NURS 623 Worksheet for Exam 3
Working through the questions should help point out areas you need to spend more time
further reviewing. Also, please look over the review guide in the module section.
Psychosocial
1. What is the most common psychiatric disorder in the United States?
A: Anxiety
2. What are the DSM-5 symptom criteria for a diagnosis of general anxiety disorder?
1. The presence of excessive anxiety and worry about a variety of topics, events, or
activities. Worry occurs more often than not for at least 6 months and is clearly
excessive.
2. The worry is experienced as very challenging to control. The worry in both adults and
children may easily shift from one topic to another.
3. The anxiety and worry are accompanied with at least three of the following physical or
cognitive symptoms (In children, only one symptom is necessary for a diagnosis of
GAD):
Note: Only one item required in children.
A. Restlessness, feeling keyed up or on edge.
B. Being easily fatigued.
C. Difficulty concentrating or mind going blank.
D. Irritability.
E. Muscle tension.
F. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
4. The anxiety, worry, or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
5. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
6. The disturbance is not better explained by another medical disorder (e.g., anxiety or
worry about having panic attacks in panic disorder, negative evaluation in social anxiety
disorder [social phobia], contamination or other obsessions in obsessive-compulsive
disorder, separation from attachment figures in separation anxiety disorder, reminders of
traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa,
physical complaints in somatic symptom disorder, perceived appearance flaws in body
dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of
delusional beliefs in schizophrenia or delusional disorder).
3. What are the DSM-5 symptom criteria for a major depressive disorder?
A: The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual
must be experiencing five or more symptoms during the same 2-week period and at least one of
the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day.
, 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in
appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others,
not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a
suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically
significant distress or impairment in social, occupational, or other important areas of
functioning. The symptoms must also not be a result of substance abuse or another medical
condition.
4. What are the risk factors for major depression?
A. Age (adolescent or older adult), gender (female), family history (strong family history of
depression suicide, or suicide attempts, alcohol abuse, or other substance abuse), history of
migraines, back pain, recent MI, or peptic ulcer disease, current mental condition, current
chronic disease, insomnia, lifestyle (stress, poverty, less than high school education, recent
traumatic event, parent or caregiver of a child with behavioral disorder, retired)
5. What are the common presenting symptoms of depression in the geriatric patient?
Vegetative: poor appetite, disrupted sleep, early morning awakening
Somatic: pain throughout body or out of proportion with underlying pathology
Psychology: obsessive feelings of guilt and worry, ruminations throughout the night, suicidal
ideation, memory problems
Psychomotor: anxiety, psychomotor agitation
Diurnal variation in symptoms: cannot get moving in the morning, or specific time of day
when depression is at its worst.
6. What are the pharmacologic versus nonpharmacologic treatment for management for
major depressive disorder? Are there additional concerns with pharmacologic
management in elderly patients?
A: Interpersonal and cognitive behavior therapy have both shown to be effective
treatment for depression.
B: Some antidepressants have significant liver CYP P450 interaction effects. In the
elderly antidepressants should be started at lower doses and titrated slowly. Elderly
patients may have a slower metabolism, and be at greater risks for falls, osteoporosis,
and fractures.
Working through the questions should help point out areas you need to spend more time
further reviewing. Also, please look over the review guide in the module section.
Psychosocial
1. What is the most common psychiatric disorder in the United States?
A: Anxiety
2. What are the DSM-5 symptom criteria for a diagnosis of general anxiety disorder?
1. The presence of excessive anxiety and worry about a variety of topics, events, or
activities. Worry occurs more often than not for at least 6 months and is clearly
excessive.
2. The worry is experienced as very challenging to control. The worry in both adults and
children may easily shift from one topic to another.
3. The anxiety and worry are accompanied with at least three of the following physical or
cognitive symptoms (In children, only one symptom is necessary for a diagnosis of
GAD):
Note: Only one item required in children.
A. Restlessness, feeling keyed up or on edge.
B. Being easily fatigued.
C. Difficulty concentrating or mind going blank.
D. Irritability.
E. Muscle tension.
F. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep).
4. The anxiety, worry, or physical symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of functioning.
5. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism).
6. The disturbance is not better explained by another medical disorder (e.g., anxiety or
worry about having panic attacks in panic disorder, negative evaluation in social anxiety
disorder [social phobia], contamination or other obsessions in obsessive-compulsive
disorder, separation from attachment figures in separation anxiety disorder, reminders of
traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa,
physical complaints in somatic symptom disorder, perceived appearance flaws in body
dysmorphic disorder, having a serious illness in illness anxiety disorder, or the content of
delusional beliefs in schizophrenia or delusional disorder).
3. What are the DSM-5 symptom criteria for a major depressive disorder?
A: The DSM-5 outlines the following criterion to make a diagnosis of depression. The individual
must be experiencing five or more symptoms during the same 2-week period and at least one of
the symptoms should be either (1) depressed mood or (2) loss of interest or pleasure.
1. Depressed mood most of the day, nearly every day.
, 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day.
3. Significant weight loss when not dieting or weight gain, or decrease or increase in
appetite nearly every day.
4. A slowing down of thought and a reduction of physical movement (observable by others,
not merely subjective feelings of restlessness or being slowed down).
5. Fatigue or loss of energy nearly every day.
6. Feelings of worthlessness or excessive or inappropriate guilt nearly every day.
7. Diminished ability to think or concentrate, or indecisiveness, nearly every day.
8. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a
suicide attempt or a specific plan for committing suicide.
To receive a diagnosis of depression, these symptoms must cause the individual clinically
significant distress or impairment in social, occupational, or other important areas of
functioning. The symptoms must also not be a result of substance abuse or another medical
condition.
4. What are the risk factors for major depression?
A. Age (adolescent or older adult), gender (female), family history (strong family history of
depression suicide, or suicide attempts, alcohol abuse, or other substance abuse), history of
migraines, back pain, recent MI, or peptic ulcer disease, current mental condition, current
chronic disease, insomnia, lifestyle (stress, poverty, less than high school education, recent
traumatic event, parent or caregiver of a child with behavioral disorder, retired)
5. What are the common presenting symptoms of depression in the geriatric patient?
Vegetative: poor appetite, disrupted sleep, early morning awakening
Somatic: pain throughout body or out of proportion with underlying pathology
Psychology: obsessive feelings of guilt and worry, ruminations throughout the night, suicidal
ideation, memory problems
Psychomotor: anxiety, psychomotor agitation
Diurnal variation in symptoms: cannot get moving in the morning, or specific time of day
when depression is at its worst.
6. What are the pharmacologic versus nonpharmacologic treatment for management for
major depressive disorder? Are there additional concerns with pharmacologic
management in elderly patients?
A: Interpersonal and cognitive behavior therapy have both shown to be effective
treatment for depression.
B: Some antidepressants have significant liver CYP P450 interaction effects. In the
elderly antidepressants should be started at lower doses and titrated slowly. Elderly
patients may have a slower metabolism, and be at greater risks for falls, osteoporosis,
and fractures.
