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The following
contains 35 multiple choice questions for assessment of knowledge
and skill in the area of Major Depression. The information that
forms the basis for these questions is found in the CANMAT Guidelines
for the Diagnosis and Pharmacological Treatment of Depression (1st
Edition Revised, 1999). Please select the best possible answer,
as some of the other answers may also be correct.
As you answer
each question by clicking on the one you think is most correct,
you will receive immediate feedback confirming the correct answer.
This exercise will allow you to identify areas for further learning.
Definitions
Acute Phase Treatment - Aims at remission of symptoms
Continuation Treatment - Aims at prevention of relapse
Maintenance Treatment - Aims at prevention of recurrence in patients
with prior episodes
1. Which
of the following statements is not true?
A.
More than 50% of those who initially suffer a single major depressive
episode eventually develop another.
B. Individuals with
recurrent major depressive disorder are at greater risk for developing
bipolar disorder than are those with single episodes.
C. Individuals with
recurrent major depressive disorder are more likely to have first
degree biologic relatives with major depressive disorder.
D. Major depressive
disorder usually begins in the mid-40s and mid-50s.
2. A history
of suicidal ideation and/or attempts increases the patient's risk
for subsequent ideation/attempts. Based on the evidence, additional
risk factors for suicide include:
1. Hopelessness
2. Physical illness
3. Living alone
4. Advanced age
A.
1, 2 and 3
B. 1 and
3
C. 2 and
4
D. 1, 2,
3 and 4
3. Which
one of the following is not considered to be a melancholic feature
of major depressive disorder?
A.
Phobic symptoms
B. Psychomotor
retardation or agitation
C. Loss
of interest or pleasure
D. Early
morning awakening
4. Which
one of the following statements is not true with respect to coronary
artery disease and depression?
A.
The prevalence of major and minor depressive disorders in patients
who recently experienced a myocardial infarct is about 45%.
B. Patients
aged 55 and older with mood disorders had a mortality rate four
times higher than expected.
C. Depressed
patients adhere more carefully to cardiac treatment regiments.
D. Post
myocardial infarct patients with depression report more stress than
their non-depressed counterparts.
5. In cancer
patients, the highest rates of clinical depression are found in:
1. Bedridden
patients
2. Patients on long-acting narcotics
3. Patients with a greater level of disability
4. Ambulatory patients
A.
1, 2 and 3
B. 1 and
3
C. 2 and
4
D. 1, 2,
3 and 4
6. According
to DSM-IV criteria, which of the following is not included in the
diagnostic criteria for a manic episode?
A.
Insomnia/hypersomnia
B. Inflated
self esteem/grandiosity
C. Flight
of ideas
D. Much
more talkative than usual
7. In major
depression, which one of the following variables is not consistently
correlated with adherence to therapeutic plan (compliance)?
A.
Presence of personality disorder
B. Medication
side effects
C. Substance
abuse
D. Socioeconomic
status
8. Which
one of the following is incorrect regarding the acute phase treatment
of major depression?
A.
One of the major objectives is to reduce or eliminate the signs
and symptoms of depression.
B. 20% to
30% of depressed patients will improve with no active intervention.
C. Psychotherapy
may be of added benefit when medication alone leads to only partial
response.
D. ECT is
indicated in mild, moderate and severe depression.
9. Which
one of the following medications is not considered as first-line
therapy for depression?
A.
trazodone
B. fluvoxamine
C. venlafaxine
D. buspirone
10. A patient
with major depression who has experienced a medication treatment
failure:
A.
Should be reevaluated to ensure that the diagnosis is accurate.
B. Should
be given a second antidepressant in addition to the first antidepressant.
C. Should
be immediately referred to a psychiatrist.
D. Should
be hospitalized.
11. In a
patient with a single episode of major depression, that has responded
well to acute phase medication, for how long is the continuation
phase treatment continued?
A.
