NURS 663 Exam 1: Key Points 2023 with complete solution
Exam 1: Key Points
Depressive Disorders
Depressive Disorder Due to Another Medical Condition
• Prominent & persistent disturbance in mood
• Characterized by:
o Depressed mood
o Diminished interest or pleasure in all or almost all activities
• Evidence is found from the history, physical examination, or lab findings of:
o Disturbance is the direct pathophysiological consequence of another medical condition
• Can mimic or mask symptoms of depression
o Infectious mono in adolescents
o Thyroid dysfunction (labs to diagnose)
o Adrenal dysfunction (labs to diagnose)
o HIV
o Covid-19
o Post CVA
▪ Left frontal stroke
o Huntington’s
▪ Neuropsych symptoms are FIRST symptoms to occur
o Parkinson’s motor symptoms
o TBI
▪ Mood symptoms can be episodic or recurring
o Temporal lobe epilepsy
▪ If epileptic focus is on right side
o Cancer
Disruptive Mood Dysregulation Disorder (DMDD)
• Severe Inconsistent Temper outbursts (SIT)
o Three or more times per week
• Irritable mood in between outbursts
• Duration:
o Outbursts occur at least 3 times/week
o Occurs for at least 1 year
o No more than 3 months during that time when criteria is not met
• Onset:
o Between ages 6 and 10 years old
▪ Occurs more in boys
o Criteria must be met BEFORE 18 years old
• Symptoms:
, o Recurrent inappropriate outbursts
▪ Verbal or behavioral
▪ Occurs 3 times/week for at least 1 year in at least two different settings
• Home
• School
o Developmentally inappropriate
o Irritable/angry most days in between outbursts
o Irritable and mad most days
▪ Must have all symptoms to diagnose
• Can occur with:
o ADHD
o Major depressive disorder (MDD)
o Anxiety
o Autism spectrum disorder
(ASD)
• Cannot occur with (differential diagnoses):
o Oppositional defiant disorder
o Intermittent explosive disorder
o Bipolar disorder
• Criteria: OI VEY
,Major Depressive Disorder (MDD)
• Duration:
o Must have symptoms for at least 2 weeks
• Must have at least 5 symptoms within the 2-week period
• Symptoms:
o At least 1 symptom must be DEPRESSED MOOD or ANHEDONIA
▪ Loss of interest or pleasure in things
▪ Lack of motivation
o Depressed mood
▪ Sad
▪ Empty
▪ Hopeless
o Weight loss/poor appetite
o Insomnia or hypersomnia
o Psychomotor agitation/retardation
o Fatigue/loss of energy
o Feelings of worthlessness or guilt
o Decreased concentration
o Recurrent thoughts of death or suicide
• Symptoms cause significant distress to:
o Social life
o Occupation
o Other areas of functioning
• Difference between MDD and bereavement/grief:
o MDD:
▪ Feelings of worthlessness
▪ Self-loathing
• Exclusions:
o Medical illness
o Substance use
o Other psychiatric disorders
, o History of mania or hypomania
• MDD subtypes
o With anxious distress must have 2 of the 5 symptoms
▪ CAR LoT
• Concentration difficulty
• Awful or apprehension
• Restless
• Lose control
• Tense or keyed up
o With atypical features
▪ RAILS
• Reactivity in mood
• Appetite increase
• Interpersonal rejection sensitivity
• Leaden paralysis
• Sleep increase
o With melancholic features
▪ PRe MED GAP
• Pleasure loss
• Reactivity loss
o Must have 1 of the 2
• Morning worsening
• Early morning awakening
• Distinct quality of mood
• Guilt
• Anorexia
• Psychomotor changes
o Agitation or retardation
• Other MDD Specifiers
o Mixed features
▪ Three manic or hypomanic symptoms + full MDD symptoms
o Peripartum onset
▪ Onset of symptoms occur while pregnant OR in the 4 weeks after delivery
o Seasonal pattern
▪ Regular pattern between depressive symptoms & time of year (fall & winter) with
remission in spring/summer
▪ Pattern must have occurred in the last 2 years
• Prevalence/Epidemiology/Comorbidities
o Depressed individuals admitted to a nursing home increased risk of death within 1st year
