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The rates of all of these disorders are increased in relatives of persons with schizophrenia except

['A. Bipolar disorder', 'B. Schizophrenia', 'C. Schizoaffective disorder', 'D. Schizotypal disorder']

Answer: B. Individuals with schizophrenia, especially men, have a low fertility rate. The low male fertility rate is ascribed to the fact that the disease process has an earlier onset in men.

Factors associated with the development of psychosis in persons with complex partial seizures include

['A. Lateral temporal focus', 'B. Late onset of seizures', 'C. Left-sided seizure focus', 'D. Right-sided seizure focus']

Answer: A. The structural abnormality present in persons with schizophrenia is predominantly seen in the left side of the brain.

All of the following suggest a viral hypothesis for the etiology of schizophrenia except

['A. Increased prevalence in children born during winter B. Increased rate of complications during pregnancy C. Nonlocalized pathology', 'D. Increased prevalence in males']

Answer: B. The presence of psychomotor retardation in schizophrenic patients is associated with increased blood flow in the caudate nuclei.

All of the following are true regarding chronic institutionalized schizophrenic patients except

['A. Patients underestimate their age.', 'B. Patients score poorly on IQ tests.', 'C. Patients are similar in cognitive deficits to the mentally retarded.', 'D. Patients are more likely to be male than female.']

Answer: C. Their children have a 46% chance of developing schizophrenia if both parents have schizophrenia.

Which of the following is true regarding depression seen in persons with schizophrenia?

['A. Depression might be an integral part of schizophrenia.', 'B. Depressive symptoms may be a response to recovery of insight.', 'C. Depression may be a side effect of antipsychotic medications.', 'D. Fifty percent of patients with acute schizophrenia have depressive symptoms.', 'E. All of the above']

Answer: B. Enlargement of the lateral ventricles is present in 75% of schizophrenic patients. It is more prevalent in males and is associated with earlier onset of illness and impairment shown by neuropsychological testing.

Which of the following findings is not associated with schizophrenic patients?

['A. High activation levels on the EEG, as judged by reactivity upon opening the eyes', 'B. Lower alpha power of the EEG', 'C. Increased variability of frequency', 'D. Higher wave symmetry than EEGs of control subjects E. All of the above']

Answer: A. The risk of schizophrenia, schizoaffective disorder, and schizotypal personality disorder is increased in the first-degree relatives of patients with schizophrenia. The risk of schizophrenia and mood disorder is increased in relatives of patients with schizoaffective disorder.

Which of the following is true regarding structural changes in the brain in schizophrenic patients?

['A. Reduction in size of hippocampus', 'B. Reduction in size of amygdala', 'C. Absence of gliosis', 'D. Decrease in volume of the hippocampus is restricted to the white matter.', 'E. All of the above']

Answer: C. Left-sided seizure focus is associated with the development of psychosis in patients with complex partial seizures.

Which of the following is true regarding the prevalence of schizophrenia in new immigrants to the United States compared to the population in the immigrants’ home country?

['A. Prevalence is decreased in migrants from Norway.', 'B. Prevalence is increased in migrants from Norway.', 'C. Prevalence is increased in migrants from Mexico.', 'D. Prevalence is increased in all recent migrant subpopulations.', 'E. None of the above']

Answer: D. According to the viral hypothesis of the origin of schizophrenia, the disease process has its origin in viral infection of the child in utero. The following factors have been postulated to support this hypothesis: increased prevalence in children born during winter, increased rate of birth complications in children who later develop schizophrenia, and the potential of the viral hypothesis to explain the symptoms of schizophrenia without overt encephalitis.

Which of the following is not true regarding the prevalence of schizophrenia in different social classes?

['A. In most countries there is a higher prevalence in lower socioeconomic classes.', 'B. Social causation theory states that lower socioeconomic living condition leads to development of schizophrenia.', 'C. Social drift theory proposes that lower socioeconomic status is a consequence of the disease.', 'D. There is a higher prevalence in the upper castes of social hierarchy in India.', 'E. All of the above']

Answer: C. Institutionalized patients with chronic schizophrenia are characterized by thought disorder and negative symptoms. They show decreased activity, apathy, anhedonia, poor self-hygiene, and social withdrawal. Because onset is earlier in males, and men have a poorer prognosis, the number of chronic institutionalized male schizophrenic patients is higher than the number of females.

Which of the following is associated with increased suicide rates in persons with schizophrenia?

['A. Being young', 'B. Being male', 'C. Awareness of the deteriorative effects of the illness D. Chronic illness with frequent exacerbations E. All of the above']

Answer: E. Depressive symptoms are common in both acute and chronic stages of schizophrenia. Depression may be an integral part of schizophrenia and is present in 50% of patients with acute schizophrenia. Depressive symptoms might also develop as a side effect of the antipsychotic medications. Recovery of insight can also lead to development of depression.

All of the following statements are true regarding the prevalence of schizophrenia in the two sexes except

['A. Peak onset in men is at ages 17–25.', 'B. Peak onset in women is at ages 24–35.', 'C. Male-to-female ratio of incidence is close to 1.', 'D. Female schizophrenics are associated with more premorbid asocial characteristics.', 'E. Male schizophrenics are associated with more birth complications and cerebral structural changes.']

Answer: E. The EEGs of schizophrenic patients differ from those of normal controls. According to Nuechterlein KH and Dawson ME, in Pharmacology: The Fourth Generation of Progress, ACNP, 2000, one difference is “high activation levels, as judged by reactivity of the EEG upon opening the eyes, among schizophrenic patients in an unmedicated state.” Also, schizophrenic patients’ EEGs have “lower alpha power, increased variability of frequency, and higher wave symmetry” than those of normal controls.

Which of the following substances demonstrate effects that support the dopamine hypothesis of schizophrenia?

['A. Cocaine', 'B. d-amphetamine', 'C. Levodopa', 'D. Methylphenidate', 'E. All of the above']

Answer: E. Many structural abnormalities are seen in the brains of patients with schizophrenia. Enlargement of lateral ventricles is the most consistent finding. The other findings seen are smaller size of the hippocampus, thalamus, and amygdala. Neuronal cell architecture abnormalities have been seen in the entorhinal cortex, hippocampus, prefrontal cortex, orbitofrontal cortex, and cingulate cortex.

A 19-year-old man was recently discharged from the hospital after treatment for acute schizophrenia. On his follow-up visit 2 weeks later, he reports having stopped taking the prescribed medication. What should be the next step in his treatment?

