Kaplan and Sadock's Chapter 15

15.52. Symptoms of hypomania are present A. Unipolar depression B. Bipolar II depression C. Can be Both D. Neither of the two

B. Bipolar II depression

15.42. Active suicidal ideation is common A. Bereavement B. Depression C. Can Be Bereavement and Depression D. Not Bearevement and not depression

B. Depression

15.45. Delusions of worthlessness A. Bereavement B. Depression C. Can Be Bereavement and Depression D. Not Bearevement and not depression

B. Depression

15.17. Which of the following is not an indicator of a good prognosis for major depressive disorder? A. Stable family functioning B. No more than one previous hospitalization C. A history of more than one previous depressive episode D. Advanced age of onset E. The absence of psychotic symptoms

C. A history of more than one previous depressive episode

15.3. Thefollowingsituationscallforabreakindoctor-patient confidentiality except A. A patient with a delusional disorder thinks his boss is out to get him and threatens to kill her. B. A patient with major depressive disorder who is sexually promiscuous contracts syphilis. C. A patient with bipolar I disorder admits he is homosexual. D. A patient with conduct disorder thrives on the sexual abuse of young children. E. A patient with schizoaffective disorder hallucinates that he can fly.

C. A patient with bipolar I disorder admits he is homosexual.

15.56. Rarely progresses to manic psychosis A. Dysthymic disorder B. Neurasthenia C. Bipolar I disorder D. Cyclothymic disorder E. Bipolar II disorder F. Hypomania

F. Hypomania

15.50. Never any history of acute mania . A. Unipolar depression B. Bipolar II depression C. Can be Both D. Neither of the two

C. Can be Both

15.53. Can present with atypical features A. Unipolar depression B. Bipolar II depression C. Can be Both D. Neither of the two

C. Can be Both

15.8. Which graph in Figure 15.1 depicts the pattern with the best future prognosis? A. A B. B C. C D. D E. None of the above

A

15.18. Reactive depression can best be compared to A. Adjustment disorder B. Atypical depression C. Conduct disorder D. Oppositional defiant disorder E. Schizoaffective disorder

A. Adjustment disorder

15.30. Which of the following statements regarding electroconvulsive therapy (ECT) is false? A. ECT should be used in cases of psychotic depression only. B. Bilateral ECT is somewhat more effective than unilateral ECT. C. Retrograde memory impairment is a common side effect. D. ECT is often used for refractory mterm-21ood disorders. E. Eight to 12 treatments are usually needed for symptomatic remission.

A. ECT should be used in cases of psychotic depression only.

15.38. A suicidal patient with chronic depressive disorder presents to your office very frustrated and in tears. He tells you he cannot stop thinking about ending his life because he is so depressed. You ask him if he has a plan, and he details where he could buy a handgun and where he would go to shoot himself. You fear the patient will carry out this plan because he has not had adequate control of his symptoms since his last antidepressant change 1 month ago. You discuss inpatient hospitalization for medication stabilization, but the patient refuses. You're next step in management of this patient would best be: A. Admit the patient to the hospital anyway. B. Give the latest antidepressant more time to take affect. C. Change to another class of antidepressant. D. Try to persuade the patient to admit himself to the hospital. E. Initiate psychotherapy to discuss the reasons behind the suicidal thoughts

A. Admit the patient to the hospital anyway.

15.19. Which of the following statements regarding rapid cycling bipolar disorder is true? A. Alcohol, stimulants, and caffeine use are risk factors. B. It is defined as at least four episodes per month. C. Hospitalization of these patients is rare. D. It is more common in men than women. E. It often responds to tricyclic antidepressants

A. Alcohol, stimulants, and caffeine use are risk factors.

15.41. Is perceived as normal A. Bereavement B. Depression C. Can Be Bereavement and Depression D. Not Bearevement and not depression

A. Bereavement

15.44. Persons react to the environment A. Bereavement B. Depression C. Can Be Bereavement and Depression D. Not Bearevement and not depression

