A 29 year old post-partum females reports difficulty with concentration, sleep, and guilt. She feels sad
most of the time. She reports that these symptoms have been ongoing since her baby's birth about one
month ago. What is her diagnosis? Correct Answer: Postpartum Depression
What is the most common co-morbidity associated with depression? Correct Answer: anxiety
Who is most likely to exhibit depression related to his illness? Correct Answer: A patient with
Parkinson's disease.
A 69 year old female reports anhedonia last month. What should be part of the assessment? Correct
Answer: Depression
What depressed patient has risk factors for suicide? Correct Answer: 78 year old widowed male
A 38 year old bipolar male has taken lithium for many months, with stabilized mood. He reports
frequent urination, while on lithium. What could be the underlying cause of his frequent urination?
Correct Answer: Diabetes insipidus
A 79 year old female lost her husband of 55 years 4 days ago. She reports hearing her husband's voice,
even though she knows he has passed. She has not slept well or eaten very much since his death, and
has no history of psychiatric illness. How should you manage this? Correct Answer: Tell her that this is a
normal response, and it will resolve.
What is a major advantage of CAGE questionnaire? Correct Answer: Brevity of questions
What suggests that a patient may be abusing alcohol? Correct Answer: Macrocytosis, tremulousness,
hypertension
You suspect a patient abuses ethanol. What lab values would support this suspicion? Correct Answer:
Elevated ALT, AST, GGT.
A adolescent female with anorexia nervosa must exhibit 4 criteria for diagnosis. What are they? Correct
Answer: Intense fear of weight gain, severe body image disturbance, absence of menstrual cycle, weight
below 85% of ideal body weight.
What characterizes bulimia nervosa? Correct Answer: Binge eating
What other disorder could a patient with an eating disorder concomitantly have? Correct Answer:
Anxiety disorders
A 19 year old with anorexia has bradycardia, and orthostatic hypotension. What might accompany
today's findings? Correct Answer: Amenorrhea
Why would Selective Serotonin Reuptake Inhibitors (SSRI's) be chosen as a common medication for
depression treatment? Correct Answer: Safer than other meds for depression
,A patient reports intermittent nausea and daily mild headache since starting SSRI 5 days ago. How would
you respond? Correct Answer: These are typical side effects of SSRI's.
What is a common side effect of trazodone (antidepressant TCA)? When should trazodone be taken?
Correct Answer: Trazodone cause profound drowsiness, and should be taken at bedtime.
Within 6 months of treatment, what do patients (using SSRI's) often exhibit? Correct Answer: weight
gain
What do elderly patients taking tricyclic antidepresants often exhibit? Correct Answer: Arrhythmias
What strategy is used to minimize the incidence of side effects when giving an elderly patient an SSRi?
Correct Answer: prescribe a low dose initially
This patient is at highest risk of suicide? Correct Answer: 86 year old male with chronic pain
A male patient has a family history of bipolar disorder in two first degree relatives. How does bipolar
disorder affect family? Correct Answer: Bipolar disorder often affects multiple family members.
What is the usual age of onset of symptoms for patients with bipolar disorder? Correct Answer:
Between 15 and 30 years
A 34 year old bipolar patient is on fluoxetine and valproate for manic depressive symptoms. What must
be monitored in this patient? Correct Answer: Valproate levels, platelet count, liver function studies.
Carbamazepine is for bipolar disorder for mood stabilization. What should you be alert for in patients
taking carbamazepine? Correct Answer: drug-drug interactions. Carbamazepine is an enzyme inducer in
the cytochrome P450 system.
Before a diagnosis of depression is made for a pregnant teenager, what labs should be obtained?
Correct Answer: CBC, TSH, renal and liver function tests, urine toxicology screen.
