1. Antidepressant medication is an initial primary treatment modality for moderate to severe major depressive disorder unless:
- ECT is planned
- Patient is less than 18 years of age
- Patient is admitted to hospital
- Patient is age 65 and older
2. Dysthymia may be treated with all of the following except:
- Cognitive behavioral therapy
- Interpersonal therapy
3. Symptoms of depression in children and adolescents include all of the following except:
- Persistent depressive or sad mood
4 Prior to initiating bright light therapy for seasonal affective disorder, it is important to:
- Try a course of antidepressant drugs
- Consider ophthalmological evaluation for persons with a history of eye disorders
- Initiate milieu therapy
- Complete a course of cognitive behavioral therapy
5. All of the following are associated with bipolar disorder except:
- Functional impairment
- Manic episodes
- Rapid cycling
- Frequent spontaneous resolution of all symptoms
6. Which of the following statement about children and adolescents with bipolar disorder is not true?
- Most require ongoing treatment to prevent relapse and some require lifelong treatment
- Many have co-occurring disorders such as substance abuse, suicidality, and psychosocial issues
- Treatment generally involves a combination of medication and behavioral/psychosocial interventions
- A significant proportion outgrows the disorder and requires no further follow-up
7. The goals of acute treatment for schizophrenia include all except:
- Encouraging introspection and reflection
- Eliminating or reducing symptoms such as disturbed behavior
- Reducing the severity of psychosis and associated symptoms
- Preventing harm
8. When may ECT be used to treat adults with schizophrenia or schizoaffective disorder?
- In both the acute phase and stable phase for psychotic symptoms that have not responded to pharmacological treatment
- Only during the acute phase
- Only during the stable phase
- Only in persons who have not been treated with antipsychotic agents
9. The most common behavioral health problem in adults, adolescents and children is:
- Thought disorders
10. An effective intervention for many anxiety disorders is:
- Antipsychotic agents alone
- Antidepressants alone
- Behavioral health treatment, especially cognitive behavioral therapy
- ECT and pharmacotherapy
11. The percentage of persons with generalized anxiety disorder with a comorbid condition is:
12. Symptoms of panic disorder may include all of the following except:
- Chest pain and tachycardia
- Feelings of impending doom
- Dizziness and shortness of breath
- Fever and shaking chills
13. All of the following are true about panic disorder except:
- Panic attacks do not occur during sleep
- It affects an estimated 6 million adults in the United States
- Twice as many women are affected
- The tendency to develop panic attacks appears to be heritable
14. Trichotillomania is an impulse control disorder that involves:
- Disordered eating
- An irresistible urge to pull out hair
- Compulsive gambling
- Harming pets and small animal
15. All of the following statements about oppositional defiant disorder are true except:
- It involves recurrent patterns of hostility and negative behaviors
- It arises from a combination of genetic, biological and environmental causes
- It is a developmentally appropriate behavior displayed by children
- Early onset is associated with poorer prognosis
16. Persons with intermittent explosive disorder generally display all of the following except:
- Aggressive outbursts and violence
- Destruction of property
- Remorse, regret and embarrassment about their actions
17. All of the following are impulse disorders or disruptive behaviors except:
- Pathological gambling
18. Naltrexone may be used as pharmacotherapy for which of the following disorders:
- Mood disorders
- Impulse and Disruptive Behaviors
- Schizoaffective disorder
- Substance use disorders
19. Outpatient detoxification may be contraindicated for all of the following groups except:
- Persons with a history of delirium tremens or withdrawal seizures
- Persons with unstable medical conditions such as diabetes, hypertension, or pregnancy
- Persons whose withdrawal signs and symptoms are sufficiently severe to require 24-hour inpatient care
20. Nearly one-half of patients with schizophrenia have which type of comorbid disorders?
- Substance use disorders
Answers and Explanations
Antidepressant medication is an initial primary treatment modality for mild major depressive disorder as well as moderate to severe major depressive disorder. For psychotic depression, a combination of antipsychotic and antidepressant medication or ECT may be prescribed. Psychotherapy alone as an initial treatment modality may be used for patients with mild to moderate depressive disorder.
Drug treatment for dysthymia is similar to treatment for depression and may include tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs). Along with the above-mentioned therapies, persons with dysthymia also may respond to cognitive therapy and behavioral therapy.
Additional symptoms of depression in children and adolescents include the following: irritable mood; loss of interest and pleasure; persistent thoughts of death; suicidal ideation or attempts; changes in appetite, weight or sleep; diminished activity, concentration or energy; and changes in feelings of self-worth and guilt. Depressed children may withdraw socially, present with somatic complaints, exhibit low tolerance for frustration, and throw temper tantrums.
