AAFP Behavioral Health Exam 2025 With
100% Correct Answers
You are evaluating screening instruments to help you better identify depression and anxiety in your
patients. Which one of the following is NOT true regarding screening instruments for mental health
disorders in primary care settings?
The Mood Disorder Questionnaire (MDQ) can be used to screen for bipolar disorder
The PHQ-2 has high sensitivity for depression
The GAD-2 questionnaire can detect several anxiety disorders
The GAD-7 can identify panic disorder
The question "Do you want help with this?" increases the sensitivity of a two-question anxiety screen -
correct answers ✔✔The question "Do you want help with this?" increases the sensitivity of a two-
question anxiety screen
The Mood Disorder Questionnaire (MDQ) is a validated self-administered tool that can be used to screen
for bipolar disorder. It correctly identifies almost three-quarters of patients with bipolar disorder and will
screen out bipolar disorder in 9 of 10 patients without the condition. However, it is not a diagnostic
instrument. Patients who screen positive must be further assessed before a formal diagnosis is made or
treatment is prescribed.The sensitivity of the PHQ-2 for detecting depression in primary care settings is
generally in the 70%-90% range. The specificity, however, is generally in the 60%-90% range.The GAD-2
has been shown to have a sensitivity and specificity in the 70%-90% range for generalized anxiety
disorder, panic disorder, and social anxiety disorder, similar to the GAD-7. The sensitivity of the GAD-2 for
detecting posttraumatic stress disorder is in the 50%-60% range, slightly lower than that of the GAD-7,
but the specificities of both are in the 80% range across studies. The GAD-2 does not differentiate
between types of anxiety disorders.One study showed that asking, "Do you want help with this today?"
increased the specificity of the PHQ-2 to 89%-98% but did not increase the sensitivity. Asking this
question can also increase the specificity of the GAD-2 from 77% to 99% but does not improve the
sensitivity.The PHQ-4 combines the two questions from the PHQ-2 depression screen and the GAD-2
anxiety screen. Elevated scores have been shown to relate to decreased patient functional status in
several mental and physical domains. The sensitivity and specificity of the PHQ-4 are both in the 70%-
80% range, which is consistent with the performance of its PHQ-2 and GAD-2 components.
During a visit to establish care, a 60-year-old female requests a refill of temazepam (Restoril), which she
has used for the past several months because of difficulty staying asleep. Her sleep problem started
,when her husband was being treated for cancer. Other than well controlled hypertension and occasional
symptoms from osteoarthritis in her knees, she has no significant medical problems. She is not obese,
does not smoke, usually limits her alcohol consumption to two glasses of wine on weekends, and has
negative screening questionnaires for depression and anxiety. Her husband has not mentioned that she
has been snoring.
Which one of the following statements is true regarding this scenario?
Most patients with chronic sleep problems have primary insomnia
Cognitive-behavioral therapy is generally ineffective
Doxepin (Silenor) would be preferred to temazepam for this condition
Zolpidem (Ambien) is safe for long-term - correct answers ✔✔Doxepin (Silenor) would be preferred to
temazepam for this condition
Insomnia accounts for more than five million visits to family physicians each year. The DSM-5 criteria for
insomnia disorder include symptoms occurring 3 or more nights per week for 3 or more months that
cause significant functional distress or impairment. These symptoms should not be associated with other
disorders such as sleep apnea. Only 6%-10% of persons have insomnia that meets these criteria, which is
more common in women and in patients who are older, in poor general health, and/or have lower
socioeconomic status.Cognitive-behavioral therapy and other behavioral interventions such as sleep
hygiene, stimulus control, and relaxation are considered first-line treatment for insomnia. The overall
quality of evidence for pharmacologic treatment is low, but for those who fail to respond
pharmacotherapy is an option. Melatonin agonists such as ramelteon can be used to accelerate sleep
onset. The so-called "z-drugs" (zolpidem, eszopiclone, and zaleplon) can be used for treating problems
with sleep onset and sleep maintenance. Low-dose doxepin can be used for those with difficulty staying
asleep, and doxepin and controlled-release melatonin are recommended as first-line agents in older
adults.There is insufficient evidence to establish the comparative safety of one pharmacologic treatment
over another. The data on melatonin is mixed, and there is insufficient evidence to make
recommendations on trazodone or diphenhydramine. The American College of Physicians recommends
that the choice to use medications should be based on shared decision making, and prescriptions should
be limited to 5 weeks or less. Risks include central nervous system depression effects and next-day
psychomotor impairment. Sudden discontinuation of the z-drugs may lead to withdrawal
Your practice is implementing steps to monitor patients being treated for depression in a more
systematic way. In monitoring for potential harms, it is important to consider that antidepressant
therapy has been associated with an increased risk of suicidal thoughts and behaviors in each of the
following age groups EXCEPT