['A. Start the patient on risperidal consta.', 'B. Hospitalize the patient.', 'C. Report him to the department of health services.', 'D. Inquire about side effects from neuroleptics.', 'E. None of the above']

Answer: B. A study by Odegaard showed that there is a greater prevalence of schizophrenia among Norwegian immigrants to the United States than among Norwegians in Norway. An Epidemiological Catchment Area (ECA) study showed that Mexican immigrants in Los Angeles had a lower prevalence than Mexicans in Mexico.

A 72-year-old patient with over 50 years of being diagnosed with schizophrenia is observed to repeat the same words and phrases over and over again for days. What is this phenomenon called?

['A. Echolalia', 'B. Echopraxia', 'C. Stilted language', 'D. Verbigeration', 'E. None of the above']

Answer: E. Schizophrenia has a higher prevalence in the lower socioeconomic classes of most countries. One exception is India, where there is a higher prevalence in the upper castes of the social hierarchy. Social causation theory states that the lower socioeconomic living condition leads to development of schizophrenia. Social drift theory proposes that lower socioeconomic status is a consequence of the disease.

A 42-year-old female patient with schizophrenia stops in the middle of a sentence while being interviewed. She is not able to explain why she stopped.

['A. Thought withdrawal', 'B. Thought blocking', 'C. Thought broadcasting', 'D. None of the above']

Answer: E. Risk factors for suicide in schizophrenic patients include male sex, age under 30 years, being unemployed, history of depression, history of substance abuse, recent discharge from a hospital, awareness of the deteriorative effects of illness, and frequent exacerbations.

Which of the following abnormalities, if present alone without any other symptom, is sufficient for a diagnosis of schizophrenia according to DSM-IV?

['A. Bizarre delusions', 'B. Hallucination giving a running commentary about the person’s thoughts and actions', 'C. Auditory hallucination of two or more voices conversing with each other', 'D. All of the above']

Answer: D. Peak onset in men is at ages 17–25; peak onset in women is at age 24–35. The male-to-female ratio of incidence of schizophrenia is close to 1. Male schizophrenics are associated with more premorbid asocial characteristics.

All of the following statements are true regarding tardive dyskinesia except A. It decreases during sleep.

['B. Oral-facial abnormalities are present in 75% of patients with tardive dyskinesia.', 'C. It is reduced by voluntary movement.', 'D. 20–30% of patients who have had chronic treatment with antipsychotic medications develop tardive dyskinesia.', 'E. It is decreased with emotional arousal.']

Answer: E. Cocaine, d-amphetamine, levodopa, and methylphenidate are all drugs that increase dopaminergic activity in the brain. All four of these drugs can lead to paranoid symptoms similar to those seen in schizophrenia.

Plasma levels of clozapine should be above what level for an adequate response?

['A. 100 ng/mL', 'B. 250 ng/mL', 'C. 450 ng/mL', 'D. 350 ng/mL', 'E. None of the above']

Answer: D. One of the main reasons for noncompliance with antipsychotic medications is the side effects. Therefore, patients who have stopped taking their prescribed medications should be asked whether they experienced side effects with the medications.

Which of the following is associated with increased incidence of tardive dyskinesia?

['A. Being elderly', 'B. Presence of affective symptoms', 'C. Presence of cognitive disorders', 'D. Sensitivity to acute extrapyramidal effects E. All of the above']

Answer: D. Verbigeration involves the senseless repetition of the same words or phrases again and again for long periods of time, sometimes even days. Echolalia involves the repetition of the examiner’s words and sentences by the patient.

Which of the following is the least common of the tardive syndromes associated with antipsychotic medications?

['A. Tardive tics', 'B. Tardive myoclonus', 'C. Tardive akathisia', 'D. Tardive dyskinesia', 'E. Tardive dystonia']

Answer: B. Thought blocking involves a sudden arrest in the train of thought. This leaves a blank and the person is not able to explain how it happened. In thought withdrawal, the person believes that someone or something took away the thought from his mind.

Which of the following pharmacological agents is not available as a long-acting intramuscular preparation for treatment of chronic schizophrenia?

['A. Fluphenazine', 'B. Haloperidol', 'C. Risperidone', 'D. Flupenthixol', 'E. None of the above']

Answer: D. A diagnosis of schizophrenia can be made even if only one of the following symptoms is present: bizarre delusions, auditory hallucinations giving a running commentary of the person’s thoughts and actions, and two or more voices conversing with each other.

Which of the following is not a good prognostic factor for delusional disorder?

['A. Acute onset', 'B. Early age of onset', 'C. Absence of precipitating factors', 'D. Female sex', 'E. Being married']

Answer: E. Tardive dyskinesia (TD) involves abnormal involuntary movements of mouth, tongue, trunk, and extremities. TD develops in 20% to 30% of patients treated chronically with antipsychotic medications. TD is reduced during voluntary movement and sleep. Emotional arousal increases the movements of TD.

Which of the following types of delusions has the best prognosis?

['A. Persecutory', 'B. Erotomanic', 'C. Jealous', 'D. Somatic', 'E. Grandiose']

Answer: D. Patients show better response to clozapine if the plasma concentration is above 350 ng/mL.

Which of the following has no role in the treatment of delusional disorder?

['A. Risperidone', 'B. Pimozide', 'C. Fluoxetine', 'D. Clozapine', 'E. Electroconvulsive therapy (ECT)']

Answer: E. Presence of affective symptoms and cognitive disorders increase the risk of developing TD. Being elderly and being sensitive to acute extrapyramidal side effects also are heightened risk factors for the development of TD.

Which of the following is the most common symptom in persons with delusional disorder?

['A. Delusions of reference', 'B. Delusions of persecution', 'C. Somatic delusions', 'D. Jealous delusions', 'E. Delusions of grandeur']

Answer: B. Tardive myoclonus is the least common and tardive dyskinesia is the most common.

For a diagnosis of delusional disorder according to DSM-IV, how long must the delusions be present?

['A. 2 weeks', 'B. 1 week', 'C. 3 months', 'D. 1 month', 'E. 6 months']

Answer: D. Risperidone, haloperidol, and fluphenazine (Prolixin) are available as long-acting intramuscular preparations. Flupenthixol long-acting preparations are not available in the United States.

Who introduced the concept of schizoaffective disorder?

['A. Gabriel Langfeldt', 'B. Jacob Kasanin', 'C. Kurt Goldstein', 'D. None of the above']

Answer: C. Presence of precipitating factors is considered a good prognostic factor in addition to acute and earlier onset, being female, and being married.

