Brs: Behavioral Science - Psychological Disorders

Front 1

When compared with a man, the chances that a woman will develop major depressive disorder, dysthymic disorder, or bipolar disorder over the course of her lifetime are, respectively

(A) higher, higher, equal
(B) higher, higher, lower
(C) higher, equal, higher
(D) higher, higher, higher
(E) equal, higher, equal
(F) equal, higher, lower
(G) equal, equal, equal

Back 1

Higher, Higher, Equal

Front 2

What are the mood or affective disorders characterized by?

Back 2

Primary disturbance in internal emotional state, causing subjective distress and problems in functioning

Front 3

What is the term for when a patient emotionally feels somewhat worse than would be expected?

Back 3

Dysthymia

Front 4

What is the term for when a patient emotionally feels very much worse than would be expected?

Back 4

Depression

Front 5

What is the term for when a patient emotionally feels somewhat better than would be expected?

Back 5

Hypomania

Front 6

What is the term for when a patient emotionally feels very much better than would be expected?

Back 6

Mania

Front 7

What are the DSM-IV-TR categories of mood disorders?

Back 7

Primary Mood Disorders:
- Major depressive disorder
- Bipolar disorder (I and II)
- Dysthymic disorder
- Cyclothymic disorder

Secondary Mood Disorders:
- Owing to a general medical condition
- Substance-induced mood disorder

Front 8

What are the differences in occurrence of mood disorders baed on ethnicity, education, marital status, and income?

Back 8

No differences in occurrence based on these factors

Front 9

What is the lifetime prevalence of major depressive disorder in males vs females?

Back 9

- 5-12% for men
- 10-20% for women

Front 10

What is the lifetime prevalence of bipolar disorder in males vs females?

Back 10

- 1% overall
- No sex difference

Front 11

What is the lifetime prevalence of dysthymic disorder in males vs females?

Back 11

- 6% overall
- Up to 3x more common in women

Front 12

What is the lifetime prevalence of cyclothymic disorder in males and females?

Back 12

- <1% overall
- No sex difference

Front 13

What are the characteristics of major depressive disorder?

Back 13

Recurrent episodes of depression, each continuing for at least 2 weeks

Approximate percentage of patients in which sign of symptom is seen:
+ = <25%
++ = 50%
+++ = 70%
++++ = >90%

Front 14

What is "masked depression"? How common?

Back 14

- Depressed patients who seem unaware of or deny depression
- Often present to PCP complaining of vague physical symptoms
- As many as 50% of depressed patients

Front 15

How can "masked depression" present to the doctor? What can it be confused with?

Back 15

- Often present to PCP complaining of vague physical symptoms
- May be mistaken for hypochondriasis

Front 16

How do depressed patients differ from patients with hypochondriasis?

Back 16

- Depressed patients show other symptoms of depression (eg, severe weight loss, suicidality) in addition to their physical complaints
- Patients with hypochondriasis only have physical complaints

Front 17

What is Seasonal Affective Disorder (SAD)? Characteristics?

Back 17

Subtype of major depressive disorder that is associated with the winter season and short days
- Characterized by atypical symptoms of depression (eg, oversleeping and overeating) and a heavy feeling in the limbs ("leaden paralysis")

Front 18

What is the suicide risk associated with Major Depressive Disorder?

Back 18

- Patients with MDD at increased risk for suicide
- Certain demographic, psychosocial, and physical factors affect this risk

Front 19

What are the top five risk factors for suicide from highest to lowest?

Back 19

1. Serious prior suicide attempt
2. Age >45 years
3. Alcohol dependence
4. History of rage and violent behavior
5. Male sex

Front 20

What are the types of Bipolar Disorder?

Back 20

Bipolar I Disorder:
- Episodes of both mania and depression

Bipolar II Disorder:
- Episodes of both hypomania and depression

Front 21

Is there a disorder of just manic episodes?

Back 21

No simple manic disorder, because depressive symptoms eventually occur (therefore one episode of symptoms of mania alone or hypomania plus one episode of major depression defines bipolar disorder)

Front 22

Do psychotic symptoms occur in Bipolar Disorder?