children
,adolescents
adults in their early 20s
adults over the age of 65 - correct answers ✔✔adults over the age of 65
In 2004, based on an analysis of 24 clinical trials, the FDA issued black-box warnings on the risk of
emergent suicidal thinking and behavior (but not death from suicide) in children, adolescents, and young
adults treated with antidepressants. Some concerns have been raised about the unintended effects of
this warning. Epidemiologic studies found a decrease in antidepressant prescribing after the warning was
issued, while depression diagnoses and potentially suicidal actions increased. Some studies conducted
after the warning was issued have questioned whether the risk of these behaviors is increased by
antidepressant use.Methodologic concerns about both particular studies and the differences between
studies before and after the black box warning make the risks and benefits of antidepressant use with
regard to suicide in these populations difficult to quantify. However, a reduced risk of suicidal thinking
and behavior has been seen with antidepressant treatment in patients over the age of 65, and there is
no change in risk in adults 25-64 years of age. Furthermore, irrespective of age, evidence of increased
mortality as a result of suicide has not been demonstrated with antidepressant use in any age group.The
FDA black-box warning is still in effect. It does not, however, contraindicate antidepressants for use in
these populations but notes that "patients of all ages who are started on antidepressant therapy should
be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in
behavior."
You are treating a 53-year-old female for her first episode of moderate major depression. Her initial PHQ-
9 score was 16. After 6 weeks of antidepressant treatment at a therapeutic dosage all depressive
symptoms have resolved. She is not experiencing any medication-related side effects. Evidence suggests
that after achieving symptom remission this patient should continue antidepressants for at least an
additional
2 months
6 months
12 months
18 months - correct answers ✔✔6 months
Early discontinuation of antidepressants is associated with an early relapse of major depression. If a
patient achieves remission of depression symptoms after 6-12 weeks of initial treatment for a first
episode of major depression, evidence suggests that antidepressants should be continued for an
additional 4-9 months at the same dosage used to achieve remission. Most guidelines recommend
continuing medication for a minimum of 6 months after symptom remission. Discontinuing treatment
, after 2 months would increase the risk of relapse. The risk of depression relapse increases after each
subsequent major depressive episode, so extending antidepressant treatment beyond 9 months for
patients with a history of multiple episodes of major depression would be reasonable.
A 38-year-old male has had periods of anxiety over the past few days. He asks for a refill of alprazolam
(Xanax) which was prescribed by another physician. Further history reveals that he has had episodes like
this since his late teens, more often in the spring and summer, and he has had three episodes of
depression in the past around the winter holidays. Previous attempts to treat the depression with SSRIs
were not helpful, sometimes causing agitation and insomnia. Which one of the following would be most
specific for confirming a diagnosis?
A brother with bipolar I disorder
A history of periods of irritable and labile mood lasting at least 7-10 days
Past symptomatic improvement on alprazolam
Symptomatic improvement with duloxetine (Cymbalta) - correct answers ✔✔A history of periods of
irritable and labile mood lasting at least 7-10 days
Mania and hypomania are signature characteristics of a bipolar disorder. Episodes of labile mood are
characterized by elation, irritability, and increased energy, plus at least three additional symptoms, or
four if the predominant mood is irritability. Additional symptoms can include the following:
impulsive goal-directed activities without concern for potential negative consequences, such as
impulsive shopping, risky business undertakings, or unsafe sexual behaviors
increased activity levels or psychomotor restlessness
pressured speech or greater talkativeness
a subjective feeling that one's thoughts are racing or jumping from topic to topic
increased distractibility by stimuli in the environment
exaggerated self-confidence, sometimes to the point of grandiose delusions
Hypomanic episodes last at least 4 days and cause an observable change in functioning that may or may
not cause impairment. Manic episodes last at least 7 days and are associated with functional
impairment. The presence of these defined periods of mood lability confirms bipolar disorder.A first
degree relative with a formal diagnosis of bipolar disorder would be a clue to a bipolar spectrum illness
but would not be diagnostic. Bipolar disorders often first present with depressive episodes. An early
onset of depression, in the late teens or early 20s, particularly in males and particularly with seasonality,
should raise suspicion for possible bipolar disorder. Symptomatic improvement with a different class of
antidepressants such as an SNRI would not help clarify the diagnosis. Resistance of symptoms to
100% Correct Answers
You are evaluating screening instruments to help you better identify depression and anxiety in your
patients. Which one of the following is NOT true regarding screening instruments for mental health
disorders in primary care settings?