Which subtype of delusional disorder is also known as de Clerambault syndrome?

['A. Persecutory', 'B. Erotomanic', 'C. Somatic', 'D. Grandiose', 'E. Jealous']

Answer: A. Persecutory delusions have the best prognosis.

Which of the following delusional disorders responds specifically to pimozide?

['A. Persecutory', 'B. Erotomanic', 'C. Somatic', 'D. Grandiose', 'E. Jealous']

Answer: E. Antipsychotic medications remain the preferred treatment method for delusional disorder though the response rates are low. ECT gives no benefit unless there is comorbid depression. SSRIs have been shown to reduce delusional beliefs.

Which of the following formal thought disorders is more prevalent in patients with schizophrenia?

['A. Tangentiality', 'B. Derailment', 'C. Incoherence', 'D. Illogicality', 'E. Circumstantiality']

Answer: B. Delusions of persecution are present in about 83% of patients with delusional order and are the most common.

All of the following are true regarding postpartum psychosis except A. Occurs in approximately in 1 or 2 per 1,000 women after childbirth B. The onset can be as early as 48 to 72 hours postpartum C. Usually occurs within 2 to 4 weeks of treatment D. Has a recurrence rate of less than 50% in future pregnancy E. Has increased incidence in patients with history of bipolar disorder 99. What is the rate of infanticide associated with untreated puerperal psychosis?

['A. 10%', 'B. 2%', 'C. 1%', 'D. 4%', 'E. None of the above']

Answer: D. For a diagnosis of delusional disorder, the delusions should be present at least 1 month. The delusions should be nonbizarre.

Which of the following can be considered in the differential diagnosis for schizophrenia?

['A. Temporal lobe epilepsy', 'B. Acute intermittent porphyria', 'C. Neurosyphilis', 'D. Systemic lupus erythematosus', 'E. All of the above']

Answer: B. Jacob Kasanin introduced the concept of schizoaffective psychosis. Langfeldt introduced the concept of schizophreniform psychosis.

All of these people were involved in distinguishing unipolar from bipolar disorders except

['A. Kraepelin', 'B. Angst', 'C. Leonhard', 'D. Perris']

Answer: B. Persons with erotomania have delusions of having secret lovers. The delusion is more prevalent in women and usually involves the belief that a person of higher social standing is in love with the woman. It is also referred to as de Clerambault syndrome.

Melancholia is also known as

['A. Reactive depression', 'B. Exogenous depression', 'C. Endogenous depression', 'D. Psychotic depression', 'E. Masked depression']

Answer: C. Monosymptomatic hypochondriacal delusion (delusional disorder, somatic type) was reported to respond specifically to a pimozide dose of 4–8 mg/day.

All of the following are features of endogenous depression except A. Lack of appetite

['B. Irritability', 'C. Weight loss', 'D. Psychomotor retardation', 'E. Anhedonia']

Answer: B. Derailment, or loose association, is present in around 45% of patients with schizophrenia and is the most common formal thought disorder in this group of patients.

One-year prevalence of bipolar affective disorder is A. 3%

['B. 2%', 'C. 1%', 'D. 5%', 'E. 10%']

Answer: D. Postpartum psychosis has a recurrence rate of around 70% in future pregnancies, and postpartum depression has a recurrence rate of 50%. It occurs in 1 or 2 per 1,000 women after childbirth. Most of the episodes occur within 2 to 4 weeks after childbirth, although the psychosis can occur as early as 48 to 72 hours postpartum.

When compared to patients with unipolar disorder, patients with bipolar disorder have

['A. Less genetic loading', 'B. Greater genetic loading', 'C. The same genetic loading', 'D. No genetic loading']

Answer: D. Risk of infanticide is estimated to be as high as 4% in untreated puerperal psychosis. The rate of suicide is also very high in this group of patients. Short-term treatment with antipsychotic medication is the most appropriate treatment. ECT is a rapidly effective treatment.

According to DSM-IV, rapid-cycling bipolar disorder is characterized by A. Four or more mood episodes per year B. Four or more mood episodes per month C. Four or more episodes of mania or hypomania in a year D. Four or more episodes of depression per year 7. All of the following are features of rapid-cycling bipolar disorder except A. Four or more mood episodes per year B. More common in women C. Occurs early in the course of illness D. Usually resistant to treatment with lithium E. Antidepressant-induced hypomania

[]

Answer: E. All of the following illnesses can present with features suggestive of schizophrenia: temporal lobe epilepsy, acute intermittent porphyria, neurosyphilis, and systemic lupus erythematosus.

All of the following medications are approved by the FDA for bipolar affective disorder except

['A. Lithium', 'B. Valproic acid', 'C. Olanzapine', 'D. Lamotrigine', 'E. Carbamazepine']

Answer: A. Karl Leonhard was one of the first to recognize the differences between unipolar and bipolar disorders. Jules Angst and Carlo Perris also made significant contributions. Emil Kraepelin was involved in distinguishing manic-depressive illness from schizophrenia. In 1899 Kraepelin unified all types of affective disorders under the term “manic-depressive insanity”; despite opposition to it, Kraepelin’s unitary concept was adopted worldwide until it was questioned by Angst, Perris, and others.

The dose of lamotrigine should be lower than the usual dose, if lamotrigine is used in combination with

['A. Valproic acid', 'B. Escitalopram', 'C. Olanzapine', 'D. Lithium', 'E. Sertraline']

Answer: C. Melancholia, also known as endogenous depression, is characterized by anhedonia, loss of appetite, weight loss, early morning awakening, psychomotor retardation, diurnal variation of mood, and lack of reactivity.

Evidence exists for the effectiveness of all of the following antiepileptics as mood stabilizers except

['A. Valproic acid', 'B. Gabapentin', 'C. Lamotrigine', 'D. Carbamazepine', 'E. Oxcarbamazepine']

Answer: B. Irritability is a feature of reactive depression. Other features of reactive depression include anxiety, initial insomnia, psychomotor agitation, and persistent reactive mood.

One of the primary reasons for slow titration of lamotrigine when it is used in treatment of bipolar disorder is

['A. Hypotension', 'B. Rash leading to Stevens-Johnson syndrome C. Extrapyramidal side effects', 'D. Sedation', 'E. Toxicity']

Answer: C. According to an Epidemiologic Catchment Area (ECA) study, the 1-year prevalence of bipolar disorder is 1%.

Which of the following drugs has been shown to decrease the suicide rate?

