How long does the natural course of an episode of untreated mania last?
B. In its natural course untreated depression lasts for 6 months while untreated mania lasts for about 4 months. So it is important that the therapy continues throughout this period as an absolute minimum. A manic episode by definition must meet a duration criteria of at least 1 week, or less if a patient must be hospitalized. A hypomanic episode must last at least 4 days. It is thought that as time goes, the intervals between episodes shorten, and the episodes themselves increase in duration. In a lifetime, patients with bipolar illness can have more than 10 episodes (both mania and depression) with duration and interepisodic interval stabilizing after the fourth or fi fth episode.
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Which of the following is NOT a part of ICD-10 somatic syndrome of depression?
D. ICD-10 somatic syndrome includes:
At least four symptoms must be definitely present to diagnose somatic syndrome.
A 32-year-old lady is incapacitated by recurrent panic attacks. She feels low and cannot leave her home, leading to loss of interest in leisure activities. She feels guilty for not being a good mother for her 12-year-old son as she finds routine housework extremely demanding.
This description best fits which of the following diagnosis?
A. The most appropriate diagnosis for this lady would be depressive disorder. According to the hierarchical organization of diagnoses, depression will trump a diagnosis of anxiety disorder. In this case, all of the mentioned features are well accounted for by depression itself. This lady fulfills two major criteria required for the diagnosis of depression. A diagnosis of mixed anxiety and depression is not coded in ICD-10.
Which of the following is incorrect with regard to social phobia?
B. Social phobia is characteristically more pronounced in smaller group setting where close scrutiny and criticism are more likely. The age of onset is around 15, much younger than other phobias. Blushing is seen as a part of anxiety symptoms in social phobia. In some cases a fear of losing control and vomiting in public is noted. Avoidance of group settings may lead to impaired social performance.
Which of the following is the endocrine abnormality most commonly seen in depression?
A. Hypercortisolaemia is seen in nearly 50% of those with major depression. This is evident by measuring excretion of urinary-free cortisol or salivary cortisol. It is posited that the normal feedback inhibition of ACTH and CRH by cortisol is disturbed due to abnormal glucocorticoid receptors, leading to high persistent cortisol levels. Dexamethasone administration (DST) fails to stimulate the feedback loop and so fails to suppress the cortisol level. This is one of the most consistent and robust findings in depression. But it is not specific to depression – it is also noted to some extent in mania, schizophrenia, dementia, and other psychiatric disorders.
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