The Mood Disorder Questionnaire (MDQ) can be used to screen for bipolar disorder
The PHQ-2 has high sensitivity for depression
The GAD-2 questionnaire can detect several anxiety disorders
The GAD-7 can identify panic disorder
The question "Do you want help with this?" increases the sensitivity of a two-question anxiety screen -
correct answers ✔✔The question "Do you want help with this?" increases the sensitivity of a two-
question anxiety screen
The Mood Disorder Questionnaire (MDQ) is a validated self-administered tool that can be used to screen
for bipolar disorder. It correctly identifies almost three-quarters of patients with bipolar disorder and will
screen out bipolar disorder in 9 of 10 patients without the condition. However, it is not a diagnostic
instrument. Patients who screen positive must be further assessed before a formal diagnosis is made or
treatment is prescribed.The sensitivity of the PHQ-2 for detecting depression in primary care settings is
generally in the 70%-90% range. The specificity, however, is generally in the 60%-90% range.The GAD-2
has been shown to have a sensitivity and specificity in the 70%-90% range for generalized anxiety
disorder, panic disorder, and social anxiety disorder, similar to the GAD-7. The sensitivity of the GAD-2 for
detecting posttraumatic stress disorder is in the 50%-60% range, slightly lower than that of the GAD-7,
but the specificities of both are in the 80% range across studies. The GAD-2 does not differentiate
between types of anxiety disorders.One study showed that asking, "Do you want help with this today?"
increased the specificity of the PHQ-2 to 89%-98% but did not increase the sensitivity. Asking this
question can also increase the specificity of the GAD-2 from 77% to 99% but does not improve the
sensitivity.The PHQ-4 combines the two questions from the PHQ-2 depression screen and the GAD-2
anxiety screen. Elevated scores have been shown to relate to decreased patient functional status in
several mental and physical domains. The sensitivity and specificity of the PHQ-4 are both in the 70%-
80% range, which is consistent with the performance of its PHQ-2 and GAD-2 components.
During a visit to establish care, a 60-year-old female requests a refill of temazepam (Restoril), which she
has used for the past several months because of difficulty staying asleep. Her sleep problem started
,when her husband was being treated for cancer. Other than well controlled hypertension and occasional
symptoms from osteoarthritis in her knees, she has no significant medical problems. She is not obese,
does not smoke, usually limits her alcohol consumption to two glasses of wine on weekends, and has
negative screening questionnaires for depression and anxiety. Her husband has not mentioned that she
has been snoring.
Which one of the following statements is true regarding this scenario?
Most patients with chronic sleep problems have primary insomnia
Cognitive-behavioral therapy is generally ineffective
Doxepin (Silenor) would be preferred to temazepam for this condition
Zolpidem (Ambien) is safe for long-term - correct answers ✔✔Doxepin (Silenor) would be preferred to
temazepam for this condition
Insomnia accounts for more than five million visits to family physicians each year. The DSM-5 criteria for
insomnia disorder include symptoms occurring 3 or more nights per week for 3 or more months that
cause significant functional distress or impairment. These symptoms should not be associated with other
disorders such as sleep apnea. Only 6%-10% of persons have insomnia that meets these criteria, which is
more common in women and in patients who are older, in poor general health, and/or have lower
socioeconomic status.Cognitive-behavioral therapy and other behavioral interventions such as sleep
hygiene, stimulus control, and relaxation are considered first-line treatment for insomnia. The overall
quality of evidence for pharmacologic treatment is low, but for those who fail to respond
pharmacotherapy is an option. Melatonin agonists such as ramelteon can be used to accelerate sleep
onset. The so-called "z-drugs" (zolpidem, eszopiclone, and zaleplon) can be used for treating problems
with sleep onset and sleep maintenance. Low-dose doxepin can be used for those with difficulty staying
asleep, and doxepin and controlled-release melatonin are recommended as first-line agents in older
adults.There is insufficient evidence to establish the comparative safety of one pharmacologic treatment
over another. The data on melatonin is mixed, and there is insufficient evidence to make
recommendations on trazodone or diphenhydramine. The American College of Physicians recommends
that the choice to use medications should be based on shared decision making, and prescriptions should
be limited to 5 weeks or less. Risks include central nervous system depression effects and next-day
psychomotor impairment. Sudden discontinuation of the z-drugs may lead to withdrawal
Your practice is implementing steps to monitor patients being treated for depression in a more
systematic way. In monitoring for potential harms, it is important to consider that antidepressant
therapy has been associated with an increased risk of suicidal thoughts and behaviors in each of the
following age groups EXCEPT
children
,adolescents
