Day # 32: Review Quiz -> Depression Part 2

Today will be our second review quiz for the depressive disorder theme. Remember now that we have switched to a M, W, F posting schedule our review quizzes will occur once every other week. I have noticed that the review posts tend to be one of the least read posts, but it's so important to fit in spaced repetition. Those of you that take these quizzes will certainly benefit!



1) A patient has unconscious thoughts that his/her therapist has traits that reminds them of their strict and controlling father. What is this an example of?

a) Free association

b) Resistance

c) Transference

d) Countertransference



2) Which of the following is not an element of cognitive behavioral therapy?

a) Graded task assignment

b) Social role disputes

c) Identifying and challenging cognitive distortions

c) Activity scheduling



3) Antidepressant medications can be used in a number of conditions. Which of the following is not an approved use for antidepressants?

a) Alcohol cessation

b) Migraines

c) Fibromyalgia

d) Insomnia



4) Some select SSRI/SNRI medications can prolong the QTc interval? Which medication should not be on this list?

a) Venlafaxine (Effexor)

b) Citalopram (Celexa)

c) Escitalopram (Lexapro)

d) Sertraline (Zoloft)



5) Which antidepressant should be considered as first-line in children/adolescents?

a) Citalopram (Celexa)

b) Escitalopram (Lexapro)

c) Fluoxetine (Prozac)

d) Sertraline (Zoloft)



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Answers


DON'T LOOK UNTIL YOU HAVE FINISHED THE ENTIRE QUIZ


Question 1:

From Day 29


Answer: b

This is an example of Transference


Explanation:

Therapeutic techniques in Psychodynamic therapy:

  • The goal is to experience symptom relief and internal conflict by utilizing "transference"and "countertransference" as a way to interpret unconscious thoughts.

  • Transference = the patient's unconscious redirection of feelings from the past toward the therapist. Example: the patient has unconscious thoughts that his/her therapist has traits that reminds them of their strict and controlling father.

  • Countertransference = the therapist's unconscious association of feelings from the past toward the patient. Example: the therapist has unconscious thoughts that his/her patient reminds them of needy and emotional partner.

  • Free association: this is basically a technique where the patient is encouraged to say whatever the first thing is that comes to their mind in an attempt to "tap into" the unconscious mind.

  • Resistance: unconscious and conscious reasons that the patient is resistant to treatment or unwilling to discuss a particular topic in therapy.



Question 2:

From Day 29


Answer: b

Social role disputes is an element of interpersonal therapy not cognitive behavioral therapy.


Explanation:


Cognitive Techniques

  • Identify and challenge their underlying "cognitive distortions"

  • Identify automatic negative thoughts and core beliefs

  • Treatment involves education about their disorder and cognitive distortions, challenging their thoughts, examining the evidence for a belief, and many other techniques.


Behavioral Techniques

  • Identifying and removing unwanted behaviors.

  • Therapists use various behavioral techniques and "activation" to help improve the patients self-reliance and find new healthy ways to cope.

  • Patients are given homework and assigned activities to achieve goals.

  • SMART goals

  • Activity scheduling: the patient will schedule their day by the hour and they will measure their feeling of accomplishment and pleasure for all activities done during the day.

  • Graded task assignment: breaking large (seemingly overwhelming tasks) into smaller elements.


4 elements of Interpersonal Therapy

  1. Grief: assist healing from unresolved grief by facilitating the grieving process.

  2. Social role disputes: helps identify and make a plan of action to solve interpersonal role disputes such as conflict with family members or coworkers.

  3. Social role transitions: be able to mourn and accept the loss of an old role such as job loss, getting married, divorce, children moving out, etc.

  4. Interpersonal deficits: learn to establish healthy relationships and decrease social isolation.



Question 3:

From Day 30


Answer: a

Smoking cessation (not alcohol cessation) is an approved use of an antidepressant (bupropion)


Explanation:

The use of antidepressant medications are not limited to depressive disorders. There is evidence for a variety of indications. Some of these will be summarize below.

  • Obsessive compulsive disorder: SSRIs (in high doses), TCAs (clomipramine)

  • Panic disorder: SSRIs, TCAs, MAOIs

  • Eating disorders: SSRIs (in high doses), TCAs

  • Social anxiety disorder (social phobia): SSRIs, SNRIs, MAOIs

  • Generalized anxiety disorder: SSRIs, SNRIs (venlafaxine), TCAs

  • Posttraumatic stress disorder: SSRIs

  • Irritable bowel syndrome: SSRIs, TCAs

  • Enuresis: TCAs (imipramine)

  • Neuropathic pain: TCAs (amitriptyline and nortriptyline), SNRIs

  • Chronic pain: SNRIs, TCAs

  • Fibromyalgia: SNRIs

  • Migraine headaches: TCAs (amitriptyline)

  • Smoking cessation: Bupropion

  • Premenstrual dysphoric disorder: SSRIs

  • Insomnia: Mirtazapine, trazodone, TCAs (doxepin)



Question 4:

From Day 31


Answer: d

Sertraline is not known to cause QTc prolongation


Explanation:

QTc prolongation is a known, but controversial, side effect of antidepressants. This is likely a drug specific side effect as opposed to side effect of the whole class. Known medications in the SSRI/SNRI class are citalopram, escitalopram, and venlafaxine.



Question 5:

From Day 31


Answer: c

Fluoxetine (Prozac) is first-line in children and adolescents


Explanation:


Fluoxetine (Prozac)

  • Longest half-life, with active metabolites; therefore, no need to taper (self-tapering due to long half-life ~5 days).

  • Best studied and deemed safe in pregnancy.

  • First-line for use in children and adolescents.

  • Common side effects: more "activating" = insomnia and anxiety, sexual dysfunction.

  • Show to improve motor recovery and depression after stroke (FOCUS and FLAME trials).

  • Can elevate levels of antipsychotics, leading to increased side effects.

  • Also comes in liquid formulation.

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CONCLUSION


Great job today! Like I said before if you are doing these quizzes you are in the minority of the readers of this blog but your knowledge will keep growing as you maintain your learning gains. See you back in a few days where we will cover serotonin syndrome.

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