AAFP Behavioral Health
AAFP Behavioral Health EXAM
Study online at https://quizlet.com/_9qd2v7
1. You are evaluating The question "Do you want help with this?" increases the sensitivity of
screening instruments to a two-question anxiety screen
help you better identify
depression and anxiety in The Mood Disorder Questionnaire (MDQ) is a validated self-adminis-
your patients. Which one tered tool that can be used to screen for bipolar disorder. It correctly
of the following is NOT identifies almost three-quarters of patients with bipolar disorder and
true regarding screening will screen out bipolar disorder in 9 of 10 patients without the con-
instruments for mental dition. However, it is not a diagnostic instrument. Patients who screen
health disorders in prima- positive must be further assessed before a formal diagnosis is made
ry care settings? 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 Mood Disorder Ques- The specificity, however, is generally in the 60%-90% range.The GAD-2
tionnaire (MDQ) can be has been shown to have a sensitivity and specificity in the 70%-90%
used to screen for bipolar range for generalized anxiety disorder, panic disorder, and social anx-
disorder iety disorder, similar to the GAD-7. The sensitivity of the GAD-2 for de-
The PHQ-2 has high sen- tecting posttraumatic stress disorder is in the 50%-60% range, slightly
sitivity for depression lower than that of the GAD-7, but the specificities of both are in the 80%
The GAD-2 questionnaire range across studies. The GAD-2 does not differentiate between types
can detect several anxiety of anxiety disorders.One study showed that asking, "Do you want help
disorders with this today?" increased the specificity of the PHQ-2 to 89%-98% but
The GAD-7 can identify did not increase the sensitivity. Asking this question can also increase
panic disorder the specificity of the GAD-2 from 77% to 99% but does not improve
The question "Do you the sensitivity.The PHQ-4 combines the two questions from the PHQ-2
want help with this?" in- depression screen and the GAD-2 anxiety screen. Elevated scores have
creases the sensitivity of been shown to relate to decreased patient functional status in several
a two-question anxiety mental and physical domains. The sensitivity and specificity of the
screen 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 estab- Doxepin (Silenor) would be preferred to temazepam for this condi-
lish care, a 60-year-old tion
female requests a refill
www.stuvia.com
, AAFP Behavioral Health
AAFP Behavioral Health EXAM
Study online at https://quizlet.com/_9qd2v7
of temazepam (Restoril), Insomnia accounts for more than five million visits to family physicians
which she has used for each year. The DSM-5 criteria for insomnia disorder include symptoms
the past several months occurring 3 or more nights per week for 3 or more months that cause
because of difficulty stay-significant functional distress or impairment. These symptoms should
ing asleep. Her sleep not be associated with other disorders such as sleep apnea. Only
problem started when 6%-10% of persons have insomnia that meets these criteria, which is
her husband was being more common in women and in patients who are older, in poor gen-
treated for cancer. Oth- eral health, and/or have lower socioeconomic status.Cognitive-behav-
er than well controlled ioral therapy and other behavioral interventions such as sleep hygiene,
hypertension and occa- stimulus control, and relaxation are considered first-line treatment for
sional symptoms from os- insomnia. The overall quality of evidence for pharmacologic treatment
teoarthritis in her knees, is low, but for those who fail to respond pharmacotherapy is an
she has no significant option. Melatonin agonists such as ramelteon can be used to acceler-
medical problems. She ate sleep onset. The so-called "z-drugs" (zolpidem, eszopiclone, and
is not obese, does not zaleplon) can be used for treating problems with sleep onset and sleep
smoke, usually limits her maintenance. Low-dose doxepin can be used for those with difficulty
alcohol consumption to staying asleep, and doxepin and controlled-release melatonin are
two glasses of wine on recommended as first-line agents in older adults.There is insufficient
weekends, and has neg- evidence to establish the comparative safety of one pharmacologic
ative screening question- treatment over another. The data on melatonin is mixed, and there
naires for depression and is insufficient evidence to make recommendations on trazodone or
anxiety. Her husband has diphenhydramine. The American College of Physicians recommends
not mentioned that she that the choice to use medications should be based on shared deci-
has been snoring. sion making, and prescriptions should be limited to 5 weeks or less.
Risks include central nervous system depression effects and next-day
Which one of the follow- psychomotor impairment. Sudden discontinuation of the z-drugs may
ing statements is true re- lead to withdrawal symptoms. Benzodiazepines should not be used
garding this scenario? due to their potential for abuse.
