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PC2- anxiety and depression
Terms in this set (92)
What two diseases often accompany each other and each can lead to the other?
Depression and heart disease
At what age does depression increase the risk of stroke and other medical complications?
Which labs should you run if you suspect MDD in a pt with no personal or family hx?
CBC, B12, TSH, Electrolytes
What is the mneumonic for suicide risks
Age (< 19 or >45)
Previous suicide attempt
Excessive alcohol use
Rational thinking loss
Separated, divorced, or widowed
Organized plan or serious attempt
No social support
Sickness, chronic dz
approx. how many adults experience depression each yr
1 in 10 adults
T/F: Although most depressed people aren't suicidal, 2/3 of those who die by suicide suffer from a depressive illness.
The DSM says that for the Dx of MDD- at least 5 criterions must be met. What are the two that must ALWAYS be present
1. Subjective report or observation by others of depressed mood
2. Markedly decreased interest or pleasure in most activities
Diagnosis of MDD Criterion B means:
no symptoms of mania
Diagnosis of MDD Criterion C means:
sig. distress or impairment in social or occupational functioning
Diagnosis of MDD Criterion D means:
Sx caused by AOD or medical
Diagnosis of MDD Criterion E means:
Sx caused by bereavement
What is the mnemonic for dx of depression?
What are some medical d/o that present with depression?
- degenerative CNS
What are some medications that can cause depression:
How long does a pt diagnosed with dysthymia have to have a chronic depressed mood, for most of the days, for more days than not?
For at least 2 yrs. Pt may not have gone more than 2 months w/out suffering symtoms
In order to be diagnosed with dysthymia you cant have more than 2 months without having experienced 2 or more of the following symptoms:
- poor appetite or overeating
- insomnia or hypersomnia
- low energy or fatigue
- low self esteem
- poor concentration or difficulty making decisions
- feelings of hopelessness
Is perinatal depression recognized as a distinct diagnostic entity by the DSM?
When can perinatal depression occur?
anytime during pregnancy or up to 1 yr after childbirth
Can perinatal depression be seen in fathers?
yes. Although they arent directly affected by biochem changes, they are subject to psychosocial stressors
How do you distinguish the difference between post partum depression and "baby blues"?
Time frame. Baby blues can last a few days vs weeks. PPD can occur anytime during the first yr after child birth.
What are some symptoms that occur in PPD that do NOT occur in Baby Blues
Loss of appetite
Thoughts of harming yourself or the baby
Feelings of shame, guilts or inadequacy
Loss of interest in sex
When do symtoms of PMDD occur?
Last week of menstrual cycle and usually improve w/in a few days after menstruation
How is Seasonal Affective Disorder classified according to the DSM?
It is not a separate mood disorders. It is classifies as a subtype of MDD or Bipolar I or II
What season is most SAD most prevalent?
What symptoms are seen in winter depression that aren't typically seen in summer depression?
Heavy feeling of arms and legs
What symptoms are seen in summer depression that aren't seen in winter?
INCREASED sex drive
Discrete episodes of both depression and mania is characteristic of:
Discrete episodes of both depression and hypomania is characteristic of:
What pt population is 3x more likely to experience rapid cycling bipolar d/o (NAMI)
Females have an increased rate of which phase in manic depression?
What does the mnemonic DIGFAST stand for?
Dx of Mania:
F: flight of ideas
The primary symptom is manic or rapid (daily) cycling episodes of mania & depression- this describes what d/o?
A chronic state, lasting at least 2 yrs, of cycling between hypomanic & depressive episodes that don't reach the diagnostic standard for standard bipolar d/o- this describes what d/o?
The primary symptom is recurrent depression accompanied by hypomanic episodes - this describes what d/o?
During the period of mood disturbance within bipolar d/o - how many symptoms need to be present?
4-> if the mood is only irritable
3-> if the mood is elevated or expansive
A distinct period of persistently elevated, expansive or irritable mood, lasting throughout @ least 4 days describes what?
Hypomania (Bipolar II)
Pt presents to your clinic talking 1000 mph, stating that for the past week she has only needed 3 hrs of sleep a night, and that she recently lost all her life savings in Vegas. What do you suspect?
Hypomania - Bipolar II
(must last at least 4 days)
Pt presents to your office and tells you that her husband was recently arrested for prostitution and crack. What d/o do you automatically suspect?
Older pts with depression tend to originally present with:
primarily somatic complaints
This group of drugs function by blocking the reuptake of NE & serotonin
- have cardio and neuro effects -> get EKG
- have anticholinergic & antihistamine s/e
This group of drugs is often used for atypical depression & functions by inhibiting the breakdown of neurotransmitters.