adults in their early 20s
adults over the age of 65 - correct answers ✔✔adults over the age of 65
In 2004, based on an analysis of 24 clinical trials, the FDA issued black-box warnings on the risk of
emergent suicidal thinking and behavior (but not death from suicide) in children, adolescents, and young
adults treated with antidepressants. Some concerns have been raised about the unintended effects of
this warning. Epidemiologic studies found a decrease in antidepressant prescribing after the warning was
issued, while depression diagnoses and potentially suicidal actions increased. Some studies conducted
after the warning was issued have questioned whether the risk of these behaviors is increased by
antidepressant use.Methodologic concerns about both particular studies and the differences between
studies before and after the black box warning make the risks and benefits of antidepressant use with
regard to suicide in these populations difficult to quantify. However, a reduced risk of suicidal thinking
and behavior has been seen with antidepressant treatment in patients over the age of 65, and there is
no change in risk in adults 25-64 years of age. Furthermore, irrespective of age, evidence of increased
mortality as a result of suicide has not been demonstrated with antidepressant use in any age group.The
FDA black-box warning is still in effect. It does not, however, contraindicate antidepressants for use in
these populations but notes that "patients of all ages who are started on antidepressant therapy should
be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in
behavior."
You are treating a 53-year-old female for her first episode of moderate major depression. Her initial PHQ-
9 score was 16. After 6 weeks of antidepressant treatment at a therapeutic dosage all depressive
symptoms have resolved. She is not experiencing any medication-related side effects. Evidence suggests
that after achieving symptom remission this patient should continue antidepressants for at least an
additional
2 months
6 months
12 months
18 months - correct answers ✔✔6 months
Early discontinuation of antidepressants is associated with an early relapse of major depression. If a
patient achieves remission of depression symptoms after 6-12 weeks of initial treatment for a first
episode of major depression, evidence suggests that antidepressants should be continued for an
additional 4-9 months at the same dosage used to achieve remission. Most guidelines recommend
continuing medication for a minimum of 6 months after symptom remission. Discontinuing treatment
, after 2 months would increase the risk of relapse. The risk of depression relapse increases after each
subsequent major depressive episode, so extending antidepressant treatment beyond 9 months for
patients with a history of multiple episodes of major depression would be reasonable.
A 38-year-old male has had periods of anxiety over the past few days. He asks for a refill of alprazolam
(Xanax) which was prescribed by another physician. Further history reveals that he has had episodes like
this since his late teens, more often in the spring and summer, and he has had three episodes of
depression in the past around the winter holidays. Previous attempts to treat the depression with SSRIs
were not helpful, sometimes causing agitation and insomnia. Which one of the following would be most
specific for confirming a diagnosis?
A brother with bipolar I disorder
A history of periods of irritable and labile mood lasting at least 7-10 days
Past symptomatic improvement on alprazolam
Symptomatic improvement with duloxetine (Cymbalta) - correct answers ✔✔A history of periods of
irritable and labile mood lasting at least 7-10 days
Mania and hypomania are signature characteristics of a bipolar disorder. Episodes of labile mood are
characterized by elation, irritability, and increased energy, plus at least three additional symptoms, or
four if the predominant mood is irritability. Additional symptoms can include the following:
impulsive goal-directed activities without concern for potential negative consequences, such as
impulsive shopping, risky business undertakings, or unsafe sexual behaviors
increased activity levels or psychomotor restlessness
pressured speech or greater talkativeness
a subjective feeling that one's thoughts are racing or jumping from topic to topic
increased distractibility by stimuli in the environment
exaggerated self-confidence, sometimes to the point of grandiose delusions
Hypomanic episodes last at least 4 days and cause an observable change in functioning that may or may
not cause impairment. Manic episodes last at least 7 days and are associated with functional
impairment. The presence of these defined periods of mood lability confirms bipolar disorder.A first
degree relative with a formal diagnosis of bipolar disorder would be a clue to a bipolar spectrum illness
but would not be diagnostic. Bipolar disorders often first present with depressive episodes. An early
onset of depression, in the late teens or early 20s, particularly in males and particularly with seasonality,
should raise suspicion for possible bipolar disorder. Symptomatic improvement with a different class of
antidepressants such as an SNRI would not help clarify the diagnosis. Resistance of symptoms to