4 months
B. 4 to
9 months
C. 9 to
15 months
D. 2 years
12. A referral
to a psychiatrist is appropriate for which of the following?
1. Recommendations
on medication management.
2. Severe, recurrent or psychotic depression.
3. Presence of complex general medical problems.
4. Need for involuntary commitment.
A.
1, 2 and 3
B. 1 and
3
C. 2 and
4
D. 1, 2,
3 and 4
13. Which
of the following are considered to be risk factors for depression?
1. Prior
episodes of depression.
2. Medical comorbidity.
3. Family history of depression.
4. Stressful life events.
A.
1, 2 and 3
B. 1 and
3
C. 2 and
4
D. 1, 2,
3 and 4
14. Which
one of the following statements is most true?
A.
Self Rating Depression Scales (e.g., Beck, Zung etc.) are expensive
to administer.
B. Self
Rating Depression Scales (e.g., Beck, Zung etc.) have high rate
(25% to 40%) of false negative results.
C. Self
Rating Depression Scales (e.g., Beck, Zung etc.) have a high rate
(25% to 40%) of false positive results.
D. The
Beck Depression Inventory is the best tool to diagnose major depression.
15. Which
of the following is not included in the DSM-IV criteria for diagnosis
of major depressive disorder?
A.
Impaired concentration.
B. Marked
distractibility.
C. Fatigue.
D. Feelings
of worthlessness.
16. Which
one of the following statements about postpartum depression is least
true?
A.
Non-psychotic postpartum depression typically occurs within 6 months
of delivery.
B. The
risk of non-psychotic postpartum depression is higher for persons
with a psychiatric history.
C. The
symptoms of postpartum psychosis typically develop 2 to 3 months
following delivery.
D. Postpartum
"blues" occur in 50% to 80% of women following delivery.
17. Which
one of the following drugs is least likely to cause depression?
A.
prednisone
B. anabolic
steroids
C. digoxin
D. L-dopa
18. Which
one of the following statements about mood disorders is not true?
A.
The clinical presentation of depression in the elderly is similar
to that in other adults.
B. It may
be difficult to distinguish depression from dementia in those over
age 65.
C. In prepubertal
children, boys are affected with depression more often than girls.
D. Onset
of major depression before age twenty is associated with a greater
likelihood of a more recurrent pattern in adulthood.
19. Acute
phase treatment for major depression may include all of the following
EXCEPT:
A.
Antidepressant medication for mild to moderate depression.
B. Psychotherapy
for psychotic depression.
C. Electroconvulsive
therapy (ECT) for severe depression.
D. Antidepressant
medication for severe depression.
20. Which
of the following forms of psychotherapy have shown to be effective
in the acute phase treatment of mild to moderate major depression?
1. Cognitive
therapy.
2. Behavioural therapy.
3. Interpersonal psychotherapy.
4. Long-term psychotherapy.
A.
1, 2 and 3
B. 1 and
3
C. 2 and
4
D. 1, 2,
3 and 4
21. Which
one of the following statements is not true regarding acute phase
treatment with antidepressant medications?
A.
There is strong evidence for the efficacy of medication in severe
depression.
B. There
is strong evidence for the efficacy of medication in psychotic depression.
C. The
efficacy of antidepressant medication in patients with major depression
with atypical features had not been shown.
D. Maintenance
psychotherapy has not been shown to prevent recurrences.
22. A medication
treatment failure is considered to have occurred when:
1. There
has been no response by 6 weeks.
2. There has been only a partial response by 6 weeks.
3. An optimum dosage of the antidepressant has been used.
4. All forms of psychotherapy have been attempted.
A.
1, 2 and 3
B. 1 and
3
C. 2 and
4
D.
1, 2, 3 and 4
23. Which
one of the following statements concerning continuation phase treatment
is not correct?
A.
Early discontinuation of medication is followed by about 25% relapse
rate within 2 months
B. Continuation
phase treatments includes the same medication that was successful
in the acute phase.
C. Continuation
phase treatment includes the same medication at half the acute phase
treatment dose.