['A. Carbamazepine', 'B. Olanzapine', 'C. Sertraline', 'D. Lithium', 'E. Valproic acid']

Answer: B. Persons with bipolar disorder have greater genetic loading than those with unipolar disorder. In fact, the risk of bipolar illness in a first-degree relative of a person with bipolar disorder is 7–8%. Concordance rates in monozygotic twins are as high as 80%.

All of the following are indicators of good response to lithium except A. Family history of bipolar disorder

['B. Good baseline functioning', 'C. Nonrapid cycling', 'D. Mixed episode']

Answer: A. Rapid-cycling bipolar disorder is characterized by at least four episodes of mood disorder, either depression or hypomania or mania in 1 year. Each episode is characterized either by a switch to opposite polarity or by remission.

Studies have shown that relapse of bipolar disorder after discontinuation of lithium is

['A. 10% in 1 year', 'B. 50% in 1 year', 'C. 50% in 6 months', 'D. 20% in 6 months', 'E. 50% in 2 years']

Answer: C. The phenomenon of rapid cycling usually occurs in the later part of bipolar illness and is thought to be due to kindling. More than 50% of rapid cycling is limited to less than 2 years.

According to an ECA study, the lifetime prevalence of depressive illness is A. 13%

['B. 70%', 'C. 40%', 'D. 6%', 'E. 3%']

Answer: E. Carbamazepine is not approved by the U.S. Food and Drug Administration for bipolar disorder, although psychiatrists have prescribed it for many years as a mood stabilizer. Lamotrigine is the most recent addition to the list of FDA-approved drugs for bipolar disorder.

According to Brown and Harris, all of the following are vulnerability factors for depression in women except

['A. Loss of mother before the age of 11', 'B. Three or more children under the age of 15', 'C. Lack of work outside the house', 'D. Lack of anyone in whom to confide', 'E. Living in a homeless shelter']

Answer: A. Because valproic acid is a strong inhibitor of hepatic metabolic enzymes, lamotrigine should be started at a low dose and titrated gradually if used in combination with valproic acid. The final dose of lamotrigine is usually half of the usual dose if the drug is prescribed in combination with valproic acid.

Who proposed the theory of “learned helplessness” to explain depression?

['A. Wolpe', 'B. Seligman', 'C. Freud', 'D. Beck', 'E. Kraepelin']

Answer: B. No studies to date have shown that gabapentin is effective as a mood stabilizer. Although the FDA does not approve carbamazepine and ox-carbamazepine as mood stabilizers, studies have shown them to be beneficial.

The “negative cognitive triad” was proposed by Beck to explain A. Anxiety

['B. Depression', 'C. Bereavement reaction', 'D. Adjustment disorder', 'E. Posttraumatic stress disorder']

Answer: B. The incidence of rash leading to Stevens-Johnson syndrome is lowest when the dosage of lamotrigine is increased very slowly.

A 67-year-old woman with depression and anxiety is prescribed paroxetine and clonazepam by her primary care physician. She also has a history of seizure disorder, which has been stable with phenytoin for many years. A few weeks after she begins taking paroxetine and clonazepam, the patient complains of unsteady gait. Which of the following is the most common cause of ataxia in this patient?

['A. Paroxetine', 'B. Clonazepam', 'C. Phenytoin', 'D. Phenytoin toxicity', 'E. All of the above']

Answer: D. Many naturalistic studies have shown that lithium and clozapine decrease the rate of suicide independent of their mood-stabilizing and antipsychotic properties, respectively.

All of the following are true about carbamazepine except A. Can cause SIADH

['B. Induces its own metabolism', 'C. Eliminated by extrahepatic metabolism D. Reduces levels of valproic acid', 'E. Toxicity is not accurately indicated by plasma level 21. The following are recognized side effects of lithium at therapeutic dose except', 'A. Thirst', 'B. Fine tremors', 'C. Polydipsia', 'D. Diplopia', 'E. Erectile dysfunction']

Answer: D. Mixed episode, rapid cycling, substance abuse, and mood disorder secondary to general medical condition respond poorly to lithium.

A 36-year-old White male patient has been stable on lithium for bipolar illness for the past 4 years. During his routine visit with his primary care provider, he complains of feeling weak and lacking motivation and energy.

['E. Refer the patient to a psychiatrist immediately 23. A 23-year-old woman is diagnosed with schizophrenia, paranoid type, following a first episode of psychosis and is started on an atypical antipsychotic. She is worried that the antipsychotics will cause weight gain. Which of the following is the most accurate statement regarding weight gain and antipsychotics?', 'A. There is no significant weight gain with antipsychotics.', 'B. Weight gain occurs mainly in the first 2 months.', 'C. Weight gain is related to the patient’s pretreatment BMI.', 'D. All antipsychotics cause the same amount of weight gain.', 'E. Weight gain is associated with clinical improvement.']

Answer: C. Bipolar disorder has one of the highest rates of relapse, especially after discontinuation of treatment. Therefore, prophylactic treatment is strongly advised if there are more than two episodes.

Which of the following antipsychotics also has an antidepressant effect?

['A. Flupenthixol', 'B. Chlorpromazine', 'C. Haloperidol', 'D. Trifluperazine', 'E. Fluphenazine']

Answer: D. An ECA study showed that the lifetime prevalence of depression was as high as 5.8% and that 70% of women and 40% of men had clinically significant depressive symptoms by the age of 65 years.

Peripheral neuropathy is a side effect of A. SSRI

['B. TCA', 'C. SNRI', 'D. MAOI', 'E. NRI']

Answer: E. Brown and Harris studied women in Camberwell, a district of London, in 1978 and enumerated the vulnerability factors for depression in women. However, subsequent studies have only partly replicated their findings.

A 48-year-old male patient with difficult-to-treat depression has tried all the antidepressants except MAOIs. He is currently on an SSRI. Which of the following SSRIs needs the longest washout period before switching a patient to an MAOI?

['A. Paroxetine', 'B. Fluoxetine', 'C. Citalopram', 'D. Sertraline', 'E. Escitalopram']

Answer: B. Seligman conducted an experiment with dogs that showed that when an effort is not rewarded repeatedly, the dogs give up. He named the phenomenon “learned helplessness” and proposed that, in human beings, this phenomenon would lead to depression.

Which of the following tricyclic antidepressants closely resembles an SSRI in its action mechanism?

['A. Amitriptyline', 'B. Nortriptyline', 'C. Imipramine', 'D. Clomipramine', 'E. Doxepine']

Answer: B. Beck explained depression in terms of cognitive distortions, maladaptive schemata, and a negative cognitive triad (a negative view of self, world, and future). He is pioneered in the development of cognitive behavioral therapy for depression.

