1. A 76-year-old male patient is admitted to an acute psychiatric unit for severe suicidal ideation. He admits to feeling hopeless and refuses to contract for safety. He has a history of noncompliance with treatment and is refusing to take any medicines. He has severe psychomotor retardation and stops eating and drinking. A reasonable choice of treatment in this patient would be:

2. A 22-year-old female is self-referred for an evaluation to rule out bipolar disorder. She complains of rapid mood swings with uncontrollable anger and irritability. During the assessment, it is noted that she has not had any sustained relationships for many years and feels empty. She fears abandonment by her friends and blames others for making her feel angry. What is the most important differential diagnosis in this patient?

3. A 56-year-old female is admitted to an acute psychiatric inpatient unit for severe depression. The patient was ruminating about suicide and guilt feelings that were distressing her. She is “convinced” that she has committed sin and deserved to be punished, although there was nothing in her history to justify this. The resident doctor thinks that the patient is obsessed with thoughts of guilt and feels that the patient has a primary obsessional disorder. A trial of antidepressant medication was not helpful despite trying a high dose. The attending physician explains that patient is not obsessional but severely depressed because:

4. A 62-year-old female with seasonal affective disorder prefers “nonmedical” treatment for depression. She tried cognitive behavioral therapy with limited success. She likes the idea of bright light therapy and is willing to spend 30 to 40 minutes every morning in front of the light therapy unit. For light therapy to be effective, the intensity of the light should ideally be:

5. All of the following support the norepinephrine deficiency hypothesis for depression except:

6. Several biomarkers were investigated for depression, but none of them had a high specificity. One of the consistent findings in depression, however, is abnormally elevated cortisol levels. This is thought to be secondary to:

7. A 56-year-old male with a history of chronic recurrent depression is bothered by a recent news article that mentions increased mortality in patients with depression because of increased incidence of a variety of health problems and infections. He would like to know if this is true. According to the psychoimmunology theory, the higher incidence of infections and other chronic conditions is because:

8. Research in subjects with depression has revealed several immunological abnormalities that are in turn responsible for increased morbidity and mortality. All of the following findings are true except:

9. A 63-year-old male with major depressive disorder complains of difficulty falling asleep and early morning awakenings. He is otherwise healthy and does not have any physical health problems. He is referred for a sleep study. The sleep architecture in this patient is likely to show all of the following except:

10. Brain imaging studies in depression have revealed some interesting facts that have enhanced our understanding of the pathophysiology of depression. All of the following were found in brain imaging studies in subjects with depression except:

11. One of the criteria for the diagnosis of major depressive disorder is weight loss that is unintentional. The criteria for weight loss specify that:

12. The manifestation of depression symptoms are slightly different in different age groups and also in men and women. Agitated depression is a term more commonly used to describe depression in which group of patients?

13. A 32-year-old female presents with low mood and lack of interests. After careful history and extensive collateral information, the treating psychiatrist makes a diagnosis of atypical depression. All of the following are the features of atypical depression except: