2025 AAFP BEHAVIORAL HEALTH FINAL EXAM
UPDATED QUESTIONS AND ANSWERS | CORRECTLY
VERIFIED 100% GRADED A
1. You are evaluating screening instruments to help you better identify de- pression and anxiety in
your clients. 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:
The question "Do you want help with this?" increas- es 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 clients with bipolar disorder and will screen out
bipolar disorder in 9 of 10 clients without the condition.
However, it is not a diagnostic instrument. Clients 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 client 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.
2. 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 be- cause of difficulty staying asleep. Her sleep
problem started when her hus- band was being treated for cancer. Other than well controlled
hypertension
and occasional symptoms from osteoarthritis in her knees, she has no signif- icant medical problems. She
not obese, does not smoke, usually limits her alcohol consumption to two glasses of wine on weekends, an
has negative screening questionnaires for depression and anxiety. Her husband has not mentioned that sh
has been snoring.
Which one of the following statements is true regarding this scenario? Most clients 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-te
treatment of this condition: 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 impair- ment. 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
clients 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 recom- mendations 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 symptoms. Benzodiazepines should not be used due to their potential for abuse.
3. Your practice is implementing steps to monitor clients 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: 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 con- cerns 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 clients 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 "clients 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."
4. 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 sug-
gests that after achieving symptom remission this client should continue antidepressants for at least an
additional
2 months
6 months
12 months
18 months: 6 months
Early discontinuation of antidepressants is associated with an early relapse of major
UPDATED QUESTIONS AND ANSWERS | CORRECTLY
VERIFIED 100% GRADED A
1. You are evaluating screening instruments to help you better identify de- pression and anxiety in
your clients. 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:
The question "Do you want help with this?" increas- es 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 clients with bipolar disorder and will screen out
bipolar disorder in 9 of 10 clients without the condition.
However, it is not a diagnostic instrument. Clients 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 client 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.
2. 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 be- cause of difficulty staying asleep. Her sleep
problem started when her hus- band was being treated for cancer. Other than well controlled
hypertension
and occasional symptoms from osteoarthritis in her knees, she has no signif- icant medical problems. She
not obese, does not smoke, usually limits her alcohol consumption to two glasses of wine on weekends, an
has negative screening questionnaires for depression and anxiety. Her husband has not mentioned that sh
has been snoring.
Which one of the following statements is true regarding this scenario? Most clients 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-te
treatment of this condition: 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 impair- ment. 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
clients 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 recom- mendations 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 symptoms. Benzodiazepines should not be used due to their potential for abuse.
3. Your practice is implementing steps to monitor clients 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: 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 con- cerns 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 clients 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 "clients 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."
4. 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 sug-
gests that after achieving symptom remission this client should continue antidepressants for at least an
additional
2 months
6 months
12 months
18 months: 6 months
Early discontinuation of antidepressants is associated with an early relapse of major
