Anxiety and Depression

Self-Study Examination

Instructions: After studying the text answer the following true/false or multiple choice questions.  Remember, there's only one answer to each question.

1. Select the correct statements from the following.

a) Depressive illnesses are among the most prevalent of the mental disorders.
b) Depressive illnesses are among the most treatable of all mental illnesses.
c) Most people with a depressive illness do not seek treatment.
d) all of the above
e) a and b

2. Symptoms of depressive illnesses include all of the following except:

a) loss of interest or pleasure in usual activities including sex
b) sleep disturbances
c) systemetized delusions
d) appetitie and weight changes
e) thoughts of suicide

3. Alternating bouts of depression and mania in a person calls for the diagnosis of double depression.

a) True
b) False

4. People with melancholic depression have symptoms that become dramatically more severe for a while but then return to their usual reduced level.

a) True
b) False

5. Among non-identical twins, the risk that both twins will be afflicted with depression is:

a) 25%
b) 50%
c) 75%
d) 100%

6. Select the incorrect statement from the following:

a) Women as compared to men are at greater risk for major depression at every age.
b) Bipolar disorder occurs more frequently in men than in women.
c) The highest rates of major depression are found in people between the ages of 18 and 44.
d) Empty-nest syndrome is not a valid explanation for depression in older women.

7. Which of the following catagories of drugs are used to control manic depressive illness?

a) tricyclics
b) MAOIs
c) lithium
d) aspirin

8. Persons with mood disorders have less eye movements during REM sleep.

a) True
b) False

9. The most effective treatment for major endogenous or delusional depression is:

a) drug therapy
b) psychosocial therapy
c) electroconvulsive therapy

10. Diagnosis of depression in elderly person is complicated by all of the following factors except:

a) medications taken by older persons
b) inadequate diet
c) senility
d) Elderly persons generally exaggarate their problems

11. Depression affects women in larger proportion than men.

a) True
b) False

12. The symptoms of depression include all of the following except:

a) sad, anxious mood lasting over a long period of time
b) feeling of hopelessness, pessimism
c) increased activity
d) loss of appetite

13. The issues of adolescence affect males and females equally, making them susceptible to depression and anxiety disorders in equal numbers.

a) True
b) False

14. Select the most correct statement:

a) Women are more vulnerable to depression than men.
b) Women are not necessary more vulnerable to depression, but simply express or label their symptoms differently.
c) Men are socially conditioned to deny feelings of depression or to bury them in alchohol.
d) All of the above
e) None of the above

15. Select from the following the incorrect statement:

a) Up to one in 8 individuals may require treatment for depression during their lifetimes.
b) Among all patients, patients with bipolar disorder are diagnosed and treated most often.
c) Less than 1/2 of the patients with major depressive disorder are properly recognized by practitioners.
d) Most patients with depressive symptoms generally have their first contact with their primary care providers who are non-psychiatric practitioners.

16. The risk factors for depression include all of the following except:

a) prior episodes of depression
b) family history of depressive disorder
c) prior suicide attempts
d) female gender
e) age over 50

17. Most people suffering from depressive disorders avoid treatment due to the social stigma attached to depression.

a) True
b) False

18. Select from the following the incorrect statement:

a) Once identified, depression can almost always be treated successfully.
b) Not all patients respond to the same therapy, such as medication, psychotherapy, or a combination of both.
c) A patient who fails to respond to the first treatment attempted is highly likely to respond to a different treatment.
d) A clinical depression is a normal reaction to life’s difficulties and stresses.

19. Which of the following is a True statement?

a) Depressive disorders should not be confused with a depressed or sad mood.
b) Depressed or sad mood is a normal response to specific life experiences, such as losses or disappointments.
c) A depressed or sad mood is generally transient and is not associated with significant functional impairment.
d) A sad or depressed mood is only one of the many signs and symptoms of clinical depression.
e) all of the above

20. Major depressive episodes, by definition, last only a few days, often less than two weeks.

a) True
b) False

21. Which of the following is not a correct statement in regards to major depressive disorder?

a) Most major depressive disorders begin when the person is in his or her 20s to 30s.
b) More than 50% of those who suffer a single major depressive episode eventually develop another.
c) The lifetime risk for major depressive disorder for women is 3 times that for men.
d) Race, education and income have significant impact on the prevalence rates for major depressive disorder.

