CMN 552 FINAL EXAM SCRIPT SOLVED
QUESTIONS AND COMPLETE SOLUTIONS
◉ What are some common sleep disturbances experienced by
patients with MDD?
Answer: Insomnia, hypersomnia.
◉ What psychomotor changes would the clinician see when
interviewing a patient with MDD?
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?
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?
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?
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?
Answer: Table 8.8-1
◉ 20. How does the clinician differentiate MDD from Bipolar
Disorder?
,Answer: Episodes of mania-like symptoms, indicating bipolar I
disorder (complete manic and depressive syndromes), bipolar II
disorder (recurrent major depressive episodes with hypomania),
◉ 21. What are some psychosocial therapies for the treatment of
MDD?
Answer: cognitive therapy, interpersonal therapy, and behavior
therapy
◉ 22. How does transcranial magnetic stimulation work?
Answer: Short pulses of magnetic energy stimulate nerve cells in the
brain.
Used in adult patients who have failed to achieve satisfactory
improvement from antidepressants.
Produces focal secondary electrical stimulation of targeted cortical
regions.
It is nonconvulsive, requires no anesthesia, has a safe side effect
profile, and is not associated with cognitive side effects.
40-minute outpatient procedure that is prescribed by a psychiatrist
and performed in a psychiatrist office. The treatment is typically
administered daily for 4 to 6 weeks. The most common adverse
event related to treatment was scalp pain or discomfort. TMS
, therapy is contraindicated in patients with implanted metallic
devices or nonremovable metallic objects in or around the head.
◉ 23. What are the indications for Phototherapy?
Answer: Seasonal disorders, sleep disorders.
◉ 24. What are the pharmacotherapeutic options in treating MDD?
How long should pharmacotherapy last? How does the clinician
select the best medication for treating MDD? What are the reasons
some patients experience treatment failure?
Answer: SSRIs, SNRIs, MAOIs, Tricyclics, atypical antidepressants.
Should last at least six months, or the duration of the depressed
episode.
Selection of the initial treatment depends on the chronicity of the
condition, course of illness (a recurrent or chronic course is
associated with increased likelihood of subsequent depressive
symptoms without treatment), family history of illness and
treatment response, symptom severity, concurrent general medical
or other psychiatric conditions, prior treatment responses to other
acute phase treatments, potential drug-drug interactions, and
patient preference.
QUESTIONS AND COMPLETE SOLUTIONS
◉ What are some common sleep disturbances experienced by
patients with MDD?
Answer: Insomnia, hypersomnia.
◉ What psychomotor changes would the clinician see when
interviewing a patient with MDD?
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?
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?
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?
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?
Answer: Table 8.8-1
◉ 20. How does the clinician differentiate MDD from Bipolar
Disorder?
,Answer: Episodes of mania-like symptoms, indicating bipolar I
disorder (complete manic and depressive syndromes), bipolar II
disorder (recurrent major depressive episodes with hypomania),
◉ 21. What are some psychosocial therapies for the treatment of
MDD?
Answer: cognitive therapy, interpersonal therapy, and behavior
therapy
◉ 22. How does transcranial magnetic stimulation work?
Answer: Short pulses of magnetic energy stimulate nerve cells in the
brain.
Used in adult patients who have failed to achieve satisfactory
improvement from antidepressants.
Produces focal secondary electrical stimulation of targeted cortical
regions.
It is nonconvulsive, requires no anesthesia, has a safe side effect
profile, and is not associated with cognitive side effects.
40-minute outpatient procedure that is prescribed by a psychiatrist
and performed in a psychiatrist office. The treatment is typically
administered daily for 4 to 6 weeks. The most common adverse
event related to treatment was scalp pain or discomfort. TMS
, therapy is contraindicated in patients with implanted metallic
devices or nonremovable metallic objects in or around the head.
◉ 23. What are the indications for Phototherapy?
Answer: Seasonal disorders, sleep disorders.
◉ 24. What are the pharmacotherapeutic options in treating MDD?
How long should pharmacotherapy last? How does the clinician
select the best medication for treating MDD? What are the reasons
some patients experience treatment failure?
Answer: SSRIs, SNRIs, MAOIs, Tricyclics, atypical antidepressants.
Should last at least six months, or the duration of the depressed
episode.
Selection of the initial treatment depends on the chronicity of the
condition, course of illness (a recurrent or chronic course is
associated with increased likelihood of subsequent depressive
symptoms without treatment), family history of illness and
treatment response, symptom severity, concurrent general medical
or other psychiatric conditions, prior treatment responses to other
acute phase treatments, potential drug-drug interactions, and
patient preference.