D. Some
antidepressant medications need to be tapered off gradually.
24. Which
of the following is an indication for maintenance therapy?
1. A patient
who has a family history of recurrent major depressive disorder
and has experienced a single episode of major depression.
2. A patient who has a family history of recurrent major depressive
disorder and has experienced two episodes of major depression.
3. A patient who has a family history of bipolar affective disorder
and has experienced a single episode of major depression.
4. A patient who has a family history of bipolar affective disorder
and has experienced two episodes of major depression.
A.
1, 2 and 3
B. 1 and
3
C. 2 and
4
D. 1, 2,
3 and 4
25. Which
one of the following statements concerning alcoholism and depression
is most true?
A.
Alcoholism and depression are different expression of the same underlying
condition.
B. The
prevalence of alcoholism in patients with depression is much higher
than in the general population.
C. Alcoholics
were nearly twice as likely as those without alcoholism to develop
a major depressive episode.
D. Men
are more likely than women to develop depression as a consequence
of heavy drinking.
26. Which
of the following statements is not true?
A.
First degree relatives of bipolar disorder patients are at substantially
higher risk for developing a recurrent major depressive disorder.
B. Patients
who develop major depressive disorder before age 20 have a greater
familial morbidity for depression.
C. A history
of two major depressive episodes is associated with a 40% chance
of a subsequent episode.
D. A history
of three or more major depressive episodes is associated with a
90% chance of a subsequent episode.
27. Vegetative
features of major depressive disorder include all of the following
EXCEPT:
A.
Overeating
B. Oversleeping
C. A feeling
of heaviness in the arms or legs.
D. Lack
of reactivity to usually pleasant stimuli.
28. Which
one of the following statements concerning depression in medically
ill patients is true?
A.
The general medical disorder biologically causes depression.
B. The
general medical disorder triggers depression in those who are genetically
vulnerable.
C. The
general medical disorder psychologically causes depression.
D. All
of the above statements may be true.
29. According
to DSM-IV criteria, which one of the following is not common to
both major depression and dysthymia?
A.
Feelings of hopelessness.
B. Low
energy.
C. Low
self esteem.
D. Recurrent
thoughts of suicide.
30. Which
one of the following interventions is most likely to improve compliance
in the treatment of major depression?
A.
Educating the patient and family about depression.
B. Monitoring
blood levels of medications.
C. Prescribing
weekly follow-up appointments.
D. Doing
regular pill counts.
31. If a
patient undergoing treatment for depression is showing a partial
response at 5 to 6 weeks, it is recommended that:
A.
The same medication be continued for another 5 or 6 weeks.
B. A second
antidepressant medication be added.
C. A consultation
be obtained.
D. The
current antidepressant medication type be changed.
32. Which
one of the following statements is not true?
A.
Antidepressant medications have been shown to be effective in all
forms of major depressive disorder.
B. The
newer antidepressants have clearly shown better efficacy when compared
to the tricyclics.
C. The
newer antidepressants have less side effects than the tricyclics.
D. Augmentation
of therapy implies adding a second drug to the first one.
33. Depressive
symptoms remit with the first antidepressant medication in:
A.
10% to 30% of patients.
B. 40%
to 60% of patients.
C. 70%
to 80% of patients.
D. 80%
to 90% of patients.
34. Which
one of the following statements regarding maintenance therapy of
major depression is not correct?
A.
Maintenance therapy is aimed at preventing a new episode of depression.
B. Patients
who have had three or more episodes of major depression are candidates
for maintenance therapy with an antidepressant.
C. The
medication used in maintenance therapy is generally the same as
was effective in acute phase therapy.
D. The
medication used in maintenance therapy is generally at a lower dose
than used in acute phase therapy.
35. Which
one of the following antihypertensives is most likely to cause depression?
A.
captopril
B. reserpine
C. alphamethyldopa
D. verapamil
Thank
You for your participation in this module.
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