Because bright light therapy has the potential to cause eyestrain and headaches, an ophthalmologic exam is advised for persons with a history of eye diseases. In is important to bear in mind that in bright light treatment has the potential to trigger episodes of hypomania or mania in vulnerable patients.
Bipolar disorder is associated with functional impairments even during periods of euthymia. Along with periodic episodes of mania and depression, some patients experience rapid cycling – four or more mood disturbances in a single year that meet the criteria for a major depressive, mixed, manic, or hypomanic episode.
Children and adolescents with bipolar disorder should be carefully evaluated for all of the above-mentioned co-occurring disorders as well as medical problems. Primary treatment for mania is pharmacotherapy; however, psychotherapy is an important component of comprehensive treatment.
The goals of treatment during the acute phase of illness are to prevent harm, control disturbed behavior, reduce symptoms such as agitation and aggression, evaluate and address the stressors that triggered the acute episode, and enable rapid return to the best level of functioning. As with other psychiatric disorders it is vitally important to develop an alliance with the patient and family, establish attainable objectives of treatment, and follow-up with appropriate care.
A combination of ECT and antipsychotic medications may be prescribed for patients with schizophrenia or schizoaffective disorder with severe psychotic symptoms that have not responded to pharmacological treatment. Maintenance ECT may benefit some patients who have responded to acute treatment with ECT but for whom pharmacological prophylaxis alone has not prevented relapse or is not tolerated.
An estimated 40 million adults in the United States have an anxiety disorder. Anxiety disorders include panic disorders with or without agoraphobia, specific phobias, social anxiety disorder, obsessive-compulsive disorder, generalized anxiety disorder, and post-traumatic stress disorder (PTSD).
A combination of psychotherapy and medication management is helpful for most anxiety disorders. Of psychotherapeutic interventions, cognitive-behavioral therapy (CBT) has demonstrated efficacy; however, it requires the patient to commit to approximately 12 to 20 sessions of treatment.
More than half of persons diagnosed with generalized anxiety disorder have a comorbid condition such as panic disorder and major depressive disorder is the most common. Panic disorder is often comorbid with substance abuse. Because the anxiety disorders share many common signs and symptoms, it is imperative to conduct a thorough assessment to establish the primary diagnosis.
People who have panic disorder are often disabled by the condition; they avoid normal activities of daily living such as shopping and riding buses or trains. About one-third becomes housebound or able to confront a feared situation only when accompanied. Panic disorder is one of the most treatable of all the anxiety disorders; most people respond well to pharmacological and psychosocial interventions.
Panic attacks occur suddenly, often without warning, and can occur at any time, even during sleep. Panic attacks commonly begin in late adolescence or early adulthood, but not everyone who experiences panic attacks will develop panic disorder. Many people have a single attack and do not develop the persistent pattern that characterizes panic disorder.
A combination of pharmacological and psychotherapeutic treatment appears to be most effective. Selective serotonin reuptake inhibitors (SSRIs) are the drugs of choice and cognitive behavioral therapy is the psychotherapeutic modality of choice.
Oppositional defiant disorder (ODD) is not the oppositional behavior displayed by children in the course of normal development; ODD is an extreme and significant exaggeration of developmentally normal behaviors. Because ODD is frequently a co-morbid condition, it is vital that other conditions/disorders be identified and treated.
Intermittent explosive disorder is characterized by repeated outbursts of aggressive, violent behavior People with intermittent explosive disorder may attack and harm others and vandalize and destroy property. Following these outbursts they are often contrite, expressing remorse, regret and embarrassment about their actions.
Although persons with mania may behave impulsively, mania is a mood disorder characterized by abnormal affect, inflated feelings of self-worth, pressured speech, scattered ideas, increased interest in goal-directed activities and high-risk behaviors, unexplained euphoria, irritable mood, decreased need for sleep, and magical thinking.
Naltrexone, an opioid receptor antagonist, may be used as a pharmacotherapy for alcohol-dependent and opioid-dependent patients. It has demonstrated efficacy in helping alcohol-dependent patients adhere to treatment by reducing cravings, thereby, reducing the frequency and severity of relapse. Naltrexone has not demonstrated comparable efficacy for opioid dependency, largely because there is lower adherence to treatment in this population.
Persons with mild to moderate withdrawal symptoms may be effectively managed in intensive outpatient programs or partial hospitalization programs. Because many such programs are on medical center campuses or close to hospitals, immediate transfer to a higher level of care is feasible.
Many patients with schizophrenia self-medicate with alcohol, prescription drugs, and street drugs. It is vitally important to identify the presence of comorbid substance use and to develop a treatment plan that effectively addresses schizophrenia and substance use.