A. Bereavement

15.35. Ms. S, a 24-year-old woman, is brought for a psychiatric consultation by her mother who complains of bizarre behavior. One month ago, Ms. S was fired from her job at a local bookstore because of frequently arriving late and not performing her duties adequately. She states that she fell in love with another employee and tried to get his attention and spend time with him even though he seemed uninterested. Over the past 3 months, she increased her use of alcohol and marijuana to three beers and two to three joints per day. Her mother reports a 2-week history of increased energy, eating little, talking a great deal, and interrupting others frequently. A week ago, Ms. S reported that her former work colleagues were plotting against her and attempting to control her by broadcasting thoughts into her brain. She did not sleep the previous 2 nights. Ms. S has no significant psychiatric or medical history. She takes no medications. Physical examination reveals a blood pressure of 135/75 mm Hg, heart rate of 84 beats/min, and temperature of 37◦C. Her conjunctivae are pink, and her pupils are equal, 3 mm, and reactive to light. Deep tendon reflexes are normal throughout. Urine toxicology reveals the presence of cannabinoids. On mental status testing, her mood is euphoric, her speech is pressured, and she is emotionally labile and irritable. Her thinking is illogical and disorganized. She denies hallucinations. She is alert and oriented to person, place, and time. Immediate recall andrecentandremotememoryareintact.Throughoutthe interview,sheispreoccupiedbythoughtsofthecoworker with whom she has fallen in love. Ms.Sisadmittedtoapsychiatricunit,andtreatmentis initiated with haloperidol, 10 mg/day, which is increased to 20 mg/day on day 5 because of continued agitation. On day 6, she becomes withdrawn and uncommunicative. She is diffusely rigid with a temperature of 39◦C. Her white blood count is 14,300 and her creatinine phosphokinase is 2,100. Several blood cultures are negative. Which of the following is the most likely diagnosis at the time of admission? A. Bipolar disorder B. Delusional disorder, erotomanic type C. Marijuana-induced psychotic disorder D. Schizoaffective disorder, bipolar type E. Schizophrenia

A. Bipolar disorder

15.57. Insidious onset of depression dating back to childhood A. Dysthymic disorder B. Neurasthenia C. Bipolar I disorder D. Cyclothymic disorder E. Bipolar II disorder F. Hypomania

A. Dysthymic disorder

15.6. All of the following are vegetative disturbances of depression except A. Hypersexuality B. Anorexia C. Hypersomnia D. Insomnia E. Circadian dysregulation

A. Hypersexuality

15.5. Which of the following statements regarding mood disorders is false? A. One of four patients with an acute depressive episode will have recurrences throughout life. B. Approximately15percentofdepressedpatientseventually commit suicide. C. Incidence of depression in younger age groups is increasing. D. Manic forms of mood disorders predominate in men. E. Depressive disorders are more common in women.

A. One of four patients with an acute depressive episode will have recurrences throughout life

15.4. A 27-year-old patient has been diagnosed with bipolar disorder. Before starting this patient on lithium for mood stabilization, which of the following laboratory tests should be obtained? A. Thyroid function tests, creatinine, pregnancy test B. Thyroid function tests, creatinine, liver function tests C. Thyroid function tests, creatinine, complete blood count D. Thyroidfunctiontests,liverfunctiontests,pregnancy test

A. Thyroid function tests, creatinine, pregnancy test

15.16. l-Tryptophan A. has been used as an adjuvant to both antidepressants and lithium B. has not been associated with any serious side effects C. is the amino acid precursor to dopamine D. has been used as a stimulant E. all of the above

A. has been used as an adjuvant to both antidepressants and lithium

15.20. All of the following are common causes of misdiagnosis of mood disorder as schizophrenia except A. reliance on the longitudinal rather than crosssectional picture B. flight of ideas perceived as loose associations C. ascribing irritable mood to paranoid delusions D. mistaking depressive depersonalization for schizophrenic emotional blunting E. incomplete interepisodic recovery equated with schizophrenic defect

A. reliance on the longitudinal rather than crosssectional picture

15.40. A 28-year-old woman presents to a clinic with a chief complaintoffatigue.Shestatesthatthisfeelingof"being tired"haspersistedforthepast4years.Shehaslost12lb overthepast2yearsandadmitstoovereating.Thepatient states that she sleeps at least 11 hours per night. She denies suicidal ideation but complains about not being able to concentrate. What is the likely diagnosis? A. Generalized anxiety disorder B. Dysthymia C. Major depressive disorder D. Substance abuse E. None of the abov

