Major Depressive Disorder: Evidence Based Practice

Transcription

1 Major Depressive Disorder: Evidence Based Practice 1) For the diagnosis of MDD, the symptoms must be present for at least a) 2 weeks b) 4 weeks c) 90 days d) 2 months 2) If a MDD episode persists for over it is defined as chronic MDD. a) 6 months b) 1 year c) 2 years d) 3 years 3) MDD is considered to be in Full Remission if the BDI score is or less, maintained for at least 1 month. a) 3 b) 5 c) 8 d) 10 4) A PHQ-2 score of indicates a 78.6% probability of a major depressive disorder. a) 3 b) 4 c) 5 d) 6 5) Watson et al. (2004) suggests that longer instruments such as the may not perform as well in individuals over 75 years old. a) BDI b) PHQ-360 c) EPDS d) GDS 6) In the first 3 months after childbirth, it is estimated that of women have a new episode of major or minor depression. a) 9.5% b) 14.5% c) 19.5% d) 24.5%

2 7) Boyd et al. (2005) found that the is the most extensively studied postpartum measure with moderate psychometric soundness. a) BDI b) PHQ-2 c) PHQ-9 d) EDPS 8) Delirium is also known as all the following EXCEPT a) Minimal Brain Dysfunction b) Organic Psychosis c) Acute Confusional State d) Acute Brain Syndrome 9) The PHQ-9 is sufficient to effectively assess whether the patient is a threat to self or others. 10) Which screening tool can improve detection of substance use disorders? a) CRUSH-R b) EVAL-III c) AUDIT-C d) SUM-CD 11) Which is a nine-item validated self-or interviewer-administered instrument that assesses DSM-IV-TR criterion symptoms and effects on functioning? a) BDI b) PHQ-9 c) EDPS d) DSM-9 12) Although there is little published information of their impact on depression, particularly when consumed in large doses, consideration should be given to all the following EXCEPT a) Herbal supplements, b) Nutritional supplements c) Vegan diets d) Body building supplements 13) There is an association between all the following medications and depression or depressive symptoms EXCEPT a) Isotretinoin b) Corticosteroids c) Barbiturates d) Benzodiazepines

3 14) A condition that should prompt the primary care provider are symptoms suggestive of a) Anorexia nervosa b) Post traumatic stress disorder c) Personality Disorder d) All of the above 15) A manic episode can involve all the following symptoms EXCEPT a) Decreased need for sleep b) Distractibility c) Increase in goal-directed activity d) Decreased self esteem 16) Depression NOS includes depressive syndromes with fewer than symptoms or less than duration. a) 2, 3 months b) 3, 2 months c) 4, 4 weeks d) 5, 2 weeks 17) Dysthymic symptoms are generally the same as major depressive symptoms, with the addition of feelings of and the omission of. a) hopelessness, suicidal ideation b) vulnerability, psychosis c) mania, a time frame d) anxiety, sleep disturbance 18) What refers to comorbid diagnoses of both dysthymia and major depression? a) Unipolar depression b) Double depression c) Resilient depression d) Comorbid depression 19) Klein et al. (2006) found that individuals who recover from dysthymic episodes had a likelihood of recurrence of some depressive disorder. a) 51.4% b) 61.4% c) 71.4% d) 81.4%

4 20) Approximately of patients in primary care settings suffer from depressive disorders. a) 5 to 10% b) 10 to 20% c) 20 to 30% d) 30 to 40% 21) Regarding psychoeducation, education on the nature of depression and its treatment options should include all the following EXCEPT a) Depression is a medical illness b) The goal of treatment is complete remission c) Treatment of depression can lead to decreased physical disability d) All treatments have side effects 22) Self-management may include information and goals which include all EXCEPT a) Exercise often has significant antidepressant effects b) Bibliotherapy may be helpful for understanding illness c) High caffeine intake can have antidepressant effects d) Patients with MDD often have substantial sleep problems 23) What is defined as prospective monitoring of symptoms and disability? a) Therapeutic Hypervigilance b) Symptom Introspection c) Watchful Waiting d) Hypo-Hypochondriasis 24) In patients with moderate to sever MDD, the initial treatment strategy should include a) Empirically validated psychotherapy b) Antidepressant medications c) Neither d) Both 25) ECT may be a first line treatment for pregnant women, patients with psychotic depression and catatonic patients. 26) Monroe et al. (2006) noted that it is widely accepted that is often an important factor in the first episode of MDD. a) Marital status b) Genetic loading c) Major life stress d) Age