Back 22

Psychotic symptoms, such as delusions, can occur in depression as well as in mania

Front 23

What are the symptoms of mania?

Back 23

Approximate percentage of patients in which sign of symptom is seen:
+ = <25%
++ = 50%
+++ = 70%
++++ = >90%

Front 24

When is a patient with a mood disorder more likely to be misdiagnosed as schizophrenia?

Back 24

Some patients (eg, poor patients with low access to healthcare) with a mood disorder with psychotic symptoms can be severe enough that it is misdiagnosed

Front 25

What is a key difference between mood disorders with psychotic symptoms and patients with true schizophrenia or schizoaffective disorders?

Back 25

In mood disorders, the patient's mood and functioning usually return to normal between episodes

Front 26

What is dysthymic disorder?

Back 26

Dysthmia (feeling somewhat worse than would be expected) over a 2-year period (1-year in children) with no discrete episodes of illness

Front 27

What is cyclothymic disorder?

Back 27

- Periods of hypomania and dysthymia
- Occurs over a 2-year period (or 1-year in children)
- No discrete episodes of illness

Front 28

What is the difference between major depressive disorder and dysthymic disorder, as well as between bipolar disorder and cyclothymic disorder?

Back 28

Dysthymic and Cyclothymic disorders are less severe, non-episodic, chronic, and never associated with psychosis or suicide

Front 29

What does the biologic etiology of mood disorders include?

Back 29

- Altered NT activity
- Genetic component (strongest in bipolar)
- Physical illness and related factors
- Abnormalities of limbic-hypothalamic-pituitary-adrenal axis

Front 30

What does the psychosocial etiology of depression and dysthymia include?

Back 30

- Loss of parent in childhood
- Loss of spouse or child in adulthood
- Loss of health
- Low self-esteem and negative interpretation of life events
- Learned helplessness (ie, because attempts to escape bad situations in the past have proven futile, person now feels helpless)

Front 31

What medical conditions must be included in the differential diagnosis of depression?

Back 31

- Cancer (particularly pancreatic and other GI tumors)
- Viral illness (eg, pneumonia, influenza, AIDS)
- Endocrine abnormalities (eg, hypothyroidism, diabetes)
- Neurologic illness (eg, Parkinson disease, Huntington disease, stroke - particularly left frontal)
- Nutritional deficiency (eg, folic acid, B12)
- Renal or cardiopulmonary disease

Front 32

Which psychiatric and pharmacologic conditions must be included in the differential diagnosis of depression?

Back 32

- Schizophrenia (particularly after an acute psychotic episode)
- Anxiety disorder
- Somatoform disorder
- Eating disorder
- Drug and alcohol abuse (particularly use of sedatives and withdrawal from stimulants)
- Prescription drug use (eg, reserpine, steroids, anti-HTNs, anti-neoplastics)

Front 33

How do psychosocial factors affect the etiology of mania or hypomania?

Back 33

Psychosocial factors are not involved

Front 34

How common is treatment sought and received for patients with depression? How effective?

Back 34

- 25% of patients with depression seek and receive treatment (many do not seek treatment because they believe it indicates personal failure or weakness)
- Depression is successfully treated in most patients

Front 35

What are the characteristics of untreated episodes of depression and mania? How long?

Back 35

- Self-limiting
- Depressive episodes last approximately 6-12 months
- Manic episodes last approximately 3 months

Front 36

What are the most effective treatments for mood disorders?

Back 36

Pharmacologic

Front 37

What are the types of pharmacologic treatments for depression and dysthymia?

Back 37

Antidepressant agents
- Heterocyclics
- SSRIs and SNRIs
- MAOIs
- Stimulants

Front 38

What are the mood stabilizers? Use?

Back 38

- Lithium and anti-convulsants such as Carbamazepine and Divalproex used to treat bipolar disorder
- Also used for cyclothymic disorder (in similar doses)

- Atypical antipsychotics (eg, Olanzapine and Risperidone)

- Sedative agents (eg, Lorazepam) used to treat acute manic episodes because they resolve symptoms quickly

Front 39

What are the types of psychological treatments used for depression and dysthymia? Efficacy?

