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Part II ISQ Club - Mood

35 posts in this topic

Part II ISQs will be posted regularly. You are encouraged to post a reply in the thread, stating whether you think an ISQ is true or false and why (eg. a short explanation, with reference to the textbook you used). Please only deal with one ISQ in each post and include the question as the first line of your post.

In a few days this ISQ Club thread will be moved to the Question Bank board. If you submit an answer, your status will be changed to 'Question Bank member' and you will be able to see the Question Bank board. Please allow up to 48 hours for this change to happen.

1. Lower social classes are more likely than middle social classes to develop depression following a life event.

2. Exit life events have been shown to be more common than enter life events in depression.

3. Platelet 5HT binding is decreased in depression.

4. Imipramine and ECT work synergistically.

5. Imipramine and MAOIs are equally effective in treating severe depression.

6. Imipramine and CBT are equally effective in treating moderately severe depression.

7. Kraeplin’s mixed state includes depression with flight of ideas.

8. Heritability for bipolar disorder is 65%.

9. One third of old age depression becomes chronic and unremitting in nature.

10. A third of late onset depresson in the elderly follow a non remittent and poor prognosis course.

11. Amitriptyline in old age depression is associated with decreased REM sleep.

12. Amitriptyline in old age depression is associated with decreased non-REM sleep.

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3. Platelet 5HT binding is decreased in depression.

FALSE, it is possibly increased:

Increasing evidence of an association between depressive disorders and coronary artery disease makes it important to ascertain the strength of this association because of the important practical health implications. Therefore, researchers have assessed both the persistence of this relation over time and its magnitude. In most patients with coronary artery disease, depressive disorders do not appear to be a transient adjustment to a major illness, but rather a clinically significant comorbid disorder that is often chronic. Moreover, recent studies have shown that among individuals with coronary artery disease, women appear to have a higher prevalence of depressive disorders than men. The impact of depressive disorders on poor outcome of coronary artery disease appears to equal or exceed that of other well-known cardiovascular risk factors. Current explanations for this relation include biological correlates related to sympathetic activity and autonomic dysregulation, neuroendocrine-immunological interactions producing cytokine-mediated coronary artery occlusion including serotonin-mediated platelet aggregation, and behavioral factors related to the effect of depression on cardiac treatment adherence. The importance of aggressive treatment of depression in coronary artery disease is clear, and research examining treatment benefits and prevention strategies is under way.

KS CTP Ch 25.1

Also from http://www.ipa-online.org/ipaonlinev3/publications/bulletinarchive/bul_vol21_2_june_ra.asp

SSRI’s and clotting

It is well known that patients who have coronary events and who are depressed have higher mortality than those without depression. But why should this be? Serebruany et al (Circulation, 2003;108: 939-944) examined 184 patients from the “SADHART” trial and from a platelet substudy. Patients had been treated either with a placebo or sertraline. These patients were on average in their late fifties, but included some older people. Of eight biomarkers of platelet and endothelial function, two were markedly different in the two groups. This suggested that those treated with sertraline had reduced platelet aggregation, which was all the more surprising given that many of the patients were on already on aspirin and/or anti-thrombotic treatment. The authors speculate that drugs such as sertraline, and other SSRIs, exert their effect by influencing platelet 5HT binding and possibly collagen-induced platelet secretion, an important component of the clotting cascade. This is a different mechanism from drugs such as aspirin, dipyridamole and clopidogrel. Importantly, SSRIs may now be the treatment of choice for mood disorders in the setting of cardiovascular disease.

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3. Platelet 5HT binding is decreased in depression. TRUE

I found the following in 'Clinical Psychopharmacology' (GASKELL), p.237:

...The indoleamine theories of depression centre on abnormal serotonin function at the synaptic level and include the possibility of altered 5- HT reuptake.

The platelet is rich in serotonin, which is captured by similar reuptake mechanisms.

Studies suggest that the speed of 5- HT uptake into the platelet (Vmax) may be reduced in depressed patients.

ECT normalises this reduction in Vmax. ::)

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4. Imipramine and ECT work synergistically. TRUE ???

Question is unclear though. Synergistically regarding what? Re mania? Then FALSE. Re depression? Probably TRUE. Or is this question aiming at the seizure threshold?

Little is known about the combined effects of TCA's and ECT on seizure threshold. Although TCA's lower the seizure threshold in some patients, there is little evidence that they have a clinically significant effect on seizure threshold on ECT. (ECT Guidelines RCP)

RE 5- HT:

Acute changes in ECT:

The plasma conc. of the main metabolite of 5-HT (5-hydroxy-indole-acetic acid), is not altered. No data on 5-HT itself.

After a course of ECT:

ECT normalises the reduction of 'uptake speed' into the platelets. See Q 3. above

( Clin. Phsychopharm., GASKELL)

But: Is that what the question is about? :-/

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3. Platelet 5HT binding is decreased in depression.  TRUE

I found the following in 'Clinical Psychopharmacology' (GASKELL), p.237:

...The indoleamine theories of depression centre on abnormal serotonin function at the synaptic level and include the possibility of altered 5- HT  reuptake.

The platelet is rich in serotonin, which is captured by similar reuptake mechanisms.

Studies suggest that the speed of 5- HT uptake into the platelet (Vmax) may be reduced in depressed patients.

ECT normalises this reduction in Vmax.   ::)

You're right, thanks. I had platelet aggregation in mind. A lesson to keep focused on the question and not get lost in the reading.

Zoran

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11. Amitriptyline in old age depression is associated with decreased REM sleep. TRUE

TCA's have profound effects on sleep:

-They decrease the number of awakenings,

-increase stage- 4 sleep,

-increase the latency to onset and reduce the duration of REM sleep.

