Psychiatric Treatment Of Depression Quiz

1. This same patient continues to follow-up for medication management in your clinic. After about 2 years, she reports that she has started a new relationship and reports that she is having difficulty with sexual arousal. She asks you to change the medication. Asking which of the following questions might be helpful before making a decision to change the medication?

How is your relationship with your new Partner?

Have you had problems with sexual function prior to this relationship?

What other medications are you taking?

How do you feel about your body?

All of the above

Before making a decision to change the medication, it would be helpful to ask all of the above questions. By asking about the patient's relationship with their new partner, it can help determine if any relationship issues are contributing to the difficulty with sexual arousal. Asking about prior problems with sexual function can help determine if the issue is specific to the new relationship or if it has been ongoing. Inquiring about other medications can help identify if any of them could be causing the sexual arousal difficulties. Lastly, asking about how the patient feels about their body can help identify any body image concerns that may be impacting sexual arousal.

Explanation

Before making a decision to change the medication, it would be helpful to ask all of the above questions. By asking about the patient's relationship with their new partner, it can help determine if any relationship issues are contributing to the difficulty with sexual arousal. Asking about prior problems with sexual function can help determine if the issue is specific to the new relationship or if it has been ongoing. Inquiring about other medications can help identify if any of them could be causing the sexual arousal difficulties. Lastly, asking about how the patient feels about their body can help identify any body image concerns that may be impacting sexual arousal.

2. In your assessment of this patient, you ascertain that there are no suicidal thoughts. You make a referral for specialized therapy for her condition and ask her to follow-up with you in one week. Why do you ask to follow-up in one week?

To monitor for emergence of another seizure

To monitor for emergence of antidepressant induced suicidal ideation

To monitor for emergence of sexual dysfunction related to antidepressant use

To assess if the patient has recovered from her depression

To assess for additional psychopathology

The reason for asking the patient to follow-up in one week is to monitor for the emergence of antidepressant-induced suicidal ideation. This is a crucial step in ensuring the patient's safety and well-being, as certain antidepressant medications have been associated with an increased risk of suicidal thoughts or behaviors, especially in the early stages of treatment. Regular follow-up allows the healthcare provider to closely monitor the patient's response to the medication and intervene if any concerning symptoms arise.

Explanation

The reason for asking the patient to follow-up in one week is to monitor for the emergence of antidepressant-induced suicidal ideation. This is a crucial step in ensuring the patient's safety and well-being, as certain antidepressant medications have been associated with an increased risk of suicidal thoughts or behaviors, especially in the early stages of treatment. Regular follow-up allows the healthcare provider to closely monitor the patient's response to the medication and intervene if any concerning symptoms arise.

3. You review the medication prescribed to this patient and determine that a different choice may be more appropriate. Which of the following would be an appropriate choice for medications at this time?

Geodon (Ziprasidone)

Depakote (Divalproex Na)

Clonazepam

Buspar (Buspirone)

Prozac (Fluoxetine)

The correct answer is Prozac (Fluoxetine) because it is indicated for the treatment of depression, which is a common comorbidity in patients with psychiatric disorders. Geodon (Ziprasidone) is an antipsychotic medication used for the treatment of schizophrenia and bipolar disorder. Depakote (Divalproex Na) is an antiepileptic drug used for the treatment of seizures and bipolar disorder. Clonazepam is a benzodiazepine used for the treatment of anxiety and panic disorders. Buspar (Buspirone) is an anxiolytic medication used for the treatment of generalized anxiety disorder. Therefore, Prozac (Fluoxetine) would be the most appropriate choice for medication in this case.

Explanation

The correct answer is Prozac (Fluoxetine) because it is indicated for the treatment of depression, which is a common comorbidity in patients with psychiatric disorders. Geodon (Ziprasidone) is an antipsychotic medication used for the treatment of schizophrenia and bipolar disorder. Depakote (Divalproex Na) is an antiepileptic drug used for the treatment of seizures and bipolar disorder. Clonazepam is a benzodiazepine used for the treatment of anxiety and panic disorders. Buspar (Buspirone) is an anxiolytic medication used for the treatment of generalized anxiety disorder. Therefore, Prozac (Fluoxetine) would be the most appropriate choice for medication in this case.

