Day # 26: Review Quiz -> Depression Part 1

Today will be our first review quiz for the depressive disorder theme. These quizzes will occur about once every other week. Spaced repetition is so important to retain what you are working hard to learn.

1) Which of the following criteria regarding disruptive mood dysrugulation disorder (DMDD) is not correct?

a) Outbursts occur ≥3x per week and inconsistent with developmental level.

b) Symptoms for ≥2 year in at least 2 settings.

c) Not symptom free for ≥3 months.

d) Started before age 10, but diagnosis can be made from ages 6-18.

2) Which of the following is true regarding the epidemiology of depressive disorders?

a) Lifetime prevalence of MDD is ~20%

b) Lifetime prevalence of PDD is ~10%

c) Risk of recurrent depressive episode in MDD is 50%

e) Higher risk of suicide in this population >30:1 for both genders

3) Please list the following criteria for a major depressive disorder (MDD).

1. At least one of the symptoms is either ________ or ________.

2. Must have __ of the 9 symptoms.

3. List the symptoms in the SIG-E-CAPS mnemonic.

4. Duration: How long must the episode last?

4) Which of the following is incorrect regarding the diagnosis of persistent depressive disorder (PDD)?

a) Duration: symptoms must persist for ≥2 years.

b) For child/adolescent timeline is ≥1 year and mood can be irritable.

c) Never been symptom free for longer than 1 months.

d) Must have ≥2 of the 6 symptoms below for most of the day and more days than not.

5) Throwback question to the psychotic disorders theme. Name the core features of psychotic disorders? Remember that they must have at least one of 1, 2, or 3 for the diagnosis of schizophrenia.

1. xxx

2. xxx

3. xxx

4. Disorganized or catatonic behavior

5. “Negative symptoms”

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Answers

Question 1:

From Day 22

Answer: b

Corrected: Symptoms for ≥1 year in at least 2 settings

Explanation:

DISRUPTIVE MOOD DYSREGULATION DISORDER

•Severe recurrent verbal and/or physical outbursts out of proportion to the situation.

•Outbursts occur ≥3x per week and inconsistent with developmental level.

•Mood between outbursts is persistently angry/irritable most of the day nearly every day and is observed by others.

•Symptoms for ≥1 year in at least 2 settings. Not symptom free for ≥3 months.

•Started before age 10, but diagnosis can be made from ages 6-18.

•Diagnosis cannot coexist with oppositional defiant disorder (ODD), intermittent explosive disorder (IED), or bipolar disorder.

Question 2:

From Day 23

Answer: a

Lifetime prevalence of MDD is in fact ~20%. All other answers are wrong. See explanation below.

Explanation:

Major depressive disorder (MDD)

• Prevalence: 12-month prevalence = 10.4%. Lifetime prevalence = 20.6%. Meaning about 10% of the population at a given time has MDD.

• Gender: For every 2 woman with MDD there is 1 man with the disorder.

• Can occur at any age.

• Recurrent major depressive episodes occur in 85% of those with single major depressive episode.

• Higher risk of suicide than the non-depressed general population. 21:1 for males. 27:1 for females.

• Mortality risk in patients with MDD is 2x the general population. This factors in suicide, higher rates of substance use, as well as MDD being correlated to other medical issues (see below).

Persistent depressive disorder (PDD)

• Prevalence: Lifetime prevalence = 3-6%.

• Can occur at any age but most commonly early onset with a chronic course.

Question 3:

From Day 22

Answer:

Following criteria for a major depressive disorder (MDD).

1. At least one of the symptoms is either depressed mood or loss of interest/pleasure (anhedonia).

2. Must have 5 of the 9 symptoms.

3. List the symptoms in the SIG-E-CAPS mnemonic (see below).

4. Duration: How long must the episode last? ≥2 weeks

Explanation:

Full criteria can be remembered by the very popular mnemonic: SIG-E-CAPS.

• Depressed mood: Subjective (feels sad, empty, hopeless) or observation.

• Sleep: Insomnia or hypersomnia nearly every day.

• Interest: Markedly diminished interest in all or almost all activities. Aka Anhedonia.

• Guilt: Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

• Energy: Fatigue or loss of energy nearly every day.

• Concentration: Diminished ability to think or concentrate.

• Appetite: Increase or decrease. Significant weight loss or weight gain.

• Psychomotor: Agitation or retardation nearly every day (observable by others).

• Suicidality: Recurrent thoughts of death, suicidal ideation, with or without plan.

Question 4:

From Day 22

Answer: c

Never been symptom free for longer than 2 months (not 1 month)

Explanation:

•Duration: symptoms must persist for ≥2 years.

•For child/adolescent timeline is ≥1 year and mood can be irritable.

•Never been symptom free for longer than 2 months.

•Must have ≥2 of the 6 symptoms below for most of the day and more days than not.

Criteria can be remembered by a little known mnemonic: CHASES.

• Concentration: poor, or difficulty making decisions

• Hopelessness

• Appetite: poor or overeating

• Sleep: insomnia or hypersomnia

• Energy: low, fatigue

• Self-esteem: low

Question 5:

From Day 1

Answer:

1. Delusions

2. Hallucinations

3. Disorganized speech

4. Disorganized or catatonic behavior

5. “Negative symptoms”

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Conclusion

Today's quiz was very "criteria heavy" but it's important to get these foundations down in order to build your knowledge from there. See you back in a few days!