Which of the following antidepressant blocks reuptake of dopamine?

['A. Venlafaxine', 'B. Bupropion', 'C. Buspirone', 'D. Mirtazapine', 'E. Fluoxetine']

Answer: B. Benzodiazepines commonly cause ataxia at therapeutic doses, especially in the elderly. Phenytoin toxicity can cause ataxia and is a possi-bility in this patient because paroxetine increases the levels of phenytoin. However, this would not be the most common cause of ataxia in this patient.

Which of the following can cause depression?

['A. Methyldopa', 'B. Procyclidine', 'C. Tryptophan', 'D. Flupenthixol', 'E. Testosterone']

Answer: C. Carbamazepine is a potent inducer of hepatic enzymes and promotes the metabolism of many other drugs, including itself. It is metabolized mainly by CYP3A4 and other oxidative mechanisms in the liver. Plasma levels of carbamazepine are not very useful in determining the degree of carbamazepine toxicity.

Which of the following is used as an augmenting agent in the treatment of depression?

['A. Propranolol', 'B. Pindolol', 'C. Metaprolol', 'D. Sotalol', 'E. Labetolol']

Answer: D. Thirst, polyuria, and polydipsia are some of the early side effects related to Na-K pump changes in the renal tubule. Fine tremors are associated with therapeutic levels, while toxic levels cause coarse tremors. It has been shown that about 7% of male patients report problems with erec-tion when on therapeutic dose of lithium. Lithium causes blurred vision but not diplopia.

Which of the following are risk factors for tardive dyskinesia?

['A. Old age', 'B. Diffuse brain damage', 'C. Duration of antipsychotic treatment D. Affective psychosis', 'E. All of the above']

Answer: C. Patients who are on lithium should have their TSH levels tested before starting lithium and at regular intervals thereafter. Lithium can cause hypothyroidism and therefore TSH should be checked before diagnosing the patient with depression or starting antidepressants.

All of the following are true about antidepressant discontinuation syndromes except

['A. More common with short half-life drugs B. Are caused by most antidepressants', 'C. May be caused by abrupt discontinuation of antidepressants D. Indicate that the patient is dependent on these medicines E. Cause irritability, insomnia, and restlessness 33. All of the following are true about zopiclone except A. Can cause tolerance B. Binds preferentially to BDZ receptors C. Is a benzodiazepine derivative', 'D. Dose should be reduced by half in elderly patients.', 'E. Dependence can be an issue if the drug is prescribed for long periods.']

Answer: C. Weight gain with antipsychotics seems to be associated with pretreatment body mass index such that greatest weight gain is seen in patients with the lowest baseline BMI. Although all antipsychotics cause some weight gain, some antipsychotics cause more weight gain than others, though the weight is likely to plateau after 6 months.

All of the following are true about dystonia except A. More common in men than in women

['B. More common in younger than older patients C. Is more common than akathisia in patients treated with neuroleptics D. Treated with lorazepam or diphenhydramine hydrochloride E. Can cause trismus 35. A 37-year-old man is admitted to an acute psychiatric unit for psychosis and agitation, where he is prescribed haloperidol 10 mg IM. Later in the evening, the resident on call is summoned because the patient is noticed to be having rigidity and fever. The resident suspects neuroleptic malignant syndrome (NMS). Which of the following is not a feature of NMS?', 'A. Clear consciousness', 'B. Rigidity', 'C. Elevated temperature', 'D. Leukocytosis', 'E. Elevated CK']

Answer: A. Flupenthixol, which is a typical antipsychotic, also has an antidepressant effect. Amoxapine is another drug that has both antipsychotic and antidepressant effects.

All of the following drugs are effective in the treatment of the acute phase of mania except

['A. Lithium', 'B. Lamotrigine', 'C. Olanzapine', 'D. Valproic acid', 'E. Haloperidol']

Answer: D. Monoamine oxidase inhibitors (MAOIs) are sometimes associated with peripheral neuropathy, which is thought to be due to pyridoxine deficiency.

Venlafaxine acts as an antidepressant by A. Inhibiting the reuptake of dopamine B. Antagonizing H1 receptors

['C. Inhibiting the reuptake of serotonin and noradrenaline D. Stimulating the glutamate receptors E. Inhibiting the GABA receptors']

Answer: B. Norfluoxetine, the active metabolite of fluoxetine, has a half-life of up to 5 to 7 days. Therefore, a washout period of at least 5 weeks is recommended before switching to MAOIs.

All of the following are true about cyproterone acetate except A. Used sometimes in the treatment of sexually disinhibited behavior in the context of mental illness

['B. Decreases the erectile response to stimulation C. Can be given orally or intramuscularly D. More effective in older men', 'E. Has been used to control sexual disinhibition in mentally retarded people']

Answer: D. Clomipramine, although classified as a tricyclic antidepressant, has a strong serotonin reuptake inhibition effect.

A 36-year-old woman is diagnosed with bipolar illness and, after a discussion of the risks and benefits, single agrees to take lithium. The psychiatrist advises her to undergo a few tests before starting lithium. All of the following are relevant in this patient except A. Pregnancy test

['B. TSH', 'C. Urea and creatinine', 'D. ECG', 'E. Liver function tests']

Answer: B. Bupropion blocks reuptake of both noradrenaline and dopamine. Its unique mechanism of action is said to be particularly useful in persons with psychomotor retardation. Buspirone is a 5HT1A agonist and is effective in anxiety.

A 68-year-old man is admitted to an acute psychiatric unit for severe suicidal ideation. He is very much preoccupied with death and refuses to agree to a contract for safety. The diagnostician determines the patient to be severely depressed because of noncompliance with medication and severe social stressors. The patient refuses to take any medication because, he says, “Nothing will change, anyway.” He also stops eating and drinking and becomes increasingly dehydrated. A reasonable choice of treatment in this patient would be to

['A. Persuade the patient to take antidepressants B. Wait and watch for the patient to change his mind C. Restrain the patient and administer intravenous fluids D. Prescribe electroconvulsive therapy E. Prescribe intensive psychotherapy 41. A 48-year-old man with treatment-resistant schizophrenia has been relatively stable for the past 6 months on clozapine. On a routine follow-up visit, the patient is observed to be depressed and reports lack of appetite and insomnia, among other features of depression. The attending psychiatrist decides to treat the patient with antidepressants. Which of the following antidepressants would mandate particular caution in this patient?', 'A. Mirtazapine', 'B. Fluoxetine', 'C. Sertraline', 'D. Citalopram', 'E. Trazodone']

Answer: A. Methyldopa is an antihypertensive. It is converted to al-phamethylnoradrenaline in the central presynaptic neurons, acting as a false neurotransmitter. This reduces overall noradrenergic neurotransmission to the postsynaptic neurons, resulting in depression.

