Luc's family comes home one evening to find him extremely agitated, and they suspect he is in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting?

Correct Answer: D

Rationale: During a manic episode, individuals often exhibit symptoms such as hyperactivity, decreased need for sleep, and excessive involvement in activities that can have harmful consequences, such as overconsumption of stimulants like energy drinks. Energy drinks are particularly relevant here because they contain high levels of caffeine and other stimulants, which can exacerbate manic symptoms or even trigger manic episodes in susceptible individuals. The presence of multiple empty energy drink containers would strongly suggest that Luc has been consuming large quantities of these beverages, aligning with the behavioral patterns seen in mania. This makes option D the most plausible answer, as it directly connects the clinical presentation (agitation, hyperactivity) with a common behavioral correlate of mania. Option A (hypodermic needles) is unlikely because while substance abuse can occur during manic episodes, hypodermic needles are more associated with intravenous drug use, which is not specifically tied to the symptoms described. Mania is more commonly linked to stimulant consumption in less invasive forms, such as energy drinks or caffeine pills, rather than injectable drugs. Additionally, the scenario does not mention any signs of intravenous drug use, such as track marks or drug paraphernalia beyond what is on the desk. Option B (fast food wrappers) is incorrect because while poor dietary habits can occur during manic episodes due to impulsivity or neglect of self-care, fast food wrappers are not a direct indicator of manic behavior. They might suggest disordered eating or lack of meal planning, but they do not specifically correlate with the heightened energy and stimulant use characteristic of a manic episode. The question focuses on a behavior (counting items) that is more likely tied to a direct contributor to the agitation, such as stimulant consumption. Option C (empty soda cans) is less likely than energy drink containers because while soda does contain caffeine, the levels are significantly lower than in energy drinks. Soda consumption does not typically lead to the extreme levels of stimulation or agitation seen in full-blown mania. Energy drinks, on the other hand, often contain not only high caffeine levels but also additional stimulants like taurine or guarana, which are more likely to precipitate or worsen manic symptoms. The medic would be more inclined to count energy drink containers as they are a more salient clue to the patient's condition. In summary, the correct answer is D because energy drink containers are the most direct evidence of stimulant overuse, which is a common and clinically relevant behavior during manic episodes. The other options either lack specificity (fast food wrappers, soda cans) or are unrelated to the typical presentation of mania (hypodermic needles). The rationale hinges on the direct link between energy drink consumption and the exacerbation of manic symptoms, making it the most logical choice for what the medic would be counting.

Correct Answer: A

Rationale: Questions about anxiety management, disordered eating, and alcohol use are relevant to identifying comorbid conditions with major depressive disorder, but the question 'Do rules apply to you?' does not directly address common comorbid mental health conditions associated with major depressive disorder.

