Mental Health in Primary Care Flashcards

A 42-year-old patient with bipolar I disorder presents to primary care reporting 4 days of decreased need for sleep, grandiosity, and pressured speech. The most appropriate management is:

Answer: Consult psychiatry urgently; avoid SSRIs (can precipitate mania); ensure mood stabilizer is at therapeutic levels

Active mania requires urgent psychiatric consultation and mood stabilizer optimization. SSRIs are contraindicated during manic episodes as they can worsen or precipitate mania.

When prescribing bupropion for depression in primary care, which contraindication is most important to assess before initiation?

Answer: History of seizure disorder, eating disorders such as anorexia or bulimia, or concurrent MAOI use

Bupropion is contraindicated in patients with seizure disorders (lowers seizure threshold), active eating disorders (increased seizure risk from electrolyte disturbances), and concurrent or recent MAOI use (risk of hypertensive crisis).

Adult ADHD is most accurately diagnosed using which approach in primary care?

Answer: Comprehensive clinical evaluation including DSM-5 criteria with 5 or more inattentive and/or hyperactive-impulsive symptoms present before age 12 for 6 months or longer

Adult ADHD diagnosis requires DSM-5 criteria: 5 or more inattentive and/or hyperactive-impulsive symptoms, present before age 12, in 2 or more settings, causing significant impairment.

A 68-year-old patient with new-onset confusion, agitation, disorientation, and visual hallucinations that developed over 2 days is most likely experiencing:

Answer: Delirium — acute onset, fluctuating course, and attention disturbance

Delirium presents with acute onset confusion, fluctuating course, attention disturbance, and often perceptual disturbances — distinguishing it from dementia (gradual onset) and psychiatric disorders.

A patient is prescribed sertraline for MDD and returns 2 weeks later reporting no improvement. The appropriate next step is:

Answer: Counsel the patient that SSRIs require 4-6 weeks for full effect; assess tolerability, adherence, and any worsening symptoms including suicidality

At 2 weeks, SSRIs have not yet reached full therapeutic effect. The correct response is to reinforce the 4-6 week timeline, assess medication tolerability, confirm adherence, and screen for suicidality.

A patient asks about mental health benefits of regular exercise. The evidence base supports aerobic exercise as an adjunct treatment for which mental health conditions managed in primary care?

Answer: Exercise has strong evidence as adjunct treatment for depression and anxiety, reducing symptom severity comparably to pharmacotherapy in mild to moderate cases

Strong evidence supports aerobic exercise as an effective adjunct treatment for depression and anxiety, with effects comparable to antidepressants in mild to moderate cases.