Most patients with chron-
ic sleep problems have
primary insomnia
Cognitive-behavioral
www.stuvia.com
, AAFP Behavioral Health
AAFP Behavioral Health EXAM
Study online at https://quizlet.com/_9qd2v7
therapy is generally
ineffective
Doxepin (Silenor) would
be preferred to
temazepam for this con-
dition
Zolpidem (Ambien) is safe
for long-term treatment
of this condition
3. Your practice is imple- adults over the age of 65
menting steps to monitor
patients being treated forIn 2004, based on an analysis of 24 clinical trials, the FDA issued
depression in a more sys- black-box warnings on the risk of emergent suicidal thinking and
tematic way. In monitor- behavior (but not death from suicide) in children, adolescents, and
young adults treated with antidepressants. Some concerns have been
ing for potential harms, it
is important to consider raised about the unintended effects of this warning. Epidemiologic
that antidepressant ther- studies found a decrease in antidepressant prescribing after the warn-
apy has been associat- ing was issued, while depression diagnoses and potentially suicidal
ed with an increased risk actions increased. Some studies conducted after the warning was is-
of suicidal thoughts and sued have questioned whether the risk of these behaviors is increased
behaviors in each of the by antidepressant use.Methodologic concerns about both particular
following age groups EX- studies and the differences between studies before and after the black
CEPT box warning make the risks and benefits of antidepressant use with
regard to suicide in these populations difficult to quantify. However,
children a reduced risk of suicidal thinking and behavior has been seen with
adolescents antidepressant treatment in patients over the age of 65, and there is no
adults in their early 20s change in risk in adults 25-64 years of age. Furthermore, irrespective
adults over the age of 65 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
www.stuvia.com
, AAFP Behavioral Health
AAFP Behavioral Health EXAM
Study online at https://quizlet.com/_9qd2v7
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 6 months
53-year-old female for
her first episode of mod- Early discontinuation of antidepressants is associated with an early
erate major depression. relapse of major depression. If a patient achieves remission of de-
Her initial PHQ-9 score pression symptoms after 6-12 weeks of initial treatment for a first
was 16. After 6 weeks episode of major depression, evidence suggests that antidepressants
of antidepressant treat- should be continued for an additional 4-9 months at the same dosage
ment at a therapeu- used to achieve remission. Most guidelines recommend continuing
tic dosage all depres- medication for a minimum of 6 months after symptom remission. Dis-
sive symptoms have re- continuing treatment after 2 months would increase the risk of relapse.
solved. She is not ex- The risk of depression relapse increases after each subsequent major
periencing any medica- depressive episode, so extending antidepressant treatment beyond
tion-related side effects. 9 months for patients with a history of multiple episodes of major
Evidence suggests that depression would be reasonable.
after achieving symptom
remission this patient
should continue antide-
pressants for at least an
additional
2 months
6 months
12 months
18 months
5. A 38-year-old male has A history of periods of irritable and labile mood lasting at least 7-10
had periods of anxiety days
over the past few days.
www.stuvia.com
AAFP Behavioral Health EXAM
Study online at https://quizlet.com/_9qd2v7
1. You are evaluating The question "Do you want help with this?" increases the sensitivity of
screening instruments to a two-question anxiety screen
help you better identify
depression and anxiety in The Mood Disorder Questionnaire (MDQ) is a validated self-adminis-
your patients. Which one tered tool that can be used to screen for bipolar disorder. It correctly
of the following is NOT identifies almost three-quarters of patients with bipolar disorder and
true regarding screening will screen out bipolar disorder in 9 of 10 patients without the con-
instruments for mental dition. However, it is not a diagnostic instrument. Patients who screen
health disorders in prima- positive must be further assessed before a formal diagnosis is made
ry care settings? 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 Mood Disorder Ques- The specificity, however, is generally in the 60%-90% range.The GAD-2
tionnaire (MDQ) can be has been shown to have a sensitivity and specificity in the 70%-90%
used to screen for bipolar range for generalized anxiety disorder, panic disorder, and social anx-
disorder iety disorder, similar to the GAD-7. The sensitivity of the GAD-2 for de-
The PHQ-2 has high sen- tecting posttraumatic stress disorder is in the 50%-60% range, slightly
sitivity for depression lower than that of the GAD-7, but the specificities of both are in the 80%
The GAD-2 questionnaire range across studies. The GAD-2 does not differentiate between types
can detect several anxiety of anxiety disorders.One study showed that asking, "Do you want help
disorders with this today?" increased the specificity of the PHQ-2 to 89%-98% but
The GAD-7 can identify did not increase the sensitivity. Asking this question can also increase
panic disorder the specificity of the GAD-2 from 77% to 99% but does not improve
The question "Do you the sensitivity.The PHQ-4 combines the two questions from the PHQ-2
want help with this?" in- depression screen and the GAD-2 anxiety screen. Elevated scores have
creases the sensitivity of been shown to relate to decreased patient functional status in several
a two-question anxiety mental and physical domains. The sensitivity and specificity of the
screen 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 estab- Doxepin (Silenor) would be preferred to temazepam for this condi-
lish care, a 60-year-old tion
female requests a refill
www.stuvia.com
, AAFP Behavioral Health
AAFP Behavioral Health EXAM