- lots of dietary & drug interactions
- can cause serotonin syndrome
Class of drugs used to tx: OCD, Panic d/o, PTSD, PMDD, depression
-less cardiotoxic & fewer s/e
- s/e include: GI, sexual dysfunction & TMJ dysfunction
Class of drugs that typically provides more active symptom relief. Can also be used for fibromyalgia, diabetic peripheral neuropathy & other chronic pain
How long should meds be continued after sx relief to prevent relapse
(recurrence is common)
Pt presents with severe mania and treatment resistant depression. What other approach can you try? How does it work?
- electric currents are passed through the brain initially triggering a brief seizure
List 5 indications for ECT use:
1. Severe depression
2. Treatment-resistant depression
3. Severe mania
5. Agitation & aggression in people w/ dementia
This tx uses magnetic fields to stimulate nerve cells in the brain to improve symptoms of depression.
TMS (Transcranial magnetic stimulation)
What is St. Johns wort typically used for?
depression, anxiety, tiredness, loss of appetite & trouble sleeping
A 65 y.o. man has been diagnosed w/ advanced prostate cancer. The pt has lost 20 lbs. & has decreased energy & difficulty sleep because of pain. Over the past month he has been expressing fearfulness about dying & strong feelings of guilt about "bad things I've done in my life," which he believes have caused his illness. The sign or sx most likely to indicated that this pt is experiencing a major depressive episode rather than a normal rxn to serious illness is:
When compared w/ an American man, the chances that an American woman will develop major depressive disorder (MDD) or bipolar disorder over the course of her lifetime are, respectively:
A depressed 25 y.o. female pt who is slow moving & shows a flat affect is put on fluoxetine (Prozac). W/in 2 weeks, she is showing greatly increased activity level, flight of ideas, and pressured speech. In this pt, the medication has
precipitated a manic episode
• A 45 y.o. man reports a variety of aches, pains, and extreme fatigue that have been present for the past 6 months. PE is unremarkable but the pt has lost 10 lbs. w/out dieting since checkup last year. The pt reports that he wakes 2 hrs. before his alarm and has significant problems concentrating on his work. The pt denies that he is sad or hopeless. After a 5-week trial of antidepressant meds, the pt's aches and paings are gone, he is sleeping all night, his energy level and concentration are normal, and he has gained 5 lbs. This pt's sx before tx were probably a result of:
major depressive disorder
Analysis of neurotransmitter availability in the brain of the pt above is tx is most likely to reveal what?
Anxiety d/o are highly treatable, yet only how many pts of those suffering - receive treatment?
Who is 2-3x more likely to have panic d/o or PTSD?
Pt presents to your office. You notice she is shaking and profusely sweating. What do you suspect? What other symptoms are you likely to find?
- N/D/ urinary disturbance
The following describes what d/o?
-symptoms of fear w/out adequate cause
-symptoms present for about 6 months
- symptoms interfere w/ normal functioning
- symptoms cause sig. distress
The age of onset for OCD appears to be
mid 20s to early 30s
The median age of onset of social phobia was
Panic d/o demonstrates a bimodal age of onset in the
age groups of 15-24 years and 45-54 years
This d/o may be a precursor for adult anxiety disorders.
17 y/o presents to your office & tells you that during her ACT's last wknd, she had a sudden onset of intense trembling, dizziness and chills. She said it felt like she was having a heart attack. What do you suspect?
What would be the correct treatment for the pt mentioned above?
cognitive psychotherapy (to change thinking patterns) and meds
T/F: Panic attacks can only occur during waking hours
False. Panic attacks can occur even during sleep
Pt presents to the office. You notice that she is very anxious. SHe tells you that before she leaves the house she has to re-lock the door 17 times. However even this, only provides temporary relief. What do you suspect?
Treatment for the above pt includes what?
Exposure based psychotherapy & meds
PTSD encompasses 3 elements. What are they?
Hyper-arousal, avoidance, re-experiencing
In order to be classified as PTSD pt must have at least 1 of the following symptoms of re-expereincing :
- recurrent & intrusive recollections
- recurrent distressing dreams/ nightmares
- feelings of reliving traumatic event
- intense psych distress w/ internal or external cues to the trauma
- physiological reactivity on exposure to trauma cues
In order to be classified as PTSD pt must have at least 3 of the following symptoms of avoidance:
- avoidance if thoughts or conversation related to the trauma
- avoidance of activities, places, or people related to the following
- amnesia for important trauma- related events
- decreased participation in sig. activities
-feeling detached from others
-foreshortened sense of the future
In order to be classified as PTSD pt must have at least 2 of the following symptoms of hyper-arousal:
-difficulty staying or falling asleep
-irritability or anger outbursts
-exaggerated startle response
Are suicidal and homicidal ideations a diagnostic feature of PTSD?
