Depression, PTSD, And Anxiety Disorders
For students. By students.
- 1.
Who is more likely due to develop PTSD?
- A.
Men
- B.
Women
Correct Answer
B. WomenExplanation
Women are more likely to develop PTSD compared to men. This could be due to various factors such as the higher prevalence of traumatic events experienced by women, including sexual assault and domestic violence. Women may also have different physiological responses to trauma and may be more likely to experience symptoms of anxiety and depression, which are often associated with PTSD. Additionally, societal factors such as gender roles and expectations may contribute to women being more vulnerable to developing PTSD.Rate this question:
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- 2.
Which of the following best classifies the symptom of “insomnia”?
- A.
Avoidance Symptoms
- B.
Depressive Symptoms
- C.
Hyperarousal Symptoms
- D.
Re-experiencing Symptoms
Correct Answer
C. Hyperarousal SymptomsExplanation
Depressive Symptoms are not symptoms of PTSDRate this question:
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- 3.
A patient presents to the ER, is stabilized, and diagnosed with PTSD. Before the patient is discharged or any treatment is began, what should be a clinician’s first option?
- A.
Sertraline
- B.
Paroxetine
- C.
SSRI + atypical antipsychotic titrated to severity
- D.
Venlafaxine ER (Effexor XR)
- E.
Either A or B
- F.
None of the above/Other
Correct Answer
F. None of the above/OtherExplanation
CBT is first in the treatment algorithm of treatment for PTSDRate this question:
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- 4.
Which pharmacotherapy treatment option would be considered the best for use in a pregnant patient with OCD?
- A.
Amitriptyline
- B.
Citalopram
- C.
Clomipramine
- D.
Fluoxetine
Correct Answer
D. FluoxetineExplanation
CBT alone should be used except in cases where the risks of untreated OCD outweigh the risks of drug useRate this question:
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- 5.
Of the following, which would be the most appropriate treatment consideration for adolescents with OCD?
- A.
CBT + amitriptyline
- B.
CBT + paroxetine
- C.
CBT + sertraline
- D.
None of the above, the risk of suicidality associated with SSRIs is too great in adolescents. CBT should be used alone.
Correct Answer
C. CBT + sertralineExplanation
In Children/Adolescent patients with OCD, CBT + SSRI treatment is recommended. FDA-approved SSRI for this include Fluoxetine, Fluvoxamine, Sertraline, ClomipramineRate this question:
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- 6.
Of the following, which SSRIs require lower doses in patients with renal impairment? (check all that apply)
- A.
Citalopram
- B.
Clomipramine
- C.
Fluoxetine
- D.
Fluvoxamine
- E.
Sertraline
Correct Answer(s)
C. Fluoxetine
D. FluvoxamineExplanation
All SSRIs are hepatically metabolized and should therefore be used cautiously in patients with hepatic impairment. Renally, doses of fluoxetine and fluvoxamine should be lowered in addition to the initial dose of paroxetineRate this question:
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- 7.
Duration of treatment: How long should CBT typically last (assuming weekly sessions)? How long should pharmacotherapy be continued?
- A.
8-12 weeks; 4-6 weeks
- B.
13-20 weeks ; 8-12 weeks
Correct Answer
B. 13-20 weeks ; 8-12 weeksExplanation
CBT - 13-20 weeks of weekly sessions + daily homework, Pharm- 8-12 weeks including 4-6 weeks at max. tolerable doseRate this question:
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- 8.
Which of the following properties regarding BZD is false?
- A.
Are excreted unchanged, primarily through urine
- B.
BZDs are lipophilic leading to increased half-lives in older adults
- C.
Carry a risk of cognitive impairment with long-term use
- D.
Risk associated with withdrawal/rebound symptoms are associated with high doses, but can occur at therapeutic doses as well
Correct Answer
A. Are excreted unchanged, primarily through urineExplanation
BZDs are not primarily excreted unchanged through urine. They undergo extensive metabolism in the liver, forming active metabolites that are then excreted through urine. This is why the answer stating that BZDs are excreted unchanged, primarily through urine, is false.Rate this question:
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- 9.
A patient in the ER manifests a series of violent seizure. Which medication would be best (in terms of kinetics for just this episode of seizures) for this patients?
- A.
Diazepam (Valium ®)
- B.
Clorazepate (Tranzene ®)
- C.
Lorazepam (Ativan ®)
Correct Answer
A. Diazepam (Valium ®)Explanation
Diazepam is rapidly distributedly, has rapid onset, and rapid termination (due to distribution in fat) making good for “fast on fast off”. Lorazepam may be used for a longer effect, but has a slower onset.Rate this question:
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- 10.
