Mental Health in Primary Care Flashcards

A 34-year-old patient presents with 2 weeks of depressed mood, anhedonia, insomnia, fatigue, poor concentration, and feelings of worthlessness. DSM-5 criteria require how many symptoms for a minimum of how many days to diagnose major depressive disorder?

Answer: 5 or more symptoms for at least 14 days, including depressed mood or anhedonia

DSM-5 requires 5 or more of 9 symptoms for at least 2 weeks, with at least one being depressed mood or anhedonia. This patient meets criteria.

A 28-year-old patient is diagnosed with moderate major depressive disorder. First-line pharmacotherapy for MDD in primary care includes which class of medications?

Answer: Selective serotonin reuptake inhibitors (SSRIs) such as sertraline, escitalopram, and fluoxetine

SSRIs are first-line pharmacotherapy for MDD due to their efficacy, tolerability, safety profile, and availability in generic form. TCAs and MAOIs are reserved for refractory cases.

Generalized anxiety disorder (GAD) is characterized by which core symptom that distinguishes it from other anxiety disorders?

Answer: Excessive, difficult-to-control worry about multiple areas of life occurring more days than not for 6 months or longer

GAD is characterized by excessive, uncontrollable worry across multiple domains for 6 or more months, distinguishing it from specific phobia (discrete triggers) or panic disorder (episodic attacks).

A 25-year-old female presents with recurrent unexpected panic attacks including palpitations, diaphoresis, chest tightness, fear of dying, and paresthesias. She now avoids public places for fear of another attack. The most likely diagnosis is:

Answer: Panic disorder with agoraphobia

Recurrent unexpected panic attacks combined with avoidance of situations where escape might be difficult defines panic disorder with agoraphobia per DSM-5 criteria.

When prescribing an SSRI for depression or anxiety in primary care, patients should be counseled that full therapeutic effects typically occur after:

Answer: 4 to 6 weeks

SSRIs typically require 4-6 weeks to achieve full therapeutic antidepressant or anxiolytic effects. Patients should be counseled to continue the medication for the full trial period before assessing efficacy.

A 22-year-old male patient screens positive on the PC-PTSD-5. Which exposure history is required to diagnose PTSD per DSM-5?

Answer: Direct exposure to, witnessing, or learning about actual or threatened death, serious injury, or sexual violence

DSM-5 PTSD requires exposure to actual or threatened death, serious injury, or sexual violence — either directly experienced, witnessed, learned about in a close person, or through repeated extreme exposure as in first responders.