NO - not diagnostic - both just associated w/ PTSD
Pt presents to the office and tells you that she stayed home from school for 5 days straight. You also learn that she was supposed to attend a class party this past weekend. She states that the thought of attending such event caused her such intense fear and anxiety. What do you suspect?
(= Marked and persistent fear of social situations to the extent that a person's ability to function at school is impaired)
Pt presents to your office and tells you that he is able to ski the world's tallest mountains with ease but be unable to go above the 5th floor of an office building. What do you suspect?
T/F: Specific phobia is an extreme fear that poses little or no actual danger.
False. It is an IRRATIONAL fear (not extreme) of something that poses little or no actual danger
T/F: Adults with phobias realize that these fears are in fact - irrational.
In order to qualify as GAD (gen. anxiety d/o) how long must the pt experience everyday worry about everyday problems?
at least 6 months
In order to qualify as GAD pt must have anxiety and worry associated w/ @ least 3 of the following symptoms:
- Restlessness or feeling keyed-up or on edge
- Being easily fatigued
- Difficulty concentrating or mind going blank
- Muscle tension
- Sleep disturbance
In your clinical evaluation of a pt presenting with a suspected anxiety d/o you must review the use of:
- OTC drugs
-alcohol and illicit drugs
Pt presents to the office with a suspected anxiety d/o and his biggest complaint today is how much it is affecting his sleep. Who would be an important person to talk to other than your pt and what would you inquire about?
Ask the patient's sleep partner about sleep patterns, apneic episodes or myoclonic limb jerks
What labs would you send for in your initial workup?
- CBC count
- Chemistry profile
- Thyroid function tests
- Urine drug screen
Older pt presents to your office and you have a high index of suspicion that his anxiety might be d/t other medical causes. What tests would you initially order for this pt?
- R/o CNS -using EEG, LP, or brain CT
- R/o cardiac- using EKG
- R/o infectious causes using rapid plasma reagent test, LP (CNS infections), or HIV testing.
T/F: Electroconvulsive therapy is an effective tx for anxiety d/o.
FALSE- not effective for anxiety d/o. (May successfully treat comorbid conditions such as severe major depression/ pts @ high risk for suicide)
Pt is brought to the ER complaining that she feels like she is going to die. She has worked herself into such a frenzy that she has exacerbated her asthma. What do you do when verbally calming her doesnt seem to work?
Pt has panic d/o. Give acute sedation w/ benzo's
With anxiety disorders when would you suggest further INpatient care?
- when anxiety d/o is complicated w/ comorbid conditions such as affective or substance abuse
-detox is needed for a comorbid substance dependence
T/F: Anxiety disorders often are rarely chronic and therefore rarely require lifelong medical/psychiatric care
False. (Anxiety disorders often are chronic and require ongoing medical/psychiatric care)
A 22 y.o. medical student relates that she has recently begun to experience sudden bouts of dizziness and shortness of breath that last about 20 min. and then subside. Because of these attacks, she must sit near the door of the lecture hall so that she can leave in a hurry. This student has no history of asthma. Other than an increased pulse rate, physical findings are normal. Of the following, the most effective IMMEDIATE tx for this pt when she develops these sx is:
the most effective LONG TERM tx for the pt mentioned above would be:
A 26 y.o., 4th yr. med student w/ no previous psychiatric hx reports that he has had a recurring thought over the past year that he will kill a pt before he graduates. The student has never harmed a pt and has no intention of doing so. When he snaps his fingers repeatedly, he feels somewhat calmer. This student is most likely to be experiencing
obsessive-compulsive disorder (OCD)
A 45 y.o. diabetic man is admitted to the hospital with a serious foot infection. During the last year, his wife divorced him and he declared personal bankruptcy. After this, he moved to a new apartment. On his first day in the apt he was robbed at knifepoint in the elevator. Which of the events experience by this man is most likely to result in PTSD?
A 23 y.o. student reports that he becomes very "uptight" when he must use a public restroom but otherwise does not report episodes of anxiety. Because he becomes so uncomfortable about using public restrooms, he refuses when his classmates ask him to join them when they go out. Of the following, the pharmacologic agents, which has FDA approval for the long-term tx of this student's sx
A 35 y.o. pt complains that he has been experiencing insomnia, palpitations, anxiety, HA and flatulence since he lost his job 2 months ago. Althought he has no hx of medical or psychiatric d/o, the family hx includes a mother w/ bipolar d/o, a father w/ alcoholism, and a younger sister who was in rehab for drug abuse. The most likely dx for this pt is
For 2 weeks after a 10 y.o. boy hears a shooting at a nearby school, he reports hearing voices telling him that his mother is trying to hurt him. He also says that he sees red eyes following him around. The most likely dx for this child at this time is
brief psychotic disorder
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