A 28-year-old woman is being assessed for bipolar disorder. She complains of mood swings from time to time ranging from “tearfulness to feeling really good.” On further questioning, she reveals that she has not been able to maintain any relationships because of her mood swings and feels empty. She fears abandonment by her friends because of her mood swings but also blames everyone for her “current state.” The most important differential diagnosis in this patient is A. Major depressive disorder

['B. Borderline personality disorder', 'C. Histrionic personality', 'D. Depressive personality', 'E. Generalized anxiety disorder']

Answer: B. Pindolol, which is a 5HT1A antagonist, is used as an augmenting agent in the treatment of depression, particularly with SSRIs.

A 54-year-old with a history of coronary artery disease is diagnosed with psychosis NOS and treatment with an atypical antipsychotic, ziprasidone, is considered. The pharmacist requests an ECG before she can dispense ziprasidone. The most important thing to look at on the ECG is A. QTc interval B. Heart rate

['C. Signs of ischemia', 'D. Signs of old infarction', 'E. Signs of hypokalemia']

Answer: E. Having an affective psychosis increases the risk of tardive dyskinesia. Increasing age is a much stronger risk factor for men than women. The risk of tardive dyskinesia increases with the duration of antipsychotic treatment.

Which of the following SSRIs is least likely to cause discontinuation syndrome?

['A. Sertraline', 'B. Citalopram', 'C. Escitalopram', 'D. Paroxetine', 'E. Fluoxetine']

Answer: D. Discontinuation syndrome following cessation of antidepressants does not indicate drug dependence. Patients on antidepressants do not show evidence of tolerance, compulsive desire to take the drug, or difficulty controlling the level of use despite knowledge of harmful effects, etc.

A 32-year-old woman is admitted to an acute psychiatric inpatient unit for severe depression. The patient has been ruminating about suicide and guilt feelings. She believes that she has committed a sin and deserves to be punished. The resident physician thinks that the patient is obsessed with thoughts of guilt and suspects that patient has a primary obsessional disorder. The attending psychiatrist explains that patient is not obsessional but severely depressed because A. The patient has suicidal ideation.

['B. The patient has indeed committed a sin.', 'C. The patient is not distressed by the guilt feelings and is mood congruent.', 'D. The psychiatrist thinks so.', 'E. Antidepressants alone were not effective.']

Answer: C. Zopiclone is a cylopyrrolone and not a benzodiazepine derivative.

A 54-year-old woman is diagnosed with seasonal affective disorder and light therapy is prescribed. Ideally the intensity of the light should be A. 1,000 lux

['B. 10,000 lux', 'C. 100,000 lux', 'D. 500 lux', 'E. 5,000 lux']

Answer: C. Acute dystonia is usually seen in the first few days after starting neuroleptics, although it can occur anytime. Akathisia, which is a subjective sense of psychomotor restlessness, is more common than acute dystonia.

A 36-year-old man is treated for depression with an SSRI. He has a less than full recovery despite taking the highest recommended dose of the SSRI. The attending psychiatrist is considering using an augmenting agent. All of the following can be used except A. Thyroxine

['B. Lithium', 'C. Tryptophan', 'D. Propranolol', 'E. Pindolol']

Answer: A. Altered sensorium is a common feature with confusion or delirium. NMS is an emergency and needs aggressive treatment. Mortality is high if untreated.

Which of the following support the serotonin deficiency hypothesis of depression?

['A. Decreased 5HT platelet uptake', 'B. Decreased plasma tryptophan levels', 'C. Decreased 5HIAA levels in CSF', 'D. Blunted 5HT1 mediated prolactin release in response to L-tryptophan', 'E. All of the above']

Answer: B. Lamotrigine, although one of the drugs approved for the treatment of bipolar disorder, is not effective for the treatment of acute mania. Lamotrigine has to be started in a small dose and has to be titrated gradually over the next few weeks. Data exists about its utility in improving bipolar depression.

All of the following support the norepinephrine deficiency hypothesis of depression except

['A. Decreased norepinephrine mediated release of growth hormone in response to clonidine', 'B. Decreased cAMP turnover in platelets following stimulation with clonidine', 'C. Increased platelet alpha 2 adrenergic receptor binding D. Increased beta adrenergic receptors in depression and suicides E. Decreased levels of cAMP in CSF']

Answer: C. Venlafaxine inhibits the reuptake of serotonin and noradrenaline in a dose-dependent way in the treatment of depression.

One of the consistent findings in depression, cortisol secretion abnormality, can be explained by

['A. Primary hypersecretion of cortisol', 'B. Primary hypersecretion of ACTH', 'C. Primary hypersecretion of CRF by hypothalamus D. Positive dexamethasone test', 'E. Higher incidence of adrenal tumors in depression 51. All of the following are true regarding sodium and mood disorders except A. Increased “residual sodium” found in some patients with depression B. Decreased “residual sodium” found in some patients with mania C. Increased sodium pump activity in the erythrocytes of drug-free manic patients D. Increased Na-K pump activity on recovery from depression E. Increased Na-K pump activity on recovery from mania 52. According to psychoimmunology, patients with depression are generally more prone to other illnesses because A. Patients with depression do not take care of themselves.', 'B. Patients with depression do not get adequate care because they have mental illness.', 'C. Antibiotics are not as effective in depressed patients compared to other patients.', 'D. Hypothalamic-pituitary-adrenal dysfunction causes immune suppression.', 'E. Replication of T cells is increased in these patients.']

Answer: D. Cyproterone acetate is used to reduce sex drive in men who have excessive sex drive and for the treatment of pronounced sexual aggression . It is also prescribed to treat severe hirsutism in women of childbearing age as well as to treat androgenic alopecia in women . Like cimetidine and other similar drugs, cyproterone acetate exerts its effect by blocking binding of dihydrotestosterone (DHT) to its receptors. Cyproterone acetate is found to be most effective in individuals with high testosterone and high sex drive, i.e., young people.