Back 39

- Psychological treatment for depression and dysthymia includes psychoanalytic, interpersonal, family, behavioral, and cognitive therapy
- Psychological treatment in conjunction with medication is more effective than either type of treatment alone

Front 40

What is the primary indication for Electroconvulsive Therapy?

Back 40

Major depressive disorder

Front 41

When is Electroconvulsive Therapy used?

Back 41

- When symptoms of MDD do not respond to anti-depressant meds
- When anti-depressants are too dangerous or have intolerable side effects (eg, particularly useful for elderly patients)
- When rapid resolution of symptoms is necessary (eg, patient is acutely suicidal or psychotic)

Front 42

A 22-year-old male college student is taken to the emergency department by police because he tried to enter a state office build- ing to “have a conference with the governor” about conducting a fund drive to “finance my cure for cancer.” When police prevent him from entering the building, he becomes irritable and hostile and resists attempts to restrain him.

The most appropriate diagnosis for this patient is
(A) dysthymic disorder
(B) major depressive disorder
(C) bipolar disorder
(D) hypochondriasis
(E) cyclothymicdisorder

Back 42

B - bipolar disorder

This patient is most likely to have bipolar I disorder. While this disorder involves episodes of both mania and depression, a single episode of mania defines the illness. The beliefs that one is important enough to demand a conference with the governor and cure cancer are grandiose delusions. Schizophrenic delusions are commonly paranoid in nature. Irritability and hostility are also common in a manic episode.

Front 43

A 22-year-old male college student is taken to the emergency department by police because he tried to enter a state office build- ing to “have a conference with the governor” about conducting a fund drive to “finance my cure for cancer.” When police prevent him from entering the building, he becomes irritable and hostile and resists attempts to restrain him.

The most effective long-term treatment for this patient is
(A) a heterocyclic antidepressant
(B) lithium
(C) electroconvulsive therapy
(D) psychotherapy
(E) a monoamine oxidase inhibitor

Back 43

B - Lithium

Of the listed treatments, the one most effective for bipolar disorder is lithium. Heterocyclic antidepressants, electroconvulsive therapy, monoamine oxidase inhibitors, and psychotherapy are used primarily to treat depression. Antidepres- sants and psychotherapy are used to treat dysthymia.

Front 44

A 22-year-old male college student is taken to the emergency department by police because he tried to enter a state office build- ing to “have a conference with the governor” about conducting a fund drive to “finance my cure for cancer.” When police prevent him from entering the building, he becomes irritable and hostile and resists attempts to restrain him.

This college student has two brothers. The first is his monozygotic twin; the second is two years younger. The risks that his first and second brothers will develop bipolar disorder are respectively about
(A) 75% and 60%
(B) 75% and 20%
(C) 60% and 10%
(D) 50% and 10%
(E) 10% and 1%

Back 44

B - 75% and 20%

The chances of the monozygotic twin and first-degree relative (e.g., brother) of this bipolar patient developing the disorder are about 75% and 20%, respectively.

Front 45

A 52-year-old overweight man reports that he often wakes up with a headache. He also notes that he is tired all the time and repeatedly falls asleep during the day. Evaluation of the arte- rial blood of this patient is most likely to reveal
(A) respiratory acidosis
(B) respiratory alkalosis
(C) metabolic alkalosis
(D) increased PaO2
(E) decreased PaCO2

Back 45

The answer is A.

This overweight middle-aged male patient is likely to have sleep apnea. Like other patients with pulmonary disorders leading to depressed breathing, patients with sleep apnea typically show chronic respiratory acidosis (increased partial pressure of carbon diox- ide [PaCO2]). Respiratory alkalosis (decreased PaCO2) results from hyperventilation as a result of anxiety, high fever, or stimulant abuse. Metabolic alkalosis typically results from excessive vomiting and resulting hypokalemia (and see answers to questions 9 and 10).