A 22 year old is doing well on a high dose fluoxetine after several months. Her urine test indicates
pregnancy. The provider referred her to an obstetrician who will see her in 4 weeks. How should the
fluoxetine be handled today? Correct Answer: Let the obstetrician and patient make a decision about
continuing fluoxetine.
distinguished from depressive disorders by the occurrence of manic, or hypomanic episodes, in addition
to depressive episodes Correct Answer: Bipolar disorder
Bipolar disorder is characterized by which type of mood? Correct Answer: an elevated expansive or
irritable mood
During which state are are bipolar patients very productive and extremely creative? Correct Answer:
hypomanic
Does bipolar affect intellect? Correct Answer: No
,What are the different levels on the spectrum of mood disorders? Correct Answer: mania
hypomania
normal mood
mild to moderate depression
severe depression
What is the diagnostic criteria for diagnosing bipolar disorder? Correct Answer: Presence of one or
more manic episodes or mixed episodes, including one or more major depressive episodes
What describes a manic episode? Correct Answer: abnormally and persistently elevated, expansive, or
irritable mood for at least one week
exaggerated feeling of well-being or elation during which the person may describe feeling "high"
"ecstatic" or "on top of the world" Correct Answer: Euphoria
Name the mood.
inappropriate lack of restraint in expressing one's feeling and overvaluing one's own important
(delusions of grandeur)
i.e. king of france Correct Answer: Expansive Mood
Name the mood.
easily annoyed and provoked to anger. (when someones voice is going up then lower yours let them
know they have a choice to change behavior) Correct Answer: Irritable Mood
Name the mood
alternates between euphoria and irritability (very big mood swing) Correct Answer: Lability of Mood
What is rapid, pressured speech characterized by? Correct Answer: volume or rate of speech is
increased
What will happen to the sleep pattern during a manic episode? Correct Answer: Decreased need to
sleep - accompanied by increased energy and hyperactivity.
What can stress do for a bipolar person? What can they do to help prevent this? Correct Answer: Stress
can bring an exacerbation of symptoms on. They should learn good coping skills
What can happen to a depressed or manic person who has not slept for several days? Correct Answer: If
they stay up for long enough they can get psychotic (hearing things, seeing things, perceiving things
inaccurately)
If you give meds to a person who is experiencing psychotic break, what should you always do first?
Correct Answer: assess the person for a baseline. BP, Mood, etc.
Name symptoms of depression. Correct Answer: Sadness
, Excessive crying
Loss of pleasure
Sleeping too much or too little
Low energy
Restlessness
Difficulty concentrating
Irritability
Loss of appetite or overeating
Feelings of worthlessness and hopelessness
Ongoing physical problems that are not caused by physical illness or injury
(e.g., headaches, digestive problems, pain)
Can develop psychosis
Thoughts of death or suicide
Name symptoms of manic episode. Correct Answer: Inappropriate sense of euphoria (excitement)
Reckless, impulsive behavior/poor judgment
Little sleep needed
Excessive energy
Racing thoughts; Flight of ideas
Talking too much or too fast (pressured speech)
Out of control spending
Extreme difficulty concentrating
Irritability
Abnormally increased activity, including sexual activity
Abuse of drugs, particularly cocaine, alcohol, & sleeping medications
Provocative, intrusive, or aggressive behavior
Denial that anything is wrong
Can develop psychosis
Substance abuse is very comorbid with bipolar disease. What do they usually take when they high? Low?
Correct Answer: Stimulants when low
Sleeping meds when really high (Zanex, valuim)
Can a person have thoughts of suicide during depression or mania? Correct Answer: Both
The following describes which state of a bipolar person?
Inflated self-esteem/grandiosity
Decreased need for sleep (e.g. feels rested after only 3 hrs. of sleep)
More talkative than usual
Mildly racing thoughts/flight of ideas
Easily distracted
Increase in goal-directed behavior/ productivity/creativity
Risky behaviors Correct Answer: hypomania
________ may feel good to the person who experiences it and may even be associated with good
functioning and enhanced productivity. Correct Answer: Hypomania