All of the following immunologic abnormalities are found in depression except

['A. Decreased natural killer cells', 'B. Decreased interleukin 2', 'C. Decreased absolute neutrophil count D. Decreased T-cell replication', 'E. Increased monocyte activity']

Answer: E. Lithium is eliminated almost entirely by the kidneys and does not undergo any hepatic metabolism. Therefore, there is no need for liver function tests. It is always better to get a baseline TSH, an ECG, and urea and creatinine tests. All women of childbearing age should also get a pregnancy test in view of the risk of cardiac defects to the fetus.

A 39-year-old man being treated for major depressive disorder complains of persistent sleep problems since the onset of depression. He is otherwise healthy and does not have any physical health problems. He is referred for a sleep study. The EEG is likely to show all of the following except A. Decrease in the total duration of deep sleep B. Increase in the total duration of REM sleep C. Decrease in the latency to the onset of REM sleep D. Increased latency to the onset of REM sleep E. Impaired sleep continuity 55. All of the following are found in brain imaging studies of persons with depression except

['A. Decreased volume of the parietal lobes B. Decreased volume of the frontotemporal lobes C. Decreased caudate size', 'D. Increased ventricular size', 'E. Decreased blood flow in the dorsolateral prefrontal cortex 56. The criterion for unintended weight loss used in diagnosis of depression is A. Loss of any amount of weight', 'B. Loss of 5% or more of the body weight in the past month C. Loss of 10% or more of body weight in the past month D. Loss of 10% of body weight in the past 2 weeks E. Loss of 5% of the body weight in the past 2 weeks 57. “Agitated depression” is a term more commonly used to describe depression in A. Young children', 'B. Adolescents', 'C. Adults', 'D. Women', 'E. The elderly']

Answer: D. This elderly patient has major depressive disorder, severe, with suicidal ideation. His deteriorating physical health is a real cause of concern and so is his severe suicidal ideation. To obtain response quickly, electroconvulsive treatment is a reasonable option in this patient.

All of the following are features of “atypical depression” except A. Intense, unstable emotions

['B. Increased appetite', 'C. Increased sleep', 'D. Mood reactivity', 'E. Rejection sensitivity']

Answer: A. Mirtazapine can cause neutropenia and agranulocytosis and should be used with caution in patients who are being treated with clozapine.

An obese 24-year-old woman is admitted to the psychiatry inpatient unit following an overdose of Tylenol. She has a history of being impulsive and on occasion has induced vomiting, but these instances were not frequent enough to warrant diagnosis of an eating disorder. Over the course of the next few days of observation, the psychiatrist determines that she is depressed and the treatment team debates over the choice of antidepressants.

['A. Mirtazapine', 'B. Bupropion', 'C. Venlafaxine', 'D. Citalopram', 'E. Amitriptyline']

Answer: B. In some cases, borderline personality disorder may be very difficult to distinguish from bipolar disorder. Intense mood swings are common in borderline personality, and persons with borderline personality do not have any sustained periods of normal mood in between episodes as seen in bipolar disorder. The patient in question has other traits of borderline personality, including unstable relationships, feelings of emptiness, and fear of abandonment.

What does the term “double depression” describe?

['A. Major depressive disorder superimposed on grief reaction B. Major depressive disorder superimposed on dysthymia C. Major depressive disorder not responding to treatment D. Major depressive disorder with psychosis E. Major depressive disorder with anxiety 61. How many categories of unipolar depressive disorder are listed by DSM-IV?', 'A. 4', 'B. 3', 'C. 6', 'D. 10', 'E. 5']

Answer: A. Of all the atypical antipsychotics, ziprasidone is known to cause prolongation of QT interval (prolonged QT interval predisposes to arrhythmias). Although all of the above are important observations to make in an ECG, QTc interval would be the most important.

According to DSM-IV, for a diagnosis of major depressive disorder, the symptoms should be present for a minimum of

['A. 2 months', 'B. 6 weeks', 'C. 4 weeks', 'D. 2 weeks', 'E. 6 months']

Answer: E. All the SSRIs with the exception of fluoxetine can cause discontinuation syndrome because of their short half-life . Norfluoxetine, the active metabolite of fluoxetine, has a half-life of 5 to7 days and “tapers off” on its own.

All of the following statements are true regarding mood disorders except A. The interepisode duration in bipolar I disorder increases as the illness progresses.

['B. The interepisode duration in bipolar I disorder decreases as the illness progresses.', 'C. The interepisode duration stabilizes at around 6 to 9 months after five or six episodes.', 'D. The average duration of an episode is about 6 months in recurrent depression.', 'E. Men have more manic episodes on average, and women have more depressed episodes on average.']

Answer: C. This patient is convinced that she has committed a sin and has guilt feelings about it. The feelings are mood congruent and the patient is not distressed by these thoughts and does not resist them. In patients who are depressed and delusional like this, a low-dose antipsychotic is often necessary.

A 34-year-old African American man is admitted to an inpatient psychiatry unit following a suicide attempt. The patient reports many symptoms consistent with major depressive disorder, including lack of interest, feelings of guilt, insomnia, and difficulty concentrating. He states that recently he has been hearing voices telling him that only he can save the world because he has a special gift from God. All of the following support a diagnosis of major depressive disorder, severe, except A. Voices telling him that he has a special gift B. Insomnia C. Fatigue

['D. Guilt', 'E. The suicide attempt']

Answer: B. Ideally, the light should resemble natural light and therefore 10,000 lux is recommended.

A 56-year-old woman is seen in a psychiatry outpatient clinic because she reports she is “not being able to function.” She reports feeling rejected all the time and complains of depressed mood. She also complains of lack of appetite and feeling of heaviness in the arms and legs. She reports sleeping up to 15 hours every day over the past few weeks. Her affect is observed to be reactive when she states that her mother is coming to see her in two weeks. The most appropriate diagnosis is A. Major depressive disorder, severe

['B. Borderline personality disorder', 'C. Major depressive disorder with atypical features D. Generalized anxiety disorder', 'E. Malingering']

Answer: D. Propranolol is a beta-blocker and in fact can worsen the depression. Pindolol is a 5HT1A antagonist and is used as an augmenting agent in conjunction with an SSRI.

A 24-year-old woman is referred to a psychiatrist by her primary care physician for assessment of depression. The mother of a 4-month-old infant, she reports feeling depressed for the past few weeks. The diagnosis of major depressive disorder with postpartum onset is made if the onset of symptoms is within how many weeks of delivery?

['A. 2 weeks', 'B. 8 weeks', 'C. 10 weeks', 'D. 6 weeks', 'E. 4 weeks']

Answer: E. There is a lot of evidence for the serotonin deficiency hypothesis of depression, including the effectiveness of SSRIs in its treatment.

