©FYNDLAY 2025 ALL RIGHTS RESERVED
AAFP Behavioral Health Exam Questions
and Answers 100% Pass
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 - ANS 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
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, ©FYNDLAY 2025 ALL RIGHTS RESERVED
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 - ANS 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
©FYNDLAY 2
, ©FYNDLAY 2025 ALL RIGHTS RESERVED
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 - ANS 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."
©FYNDLAY 3
, ©FYNDLAY 2025 ALL RIGHTS RESERVED
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 - ANS 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
©FYNDLAY 4
AAFP Behavioral Health Exam Questions
and Answers 100% Pass
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 - ANS 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
©FYNDLAY 1
, ©FYNDLAY 2025 ALL RIGHTS RESERVED
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 - ANS 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
©FYNDLAY 2
, ©FYNDLAY 2025 ALL RIGHTS RESERVED
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 - ANS 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."
©FYNDLAY 3
, ©FYNDLAY 2025 ALL RIGHTS RESERVED
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 - ANS 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
©FYNDLAY 4
