The most appropriate definition of agoraphobia is:
Correct Answer D:
Agoraphobia is a fear of being in places where it may be difficult or embarrassing to get out quickly or where you may have a panic attack and can't get help. Commonly feared places and situations are elevators, sporting events, lines, bridges, public transportation, driving, shopping malls and airplanes. The fears can be so overwhelming that some people are essentially trapped in their own homes, it's the only place they feel truly safe, so they don't venture out into public at all.
The other choices describe claustrophobia, arachnophobia and acrophobia respectively,(E) Ophidiophobia.
Depression is associated with which of the following sleep patterns?
Correct Answer A:
A normal sleep cycle involves five stages of sleep: rapid-eye movement, or REM, and four non-REM stages. During REM sleep, the brain is about as lively as when it's awake, and the body burns lots of energy. In non-REM sleep, the brain slows down and the body conserves energy. Healthy people alternate between REM and non-REM sleep throughout the night.
Normally, the first REM cycle begins about 90 minutes after falling asleep, but in a depressed sleeper, it may begin after just 60 minutes. A person who enters REM too early will cut short the deep sleep, necessary for biological restoration and repair, that precedes the first REM cycle.
A 19-year-old male complains of a six month history of excessive irritability, increased desire to sleep, demoralization, and difficulty focusing attention on tasks. He feels his energy level is decreased and is no longer interested in playing basketball he used to enjoy.
Which one of the following is the most likely diagnosis?
Depressive disorders (choice D) in children and adolescents are characterized by a pervasive and abnormal mood state consisting of sadness or irritability that is severe or persistent enough to interfere with functioning or cause considerable distress. Decreased interest or pleasure in activities may be as or even more apparent than the mood abnormalities.
Common symptoms include a sad appearance, excessive irritability, apathy and withdrawal, reduced capacity for pleasure (often expressed as profound boredom), feeling rejected and unloved, somatic complaints (eg, headaches, abdominal pain, insomnia), and persistent self-blame. Others include anorexia, weight loss (or failure to achieve expected weight gain), sleep disruption (including nightmares), despondency, and suicidal ideation. Diagnosis is by history and examination. Treatment is with antidepressants, psychotherapy, or both.
→ Schizoid personality disorder (choice A) is characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness. People with schizoid personality disorder, can be hard working, ambitious, and participate in productive and competitive activities, interests that are likely to be lost in depressed patients.
→ Somatization disorder (choice B) is characterized by recurring, multiple, clinically significant complaints about somatic symptoms. Symptoms often include reports of pain, gastrointestinal distress, sexual problems, and pseudo-neurological symptoms such as amnesia or breathing difficulties. Patients may undergo expensive surgical procedures only to find no pathological abnormalities.
→ Generalized anxiety disorder (choice C) is characterize by excessive worry about everyday matters such as health issues, money, death, family problems, friendship problems, interpersonal relationship problems, or work difficulties that interfere with daily functioning.
→ Chronic fatigue syndrome (choice E) presents with malaise after exertion; un-refreshing sleep, widespread muscle and joint pain, sore throat, headaches of a type not previously experienced, cognitive difficulties, chronic and severe mental and physical exhaustion,and other characteristic symptoms in a previously healthy and active person.
A 72-year-old woman enters the hospital having lost 7 kg and saying she has no interest in eating. Her physical examination and laboratory findings are normal. She has been awakening at 5 a.m. for several months and cannot fall back to sleep. She says she has been feeling anxious and helpless since her husband died 3 years ago.
Which one of the following is a reasonable medication to prescribe for her?
Correct Answer B:
Many people with depression cannot experience emotions, including grief, joy, and pleasure, in a normal way; in the extreme, the world appears to have become colorless and lifeless. Thinking, speech, and general activity may slow down so much that all voluntary activities stop. Depressed people may be preoccupied with intense feelings of guilt and self-denigration and may not be able to concentrate. They may experience feelings of despair, loneliness, and low self esteem. They can be withdrawn, speak little, stop eating, and sleep little. They are often indecisive and withdrawn, feel progressively helpless and hopeless, and think about death and suicide.
Selective serotonin reuptake inhibitors (SSRIs) (eg Fluoxetine (Prozac), Sertraline (Zoloft), Paroxetine (Paxil), Escitalopram (Lexapro), Citalopram (Celexa))) are now the most commonly used class of antidepressants. SSRIs are effective in treating depression and dysthymia as well as other mental health disorders that often coexist with depression. Although SSRIs can cause nausea, diarrhea, tremor, weight loss, and headache, these side effects are usually mild or go away with continued use. Most people tolerate the side effects of SSRIs better than the side effects of tricyclics. SSRIs are safer than the tricyclics in their side effects on the heart.
A 61-year-old man who manages his own accounting firm has a 5-year history of malignant melanoma that has been treated with local excision and immunotherapy. He now is admitted to the hospital for evaluation of constant pain in his back and left hip and an 11 kg (24 lb) weight loss. He and his wife of 35 years are worried that "the cancer may be back." Pelvic and abdominal CT scans show multiple bony metastases. He tells you, "I just want to die. I can't bear this."
Which of the following symptoms would be most suggestive of a major depressive syndrome?
Correct Answer E:
There is no question that anorexia, expressions of discouragement, insomnia, and low energy are symptoms of depression. Expressions of discouragement are less intense than the hopelessness seen in major depression. However, as patients become more depressed, they cling even tighter to the family for support, and become more dependent on them, making withdrawal from the family more significant. In addition, anorexia, insomnia, and low energy may be secondary to the malignant melanoma. As the support of family members is the mainstay of most terminally ill patients, withdrawal from this support would be strong evidence of depression, or possibly even of suicidal intent. All of the rest are either appropriate behaviors or could be the side effects of the disease or treatment, such as low energy, insomnia, or anorexia.
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