A patient is taking St John’s wort for depressive symptoms.
Which of the following drugs would be contraindicated?
Correct Answer A:
St John’ wort is an herbal medicine used in the treatment of depression. St. John's wort contains substances that appear to have an antidepressant effect. Although the exact causes of this potential interaction are not understood, the antidepressant effects of drugs like phenelzine may be increased, decreased, or erratic when taken at the same time that St. John's Wort is being used. In general, it is not advisable to use St. John's wort or any other herbal supplement while one is taking phenelzine.
Which of the following is not a symptom of barbiturate withdrawal?
Correct Answer B:
Barbiturates are prescribed as anticonvulsants, sedatives, and general anesthetics. They can also mimic some of the characteristics of alcohol intoxication (including euphoria, elation, and uninhibited behavior), which make them candidates for abuse. These drugs depress the respiratory and nervous system functions, and because abusers rapidly build up a tolerance to the effects of the drug, fatal overdose or coma can easily occur.
Symptoms of withdrawal syndrome appear 12-20 hours after the last dose, they include anxiety, irritability, elevated heart and respiration rate, muscle pain, nausea, tremors, hallucinations, confusion, and seizures. Death is a possibility if the condition is left untreated. Major withdrawal symptoms (convulsions and delirium) may occur within 16 hours and last up to 5 days after abrupt cessation of these drugs.
Psychotherapy is superior to medication in the management of:
Correct Answer D:
Dysthymia is defined as low-level or subthreshold depressive symptoms. Symptoms typically begin insidiously during adolescence and follow a low-grade course over many years or decades (diagnosis requires a course of ≥ 2 years). Dysthymia may intermittently be complicated by episodes of major depression. Affected patients are habitually gloomy, pessimistic, humorless, passive, lethargic, introverted, hypercritical of self and others, and complaining.
Both cognitive behavior therapy and interpersonal psychotherapy have been demonstrated in controlled studies to be effective in the treatment of depression and dysthymia.
A 27-year-old woman seeks evaluation for her "depression" in an out-patient clinic. She reports episodic feelings of sadness since adolescence. Occasionally she feels good, but these periods seldom last more than 2 weeks. She is able to work but thinks she is not doing as well as she should. In describing her problems she seems to focus more on repeated disappointments in her life and her low opinion of herself than on discrete depressive symptoms.
In your differential diagnosis at this point, which one of the following is the most likely diagnosis?
Correct Answer E:
A patient with low-level or subthreshold depressive symptoms is classified as having dysthymia. Symptoms typically begin insidiously during adolescence and follow a low-grade course over many years or decades (diagnosis requires a course of ≥ 2 year); dysthymia may intermittently be complicated by episodes of major depression. Affected patients are habitually gloomy, pessimistic, humorless, passive, lethargic, introverted, hypercritical of self and others, and complaining.
Which one of the following is true regarding dysthymic disorder?
Correct Answer C:
Dysthymic disorder, also known as dysthymia, is a depressive disorder characterized by mild to moderate symptoms with a duration of 2 or more years. It has an insidious onset and a waxing and waning course. There is a strong association between dysthymia and other psychiatric disorders (especially major depression, personality disorders, and social phobia) and medical conditions (cerebrovascular accidents, multiple sclerosis, AIDS, premenstrual syndrome, hypothyroidism). Long-term treatment with selective serotonin reuptake inhibitors is often necessary.
→ Antidepressants are effective in treating dysthymia.
→ A systematic review of epidemiologic studies found that 46-71% of persons with dysthymia reported remission at follow-up points ranging from 1-6 years.
→ Dysthymic disorder is characterized by a chronic course and an insidious onset.
→ By definition, dysthymia has a duration of at least 2 years in adults and 1 year in adolescents and children. To diagnose dysthymia, any major depressive episodes must not have occurred in the first 2 years of the illness (the first 1 year in children) and history of mania should not exist.
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