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Management of Major Depressive Disorder in Prison Populations

Introduction

1. Depression can be precipitated or exacerbated by which medication?

A. Steroids

B. Narcotics

C. Interferon

D. All of the above


Screening

2. Simple screening methods have proven highly sensitive for detecting depression in the primary health care setting, therefore, a negative screening interview rules out the presence of a depressive disorder.

A. True

B. False


Elements of Successful Treatment

3. All current medication treatments for depressive disorders require weeks of therapy before a significant clinical response is achieved.  During this period of waiting for a clinical response, inmates must continue to tolerate the painful symptomatology, while adhering to an inconvenient medication regimen.

A. True

B. False


4. Treatment of _____ depressive disorder should be initiated by a physician who is experienced in managing depression.

A. Mild

B. Moderate

C. Severe

D. All of the above


5. Consultation with a psychiatrist should be considered on a case-by-case basis, particularly for inmates:

A. With suicidal ideation, psychotic symptoms, catatonia, mania, severe functional decompensation, or other signs of severe depression.

B. With refractory depression after completing an adequate trial of medications.

C. Already receiving psychotropic medications for another mental health condition.

D. All of the above.


Treatment During Acute, Continuation, and Maintenance Phases

6. Which of the following is the primary treatment for inmates with moderate to severe depression?

A. Medications

B. Electroconvulsive therapy

C. Psychotherapy

D. All of the above


7. Which of the following is an FDA-approved treatment for refractory depression?

A. Transcranial Magnetic Stimulation

B. Vagus Nerve Stimulation

C. Both (A) and (B)

D. None of the above


8. During the continuation phase, antidepressant medication should be continued at the same dose that was used in the acute phase.

A. True

B. False


9. If the inmate was taking an antidepressant for at least 8 weeks and was compliant, the antidepressant should be tapered to discontinuation over approximately 4 weeks or longer.  The exception to this recommendation is paroxetine, which has a long half-life and does not require tapering.

A. True

B. False


Medications

10. Which of the following can be abused for their anticholinergic and antihistaminic side effects?

A. SSRIs

B. TCAs

C. SNRIs

D. All of the above


11. Which of the following can increase the risk of bleeding by decreasing platelet aggregation?

A. SSRIs

B. TCAs

C. SNRIs

D. All of the above


Treatment During Pregnancy

12. Tapering antidepressants over the last few weeks of pregnancy should be considered, since mild neonatal withdrawal syndromes have been seen in infants exposed to fluoxetine, paroxetine, sertraline, and tricyclics.

A. True

B. False


Appendix 2: Medical Conditions Associated with Depression

13. Deficiencies of all of the following may cause or present as depression, except for:

A. B12 or folate

B. B6

C. Niacin

D. Thiamine


Appendix 7: Food to Avoid During Treatment with MAOIs

14. Which of the following should be avoided during treatment with MAOIs?

A. Cheddar, swiss, parmesan, and mozzarella cheeses

B. Orange pulp

C. Packaged soup

D. All of the above


Appendix 8: Drug Washout Times Between Antidepressant Trials

15. What is the minimum washout period when changing from one MAOI to another MAOI?

A. None

B. 2 - 5 days

C. 2 weeks

D. 5 weeks


Appendix 9: Frequently Asked Questions about Depression

16. Depression can contribute to all of the following health problems, except for:

A. Peripheral neuropathy

B. Itching

C. Blurred vision

D. Excessive sweating


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