B. Dysthymia

15.46. Cardiotoxic A. Clozapine B. Imipramine C. Can Be Clozapine and Imipramine D. Not any of the two

B. Imipramine

15.54. Is diagnosed more in China than the rest of the world A. Dysthymic disorder B. Neurasthenia C. Bipolar I disorder D. Cyclothymic disorder E. Bipolar II disorder F. Hypomania

B. Neurasthenia

15.36. Which of the following is the most likely explanation for her behavior on day 6? A. Anticholinergic delirium B. Neuroleptic malignant syndrome C. Marijuana-induced delirium D. Occult infection E. Worsening psychosis

B. Neuroleptic malignant syndrome

15.12. The person least likely to develop major depressive disorder in his or her lifetime is A. a 60-year-old man with pancreatic cancer B. a 19-year-old woman who was raped 3 weeks ago C. a 12-year-old girl mourning the death of her mother D. a 10-year-old boy diagnosed with dysthymia E. an identical twin of a patient with major depressive disorder who committed suicide

B. a 19-year-old woman who was raped 3 weeks ago

15.24. Features of anhedonia may include all of the following except A. derealization B. difficulty describing or being aware of emotions C. inability to experience normal emotions D. loss of pleasure E. withdrawal from interests

B. difficulty describing or being aware of emotions

15.13. A hypomanic episode differs from a manic episode in that a hypomanic episode A. lasts at least 1 week B. lacks psychotic features C. is severe D. causes greater social impairment E. all of the above

B. lacks psychotic features

15.34. A 57-year-old woman presents to you after being diagnosed with major depressive disorder. She has been depressedeversincethedeathofherhusband2yearsearlier. Shehasbeentakingthesameantidepressantsinceherdiagnosis 1 year ago, with no relief of her symptoms. She states that she would like your help in ending her life. The best option for your next step is: A. respect the patient's wishes because she is of sound mind B. seek to more adequately treat her depression C. seek family members to make a more informed decision D. contact the hospital ethics committee E. obtain information from the state regarding physician-assisted suicide laws

B. seek to more adequately treat her depression

15.22. Dysthymic disorder differs from major depressive disorder because in dysthymic disorder, A. depression is episodic B. the symptoms outnumber the signs C. the onset is usually late in life D. manic episodes are common E. has a high-grade chronicity

B. the symptoms outnumber the signs

15.59. Includes a full set of mania symptoms A. Dysthymic disorder B. Neurasthenia C. Bipolar I disorder D. Cyclothymic disorder E. Bipolar II disorder F. Hypomania

C. Bipolar I disorder

15.43. Persons often experience guilt A. Bereavement B. Depression C. Can Be Bereavement and Depression D. Not Bearevement and not depression

C. Can Be Bereavement and Depression

15.47. Causes weight gain A. Clozapine B. Imipramine C. Can Be Clozapine and Imipramine D. Not any of the two

C. Can Be Clozapine and Imipramine

15.26. Which of the following is the best predictor of the likelihood of attempting suicide in the future? A. Alcohol abuse B. Gender C. Prior suicide attempt D. Recent divorce E. Unemployment

C. Prior suicide attempt

15.15. Which of the following is not part of the text revision of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) criteria for diagnosing atypical depression? A. Hypersomnia B. Leaden paralysis C. Shortening of REM latency D. Mood reactivity E. Significant weight gain

C. Shortening of REM latency

15.37. Which of the following pharmacologic approaches is most appropriate on day 6? A. Increase dose of haloperidol. B. Stop haloperidol and add risperidone. C. Stop haloperidol, add bromocriptine, and seek medical consultation. D. Continue the same dose of haloperidol and add risperidone. E. Continue the same dose of haloperidol and add benztropine.