Which of the following (regarding the “selected products” section) is False?
- A.
Diazepam has the widest range of indications
- B.
Oxazepam has no active metabolites
- C.
Flumazenil is a competitive agonist of BZD at the BZ receptor
- D.
Zolpidem is a selective BZ1 agonist
Correct Answer
C. Flumazenil is a competitive agonist of BZD at the BZ receptorExplanation
Flumazenil is competitive antagonistRate this question:
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- 11.
Which of the following regarding anxiety is False?
- A.
Most common all psychiatric disorder
- B.
More common in men than women
- C.
Can be secondary to medication
- D.
Commonly comorbid with other disease states
Correct Answer
B. More common in men than womenExplanation
Women more commonly diagnosed than menRate this question:
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- 12.
What FDA warning comes with citalopram (Celexa ®)?
- A.
Hypotension
- B.
Prolonged QT
- C.
Seizures
- D.
Sudden death
Correct Answer
B. Prolonged QTExplanation
Citalopram (Celexa®) comes with a warning for prolonged QT interval. The QT interval is a measure of the electrical activity of the heart, and a prolonged QT interval can increase the risk of a life-threatening irregular heartbeat. This warning is important for healthcare professionals and patients to be aware of, as it may influence the decision to prescribe or take citalopram.Rate this question:
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- 13.
In anxiety, benzodiazepines are _____ for patients who cannot tolerate antidepressants and ______ for patients requiring rapid relief of anxiety.
- A.
1st line ; 1st line
- B.
1st line ; 2nd line
- C.
2nd line ; 1st line
- D.
2nd line ; 2nd line
Correct Answer
C. 2nd line ; 1st lineExplanation
Benzodiazepines are considered second line treatment for patients who cannot tolerate antidepressants in the management of anxiety. This means that benzodiazepines are not the first choice of treatment for anxiety, but they may be used if other options such as antidepressants are not suitable for the patient. On the other hand, benzodiazepines are considered first line treatment for patients requiring rapid relief of anxiety. This means that if a patient needs immediate relief from their anxiety symptoms, benzodiazepines may be the initial treatment of choice.Rate this question:
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- 14.
Which of the following are Long acting benzodiazepine (4 answers) ?
- A.
Alprazolam
- B.
Chlordiazepoxide
- C.
Lorazepam, Oxazepam, Temazepam
- D.
Triazolam
- E.
Clonazepam
- F.
Diazepam
- G.
Flurazepam
Correct Answer(s)
B. Chlordiazepoxide
E. Clonazepam
F. Diazepam
G. FlurazepamExplanation
Chlordiazepoxide, Clonazepam, Diazepam, and Flurazepam are long-acting benzodiazepines. These medications have a longer duration of action in the body compared to short-acting benzodiazepines like Alprazolam, Lorazepam, Oxazepam, and Temazepam. Triazolam is an intermediate-acting benzodiazepine, which means it has a shorter duration of action compared to long-acting benzodiazepines.Rate this question:
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- 15.
When stopping BZD use, patients may to expect symptoms of withdrawal in only the first 1-3 days of stopping therapy.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Withdrawal symptoms may manifest in 1-2 days for short acting agents and 5-10 days for long acting agentsRate this question:
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- 16.
What is the taper recommended for BZD therapy?
- A.
Taper 10% every week
- B.
Taper 25% every week
- C.
Taper 25% over 2-3 weeks
- D.
Taper 50% over 2-3 weeks
Correct Answer
D. Taper 50% over 2-3 weeksExplanation
The recommended taper for BZD therapy is to decrease the dosage by 50% over a period of 2-3 weeks. This gradual reduction in dosage helps to minimize withdrawal symptoms and allows the body to adjust to the lower levels of the medication. It is important to taper off BZD therapy slowly and under the guidance of a healthcare professional to ensure a safe and successful discontinuation of the medication.Rate this question:
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- 17.
Mirtazipine is a BZD antagonist that has high affinity for BZD but lacks efficacy--making it useful in BZD overdose
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Flumazenil is a BZD antagonistRate this question:
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- 18.
All SSRIs are effective for the treatment of panic disorder
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
All SSRIs, which stands for selective serotonin reuptake inhibitors, have been found to be effective in treating panic disorder. This class of medications works by increasing the levels of serotonin in the brain, which helps regulate mood and reduce anxiety symptoms. Numerous studies have demonstrated the efficacy of SSRIs in reducing the frequency and severity of panic attacks, as well as improving overall functioning and quality of life for individuals with panic disorder. Therefore, it can be concluded that all SSRIs are indeed effective for the treatment of panic disorder.Rate this question:
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- 19.
How long after initiating anti-anxiety therapy with SSRIs does it take to assess a full response?