Study online at https://quizlet.com/_9qd2v7
of temazepam (Restoril), Insomnia accounts for more than five million visits to family physicians
which she has used for each year. The DSM-5 criteria for insomnia disorder include symptoms
the past several months occurring 3 or more nights per week for 3 or more months that cause
because of difficulty stay-significant functional distress or impairment. These symptoms should
ing asleep. Her sleep not be associated with other disorders such as sleep apnea. Only
problem started when 6%-10% of persons have insomnia that meets these criteria, which is
her husband was being more common in women and in patients who are older, in poor gen-
treated for cancer. Oth- eral health, and/or have lower socioeconomic status.Cognitive-behav-
er than well controlled ioral therapy and other behavioral interventions such as sleep hygiene,
hypertension and occa- stimulus control, and relaxation are considered first-line treatment for
sional symptoms from os- insomnia. The overall quality of evidence for pharmacologic treatment
teoarthritis in her knees, is low, but for those who fail to respond pharmacotherapy is an
she has no significant option. Melatonin agonists such as ramelteon can be used to acceler-
medical problems. She ate sleep onset. The so-called "z-drugs" (zolpidem, eszopiclone, and
is not obese, does not zaleplon) can be used for treating problems with sleep onset and sleep
smoke, usually limits her maintenance. Low-dose doxepin can be used for those with difficulty
alcohol consumption to staying asleep, and doxepin and controlled-release melatonin are
two glasses of wine on recommended as first-line agents in older adults.There is insufficient
weekends, and has neg- evidence to establish the comparative safety of one pharmacologic
ative screening question- treatment over another. The data on melatonin is mixed, and there
naires for depression and is insufficient evidence to make recommendations on trazodone or
anxiety. Her husband has diphenhydramine. The American College of Physicians recommends
not mentioned that she that the choice to use medications should be based on shared deci-
has been snoring. sion making, and prescriptions should be limited to 5 weeks or less.
Risks include central nervous system depression effects and next-day
Which one of the follow- psychomotor impairment. Sudden discontinuation of the z-drugs may
ing statements is true re- lead to withdrawal symptoms. Benzodiazepines should not be used
garding this scenario? due to their potential for abuse.
Most patients with chron-
ic sleep problems have
primary insomnia
Cognitive-behavioral
www.stuvia.com
, AAFP Behavioral Health
AAFP Behavioral Health EXAM
Study online at https://quizlet.com/_9qd2v7
therapy is generally
ineffective
Doxepin (Silenor) would
be preferred to
temazepam for this con-
dition
Zolpidem (Ambien) is safe
for long-term treatment
of this condition
3. Your practice is imple- adults over the age of 65
menting steps to monitor
patients being treated forIn 2004, based on an analysis of 24 clinical trials, the FDA issued
depression in a more sys- black-box warnings on the risk of emergent suicidal thinking and
tematic way. In monitor- behavior (but not death from suicide) in children, adolescents, and
young adults treated with antidepressants. Some concerns have been
ing for potential harms, it
is important to consider raised about the unintended effects of this warning. Epidemiologic
that antidepressant ther- studies found a decrease in antidepressant prescribing after the warn-
apy has been associat- ing was issued, while depression diagnoses and potentially suicidal
ed with an increased risk actions increased. Some studies conducted after the warning was is-
of suicidal thoughts and sued have questioned whether the risk of these behaviors is increased
behaviors in each of the by antidepressant use.Methodologic concerns about both particular
following age groups EX- studies and the differences between studies before and after the black
CEPT box warning make the risks and benefits of antidepressant use with
regard to suicide in these populations difficult to quantify. However,
children a reduced risk of suicidal thinking and behavior has been seen with
adolescents antidepressant treatment in patients over the age of 65, and there is no
adults in their early 20s change in risk in adults 25-64 years of age. Furthermore, irrespective
adults over the age of 65 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
www.stuvia.com
, AAFP Behavioral Health
AAFP Behavioral Health EXAM
Study online at https://quizlet.com/_9qd2v7
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 6 months
53-year-old female for
her first episode of mod- Early discontinuation of antidepressants is associated with an early
erate major depression. relapse of major depression. If a patient achieves remission of de-
Her initial PHQ-9 score pression symptoms after 6-12 weeks of initial treatment for a first
was 16. After 6 weeks episode of major depression, evidence suggests that antidepressants
of antidepressant treat- should be continued for an additional 4-9 months at the same dosage
ment at a therapeu- used to achieve remission. Most guidelines recommend continuing
tic dosage all depres- medication for a minimum of 6 months after symptom remission. Dis-
sive symptoms have re- continuing treatment after 2 months would increase the risk of relapse.
solved. She is not ex- The risk of depression relapse increases after each subsequent major
periencing any medica- depressive episode, so extending antidepressant treatment beyond
tion-related side effects. 9 months for patients with a history of multiple episodes of major
Evidence suggests that depression would be reasonable.
after achieving symptom
remission this patient
should continue antide-
pressants for at least an
additional
2 months
6 months
12 months
18 months
5. A 38-year-old male has A history of periods of irritable and labile mood lasting at least 7-10
had periods of anxiety days
over the past few days.
www.stuvia.com