5 27) Which is NOT one of the 5 simple education messages mentioned by Lin et al. (1995) that improve adherence? a) Check with your caseworker daily b) Take daily c) Understand gradual nature of benefits d) Continue even when feeling better 28) de Jonghe et al. (2001) found that at 24 weeks, significantly fewer combined therapy patients had stopped taking medication. a) 17% versus 35% b) 22% versus 40% c) 27% versus 45% d) 32% versus 50% 29) Response is defined a or greater reduction in symptoms. a) 50% b) 60% c) 70% d) 80% 30) Full remission is defined using the PHQ-9 as a score of or less, maintained for at least 1 month. a) 1 b) 2 c) 3 d) 4 31) According to Gartlehner et al. (2007), randomized discontinuation trials have shown that continuing antidepressants for at least 6 months following remission decreases the risk of relapse by approximately a) 30% b) 50% c) 70% d) 90% 32) Maintenance treatment should be continued at the same dosage that was used during the continuation phase, and continued for at least a) 3 months b) 6 months c) 9 months d) 12 months

6 33) Mongrain & Blackburn (2006) found that attributional style and autonomous personality style predicted recurrence of disorder. a) positive b) negative c) neutral d) insecure 34) In Fava et al s (2004) study, CBT resulted in significantly lower relapse compared to clinical management at 90%. a) 10% b) 20% c) 30% d) 40% 35) When considering adjusting or modifying treatment for partial or no response, remember that it is widely accepted that there are no differences in overall efficacy between antidepressants. 36) Consider of care management for patients with mild to moderate major depression. a) 1 to 2 months b) 2 to 4 months c) 4 to 6 months d) 6 to 12 months 37) Generally initial doses used for the elderly should be higher than in healthy adults. 38) All of the SSRIs excluding may be used as first-line agents in the treatment of adults with MDD. a) Sertraline b) Citalopram c) Fluvoxamine d) Fluoxetine 39) When using SSRIs in pregnant women, the potential for increased risk of of the newborn should be considered. a) Pediatric diabetes b) Hypoglycemia c) Persistent pulmonary hypertension d) Low birth weight

7 40) Despite FDA warning about increased suicidal ideation and behaviors on antidepressants, ecological studies in developed countries have shown either decreased rates or no increase of suicide with SSRI use. 41) It is recommended to avoid the SNRI duloxetine in patients with a) Cardiovascular illness b) Diabetes c) History of mania d) Substantial alcohol abuse 42) Bupropion should be considered as to treat depression for patients with all the following EXCEPT a) A history of bulimia b) Those who desire to quit smoking c) Had intolerable weigh gain with another antidepressant d) Had intolerable sexual side effects with another antidepressant 43) Mirtazapine s adverse event profile differs from other antidepressants, most notable in its properties at lower doses. a) Sedative b) Analgesic c) Aphrodisiac d) Activating 44) AHRQ (2007) reported that the percent of patients who experienced weight gain was greater with than all the other first-line antidepressants. a) Bupropion b) Citalopram c) Mirtazapine d) Fluoxetine 45) It is recommended that TCAs be avoided for patients with which of the following conditions? a) Cardiovascular disease b) Patients at risk for suicide c) Patients with cognitive impairment d) All the above