22. The essential feature of dysthymic disorder is a single episode of mood disturbance, with a full return to premorbid functioning.

a) True
b) False

23. Manic episodes often require hospitalization to prevent harm to the patient or others.

a) True
b) False

24. Select from the following the True statement:

a) The mean age at onset of the bipolar disorders is in the mid 30s.
b) Women are markedly more suseptible to bipolar I disorder than men.
c) Ten to fifteen percent of untreated patients with bipolar I disorder commit suicide.
d) Some patients with bipolar I disorder exhibit a “rapid cycling” pattern, in which they experience four or more episodes per year. The prognosis, however, is better with anti- depression medications.

25. The signs and symptoms of major depressive disorder are much different in children and adoles- cents than in adults.

a) True
b) False

26. A patient with depressive symptoms is also suffering from an eating disorder. The correct nursing intervention should be to treat the eating disorder first.

a) True
b) False

27. Depression often leads to alchoholism.

a) True
b) False

28. Many depressed patients exhibit unexplained somatization complaints which cause primary care physicians to misdiagnose the mental illness as somatization disorder.

a) True
b) False

29. Select from the following the incorrect statement:

a) Approximatley 12 to 16% of patients with another nonpsychiatric, general medical conditions, exhibit depressive symptoms.
b) Persons with general medical disorder are at a higher risk for major depression.
c) Most patients with a nonpsychiatric medical condition also have a mood disorder.

30. In which of the following conditions would you treat depression first, before treating the general medical condition?

a) Patient with hypothyroidism exhibiting depressive symptoms
b) Patient with Cushing’s disease who is suffering from a major depressive episode
c) Patient with cancer who has become clinically depressed as a psychological reaction to the pain and incapacity
d) all of the above
e) none of the above

31. Which of the following medications is not reported to cause mood symptoms or formal disor- ders as side affects?

a) antihypertensives
b) morphine
c) anticonvulsents
d) antibiotics
e) anabolic steroids

32. Major depressive disorder has ______ criterion symptoms that should be elicited during the clinical interview.

a) 9
b) 6
c) 5
d) 11

33. In the detection and diagnosis of major depressive disorder, the symptoms to be ascertained first are:

a) depressed, blue or sad mood
b) suicidal intention
c) disorientation
d) abnormal motor activity
e) psychotic

34. Social stigma attached to depressive and other psychiatric conditions leads to all of the following except:

a) resistance of patients to seek treatment
b) reluctance of practitioners to look for and formally diagnose depression
c) poor adherence by patients to the treatment
d) other general medical disorders
e) discrimination in employment, security clearance, etc.

35. Not all clinically depressed patients are sad, and many sad patients are not clinically depressed.

a) True
b) False

36. DSM-III-R criteria for major depressive disorders include all of the following except:

a) depressed mood most of the day, nearly every day
b) markedly diminished interest in almost all activities
c) overeating
d) insomnia/hypersomnia
e) feelings of worthlessness

37. Dysthymic disorder features a low-grade, more persistent depressed mood and associated symptoms for at least two years, punctuated by major depressive episodes every 6 to 8 weeks apart.

a) True
b) False

38. Diagnosis of DNOS (depression not otherwise specified) would be in order for a patient who had previously met the criteria for major depressive disorder but has gone into partial remission.

a) True
b) False

39. Nearly all persons with bipolar disorder also have recurrent episodes of major depression.

a) True
b) False

40. A patient has two or three associated symptoms that are mild and present for a short time, and there is no history of major depression. Which of the following diagnoses can be ruled out?

a) situational adjustment reaction
b) grief reaction
c) major depressive disorder
d) bipolar disorder
e) c and d

41. Vast majority of persons who initially suffer a single major depressive episode never develop another.

a) True
b) False

42. With respect to recurrent major depressive disorder, which of the following statements is not correct?

a) Individuals with recurrent major depressive disorder are at greater risk of developing bipolar disorder.
b) Such persons are more likely to have first-degree biologic relatives with major depressive disorder.
c) The episodes become increasingly frequent with never any symptom-free periods of normal functioning.
d) The recurrent depressive episodes can be treated effectively with lithium alone.

