CARN Co-Occurring Disorders 3 — Questions and Answers
Question 1: A patient with depression and alcohol use disorder achieves sobriety. How long should the nurse wait before reassessing depressive symptoms to distinguish substance-induced depression from independent major depression?
- 1 week
- 2-4 weeks (Correct answer)
- 3 months
- 6 months
Correct answer: 2-4 weeks
Current guidelines recommend waiting 2-4 weeks of sobriety before reassessing depressive symptoms, as many substance-induced mood symptoms resolve within this timeframe.
Question 2: Which motivational interviewing technique is MOST effective when a patient with co-occurring disorders expresses ambivalence about treatment?
- Confrontation to break through denial
- Reflective listening and exploring ambivalence (Correct answer)
- Providing detailed psychoeducation about consequences
- Setting firm boundaries and ultimatums
Correct answer: Reflective listening and exploring ambivalence
Reflective listening and exploring ambivalence are core MI techniques that help patients with co-occurring disorders move toward change by building intrinsic motivation.
Question 3: A patient with bipolar disorder begins using methamphetamine. Which mood episode is MOST likely to be precipitated by stimulant use?
- Major depressive episode
- Manic or hypomanic episode (Correct answer)
- Mixed episode only
- Dysthymic episode
Correct answer: Manic or hypomanic episode
Stimulant use such as methamphetamine is strongly associated with triggering manic or hypomanic episodes in patients with bipolar disorder due to dopaminergic activation.
Question 4: The CAGE questionnaire is being used to screen a patient with known depression. Which limitation should the nurse recognize?
- It takes too long to administer in clinical settings
- It does not detect drug use disorders, only alcohol use
- It may have reduced sensitivity in individuals with psychiatric disorders (Correct answer)
- It is only validated for use in inpatient settings
Correct answer: It may have reduced sensitivity in individuals with psychiatric disorders
The CAGE questionnaire may have reduced sensitivity in individuals with psychiatric disorders, who may minimize or deny alcohol problems, necessitating supplemental screening tools.
Question 5: Which statement about tobacco use disorder and mental illness is most accurate?
- Smoking rates among individuals with schizophrenia are similar to the general population
- People with mental illness consume approximately 44% of all cigarettes sold in the US (Correct answer)
- Nicotine replacement therapy is contraindicated in patients with schizophrenia
- Mental illness protects against nicotine dependence
Correct answer: People with mental illness consume approximately 44% of all cigarettes sold in the US
Research indicates that people with mental illness consume approximately 44% of all cigarettes sold in the US, reflecting the extremely high rates of tobacco use disorder in this population.
Question 6: A nurse is treating a patient with opioid use disorder and PTSD. Which therapeutic modality has the STRONGEST evidence base for treating both conditions concurrently?
- Seeking Safety (Correct answer)
- 12-step facilitation
- Psychodynamic therapy
- Supportive counseling
Correct answer: Seeking Safety
Seeking Safety is a present-focused cognitive-behavioral therapy with strong evidence specifically designed for individuals with co-occurring PTSD and substance use disorders.
Question 7: Which neurotransmitter dysregulation is shared between major depressive disorder and opioid use disorder, supporting the use of certain pharmacological treatments for both?
- Acetylcholine
- Histamine
- Serotonin and dopamine (Correct answer)
- GABA exclusively
Correct answer: Serotonin and dopamine
Both major depressive disorder and opioid use disorder involve dysregulation of serotonin and dopamine systems, which is why medications targeting these pathways may benefit both conditions.
CARN Co-Occurring Disorders 3
A patient with depression and alcohol use disorder achieves sobriety.
How long should the nurse wait before reassessing depressive symptoms to distinguish substance-induced depression from independent major depression?