(Clin. Psychopharm. , GASKELL, p.160)

No specific effects for elderly mentioned..... ::)

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Ques 5 - FALSE

The MRC multi centre double blind RCTtrial (1965 BMJ) clearly showed that imipramine was more effective than phenelzine. Phenelzine was shown to be as effective as placebo. critism of the trial was that phenelzine does were too low

ref : Exam notes in psychiatry, Buckley

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Ques 5 - FALSE

The MRC multi centre double blind RCTtrial (1965 BMJ) clearly showed that imipramine was more effective than phenelzine. Phenelzine was shown to be as effective as placebo. critism of the trial was that phenelzine does were too low

ref : Exam notes in psychiatry, Buckley

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Hi Zoran,

....happens to me too. But I'm sure your research was useful anyway, you never know what other strange questions they will come up with in the basic sciences ISQ's... ;)

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Ques 5 - FALSE

The MRC multi centre double blind RCTtrial (1965 BMJ) clearly showed that imipramine was more effective than phenelzine. Phenelzine was shown to be as effective as placebo. critism of the trial was that phenelzine does were too low

ref : Exam notes in psychiatry, Buckley

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12. Amitriptyline in old age depression is associated with decreased non-REM sleep. FALSE

They increase stage 4 sleep. See my answer to Q 11. wt. ref.

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12. Amitriptyline in old age depression is associated with decreased non-REM sleep. FALSE

They increase stage 4 sleep. See my answer to Q 11. wt. ref. :lol:

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2. Exit life events have been shown to be more common than enter life events in depression. TRUE

....and what are 'enter life events' anyway? ? ? :P

Studies using the LEDS (Life Event and Difficulty Schedule) have reported that it is threatening events that are predominantly associated with depression,

but other workers using different terminologies (e.g. Paykel et al., 1969) have found that 'EXIT' events such as DEATH of a loved one or DEPARTURE by some other means such as divorce, or events that are in some other way undesirable, are most strongly associated with depression.

(Surprised anyone?) :o

('Essentials of Postgrad. Psych.', Murray, Hill, Mc Guffin; 3rd editn, Cambridge. p334)

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You're right again, Doppel :) If we're lucky they might even ask about platelet aggregation etc ... Plus I can't wait next time I'm seeing an overdose to explain to the medics the rationale and significance of properly treating depression in their cardiac patients :D. I just hope that on the exam I don't misread the questions.

It's time to go to bed, I'm seeing double, even treble messages here!

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8. Heritability for bipolar disorder is 65%. FALSE

The Heritability for bipolar disorder is 85%.

If the monozygotic twin has bipolar there is a 40% risk of bipolar & a 27% chance of unipolar. if monozygotic twin has unipolar depression there is a 44% chance of unipolar depression & but only 5% chance of bipolar.

(McGuffin Arch Gen Psych 2003) ;)

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7. Kraeplin’s mixed state includes depression with flight of ideas.

TRUE

1: World J Biol Psychiatry. 2004 Apr;5(2):107-13. Related Articles, Links

Validating Kraepelin's two types of depressive mixed states: 'depression with flight of ideas' and 'excited depression'.

Akiskal HS, Benazzi F.

International Mood Center, University of Californai at San Diego, and VA Psychiatry Service CA 92161, USA. hakiskal@ucsd.edu

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1. True - people from lower social classes are more likely to develop depression after a life event compared with those from higher social classes. This is likely to be due to these individuals having less social support etc. This group are also more likely to experience negative life events.

Companion to Psychiatric Studies (p.429)

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3. False - abnormalities in serotonin receptor function have been put forward as part of the pathophysiology of depressive illness. Limited support for this hypothesis has been found in studies of [3H] serotonin binding to platelets and [3H] spiroperidol binding to cortical tissue in suicide victims. The hypothesis has been extended to involve increased release of serotonin acting upon hypersensitive postsynaptic receptors.

Companion to Psychiatric Studies (p. 58)

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4. True - ECT and imipramine work synergistically in the treatment of depression.

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5. True - patients who fail to respond to TCAs may respond to MAOIs. The previous reputation of these compounds for lack of efficacy resulted from the use of too small a dose in influential trials (MRC 1965).

Companion to Psychiatric Studies (p.439)

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6. False - trials in primary care have tended to suggest a benefit from CBT in depression, although most patients recover however treated.

For more severe depressive illness there is reasonable evidence from a large NIMH multicentre trial (Elkin et al 1995) that cognitive therapy is not particularly helpful in the acute treatment phase.

The tentative finding that patients failing CBT respond to Imipramine underlines the conclusion that severe depressive illness is best treated with an effective antidepressant.

Companion to Psychiatric Studies (p.440)

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7. True - Kraepelin maintained that mood, cognition and behaviour may vary independently, producing mixed affective states which are usually transitional, but are sometimes persistent. The 2 types of mixed depression cited are depression with flight of ideas and excited depression.

Revision Notes in Psychiatry (p.270)

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8. False the heritability for bipolar disorder is 85%.

Manchester Course

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9. True - Before the introduction of ECT, many depressive disorders in the elderly lasted for years. Nowadays considerable improvement within a few months can be expected in about 85% of admitted patients; the remaining 15% do not recover completely. However, long-term follow-up shows a less encouraging picture. Post (1972) reported that patients who recovered in the first few months fell into three groups:

1) 1/3 remained completely well for 3 years

2) 1/3 suffered further depressive disorders with complete remissions

3) 1/3 developed a state of chronic invalidism punctuated by depressive disorder.

Shorter Oxford Textbook (p.630)

10. True

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