8 46) Allow adequate wash-out periods following treatment with other antidepressants or other drugs that interact with MAOIs based on half-life - e.g., weeks after stopping fluoxetine therapy before starting an MAOI. a) 1 week b) 3 weeks c) 5 weeks d) 8 weeks 47) Which are the preferred initial augmentation strategies given their ease of use and lower risk of toxicity? a) Anxiolytic Buspirone and Olanzapine b) Olanzapine and Lithium c) Lithium and Bupropion SR d) Bupropion SR and Anxiolytic Buspirone 48) The psychostimulants including the amphetamines are not appropriate as monotherapy for the treatment of MDD. 49) The recommended courses for first line psychotherapies are CBT and IPT sessions over approximately weeks. a) 8 to 10, 8 b) 16 to 20, 16 c) 24 to 30, 24 d) 32 to 40, 32 50) For older patients with chronic MDD, combination and pharmacotherapy is the recommended first-line treatment intervention. a) DBT b) CBT c) PST d) MBT 51) Brown et al. (2005) found that a 10-session CBT led to fewer suicide attempts when compared to enhanced usual care. a) 40% b) 50% c) 60% d) 70%

9 52) All the following statements are true regarding CBT EXCEPT a) CBT Group therapy is an option for treatment of major depression b) For severe major depression, CBT alone is a treatment option c) For chronic major depression, CBT in combination with pharmacotherapy is recommended d) 8 to 10 sessions of individual CBT for major depression is a recommended treatment option 53) IPT may be particularly useful for who are concerned about risks of antidepressant medication treatment. a) Air traffic controllers b) Paranoids c) Pregnant women d) Military personnel 54) Problem-solving therapy has been examined as a treatment for depression, particularly in settings. a) Group b) Primary care c) Inpatient d) Teletherapy 55) Behavioral is a particular version of BT which targets the link between avoidant behavior and depression. a) Encouragement b) Enervation c) Prompting d) Activation 56) Which is a recommended treatment option for mild to moderate uncomplicated depression for patients concurrently experiencing marital distress? a) CFT b) MFT c) DFT d) CCT 57) Which is NOT a Necessary and sufficient condition for therapeutic change espoused by Carl Rogers? a) High positive regard for the patient b) Identification of negative cognitions c) Therapist sincerity and genuineness d) Empathic understanding of the patient s concerns

10 58) Which is not a version of Mindfulness-based interventions? a) DBT b) EMDR c) MBCT d) ACT 59) Which can be considered a SDPP? a) DBT b) CBT c) EMDR d) IPT 60) The NICE study of CCBTs for depression, recommended as an option for delivering CCBT in the management of mild to moderate depression. a) Beating the Blues b) COPE c) Overcoming Depression d) KickIT 61) According to Richards et al. (2003), Guided Self Help (GSH) should be -based and entail monitoring by a mental health professional. a) IPT b) DBT c) CBT d) PST 62) ECT should be considered in patients with severe MDD and any of the following conditions EXCEPT a) Currently taking lithium b) Catatonia c) Severe suicidality d) Patient preference 63) Symptom improvement with ECT is long-term. 64) Vagus nerve stimulation has been demonstrated to be safe and effective.

11 65) Several mechanisms may explain the mood elevating effects of exercise, including all the following EXCEPT a) Psychological b) Social c) Socio-Economic d) Physiological 66) Knubben et al. (2007) found a reduction in depression symptom severity after a 10-day aerobic exercise treatment condition which involved a) Spinning b) Rowing c) Kickboxing d) Walking 67) All the following are true about light stimulation EXCEPT? a) A 2,500-Lux white light for 2 hours a day is effective b) A 10,000 Lux light for 30 minutes a day is effective c) SAD is responsive to dawn simulation d) It is best when treatments are done later in the day 68) St. John s Wort may be used by patients with who have a strong preference for herbal treatments. a) Mild MDD b) Moderate major depression c) Severe major depression d) All the above 69) Regarding St. John s Wort, the duration of enzyme induction is unknown but has been shown to last for up to days after SJW s discontinuation. a) 9 b) 18 c) 27 d) 36 70) Acupuncture should not be recommended as a treatment for MDD.