43. For a patient diagnosed with recurrent form of major depressive disorder each new episode is precipitated by some psychosocial event or stresses of life.

a) True
b) False

44. Which of the following statements is not correct as it relates to patients with major depressive disorder?

a) Such patients usually have poorer intimate relationships.
b) Such patients generally avoid using medical services.
c) Patients with major depressive disorder have as many as five times the disability days as people in the general population.
d) A nursing-home patient with major depressive disorder has a substantially greater likelihood of death in the first year following admission compared to one without major depressive disorder.

45. In psychotic depressions, psychotic features are never present without concurrent mood symptoms.

a) True
b) False

46. Which of the following is not a True statement in connection with melancholic form of major depressive disorder?

a) A key melancholic feature is that depression worsens at night than at any other time of the day.
b) Melancholic features are not uniquely associated with a family history of depression
c) The least effective treatment is with anxiiolycs.
d) Most effective treatment is ECT.

47. Atypical features of major depressive disorder are more common in younger patients.

a) True
b) False

48. A great majority of women suffer from postpartum blues within one to five days of delivery.

a) True
b) False

49. Clinical features of dysthmic disorder include all of the following except:

a) depressed mood for most of the day for at least two years
b) poor appetite or overeating
c) occasional manic episodes
d) feelings of hopelessness
e) low self-esteem

50. Dysthymic disorder always closely follows an episode of major depressive disorder.

a) True
b) False

51. Which of the following statements is not True in connection with bipolar disorders?

a) A patient with bipolar disorder is more likely to go on an unrestrained buying spree or undertake foolish business ventures.
b) Such a patient may hear “God’s voice” explaining that the patient has a special mission or special powers.
c) The mean age at onset of bipolar disorder is in the early 30’s.
d) Women with bipolar disorder are much more likely than men to attempt suicide; men are more likely to complete suicide.

52. Patient with psyclothymic disorder suffers from alternating hypomanic and mild depressive periods, lasting days to weeks; in between such periods he may show no symptoms.

a) True
b) False

53. The clinical features of major depressive episodes are different in various age groups.

a) True
b) False

54. Select the True statement from the following:

a) Alcoholism is a consequence of depression.
b) Many alcoholics develop depressive symptoms.

55. Select the incorrect statement from the following:

a) Many persons with concurrent major depressive disorder and panic or generalized anxiety disorders may actually have only a single disorder that presents with both anxiety and depressive symptoms.
b) Anxiety disorder almost always precedes depression.
c) The combination of panic and major depressive disorders results in a more severe disorder with greater impairment than does either disorder alone.
d) Lifetime suicide attempt rates for persons with both panic and major depressive disorders are more than twice those of persons with panic disorder, but without major depressive disorder.

56. Which of the following is not a correct statement with regards to cancer and depressive disorder?

a) Major depression occurs in approximately 25% of patients with cancer.
b) Many drugs used to treat cancer are associated with depressed mood as a side effect.
c) Patients with cancer evidence a greater rate of major depression than do those with other medical disorders.
d) The highest rates of clinical depression are usually found in patients with advanced cancer.

57. According to the Centers for Disease Control (CDC), nearly all patients with complaints of chronic fatigue meet the criteria for chronic fatigue syndrome.

a) True
b) False

58. Various blood pressure medications have been linked to depression. Which of the following drugs presents the highest risk of depression?

a) reserpine
b) betablockers
c) clonidine
d) ACE inhibitors

59. Depression has been linked with suicide attempts. Additional risk factors for suicide include all of the following except:

a) living alone
b) African-American race
c) male gender
d) advanced age

60. Patient self-report questionnaires are a valuable tool for clinicians in detecting currently depressed patients. Which of the following applies to the results that these tests provide?

a) They provide more false-positive results.
b) They provide many more False-negative results.

