NUR 547 FINAL EXAM QUESTIONS & ANSWERS
What does a score of 0-7 on the Hamilton Depression Rating Scale (HAM-D) indicate? -
Answers -Normal (no depression)
What does a score of 8-16 on the Hamilton Depression Rating Scale (HAM-D) indicate?
- Answers -Mild depression
What does a score of 17-23 on the Hamilton Depression Rating Scale (HAM-D)
indicate? - Answers -Moderate depression
What does a score of 24 or higher on the Hamilton Depression Rating Scale (HAM-D)
indicate? - Answers -Severe depression
How are items on the Hamilton Depression Rating Scale (HAM-D) scored? - Answers -
Each item is scored 0-2 or 0-4, depending on severity.
What type of tool is the Hamilton Depression Rating Scale (HAM-D)? - Answers -A
clinician administered tool used to assess the severity of depression symptoms.
What aspects of depression does the Hamilton Depression Rating Scale (HAM-D)
evaluate? - Answers -Psychological and physical aspects of depression.
HAM-D 17 Components - Answers -Mood
Guilt Feelings
SI
Insomnia
Work and Activities
Psychomotor Agitation or retardation
Anxiety (psychological and somatic symptoms)
Somatic symptoms
Hypochondriasis
Loss of weight
Insight
Limitation of HAM-D rating scale - Answers -More focused on somatic symptoms which
can over estimate depression in medically ill patients
Alternative to HAM-D Scale - Answers -Montgomery-Ashberg Depression Rating Scale
(MADRS) which is better for tracking and treatment response
Geriatric Depression Scale (GDS) - Answers -Consists of yes/no questions that assess
emotional, cognitive, and behavioral symptoms of depresion in older adults. It avoids
somatic symptoms that may overlap with medical conditions
,Key Areas assessed in GDS - Answers -Mood and Enjoyment
Energy Levels
Social Withdrawal
Feelings of Hopelessness
Memory Concerns
Anxiety and Worry
Suicidal Thoughts
Scoring GDS - Answers -1 point of each depressed response
Yes to negative statements and no to positive statements
Scoring Interpretation of GDS-30 - Answers -0-30
0-9 Normal (no depression)
10-19 Mild Depression
20-30 Moderate to Severe Depression
Scoring Interpretation GDS-15 - Answers -0-15
Shorter version
0-4: Normal (No depression)
5-8: Mild Depression
9-11: Moderate Depression
12-15: Severe Depression
Patient Health Questionnaire-9 (PHQ-9) - Answers -self report tool for screening,
diagnosing, and monitoring depression. Based on the DSM-5 criteria for MDD and
evaluates symptom severity over the past two weeks
Components of the PHQ-9 - Answers -Nine Symptom Domains
1. Anhedonia
2. Depressed Mood
3. Sleep Problems
4. Fatigue
5. Appetite Changes
6. Low Self Worth
7. Concentration Issues
8. Psychomotor Changes
9. Suicidal Thoughts
PHQ-9 Scoring Interpretation - Answers -Each question is scored:
0=Not at all
1= Several Days
2= More than half the days
,3= Nearly Every Day
Total Score: 0-27
PHQ-9 Depression Severity Levels - Answers -0-4: Minimal or No depression
5-9: Mild Depression
10-14: Moderate Depression
15-19: Moderately Severe Depression
20-27: Severe Depression
Clinica Use of the PHQ-9 - Answers -Score >= 10: Possible clinical depression, further
evaluation needed
Score >=15: Likely MDD, consider therapy and/or medication
Score >=20: Severe Depression, requires urgent intervention
Mood Disorder Questionnaire - Answers -screening tool used for Bipolar Disorder, and
helps differentiate bipolar disorder from unipolar depression and other mood disorders
Consists of three parts, assessing lifetime history of manic or hypomanic symptoms
Part one of MDQ - Answers -Symptom Checklist
13 yes/no questions
Increased Energy and Activity
Euphoric or irritable mood
Decreased need for sleep
Unusual talkativeness or pressured speech
Racing Thoughts
Easily Distracted
Increase in goal-directed activities
Involvement in Risky behaviors
Unusual Confidence or grandiosity
More outgoing/social than usual
episodes lasting several days or longer
other people noticing these changes
symptoms occurring together in the same time period
Part 2 MDQ - Answers -Symptom Clustering
1 yes/no question
"Have several of the above symptoms ever happened during the same period of time?"
Part 3 MDQ - Answers -Functional Impairment
1 questions, 3 point scale: No, Minor, or Serious problem
, "How much did these problems cause difficulty in work, social, or family life?"
MDQ Scoring Interpretation - Answers -7 or more "yes" responses in Part 1
"Yes" in Part 2
Moderate or serious impairment in part 3 is a positive screen. This is possible bipolar
disorder, needs a clinical assessment
Negative Screen:
Fewer than 7 "yes" responses in Part 1 OR "No" in part 2 OR "No/Minor problems" in
Part 3= unlikely bipolar disorder
Limitations to MDQ - Answers -More sensitive to Bipolar I Disorder than Bipolar II or
Cyclothymia
May produce false positives in BPD
Anhedonia - Answers -a diminished ability to experience pleasure
TSH - Answers -0.4-4
For patients on thyroid medications 0.5 -3 is often targeted
Elevated TSH - Answers -Hypothyroidism
Low TSH - Answers -hyperthyroidism
hemoglobin - Answers -Men
13.8-17.2
Women
12.1-15.1
Pregnant women
11-14
Children
11-16
Lithium Level - Answers -Therapeutic range
0.6-1.2
Toxicity Risk
>1.5
Severe toxicity
>2
lithium toxicity symptoms - Answers -confusion
seizures
tremors
coma
What does a score of 0-7 on the Hamilton Depression Rating Scale (HAM-D) indicate? -
Answers -Normal (no depression)
What does a score of 8-16 on the Hamilton Depression Rating Scale (HAM-D) indicate?