4. A 19 year-old female arrives at the clinic complaining of depression including symptoms of anhedonia, loss of appetite, hypersomnia and low energy. She is prescribed a medication. You are notified 2 days later by a neurologist at the local hospital that she is being evaluated for a seizure disorder. Which of the following medications was most likely prescribed?

Cymbalta (Duloxetine)

Zoloft (Sertraline)

Prozac (Fluoxetine)

Wellbutrin (Bupropion)

Luvox (Fluvoxamine)

The most likely medication prescribed in this scenario is Wellbutrin (Bupropion). Wellbutrin is an atypical antidepressant that is commonly prescribed for depression. It is known to have a lower risk of causing side effects such as weight gain, sexual dysfunction, and sedation compared to other antidepressants. Additionally, Wellbutrin has been found to be effective in treating symptoms of depression, including anhedonia, low energy, and changes in sleep patterns. Given the patient's symptoms of depression and the fact that she is being evaluated for a seizure disorder, Wellbutrin may have been chosen as it is not known to lower the seizure threshold like some other antidepressants.

Explanation

The most likely medication prescribed in this scenario is Wellbutrin (Bupropion). Wellbutrin is an atypical antidepressant that is commonly prescribed for depression. It is known to have a lower risk of causing side effects such as weight gain, sexual dysfunction, and sedation compared to other antidepressants. Additionally, Wellbutrin has been found to be effective in treating symptoms of depression, including anhedonia, low energy, and changes in sleep patterns. Given the patient's symptoms of depression and the fact that she is being evaluated for a seizure disorder, Wellbutrin may have been chosen as it is not known to lower the seizure threshold like some other antidepressants.

5. You go past the hospital to check in on this patient and note for the first time some scrapes on her knuckles. What commonly comorbid condition accompanies this patient's depression?

Bipolar Disorder, Most Recent Episode Manic, Severe

Schizophrenia, Paranoid type

Conversion Disorder

Impulse Disorder NOS

Bulemia

The correct answer is Bulimia. Bulimia nervosa is commonly comorbid with depression. It is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, excessive exercise, or the misuse of laxatives or diuretics. Individuals with bulimia often experience feelings of guilt, shame, and low self-esteem, which can contribute to the development or worsening of depression. Additionally, both disorders share common risk factors such as genetic predisposition, neurotransmitter imbalances, and societal pressures related to body image.

Explanation

The correct answer is Bulimia. Bulimia nervosa is commonly comorbid with depression. It is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, excessive exercise, or the misuse of laxatives or diuretics. Individuals with bulimia often experience feelings of guilt, shame, and low self-esteem, which can contribute to the development or worsening of depression. Additionally, both disorders share common risk factors such as genetic predisposition, neurotransmitter imbalances, and societal pressures related to body image.

6. You see this patient back at the 1 week mark and discuss the events leading to her seizure. She reports that overall she is tolerating the new medication well without side effects. She asks you how long it will take for her to start having fewer symptoms of depression. You tell her:

When effective, people begin to feel better at about 1 month mark after starting medication

When effective, people begin to feel better at about the 3 week mark after starting medication

When effective, people begin to feel better at about the 2 week mark after starting medication

When effective, people begin to feel better at about the 1 week mark after starting medication

When effective, people begin to feel better at about the 2 month mark after starting medication

The correct answer is "When effective, people begin to feel better at about 1 month mark after starting medication." This answer indicates that it takes approximately one month for the medication to start showing its effectiveness in reducing symptoms of depression.

Explanation

The correct answer is "When effective, people begin to feel better at about 1 month mark after starting medication." This answer indicates that it takes approximately one month for the medication to start showing its effectiveness in reducing symptoms of depression.