Stahl’s Essential Psychopharmacology
5th Edition Test Bank
What is the key question to ask ourselves to guide a pts tx? - ANSWER-To what
extent is this disorder due to psychological factors and to what extent is it due to a
biochemical disturbance?
With depression what disorders are you differentiating? - ANSWER-reactive sadness
grief
medical illness and medications that cause depressive sxs
clinical depression
dysthymia
What depressive differentials don't require tx? - ANSWER-Reactive sadness:
emotional reaction from a relatively minor event. Lasts a few hours-days and doesn't
interfere with functioning usually.
Grief: normal response to major interpersonal loss. Much more prolonged than
reactive sadness. Normal grief can lasts for many months and may persist for several
years AEB loneliness.
How does grief differ from clinical depression? - ANSWER-1. despite intense sadness,
there is no loss of self-esteem
2. Indicators that grief has developed into depression: severe sleep disturbances (esp
early morning awakening), pervasive loss of interest in normal life activities,
significant agitation, SI
3. pt clearly relates sadness to the loss
4. mourning and time are often what is needed for emotional healing
Note: 25% of people develop depression during the year following loss. !0% will
develop PTSD sxs (intense anxiety, nightmares etc.) So watch for complicated
bereavement.
How often is clinical depression due to hypothyroidism? - ANSWER-5-10% of the
time.
Medications to watch for that can cause depression - ANSWER-- minor tranquilizers,
i.e. benzos
Note: these can also exacerbate depression, don't see the anxiety and fail to
recognize underlying depression. 50% of depression also has anxiety. These will
initially cause a calming, but a few wks later the depression worsens. Tx the
depression and the anxiety will improve. Also watch for increased caffeine use,
,depressed people increase caffeine use to combat fatigue and it also has a transient
antidepressant effect. Once they're drinking above 250 mg of caffeine, slow wave
(deep) sleep decreases (which is already decreased in depression) and this
restorative sleep never occurs and depression worsens. They will also wake up
frequently throughout the night.
Features of clinical depression - ANSWER-Sadness/emptiness or irritability
Anhedonia
Impairment of normal functioning
Irrational erosion of self-esteem
dramatic change in vegetative patterns (sleep, appetite, sex drive)
Comon disorders that can cause depression - ANSWER-Addisons disease
AIDS
Alzheimers
Anemia
Apnea
Asthma
Chronic fatigue syndromes
Chronic infection (mono, TB)
Chronic pain
CHF
Cushings
DM
Hyperthyroidism
Hypothyroidism
Infectious hepatitis Influenza
Lyme disease
Malignancies (CA)
Malnutrition
Menopause
MS
Parkinsons
PP hormonal changes
Porphyria
PMS
RLS
RA
Sleep apnea
Syphilis
SLE
Ulcerative colitis
Uremia
How does dysthymia differ from MDD - ANSWER-low grade, less severe form of
depression. More chronic and characterized by low self-esteem or lack of
enthusiasm. Typically doesn't interfere with daily functioning.
, How do you know the depression is more biological than psychological? - ANSWER-
They will present with both the universal sxs and the physiological sxs.
Universal depression sxs - ANSWER-Mood of sadness
Anhedonia
Low self-esteem
Apathy, low motivation, social withdrawal
Excessive emotional sensitivity
Negative thinking
Irritabile
SI
Excessive guilt
Indecisiveness
What is a non-reactive mood? - ANSWER-These are pts that are unable to
temporarily get out of their depressed mood. They have almost no moments of joy
or pleasure.
Physiological/vegetative sxs of depression (reflecting a biochemical dysfunction) -
ANSWER-sleep disturbance: early morning awakening, decreased sleep efficiency,
frequent awakenings throughout the night, occasionally hypersomnia, excessive
sleeping
Appetite disturbance (decreased or increased, with wt gain or loss)
Fatigue
Chronic systemic inflammation
decreased sex drive
restlessness, agitation, or psychomotor retardation
diurnal variations in mood (worse in the morning)
Impaired concentration/forgetfulness
Pronounced anhedonia
What is initial insomnia (difficulty falling asleep) characteristic of? - ANSWER-An
anxiety disorder, many people think depression but this isn't the case.
When do you start antidepressants? - ANSWER-When there are sustain physiological
sxs. Occasional disturbances in sleep or appetite don't warrant antidepressants. But
if there is continuing wt loss, marked fatigue each day, and poor sleep most nights
then antidepressants are indicated.
Note: if pts aren't suited for psychotherapy (have lower intelligence, no
psychologically minded, or refuse psychotherapy) the a trial of antidepressants could
help.