61. Clinicians should be encouraged to use fatigue and depression as prescreening symptoms to improve the likelihood of identifying hyper- or hypothyroidism with thyroid function tests as a general screen.

a) True
b) False

62. Vegetative symptoms include all of the following except:

a) overeating
b) oversleeping
c) difficulty in falling asleep
d) weight gain

63. Formal treatment for major depressive disorder falls into five broad domains. One of the following does not belong in this group:

a) medication
b) psychotherapy
c) combination of medication and psychotherapy
d) electroconvulsive therapy (ECT)
e) cognitive therapy

64. Medications have been shown to be effective in all forms of major depressive disorder.

a) True
b) False

65. Psychotherapy alone to reduce the symptoms of major depressive disorder may be considered as first-line treatment if:

a) the depression is mild to moderate
b) nonpsychotic
c) the patient desires psychotherapy
d) a and b above
e) a, b and c

66. Say a patient has responded well to acute phase medication and was continued on the drug at the same dosage for four to nine months. Subsequently the patient suffers a recurrence. Is the patient likely to respond to the same medication at the same dosage

a) yes
b) no

67. Patients who have had three or more episodes of major depression have a 90% chance of having another. Which of the following would you consider as more effective in preventing a recurrence?

a) maintenance anti-depressant medication
b) maintenance psychotherapy

68. For most patients, the benefits of medication treatment for major depression far outweigh the risks.

a) True
b) False

69. The disadvantages of psychotherapy include all of the following except:

a) physiologic side effects
b) psychotherapy is expensive
c) therapy sessions are time consuming and might be inconvenient
d) psychotherapy is not effective in patients with severe or psychotic depressions
e) the quality of the therapy depends upon the competence of the therapist

70. Adherence to treatment is a significant problem in the management of all patients. In depressed patients the following factors have been known to reduce compliance with treatment. Select the variable not consistently correlated with adherence:

a) the presence of a personality disorder
b) socioeconomic status
c) concurrent substance abuse
d) the patient’s lack of acceptance of the diagnosis or treatment plan
e) troublesome treatment side effects

71. A 4- to 6-week medication treatment plan that results in at least 50% symptom reduction would be considered a successful treatment.

a) True
b) False

72. In order to be effective, patients generally require psychotherapy over a long period of time, from several months to years.

a) True
b) False

73. The efficacy of medications to treat major depression in geriatric patients is similar to that seen in younger adults.

a) True
b) False

74. Some antidepressant medications are clearly more effective than others.

a) True
b) False

75. When a patient has shown no meaningful symptom response to medication by six weeks, the clinician should explore all of the following possible options except:

a) continue medication at corrected dosage
b) discontinue the first medication and begin a second
c) augment the first medication with the second medication
d) add psychotherapy to the initial medication
e) initiate involuntary commitment procedures for the patient

76. Which of the following is a preferred strategy when a patient has shown no meaningful symptom response by six weeks?

a) discontinue the first medication and begin with a second
b) augment the first medication with a second medication

77. The patient has shown partial response to medication, but there are still residual symptoms that are largely psychosocial that contribute to some depressive symptoms, such as, pessimism, low self-esteem, or marital difficulties. Which of the following opt

a) add psychotherapy to medication
b) change the dosage of medication
c) prescribe a drug from another class of antidepressant medications
d) reevaluate the patient’s condition

78. If a patient given the combination of medication and formal psychotherapy has not responded at all by week six or only partially by week twelve, the least effective course of action for the practitioner would be to

a) change the form of psychotherapy
b) change or augment the medication
c) consult or refer the patient for alternative medication or ECT

79. Electroconvulsive therapy (ECT) is advantageous over other treatments in all of the following situations except:

a) patients with melancholic symptoms
b) patients with less severe form of depression
c) patients who have psychotic depression
d) catatonic patients
e) where rapid response is required due to the suicidal behavior of the patient

80. Elderly men have the highest suicide rates.

a) True
b) False

81. The prevalence of major depressive disorder is lower in the elderly than in nonelderly adults.

a) True
b) False

82. There are many factors that confound the diagnosis and treatment of depression in the elderly. Which of the following is the least likely factor?

a) slower metabolism with age often requires lower dosages
b) forgetfulness
c) transportation difficulties
d) medically significant side effects
e) limited financial resources

83. Select the incorrect statement from the following:

a) Patients who have had three episodes of major depression, have a 90% chance of having another.
b) Maintenance medications should generally be of the same type and dosage found effective in acute phase treatment.
c) Depression medications are generally safe, even with long-term use.
d) For most patients, maintenance psychotherapy as the sole treatment to prevent reoccurrence of major depression disorder is generally recommended.
e) All patients with a single episode of major depression disorder are advised to discontinue medication after four to nine months of continuation treatment