Psychiatry Mcqs 2

1. Re: NICE guidelines on depression
  1. Mild depression antidepressants (ADs) are the first line treatment
  2. Dysthymia antidepressants are effective
  3. Antidepressants are recommended for moderate to severe depression
  4. In severe depression antidepressants or CBT is recommended
  5. Patient with one episode of depression with functional impairment should receive prophylaxis for 2 years
2. NICE guidelines on treatment resistant depression
  1. Combination of antidepressants are supported
  2. Augmentation with lithium is not useful
  3. ECT is recommended
  4. Augmentation with antipsychotic is recommended
3. Re: Treatment of depression
  1. People with depression are at increased risk of cardiovascular disease
  2. 2/3rd of patient who have a single episode of depression will go on to have another episode of depression
  3. Dose for prophylaxis – Adults should receive the same dose as used for acute treatment
  4. Lithium also has some efficacy in the prophylaxis of unipolar depression
  5. Patients with more than two episodes are recommended 2 years prophylactic treatment
4. Re: Treatment of depression
  1. Poor response at 2 weeks predicts no response in the future for that drug
  2. If there is poor tolerability switching between drug classes is a good option
  3. If there is non-response switching to another drug in the same class will not have any effect
  4. A single episode of depression has be treated for at least 6-9 months after full remission
  5. 50% of patients will relapse if treatment is discontinued on remission

5. True/False

  1. Relapse rates after ECT is lesser than after ADs
  2. In the elderly a lower dose of AD may be used in prophylaxis than what was used in acute treatment
  3. Each episode of depression increases the chances of having another episode
  4. Schizophrenia increases the possibility of having depression

Answers                                                                                                        

1. Re: NICE guidelines on depression
  1. Mild depression antidepressants (ADs) are the first line treatment – F, Not recommended, active monitoring, individual guided self help, CBT, exercise
  2. Dysthymia antidepressants are effective – T
  3. Antidepressants are recommended for moderate to severe depression – T, first line – SSRI
  4. In severe depression antidepressants or CBT is recommended – F, ADs and CBT is recommended
  5. Patient with one episode of depression with functional impairment should receive prophylaxis for 2 years – F, if the patient had 2 episodes 2 years are recommended
2. NICE guidelines on treatment resistant depression
  1. Combination of antidepressants are supported – T
  2. Augmentation with lithium is not useful – F, useful recommended
  3. ECT is recommended – T
  4. Augmentation with antipsychotic is recommended – T
3. Re: Treatment of depression
  1. People with depression are at increased risk of cardiovascular disease – T
  2. 2/3rd of patient who have a single episode of depression will go on to have another episode of depression – T
  3. Dose for prophylaxis – Adults should receive the same dose as used for acute treatment – T, in the elderly the dose may be reduced
  4. Lithium also has some efficacy in the prophylaxis of unipolar depression – T, but should not be used as a single agent. May be used in combination with a AD
  5. Patients with more than two episodes are recommended 2 years prophylactic treatment – T
4. Re: Treatment of depression
  1. Poor response at 2 weeks predicts no response in the future for that drug – T, Taylor et al, 2006, meta analysis
  2. If there is poor tolerability switching between drug classes is a good option – T, but not much evidence
  3. If there is non-response switching to another drug in the same class will not have any effect – F, some evidence
  4. A single episode of depression has be treated for at least 6-9 months after full remission – T
  5. 50% of patients will relapse if treatment is discontinued on remission – T, within 3-6 months

5. True/False

  1. Relapse rates after ECT is lesser than after ADs – F, Similar, thus need prophylaxis with ADs
  2. In the elderly a lower dose of AD may be used in prophylaxis than what was used in acute treatment – T, but not recommended for adults
  3. Each episode of depression increases the chances of having another episode – T, through kindling
  4. Schizophrenia increases the possibility of having depression – T, all non-affective illness increase possibility

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