- A.
2-4 weeks
- B.
6-8 weeks
- C.
10-12 weeks
- D.
12-16 weeks
Correct Answer
C. 10-12 weeksExplanation
12 weeks to assess a full response, but additional responses may be noted for up to 6 monthsRate this question:
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- 20.
Duoloxetine (Cymbalta ®) is the only SNRI approved for panic disorder
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Venlafaxine XR (Effexor XR) is the only SNRI approved for panic disorderRate this question:
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- 21.
Which of the following side effects of MAOi can be exacerbated by diet?
- A.
COPD
- B.
Hypertensive crisis
- C.
Prolonged QT
- D.
Sudden Death
Correct Answer
B. Hypertensive crisisExplanation
MAO inhibitors (MAOis) are a type of medication used to treat depression and other mental health conditions. One of the side effects of MAOis is hypertensive crisis, which is a sudden and severe increase in blood pressure. This side effect can be exacerbated by certain foods that contain tyramine, such as aged cheeses, cured meats, and fermented foods. When tyramine is consumed, it can cause the release of norepinephrine, leading to a dangerous spike in blood pressure. Therefore, it is important for individuals taking MAOis to avoid tyramine-rich foods to prevent hypertensive crisis.Rate this question:
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- 22.
Though not commonly used as such, TCA’s (historically and presently) are used PRN for panic attacks
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
Requires daily administrationRate this question:
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- 23.
Due to their greater efficacy than SSRIs, BZDs are first line treatment in GAD
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
While more effective than SSRI in (only) first 2 weeks, BZD are second line due to abuse potentialRate this question:
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- 24.
Which of the following, in regards to buspirone (Buspar ®), is True?
- A.
Acts on GABA receptors involved with fear/anxiety
- B.
Are structurally related to BZD, but have completely different mechanism of action
- C.
Have slower onset of effects than BZD
- D.
Have higher abuse potential than BZD
- E.
More convenient dosing schedule
Correct Answer
C. Have slower onset of effects than BZDExplanation
Act on serotonin receptors.
Neither structurally nor mechanistically related to BZD
Slower onset of effects (weeks) compared to BZD (days)
Require multiple dosingRate this question:
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- 25.
Which of the following Does NOT carry and FDA indication for GAD?
- A.
Escitalopram
- B.
Paroxetine
- C.
Venlafaxine ER
- D.
Venlafaxine IR
- E.
Duloxetine
Correct Answer
D. Venlafaxine IRExplanation
While both Venlafaxine ER and IR have been shown to be effective, IR does not carry the FDA indicationRate this question:
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- 26.
Which of the following is TRUE regarding benzodiazepine use in geriatric patients?
- A.
Elderly patients are less sensitive to the CNS effects of benzodiazepines
- B.
Elderly patients have an decreased fat to lean tissue ratio
- C.
Temazepam is metabolized via phase II metabolism so it is a preferred choice due to decreased CYP metabolism with advanced age
- D.
The same dose of benzodiazepines may be used in elderly patients, just monitor CNS effects and adjust dose accordingly
Correct Answer
C. Temazepam is metabolized via phase II metabolism so it is a preferred choice due to decreased CYP metabolism with advanced ageExplanation
Elderly patients have a decreased fat to lean tissue ratio, which can result in increased sensitivity to the CNS effects of benzodiazepines. Temazepam is metabolized via phase II metabolism, which is not affected by age-related changes in CYP metabolism. Therefore, it is a preferred choice in geriatric patients due to decreased CYP metabolism with advanced age. The same dose of benzodiazepines may not be used in elderly patients as they are more sensitive to the CNS effects, so monitoring and dose adjustment are necessary.Rate this question:
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- 27.
Which of the following statements is TRUE?
- A.
Long-acting acting benzodiazepines are associated with no significant rebound insomnia while short-acting are associated with moderate rebound insomnia
- B.
Short-acting acting benzodiazepines are associated with no significant rebound insomnia while long-acting are associated with moderate rebound insomnia
- C.
Both long- and short-acting benzodiazepines are associated with no significant rebound insomnia
- D.
Both long- and short-acting benzodiazepines are associated with moderate significant rebound insomnia
Correct Answer
A. Long-acting acting benzodiazepines are associated with no significant rebound insomnia while short-acting are associated with moderate rebound insomniaExplanation
Long-acting benzodiazepines are associated with no significant rebound insomnia because their effects last longer and they are gradually eliminated from the body. On the other hand, short-acting benzodiazepines are associated with moderate rebound insomnia because they are quickly metabolized and eliminated from the body, leading to a sudden withdrawal of the drug's effects, which can result in rebound insomnia.Rate this question:
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