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Self-Assessment Questions


Evaluation and Treatment of Mood Disorders in Primary Care: Review Questions

William R. Marchand, MD
Dr.Marchand is clinical assistant professor of psychiatry, University of Utah School of Medicine, Salt Lake City, UT.

Choose the single best answer for each question.

1. A 45-year-old man visits his primary care physician because of 1 month of mild depressive symptoms including dysphoria, anhedonia, hypersomnia, poor energy, and difficulty concentrating. He reports no precipitating event. He states that he was diagnosed with bipolar I disorder approximately 20 years ago by a psychiatrist and has been taking lithium carbonate 300 mg 3 times per day since that time. The patient denies suicidal ideation. What is the first step in the management of this patient?
  1. Discontinue lithium
  2. Increase lithium to 1200 mg/day
  3. Check the lithium level
  4. Start a selective serotonin reuptake inhibitor (SSRI)
  5. Start bupropion
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2. A 23-year-old woman reports symptoms of psychomotor agitation, racing thoughts, severe insomnia, anxiety, panic, severe irritability, and extreme depression. She denies any prior psychiatric history. Her mother has bipolar disorder, and her father has panic disorder. What is this patient’s most likely diagnosis?

  1. Panic disorder
  2. Bipolar disorder
  3. Schizophrenia
  4. Psychotic depression
  5. Generalized anxiety disorder
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3. A 19-year-old woman has experienced approximately 2 weeks of insomnia, rapid speech, euphoria, high energy, and mild delusions. Her primary care physician decides to prescribe lithium. She is not taking any other medications. What test must be performed before starting the medication?

  1. Electroencephalogram
  2. Spinal tap
  3. Brain magnetic resonance imaging
  4. Minnesota Multiphasic Personality Inventory
  5. Pregnancy test
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4. What criteria must be met before an antidepressant trial can be considered unsuccessful?
  1. Treatment at maximum therapeutic dose for 4 to 5 weeks
  2. Treatment at maximum therapeutic dose for 9 to 10 weeks
  3. Treatment at maximum therapeutic dose for 3 months
  4. Treatment with at least one half of the maximum therapeutic dose for 4 weeks
  5. Treatment with an antidepressant and psychotherapy for 2 months
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5. Cognitive behavioral psychotherapy without an antidepressant would be an appropriate treatment in which of the following patient scenarios?

  1. A 35-year-old woman with severe depression who does not want to take medication
  2. An 18-year-old man with both depression and obsessive-compulsive disorder
  3. A 45-year-old man with mild major depression and significant psychosocial stress
  4. A 58-year-old man who has failed adequate trials of 2 different SSRIs and has a 20-year history of recurrent depression
  5. Cognitive behavioral therapy alone would never be appropriate
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