Exam 1: Key Points
Depressive Disorders
Depressive Disorder Due to Another Medical Condition
• Prominent & persistent disturbance in mood
• Characterized by:
o Depressed mood
o Diminished interest or pleasure in all or almost all activities
• Evidence is found from the history, physical examination, or lab findings of:
o Disturbance is the direct pathophysiological consequence of another medical condition
• Can mimic or mask symptoms of depression
o Infectious mono in adolescents
o Thyroid dysfunction (labs to diagnose)
o Adrenal dysfunction (labs to diagnose)
o HIV
o Covid-19
o Post CVA
▪ Left frontal stroke
o Huntington’s
▪ Neuropsych symptoms are FIRST symptoms to occur
o Parkinson’s motor symptoms
o TBI
▪ Mood symptoms can be episodic or recurring
o Temporal lobe epilepsy
▪ If epileptic focus is on right side
o Cancer
Disruptive Mood Dysregulation Disorder (DMDD)
• Severe Inconsistent Temper outbursts (SIT)
o Three or more times per week
• Irritable mood in between outbursts
• Duration:
o Outbursts occur at least 3 times/week
o Occurs for at least 1 year
o No more than 3 months during that time when criteria is not met
• Onset:
o Between ages 6 and 10 years old
▪ Occurs more in boys
o Criteria must be met BEFORE 18 years old
• Symptoms:
, o Recurrent inappropriate outbursts
▪ Verbal or behavioral
▪ Occurs 3 times/week for at least 1 year in at least two different settings
• Home
• School
o Developmentally inappropriate
o Irritable/angry most days in between outbursts
o Irritable and mad most days
▪ Must have all symptoms to diagnose
• Can occur with:
o ADHD
o Major depressive disorder (MDD)
o Anxiety
o Autism spectrum disorder
(ASD)
• Cannot occur with (differential diagnoses):
o Oppositional defiant disorder
o Intermittent explosive disorder
o Bipolar disorder
• Criteria: OI VEY
,Major Depressive Disorder (MDD)
• Duration:
o Must have symptoms for at least 2 weeks
• Must have at least 5 symptoms within the 2-week period
• Symptoms:
o At least 1 symptom must be DEPRESSED MOOD or ANHEDONIA
▪ Loss of interest or pleasure in things
▪ Lack of motivation
o Depressed mood
▪ Sad
▪ Empty
▪ Hopeless
o Weight loss/poor appetite
o Insomnia or hypersomnia
o Psychomotor agitation/retardation
o Fatigue/loss of energy
o Feelings of worthlessness or guilt
o Decreased concentration
o Recurrent thoughts of death or suicide
• Symptoms cause significant distress to:
o Social life
o Occupation
o Other areas of functioning
• Difference between MDD and bereavement/grief:
o MDD:
▪ Feelings of worthlessness
▪ Self-loathing
• Exclusions:
o Medical illness
o Substance use
o Other psychiatric disorders
, o History of mania or hypomania
• MDD subtypes
o With anxious distress must have 2 of the 5 symptoms
▪ CAR LoT
• Concentration difficulty
• Awful or apprehension
• Restless
• Lose control
• Tense or keyed up
o With atypical features
▪ RAILS
• Reactivity in mood
• Appetite increase
• Interpersonal rejection sensitivity
• Leaden paralysis
• Sleep increase
o With melancholic features
▪ PRe MED GAP
• Pleasure loss
• Reactivity loss
o Must have 1 of the 2
• Morning worsening
• Early morning awakening
• Distinct quality of mood
• Guilt
• Anorexia
• Psychomotor changes
o Agitation or retardation
• Other MDD Specifiers
o Mixed features
▪ Three manic or hypomanic symptoms + full MDD symptoms
o Peripartum onset
▪ Onset of symptoms occur while pregnant OR in the 4 weeks after delivery
o Seasonal pattern
▪ Regular pattern between depressive symptoms & time of year (fall & winter) with
remission in spring/summer
▪ Pattern must have occurred in the last 2 years
• Prevalence/Epidemiology/Comorbidities
o Depressed individuals admitted to a nursing home increased risk of death within 1st year