5th Edition Test Bank
What is the key question to ask ourselves to guide a pts tx? - ANSWER-To what
extent is this disorder due to psychological factors and to what extent is it due to a
biochemical disturbance?
With depression what disorders are you differentiating? - ANSWER-reactive sadness
grief
medical illness and medications that cause depressive sxs
clinical depression
dysthymia
What depressive differentials don't require tx? - ANSWER-Reactive sadness:
emotional reaction from a relatively minor event. Lasts a few hours-days and doesn't
interfere with functioning usually.
Grief: normal response to major interpersonal loss. Much more prolonged than
reactive sadness. Normal grief can lasts for many months and may persist for several
years AEB loneliness.
How does grief differ from clinical depression? - ANSWER-1. despite intense sadness,
there is no loss of self-esteem
2. Indicators that grief has developed into depression: severe sleep disturbances (esp
early morning awakening), pervasive loss of interest in normal life activities,
significant agitation, SI
3. pt clearly relates sadness to the loss
4. mourning and time are often what is needed for emotional healing
Note: 25% of people develop depression during the year following loss. !0% will
develop PTSD sxs (intense anxiety, nightmares etc.) So watch for complicated
bereavement.
How often is clinical depression due to hypothyroidism? - ANSWER-5-10% of the
time.
Medications to watch for that can cause depression - ANSWER-- minor tranquilizers,
i.e. benzos
Note: these can also exacerbate depression, don't see the anxiety and fail to
recognize underlying depression. 50% of depression also has anxiety. These will
initially cause a calming, but a few wks later the depression worsens. Tx the
depression and the anxiety will improve. Also watch for increased caffeine use,
,depressed people increase caffeine use to combat fatigue and it also has a transient
antidepressant effect. Once they're drinking above 250 mg of caffeine, slow wave
(deep) sleep decreases (which is already decreased in depression) and this
restorative sleep never occurs and depression worsens. They will also wake up
frequently throughout the night.
Features of clinical depression - ANSWER-Sadness/emptiness or irritability
Anhedonia
Impairment of normal functioning
Irrational erosion of self-esteem
dramatic change in vegetative patterns (sleep, appetite, sex drive)
Comon disorders that can cause depression - ANSWER-Addisons disease
AIDS
Alzheimers
Anemia
Apnea
Asthma
Chronic fatigue syndromes
Chronic infection (mono, TB)
Chronic pain
CHF
Cushings
DM
Hyperthyroidism
Hypothyroidism
Infectious hepatitis Influenza
Lyme disease
Malignancies (CA)
Malnutrition
Menopause
MS
Parkinsons
PP hormonal changes
Porphyria
PMS
RLS
RA
Sleep apnea
Syphilis
SLE
Ulcerative colitis
Uremia
How does dysthymia differ from MDD - ANSWER-low grade, less severe form of
depression. More chronic and characterized by low self-esteem or lack of
enthusiasm. Typically doesn't interfere with daily functioning.
, How do you know the depression is more biological than psychological? - ANSWER-
They will present with both the universal sxs and the physiological sxs.
Universal depression sxs - ANSWER-Mood of sadness
Anhedonia
Low self-esteem
Apathy, low motivation, social withdrawal
Excessive emotional sensitivity
Negative thinking
Irritabile
SI
Excessive guilt
Indecisiveness
What is a non-reactive mood? - ANSWER-These are pts that are unable to
temporarily get out of their depressed mood. They have almost no moments of joy
or pleasure.
Physiological/vegetative sxs of depression (reflecting a biochemical dysfunction) -
ANSWER-sleep disturbance: early morning awakening, decreased sleep efficiency,
frequent awakenings throughout the night, occasionally hypersomnia, excessive
sleeping
Appetite disturbance (decreased or increased, with wt gain or loss)
Fatigue
Chronic systemic inflammation
decreased sex drive
restlessness, agitation, or psychomotor retardation
diurnal variations in mood (worse in the morning)
Impaired concentration/forgetfulness
Pronounced anhedonia
What is initial insomnia (difficulty falling asleep) characteristic of? - ANSWER-An
anxiety disorder, many people think depression but this isn't the case.
When do you start antidepressants? - ANSWER-When there are sustain physiological
sxs. Occasional disturbances in sleep or appetite don't warrant antidepressants. But
if there is continuing wt loss, marked fatigue each day, and poor sleep most nights
then antidepressants are indicated.
Note: if pts aren't suited for psychotherapy (have lower intelligence, no
psychologically minded, or refuse psychotherapy) the a trial of antidepressants could
help.