- Answers -Mild depression
What does a score of 17-23 on the Hamilton Depression Rating Scale (HAM-D)
indicate? - Answers -Moderate depression
What does a score of 24 or higher on the Hamilton Depression Rating Scale (HAM-D)
indicate? - Answers -Severe depression
How are items on the Hamilton Depression Rating Scale (HAM-D) scored? - Answers -
Each item is scored 0-2 or 0-4, depending on severity.
What type of tool is the Hamilton Depression Rating Scale (HAM-D)? - Answers -A
clinician administered tool used to assess the severity of depression symptoms.
What aspects of depression does the Hamilton Depression Rating Scale (HAM-D)
evaluate? - Answers -Psychological and physical aspects of depression.
HAM-D 17 Components - Answers -Mood
Guilt Feelings
SI
Insomnia
Work and Activities
Psychomotor Agitation or retardation
Anxiety (psychological and somatic symptoms)
Somatic symptoms
Hypochondriasis
Loss of weight
Insight
Limitation of HAM-D rating scale - Answers -More focused on somatic symptoms which
can over estimate depression in medically ill patients
Alternative to HAM-D Scale - Answers -Montgomery-Ashberg Depression Rating Scale
(MADRS) which is better for tracking and treatment response
Geriatric Depression Scale (GDS) - Answers -Consists of yes/no questions that assess
emotional, cognitive, and behavioral symptoms of depresion in older adults. It avoids
somatic symptoms that may overlap with medical conditions
,Key Areas assessed in GDS - Answers -Mood and Enjoyment
Energy Levels
Social Withdrawal
Feelings of Hopelessness
Memory Concerns
Anxiety and Worry
Suicidal Thoughts
Scoring GDS - Answers -1 point of each depressed response
Yes to negative statements and no to positive statements
Scoring Interpretation of GDS-30 - Answers -0-30
0-9 Normal (no depression)
10-19 Mild Depression
20-30 Moderate to Severe Depression
Scoring Interpretation GDS-15 - Answers -0-15
Shorter version
0-4: Normal (No depression)
5-8: Mild Depression
9-11: Moderate Depression
12-15: Severe Depression
Patient Health Questionnaire-9 (PHQ-9) - Answers -self report tool for screening,
diagnosing, and monitoring depression. Based on the DSM-5 criteria for MDD and
evaluates symptom severity over the past two weeks
Components of the PHQ-9 - Answers -Nine Symptom Domains
1. Anhedonia
2. Depressed Mood
3. Sleep Problems
4. Fatigue
5. Appetite Changes
6. Low Self Worth
7. Concentration Issues
8. Psychomotor Changes
9. Suicidal Thoughts
PHQ-9 Scoring Interpretation - Answers -Each question is scored:
0=Not at all
1= Several Days
2= More than half the days
,3= Nearly Every Day
Total Score: 0-27
PHQ-9 Depression Severity Levels - Answers -0-4: Minimal or No depression
5-9: Mild Depression
10-14: Moderate Depression
15-19: Moderately Severe Depression
20-27: Severe Depression
Clinica Use of the PHQ-9 - Answers -Score >= 10: Possible clinical depression, further
evaluation needed
Score >=15: Likely MDD, consider therapy and/or medication
Score >=20: Severe Depression, requires urgent intervention
Mood Disorder Questionnaire - Answers -screening tool used for Bipolar Disorder, and
helps differentiate bipolar disorder from unipolar depression and other mood disorders
Consists of three parts, assessing lifetime history of manic or hypomanic symptoms
Part one of MDQ - Answers -Symptom Checklist
13 yes/no questions
Increased Energy and Activity
Euphoric or irritable mood
Decreased need for sleep
Unusual talkativeness or pressured speech
Racing Thoughts
Easily Distracted
Increase in goal-directed activities
Involvement in Risky behaviors
Unusual Confidence or grandiosity
More outgoing/social than usual
episodes lasting several days or longer
other people noticing these changes
symptoms occurring together in the same time period
Part 2 MDQ - Answers -Symptom Clustering
1 yes/no question
"Have several of the above symptoms ever happened during the same period of time?"
Part 3 MDQ - Answers -Functional Impairment
1 questions, 3 point scale: No, Minor, or Serious problem
, "How much did these problems cause difficulty in work, social, or family life?"
MDQ Scoring Interpretation - Answers -7 or more "yes" responses in Part 1
"Yes" in Part 2
Moderate or serious impairment in part 3 is a positive screen. This is possible bipolar
disorder, needs a clinical assessment
Negative Screen:
Fewer than 7 "yes" responses in Part 1 OR "No" in part 2 OR "No/Minor problems" in
Part 3= unlikely bipolar disorder
Limitations to MDQ - Answers -More sensitive to Bipolar I Disorder than Bipolar II or
Cyclothymia
May produce false positives in BPD
Anhedonia - Answers -a diminished ability to experience pleasure
TSH - Answers -0.4-4
For patients on thyroid medications 0.5 -3 is often targeted
Elevated TSH - Answers -Hypothyroidism
Low TSH - Answers -hyperthyroidism
hemoglobin - Answers -Men
13.8-17.2
Women
12.1-15.1
Pregnant women
11-14
Children
11-16
Lithium Level - Answers -Therapeutic range
0.6-1.2
Toxicity Risk
>1.5
Severe toxicity
>2
lithium toxicity symptoms - Answers -confusion
seizures
tremors
coma