Correct Answer: A

Rationale: **Rationale:** **Correct Answer (A): Conducting routine suicide screenings at a senior center.** Suicide risk is a critical concern in older adults with major depressive disorder (MDD), as this population has one of the highest suicide rates, particularly among older white males. Depression in older adults is often underdiagnosed due to overlapping symptoms with medical conditions or the misconception that sadness is normal in aging. Routine suicide screenings proactively identify at-risk individuals, allowing for timely interventions such as therapy, medication, or social support. This approach addresses a life-threatening complication of MDD and aligns with evidence-based practices for geriatric mental health. By contrast, the other options either perpetuate myths or overlook actionable strategies. **Incorrect Answers:** **B: Identifying depression as a natural, but treatable outcome of aging.** This choice is problematic because it reinforces the harmful stereotype that depression is an inevitable part of aging. While older adults face unique stressors (e.g., chronic illness, bereavement), depression is never "natural" and always warrants clinical attention. Framing it as such may discourage individuals from seeking help, exacerbating isolation and untreated symptoms. Effective interventions must challenge this myth and emphasize depression as a medical condition requiring targeted treatment, not a normative experience. **C: Identifying males as at a greater risk for developing depression.** This is factually incorrect. While older males have higher suicide *completion* rates, women are statistically more likely to *develop* depression due to biological, hormonal, and social factors. Misidentifying risk groups could lead to inadequate screening for women or misplaced focus in prevention efforts. Accurate risk assessment must distinguish between prevalence (higher in women) and lethality (higher in men) to tailor interventions appropriately. **D: Stressing that most individuals experience only a single episode of major depression in a lifetime.** This statement is misleading and contradicts clinical evidence. MDD is often recurrent, with ~50% of patients experiencing a second episode after their first. Older adults are especially vulnerable to recurrence due to cumulative stressors and comorbidities. Promoting this misconception could result in poor long-term monitoring, reduced adherence to maintenance therapy, and unrealistic expectations about prognosis. Effective management requires preparing patients for potential relapse and emphasizing sustained care. **Key Takeaways:** Answer A stands out as the only intervention directly addressing a high-priority, actionable aspect of geriatric depression (suicide prevention). The incorrect options either misrepresent risk factors (C), minimize the severity of depression (B), or provide inaccurate prognostic information (D). Effective care for older adults with MDD requires precise risk assessment, myth dispelling, and proactive measures to mitigate the most severe outcomes.

Correct Answer: C

Rationale: Characteristics such as age, frequency of outbursts, and occurrence in multiple settings support a diagnosis of disruptive mood dysregulation disorder. While comorbid conditions like autism can coexist with disruptive mood dysregulation disorder, it is not a characteristic that serves to support a diagnosis of this specific disorder.

Correct Answer: A

Rationale: Chronic medical conditions can significantly impact mental health, often serving as triggers for major depressive disorder (MDD). The correct answer is **A: Pain**, as chronic pain is one of the most well-documented and clinically established conditions linked to the development of depression. The relationship between chronic pain and depression is bidirectional and multifaceted. Persistent pain disrupts daily functioning, limits mobility, and reduces quality of life, leading to feelings of hopelessness, helplessness, and social isolation—key contributors to depressive symptoms. Neurobiological mechanisms also play a role; chronic pain alters neurotransmitter systems (e.g., serotonin and norepinephrine) and activates inflammatory pathways, which are also implicated in depression. Studies show that up to 50% of chronic pain patients experience comorbid depression, highlighting the strength of this association. **B: Hypertension** is incorrect because, while it is a common chronic condition, its direct link to MDD is weaker. Hypertension may contribute to stress or anxiety, but it does not inherently involve the same profound disruption to daily life or neurochemical pathways as chronic pain. Some studies suggest a correlation between hypertension and depression, but this is often confounded by lifestyle factors (e.g., poor diet, lack of exercise) rather than a direct causal relationship. **C: Hypothyroidism** is incorrect as a *common* trigger for MDD, though it can mimic depressive symptoms (e.g., fatigue, low mood). However, hypothyroidism is less prevalent than chronic pain, and its depressive-like symptoms are typically resolved with thyroid hormone replacement therapy. While untreated hypothyroidism can contribute to mood disturbances, it is not among the leading chronic conditions *proven* to trigger MDD in the same way chronic pain does. **D: Crohn's disease** is incorrect because, although it is a chronic inflammatory condition that can affect mood, its association with depression is more indirect. The psychological burden of managing a gastrointestinal disorder (e.g., embarrassment, dietary restrictions) may contribute to depression, but the condition itself does not universally or directly trigger MDD to the same extent as chronic pain. The inflammatory component of Crohn's may play a role, but the evidence is not as robust as for pain-related depression. In summary, chronic pain stands out due to its high prevalence, profound impact on daily functioning, and direct neurobiological overlap with depressive mechanisms, making it the most compelling choice among the options provided. The other conditions, while relevant to mental health, lack the same breadth and depth of evidence linking them to MDD.