C. Stop haloperidol, add bromocriptine, and seek medical consultation.

15.21. All of the following statements regarding cyclothymic disorder are true except A. Symptoms must be present for at least 2 years. B. It occurs at the same rate in men and women. C. Symptoms may satisfy criteria for major depression. D. It consists of hypomania alternating with depressed mood. E. Its lifetime prevalence rate is about 0.4 to 1 percent

C. Symptoms may satisfy criteria for major depression.

15.32. A 19-year-old single woman presented with the chief complaint that "all men are bastards." Since her early teens, with the onset of her menses, she had complained of extreme variability in her moods on a nearly daily basis; irritability with hostile outbursts was her main affect, although more protracted hypersomnic depressions with multiple overdoses and wrist slashings had led to at least three hospitalizations. She also had migrainous headaches that, according to her mother, had motivated at least one of those overdoses. Despite her tempestuous and suicidal moods that led to these hospitalizations, she complained of "inner emptiness and a bottomless void." She had used heroin, alcohol, and stimulants to overcome this troubling symptom. She said that she was mentally disturbed because of a series of stepfathers who had all forced "oral rape" on her when she was between 11 and 15 years of age. She subsequently became sexually involved with any man that she met in bars, no longer knowing whether she was a "prostitute" or a "nice little girl." On two occasions, she had inflicted cigarette burns inside her vagina "to feel something." She had also engaged in a "brief lesbian relationship" that ultimately left her "emptier" and guilt ridden; nonetheless, she now believed that she should burn in hell because she could notgetridof"obsessing"abouttheexcitementofmutual cunnilingus with her much older female partner. The patient was given phenelzine (Nardil), eventually increased to 75 mg per day, at which point the mother described her as "the sweet daughter she was before age 13." At her next premenstrual phase, the patient developed insomnia, ran away from home at night, started "dancing like a go-go girl, met an incredibly handsome man" of 45 years of age (a pornography shop owner), and had a clandestine marriage to him. Other than a mood disorder, this patient also shows signs of A. an anxiety disorder B. schizophrenia C. borderline personality disorder D. schizoaffective disorder E. none of the above

C. borderline personality disorder

15.27. In the differential diagnosis, the diagnosis of schizoaffective disorder should be restricted to A. mixed episodes of bipolar disorder B. affective psychosis with concurrent brain disease C. full affective term-27and schizophrenic symptoms simultaneously D. affective psychosis superimposed on mental retardation E. a contagious expansive and elated affect

C. full affective and schizophrenic symptoms simultaneously

15.9. Which of the graphs in Figure 15.1 depicts the prototypical course of double depression? A. A B. B C. C D. D E. None of the above

D

15.29. Which of the following antidepressants would not be the best choice for a patient with a history of suicidal ideation? A. Bupropion (Wellbutrin) B. A monoamine oxidase inhibitor C. A selective serotonin reuptake inhibitor D. A tricyclic antidepressant E. Venlafaxine (Effexor)

D. A tricyclic antidepressant

15.11. Depression and mania share which of the following symptoms? A. Psychomotor acceleration B. Low-self esteem C. Grandiosity D. Anger E. Pessimism

D. Anger

15.55. Subsyndromal depression and hypomania A. Dysthymic disorder B. Neurasthenia C. Bipolar I disorder D. Cyclothymic disorder E. Bipolar II disorder F. Hypomania

D. Cyclothymic disorder

15.1. Mild,nonpsychoticdepressionwithpredominantanxiety is called A. Endogenomorphic depression B. Bipolar disorder C. Chronic depression D. Dysthymia E. Anxiety disorder

D. Dysthymia

15.39. A 64-year-old woman with an extensive smoking history has recently been diagnosed with small cell lung cancer. She develops a depressed mood, decreased interests, and difficulty concentrating soon thereafter because she reports she cannot stop thinking about how worthless her lifehasbeen.Sheeatsincessantlyandhasgained10lbin thelast5weeks;shealsoreportsincreasedsleep.Youdecidetoprescribephenelzineforhersymptomsofatypical depression. Which of the following is contraindicated in those patients taking phenelzine? A. Valproic acid B. Trazodone C. Lithium D. Fluoxetine E. Clomipramine

D. Fluoxetine

15.51. Typically has psychotic features present A. Unipolar depression B. Bipolar II depression C. Can be Both D. Neither of the two

