NURS 623 Mental Health & GI Study
Guide
Mental Health Section
Depressive Disorders
1. What is the first-line pharmacological treatment for Major Depressive Disorder
(MDD)?
ANSWER: ✓ Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline,
escitalopram, or fluoxetine are first-line due to their favorable side effect profile and
safety in overdose compared to older antidepressants.
2. A patient starting an SSRI should be educated about which potentially
dangerous side effect, especially in the first few weeks?
ANSWER: ✓ The activation syndrome, which can include increased anxiety, agitation,
and suicidal ideation. Patients, particularly adolescents and young adults, must be
monitored closely during this period.
3. What is the clinical significance of a "black box warning" on antidepressant
medications?
ANSWER: ✓ It is the strongest warning required by the FDA, indicating a significant risk
of serious or life-threatening adverse effects. For antidepressants, it specifically warns of
an increased risk of suicidal thinking and behavior in children, adolescents, and young
adults.
4. How long does a typical trial of an antidepressant last to assess for efficacy?
ANSWER: ✓ A full therapeutic trial is generally 4 to 8 weeks at an adequate dose. Lack
of any response after 4 weeks may warrant a change.
5. What is the recommended duration for the continuation phase of
antidepressant treatment after a first episode of major depression?
ANSWER: ✓ 4 to 9 months after the acute symptoms have resolved, to prevent relapse.
6. What is treatment-resistant depression?
ANSWER: ✓ Failure to respond to at least two different antidepressants of adequate
dose and duration.
7. Name two augmentation strategies for treatment-resistant depression.
ANSWER: ✓ 1) Adding a second-generation antipsychotic (e.g., aripiprazole,
, quetiapine). 2) Adding another antidepressant with a different mechanism (e.g.,
bupropion, mirtazapine).
8. What is the role of genetic testing (pharmacogenomics) in treating depression?
ANSWER: ✓ It can help identify variations in drug-metabolizing enzymes (e.g., CYP450),
which may predict poor metabolism, increased side effects, or lack of efficacy, guiding
medication selection. It is a tool, not a definitive guide.
9. Differentiate between bereavement and Major Depressive Disorder.
ANSWER: ✓ Bereavement is a normal grief reaction to a loss, where mood is often
transient and tied to thoughts of the deceased, and self-esteem is usually preserved. In
MDD, the depressed mood is persistent and pervasive, accompanied by feelings of
worthlessness, significant functional impairment, and suicidal ideation that are not solely
focused on the loss.
10. What is the most critical screening question for suicide risk?
ANSWER: ✓ "Are you having thoughts of killing yourself?" or "Do you have suicidal
ideation?" It is essential to ask directly and non-judgmentally.
11. What are key risk factors for suicide?
ANSWER: ✓ Male gender, older age, history of prior attempts, substance use, access to
lethal means (especially firearms), psychiatric disorders (depression, bipolar,
schizophrenia), chronic pain, and recent significant loss.
12. What is the first-line psychotherapy for mild to moderate depression?
ANSWER: ✓ Cognitive Behavioral Therapy (CBT) or Interpersonal Therapy (IPT).
13. A patient on long-term fluoxetine presents with dry mouth, confusion, and
myoclonus. What serious condition do you suspect?
ANSWER: ✓ Serotonin Syndrome. This is a medical emergency often caused by drug
interactions (e.g., with other serotonergic agents like tramadol, triptans, or MAOIs).
Anxiety Disorders
14. What is the first-line pharmacological class for Generalized Anxiety Disorder
(GAD)?
ANSWER: ✓ SSRIs (e.g., escitalopram) and SNRIs (e.g., duloxetine, venlafaxine) are first-
line for long-term management.
15. What medication class is used for the acute, as-needed relief of anxiety
symptoms but carries a high risk of dependence?
Guide
Mental Health Section
Depressive Disorders
1. What is the first-line pharmacological treatment for Major Depressive Disorder
(MDD)?
ANSWER: ✓ Selective Serotonin Reuptake Inhibitors (SSRIs) such as sertraline,
escitalopram, or fluoxetine are first-line due to their favorable side effect profile and
safety in overdose compared to older antidepressants.
2. A patient starting an SSRI should be educated about which potentially
dangerous side effect, especially in the first few weeks?
ANSWER: ✓ The activation syndrome, which can include increased anxiety, agitation,
and suicidal ideation. Patients, particularly adolescents and young adults, must be
monitored closely during this period.
3. What is the clinical significance of a "black box warning" on antidepressant
medications?
ANSWER: ✓ It is the strongest warning required by the FDA, indicating a significant risk
of serious or life-threatening adverse effects. For antidepressants, it specifically warns of
an increased risk of suicidal thinking and behavior in children, adolescents, and young
adults.
4. How long does a typical trial of an antidepressant last to assess for efficacy?
ANSWER: ✓ A full therapeutic trial is generally 4 to 8 weeks at an adequate dose. Lack
of any response after 4 weeks may warrant a change.
5. What is the recommended duration for the continuation phase of
antidepressant treatment after a first episode of major depression?
ANSWER: ✓ 4 to 9 months after the acute symptoms have resolved, to prevent relapse.
6. What is treatment-resistant depression?
ANSWER: ✓ Failure to respond to at least two different antidepressants of adequate
dose and duration.
7. Name two augmentation strategies for treatment-resistant depression.
ANSWER: ✓ 1) Adding a second-generation antipsychotic (e.g., aripiprazole,
, quetiapine). 2) Adding another antidepressant with a different mechanism (e.g.,
bupropion, mirtazapine).
8. What is the role of genetic testing (pharmacogenomics) in treating depression?
ANSWER: ✓ It can help identify variations in drug-metabolizing enzymes (e.g., CYP450),
which may predict poor metabolism, increased side effects, or lack of efficacy, guiding
medication selection. It is a tool, not a definitive guide.
9. Differentiate between bereavement and Major Depressive Disorder.
ANSWER: ✓ Bereavement is a normal grief reaction to a loss, where mood is often
transient and tied to thoughts of the deceased, and self-esteem is usually preserved. In
MDD, the depressed mood is persistent and pervasive, accompanied by feelings of
worthlessness, significant functional impairment, and suicidal ideation that are not solely
focused on the loss.
10. What is the most critical screening question for suicide risk?
ANSWER: ✓ "Are you having thoughts of killing yourself?" or "Do you have suicidal
ideation?" It is essential to ask directly and non-judgmentally.
11. What are key risk factors for suicide?
ANSWER: ✓ Male gender, older age, history of prior attempts, substance use, access to
lethal means (especially firearms), psychiatric disorders (depression, bipolar,
schizophrenia), chronic pain, and recent significant loss.
12. What is the first-line psychotherapy for mild to moderate depression?
ANSWER: ✓ Cognitive Behavioral Therapy (CBT) or Interpersonal Therapy (IPT).
13. A patient on long-term fluoxetine presents with dry mouth, confusion, and
myoclonus. What serious condition do you suspect?
ANSWER: ✓ Serotonin Syndrome. This is a medical emergency often caused by drug
interactions (e.g., with other serotonergic agents like tramadol, triptans, or MAOIs).
Anxiety Disorders
14. What is the first-line pharmacological class for Generalized Anxiety Disorder
(GAD)?
ANSWER: ✓ SSRIs (e.g., escitalopram) and SNRIs (e.g., duloxetine, venlafaxine) are first-
line for long-term management.
15. What medication class is used for the acute, as-needed relief of anxiety
symptoms but carries a high risk of dependence?
