According to ICD-10 criteria which of the following is considered to be the minimum required weight loss to be significant as a diagnostic criteria for somatic syndrome associated with depression?
D. Somatic syndrome is defined by a set of vegetative or biological features of depression. The ICD-10 criteria for somatic syndrome of depression require at least four symptoms from a list of eight. These are:
To diagnose anorexia nervosa, there must be a weight loss leading to a body weight at least 15% below the normal expected weight for age and height.
The prevalence of catatonic phenomenon among patients with schizophrenia is estimated to be around:
C. According to the International Pilot Study of Schizophrenia (World Health Organization 1973), 7% of 811 schizophrenia patients exhibited one or other catatonic phenomenon. Further studies that followed gave a figure of between 5% and 10%. Mannerisms are the most common catatonic phenomenon in schizophrenia, followed by stereotypies, stupor, negativism, automatism and echopraxia in order of frequency. About 10–15% of patients with catatonia meet the criteria for schizophrenia. It is widely appreciated that catatonic symptoms are more prevalent in the developing nations than in the West. When one includes all psychiatric patients, not just schizophrenia, the prevalence of catatonia increases to 10–20%. This is because depression contributes to most of the observed catatonia in practice. Immobility and mutism are the most commonly observed catatonic symptoms among depressed patients.
Seasonal affective disorder (SAD) is a popular concept but not formally considered as a separate category under current classificatory systems.
Which of the following statements is true with regard to this condition?
C. ICD-10 clinical guidelines do not include specific criteria for SAD. However, specific criteria are included in DSM-IV (Text Revision) and the research version of ICD-10. ICD-10 provisional criteria for SAD specifies the disorder as a subtype of mood disorder where three or more episodes must occur with onset within the same 90-day period of the year for three or more consecutive years; Remissions also occur within a particular 90-day period of the year. Seasonal episodes must outnumber any non-seasonal episodes that may occur. Familial risks of affective disorders in SAD are similar to those found in non-seasonal depressive illnesses. Typical depressive symptoms of SAD respond better to bright-light therapy whereas atypical symptoms respond to phototherapy at all intensities. In phototherapy retinal light exposure is important; skin absorption is not sufficient to modify circadian rhythms or depressive symptoms. Early-morning phototherapy is superior but leads to more side-effects, such as easy startle, gastrointestinal intolerance and headaches. Conventional antidepressants have also been reported to have a therapeutic effect in SAD.
The 1-year prevalence of dysthymia is estimated to be around:
C. Dysthymia has a 1-year prevalence of 1–3%. The lifetime prevalence according to the National Comorbidity Survey 1994 is 6%. Dysthymia has a high comorbidity with other psychiatric disorders, particularly major depression. In one series, only about 25–30% of cases were observed to occur over a lifetime in the absence of other psychiatric disorders. The comorbidity of personality disorders seems to be very high (60–80%). Early-onset dysthymia is defined as having onset before age 21.
The most powerful predictors of recurrence of depressive episodes among the following is:
A. Follow-up studies in depression reveal two powerful predictors of recurrence: the presence of residual symptoms after apparent recovery and history of previous episodes of depression. The presence of residual symptoms increases the risk of recurrence nearly threefold, whereas past history of depression doubles the risk, with each new episode increasing the risk further. Other possible risk predictors for recurrence include somatic syndrome, reversed vegetative signs, early age of onset, and family history of mood disorders. Recurrence risk is higher in bipolar than in unipolar mood disorders.
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