According to DSM-IV, for a mixed manic episode, criteria for both major depressive disorder and mania should be present every day for A. 1 day

['B. 1 week', 'C. 1 month', 'D. 3 days', 'E. 2 months']

Answer: E. Deficiency of norepinephrine has long been thought to be the cause of depression. The efficacy of antidepressants, which specifically inhibit the reuptake of norepinephrine, supports this theory. There is no evidence relating to abnormal cAMP levels in CSF.

All of the following statements are true of the epidemiology of depression except

['A. The rates are equal in men and women after the age of 50 years.', 'B. Women are twice as affected as men between puberty and 50 years.', 'C. Girls are four times more affected than boys before puberty.', 'D. Point prevalence of depression is 2–3% for men and 5–9% for women.', 'E. Increased rates of depression have been observed over the past 4 to 5 decades.']

Answer: C. Primary hypersecretion of cortocotropin-releasing factor (CRF) by the hypothalamus results in increased secretion of ACTH, which in turn leads to elevated cortisol levels. There is no evidence to suggest there is primary hypersecretion of either ACTH or cortisol. Dexamethasone suppression test is positive in 50% of depressed patients and is secondary to increased cortisol levels.

All of the following are true about the course of a major depressive disorder except

['A. Five to 10 percent of persons with a single episode will eventually develop bipolar disorder.', 'B. Thirty percent of patients recover within 6 months with or without treatment.', 'C. The recurrence rate is high, especially after two or more episodes.', 'D. Sudden onset of depression is usually associated with a severe psychosocial stressor.', 'E. The interepisode interval is less with an increasing number of episodes.']

Answer: B. Increased “residual sodium” is observed in manic patients, too. The relationship between sodium levels and mood disorders is not well understood, but these are some of the abnormalities found.

All of the following antidepressants increase serotonin neurotransmission by reuptake inhibition except

['A. Mirtazapine', 'B. Venlafaxine', 'C. Fluvoxamine', 'D. Citalopram', 'E. Sertraline']

Answer: D. HPA axis dysfunction leads to increased cortisol level, which is thought to be responsible for various immune system abnormalities found in depression.

In what proportion of depressed patients does the dexamethasone suppression test reveal decreased cortisol or nonsuppression of cortisol?

['A. 50%', 'B. 30%', 'C. 80%', 'D. 20%', 'E. 100%']

Answer: C. Absolute neutrophil count is found to be normal in depressed patients. All the other abnormalities mentioned above are thought to be secondary to abnormal HPA axis.

According to lipid homeostasis theory, high levels of cholesterol are found in all of the following conditions except A. Generalized anxiety disorder

['B. Panic disorder', 'C. Obsessive-compulsive disorder', 'D. Major depression with increased risk of suicide E. Posttraumatic stress disorder']

Answer: D. In depressive disorder, there is a decrease in the latency to the onset of rapid eye movement (REM) sleep and an increase in the total duration of REM sleep. Slow-wave deep sleep is decreased, and patients do not feel refreshed when they wake up in the morning.

A 73-year-old woman with a diagnosis of major depressive disorder fails to respond to treatment with an SSRI. The psychiatrist discusses the option of starting a tricyclic antidepressant. The woman states that “anything” is fine except that she does not like to be sedated by medications. Which of the following tricyclic antidepressants is relatively less sedating?

['A. Doxepine', 'B. Amitriptyline', 'C. Trimipramine', 'D. Nortriptyline', 'E. Imipramine']

Answer: A. Brain imaging studies have shown no consistent abnormalities in the parietal lobes of patients with depression.

Which of the following is a reversible MAOI?

['A. Moclobomide', 'B. Tranylcypromine', 'C. Phenelzine', 'D. L-deprenyl', 'E. Maprotiline']

Answer: B. The weight loss criterion for depression specifies it to be 5% or more of the total body weight in the past month.

All of the following are side effects resulting from muscarinic receptor blockade of antidepressants except

['A. Orthostatic hypotension', 'B. Dry mouth', 'C. Constipation', 'D. Blurred vision', 'E. Urinary retention']

Answer: E. Depression tends to present differently in different people. Irritability may be the predominant symptom in adolescents, while agitation is a common symptom in the elderly.

All of the following cause or contribute to confusion and memory problems following electroconvulsive therapy except A. Prolonged seizures

['B. Old age', 'C. High-intensity stimulus', 'D. Inadequate oxygenation', 'E. Unilateral electrode placement']

Answer: A. Intense, unstable emotions are more characteristic of borderline personality disorder than atypical depression.

Which of the following accurately states the role of therapy in depression?

['A. Antidepressants are the treatment of choice in all severities of depression.', 'B. Cognitive-behavioral therapy (CBT) is the treatment of choice in all severities of depression.', 'C. CBT is as effective as antidepressants in the treatment of mild to moderate depression.', 'D. Combined treatment with cognitive-behavioral therapy and antidepressants is no better than either on its own.', 'E. Interpersonal therapy offers more rapid response than antidepressants.']

Answer: D. For a patient who is impulsive, amitriptyline, venlafaxine, or bupropion is not a good choice because of the risk of overdose. Mirtazapine can cause significant weight gain and therefore is not indicated when the patient is already obese. Citalopram is one of the SSRIs, which are relatively safe and effective antidepressants.

According to DSM-IV, one of the criteria for dysthymic disorder is that the patient should not be symptom free for more than a certain number of months in a 2-year period (or in a 1 year period in children or adolescents).

['A. 3 months', 'B. 2 months', 'C. 1 month', 'D. 6 months', 'E. 8 months']

Answer: B. Double depression refers to major depressive disorder superimposed on dysthymia.

In DSM-IV, the category of depressive disorder not otherwise specified (NOS) is used for all the following disorders except A. Minor depressive disorder

['B. Adjustment disorder with depressed mood C. Recurrent brief depressive disorder D. Premenstrual dysphoric disorder', 'E. Postpsychotic depressive disorder']

Answer: B. DSM-IV lists three categories of unipolar depressive disorders: major depressive disorder, dysthymia, and depressive disorder not otherwise specified (NOS).

In what percentage of euthyroid patients with major depression does TRH

['A. 15%', 'B. 5%', 'C. 10%', 'D. 25%', 'E. 1%']

Answer: D. DSM-IV specifies that five or more of the symptoms should be present for at least 2 weeks and one of the symptoms should be depressed mood or loss of interest or pleasure. Other symptoms are lack of appetite, weight loss or gain, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue or loss of energy, guilt, lack of concentration, suicide ideation, and suicide attempt.