AANP Mental Health 1 — Questions and Answers
Question 1: A patient who survived a serious car accident 2 months ago now has nightmares, hypervigilance, avoidance of driving, and emotional numbing. What is the most likely diagnosis?
- Acute stress disorder
- Generalized anxiety disorder
- Post-traumatic stress disorder (PTSD) (Correct answer)
- Adjustment disorder
Correct answer: Post-traumatic stress disorder (PTSD)
PTSD is diagnosed when trauma-related symptoms including intrusion, avoidance, negative cognitions, and hyperarousal persist for more than 1 month after a traumatic event.
Question 2: Which medication is FDA-approved as a first-line pharmacological treatment for PTSD?
- Alprazolam
- Sertraline (Correct answer)
- Olanzapine
- Propranolol
Correct answer: Sertraline
Sertraline and paroxetine are the only FDA-approved medications for PTSD; benzodiazepines are not recommended due to risk of dependence and potential worsening of PTSD.
Question 3: A patient presents with a 2-week history of depressed mood, anhedonia, hypersomnia, psychomotor retardation, and suicidal ideation. What is the minimum duration criterion for major depressive disorder?
- 1 week
- 2 weeks (Correct answer)
- 1 month
- 6 months
Correct answer: 2 weeks
DSM-5 requires symptoms of major depressive disorder to be present for at least 2 weeks and represent a change from previous functioning for the diagnosis.
Question 4: A patient on lithium for bipolar disorder develops coarse tremor, confusion, and vomiting after starting a new NSAID. What is the most likely cause?
- Lithium toxicity due to reduced renal clearance (Correct answer)
- Serotonin syndrome
- NSAID hypersensitivity reaction
- Neuroleptic malignant syndrome
Correct answer: Lithium toxicity due to reduced renal clearance
NSAIDs decrease renal prostaglandin synthesis and reduce renal lithium excretion, leading to lithium accumulation and toxicity.
Question 5: Which screening tool is validated for detecting depression in the primary care setting?
- CAGE questionnaire
- PHQ-9 (Correct answer)
- AUDIT-C
- GAD-7
Correct answer: PHQ-9
The PHQ-9 (Patient Health Questionnaire-9) is a validated, widely used screening and severity assessment tool for major depressive disorder in primary care.
Question 6: What is the most appropriate initial intervention for a patient who discloses active suicidal ideation with a plan and access to a firearm?
- Schedule a follow-up appointment next week
- Prescribe an antidepressant and monitor
- Initiate an emergency psychiatric evaluation or involuntary hold (Correct answer)
- Refer to outpatient therapy
Correct answer: Initiate an emergency psychiatric evaluation or involuntary hold
Active suicidal ideation with a specific plan and means (firearm access) represents an acute psychiatric emergency requiring immediate intervention and safety evaluation.
AANP Mental Health 1
A patient who survived a serious car accident 2 months ago now has nightmares, hypervigilance, avoidance of driving, and emotional numbing.
What is the most likely diagnosis?