D. Neither of the two

15.48. Acts as an NE partial agonist A. Clozapine B. Imipramine C. Can Be Clozapine and Imipramine D. Not any of the two

D. Not any of the two

15.49. Teratogenic A. Clozapine B. Imipramine C. Can Be Clozapine and Imipramine D. Not any of the two

D. Not any of the two

15.28. Drugs that may precipitate mania include all of the following except A. Bromocriptine B. Disulfiram C. Isoniazid D. Propranolol E. All of the above

D. Propranolol

15.2. The most consistent computer tomography (CT) and magnetic resonance imaging (MRI) abnormality observed in depressive disorders is A. cortical atrophy B. sulcal widening C. ventricular enlargement D. increasedfrequencyofhyperintensitiesinsubcortical regions E. none of the above

D. increasedfrequencyofhyperintensitiesinsubcortical regions

15.14. The defense mechanism most commonly used in depression is A. undoing B. sublimation C. projection D. introjection E. altruism

D. introjection

15.58. Manic-like symptoms do not meet full manic syndrome criteria A. Dysthymic disorder B. Neurasthenia C. Bipolar I disorder D. Cyclothymic disorder E. Bipolar II disorder F. Hypomania

E. Bipolar II disorder

15.31. Mr. M is an 87-year-old man who, 6 weeks after a coronaryarterybypassgraftthatwascomplicatedbypneumonia and renal insufficiency, was admitted to an inpatient rehabilitation service for management of physical deconditioning. A psychiatrist was consulted 10 days after admission to rule out depression in the context of persistent low appetite and energy associated with suboptimal participation in rehabilitation. Mr. M reported no prior psychiatric history. He had worked as a chemist until retirement nearly 2 decades earlier. Laboratory examination revealed a low hematocrit of 21 and moderately elevated blood urea nitrogen of 65. On interview, Mr. M demonstrated psychomotor slowing and bland affect. He denied depression, hopelessness, worthlessness, and suicidal ideation. He expressed a desire to recover from hisdebilitatedstatebutacknowledgeduncertaintythathewas capable of doing so. He also complained of extreme weakness. He stated, "I just don't seem to have an appetite anymore." Cognition largely was intact; there was mild short-term memory deficit. The most likely diagnosis in this patient is: A. Anxiety disorder with depressed mood B. Delirium C. Dementia D. Major depressive disorder E. Mood disorder secondary to a general medical condition

E. Mood disorder secondary to a general medical condition

15.25. The highest suicide rates are in which of the following age groups? A. Younger than age 15 years B. 15 to 24 year olds C. 25 to 44 year olds D. 45 to 64 year olds E. Older than age 65 years

E. Older than age 65 years

15.7. Serotonin A. helps to regulate circadian rhythms B. isanimportantregulatorofsleep,appetite,andlibido C. stores are increased by transient stress and depleted by chronic stress D. permits or facilitates goal-directed motor and consummatory behavior in conjunction with norepinephrine and dopamine E. all of the above

E. all of the above

15.10. Double depression is characterized by A. two family members with major depressive disorder concurrently B. recurrent major depressive disorder with current symptoms twice as disabling as usual C. two episodes of major depressive disorder per month consistently D. superimposedbipolarIIdisorderandatypicaldepression E. recurrent major depressive disorder superimposed with dysthymic disorder

E. recurrent major depressive disorder superimposed with dysthymic disorder

15.23. Psychomotor retardation is characterized by all of the term-21following except A. indecisiveness B. paucity of spontaneous movements C. poor concentration D. reduced speech amplitude and flow E. restlessness

E. restlessness

15.33. A35-year-term-34oldwomanhasjustbeendiagnosedwithmajor depressive disorder. For the past 8 months, she has had a depressed mood, decreased energy and concentration, and loss of interest in previously enjoyed activities. Although she never attempted suicide, she acknowledges that she thought she would probably jump off a local bridge if she ever had the chance. She denies any history of excessively elevated moods. You decide to start her on antidepressant therapy. Two weeks later, this patient is at greatest risk for A. extrapyramidal symptoms B. hypomanic episode C. manic episode D. medication noncompliance E. suicide completion

E. suicide completion