspecified schizophrenia spectrum and other psychotic
disorders.
There has never been a manic episode or a hypomanic episode.
What are some common sleep disturbances experienced by patients with MDD? -
correct answer Insomnia, hypersomnia.
What psychomotor changes would the clinician see when interviewing a patient with
MDD? - correct answer Psychomotor retardation is the most common.
Psychomotor agitation is also seen, especially in older patients.
Agitation: Hair pulling, hand-wringing.
Stooped posture; no spontaneous movements; and a downcast, averted gaze.
Symptoms of psychomotor retardation may appear identical to patients with catatonic
schizophrenia.
What is the prevalence of MDD? How do sex and age of the patient impact these rates?
- correct answer Prevalence of 5-17%.
Twofold greater prevalence of major depressive disorder in women than in men.
The mean age of onset for major depressive disorder is about 40 years, with 50 percent
of all patients having an onset between the ages of 20 and 50 years.
What is the risk of suicide for patients with MDD? - correct answer About 10 to 15
percent of all depressed patients commit suicide, and about two-thirds have suicidal
ideation.
18. What are the difficulties in recognizing depression in the elderly population? -
correct answer Elderly people often have various co-morbid medical disorders that
may have similar symptoms to depression.
19. What are some common Differential diagnosis when considering MDD? - correct
answer Table 8.8-1
What two neurotransmitters are most implicated in the pathophysiology of mood
disorders? - correct answer norepinephrine and serotonin
How are dopamine levels affected in depression and mania? - correct answer
Dopamine activity may be reduced in depression and increased in mania
How does depression affect sleep neurophysiology? - correct answer Loss of deep
(slow-wave) sleep
Increase in nocturnal arousal.
The latter is reflected by four types of disturbance: (1) an increase in nocturnal
awakenings, (2) a reduction in total sleep time, (3) increased phasic rapid eye
movement (REM) sleep, and (4) increased core body temperature. T
What is the most common abnormality found in structural and functional brain imaging
in depressive disorders? - correct answer Increased frequency of abnormal
hyperintensities in subcortical regions, such as periventricular regions, the basal
ganglia, and the thalamus
What cognitive distortions are commonly seen in depressed patients? - correct answer
(1) views about the self —a negative self-precept, (2) about the environment—a
tendency to experience the world as hostile and demanding, and (3) about the future—
the expectation of suffering and failure
What is learned helplessness? - correct answer the hopelessness and passive
resignation an animal or human learns when unable to avoid repeated aversive events
What "specifiers" are used to describe patients with various mood disorders? - correct
answer Table 8.1-7
What factors are associated with a poor prognosis for patients with mood disorders? -
correct answer MDD: The percentage of patients recovering after repeated
hospitalization decreases with passing time. Generally, as a patient experiences more
and more depressive episodes, the time between the episodes decreases, and the
severity of each episode increases.
Bipolar I: Have a poorer prognosis than do patients with major depressive disorder.
About 40 to 50 percent of patients with bipolar I disorder may have a second manic
episode within 2 years of the first episode. poor occupational status, alcohol
dependence, psychotic features, depressive features, interepisode depressive features,
and male gender were all factors that contributed a poor prognosis. Short duration of
manic episodes, advanced age of onset, few suicidal thoughts, and few coexisting
psychiatric or medical problems predict a better outcome.
,Bipolar II: The course and prognosis of bipolar II disorder indicate that the diagnosis is
stable because there is a high likelihood that patients with bipolar II disorder will have
the same diagnosis up to 5 years later. Bipolar II disorder is a chronic disease that
warrants long-term treatment strategies.
What is endogenous depression? - correct answer depression with no apparent cause
What characteristics would the clinician see if a patient presented with atypical features
in a depressed patient? - correct answer Catatonic features
Postpartum onset
Rapid cycling
Seasonal features
Significant weight gain
Hypersomnia
Leaden paralysis
What diagnostic criteria are required for a patient to receive a diagnosis of Major
Depressive Disorder? - correct answer *Five (or more) of the following symptoms
have been present during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either (1) depressed mood or (2)
loss of interest or pleasure.
Depressed most of the day, nearly every day as indicated by subjective report (e.g.,
feels sad, empty, hopeless) or observation made by others (e.g., appears tearful)
Markedly diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day (as indicated by subjective account or observation)
Significant weight loss when not dieting or weight gain (e.g., change of more than 5% of
body weight in a month), or decrease or increase in appetite nearly every day
Insomnia or hypersomnia nearly every day
Psychomotor agitation or retardation nearly every day (observable by others, not merely
subjective feelings of restlessness or being slowed down)
Fatigue or loss of energy nearly every day
Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional)
nearly every day (not merely self-reproach or guilt about being sick).
Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by
subjective account or as observed by others)
, Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a
specific plan, or a suicide attempt or a specific plan for committing suicide
The symptoms cause clinically significant distress or impairment in social, occupational,
or other important areas of functioning.
The episode is not attributable to the physiological effects of a substance or to another
medical condition.
The occurrence of the major depressive episode is not better explained by
schizoaffective disorder, schizophrenia, schizophreniform disorder, delusional disorder,
or other specified and unspecified schizophrenia spectrum and other psychotic
disorders.
There has never been a manic episode or a hypomanic episode.
What are some common sleep disturbances experienced by patients with MDD? -
correct answer Insomnia, hypersomnia.
What psychomotor changes would the clinician see when interviewing a patient with
MDD? - correct answer Psychomotor retardation is the most common.
Psychomotor agitation is also seen, especially in older patients.
Agitation: Hair pulling, hand-wringing.
Stooped posture; no spontaneous movements; and a downcast, averted gaze.
Symptoms of psychomotor retardation may appear identical to patients with catatonic
schizophrenia.
What is the prevalence of MDD? How do sex and age of the patient impact these rates?
- correct answer Prevalence of 5-17%.
Twofold greater prevalence of major depressive disorder in women than in men.
The mean age of onset for major depressive disorder is about 40 years, with 50 percent
of all patients having an onset between the ages of 20 and 50 years.
What is the risk of suicide for patients with MDD? - correct answer About 10 to 15
percent of all depressed patients commit suicide, and about two-thirds have suicidal
ideation.
18. What are the difficulties in recognizing depression in the elderly population? -
correct answer Elderly people often have various co-morbid medical disorders that
may have similar symptoms to depression.
19. What are some common Differential diagnosis when considering MDD? - correct
answer Table 8.8-1
