PHQ-9 & BDI Scoring
HAM-D & GDS
EPDS & Zung Scale
PMDD Criteria
Antidepressant Pharmacology
Suicide Risk by Gender
Adjustment Disorder
Pharmacogenomics
0 / 38 answered
All Questions
38 board certification questions — click each to reveal answers and explanations
Q1
Which statement regarding the risk of death from suicide is most accurate? A. People with insomnia have equivalent risk as the general population. B. People with ADHD have lower risk than the general population. C. The rate of death by suicide in people with bipolar disorder is the highest for any disorder. D. The rate of death by suicide in bipolar disorder is higher than in major depression.
Correct answer
The rate of death by suicide in people with bipolar disorder is higher than that of people with major depression.
Why: Bipolar disorder carries a lifetime suicide risk of 15–20%, higher than unipolar depression (~6%). The lifetime risk in bipolar disorder is among the highest of any psychiatric condition, though schizophrenia and borderline personality disorder also carry significant risk. ADHD is associated with increased (not decreased) suicide risk.
Q2
A 69-year-old woman scores 6 on the Geriatric Depression Scale (GDS). What does this score indicate? A. Mild depression B. Minimal depression C. Depression D. Severe depression
Correct answer
Mild depression
Why: GDS scoring (30-item version): 0–9 = normal, 10–19 = mild depression, 20–30 = severe depression. For the 15-item GDS: 0–4 normal, 5–8 mild, 9–11 moderate, 12–15 severe. A score of 6 on the 15-item GDS = mild depression.
Q3
During a psychiatric ROS, which question is most likely designed to elicit a response for the system 'mood'? A. Is your sleep often inadequate or of poor quality? B. Have you lost interest or pleasure in things you used to enjoy? C. Is it hard for you to control or stop your worrying? D. Do you get sick more than most people?
Correct answer
'Have you lost interest or pleasure in things you used to enjoy?'
Why: Anhedonia (loss of interest or pleasure) is a core mood symptom and a diagnostic criterion for major depressive disorder. Sleep questions target neurovegetative symptoms. Worry questions target anxiety. The anhedonia question directly assesses mood.
Q4
A 33-year-old Mexican-American woman is diagnosed with depression. Which is the most appropriate clinical communication considering her cultural identity before beginning treatment? A. 'I have worked with many Hispanic patients who have been depressed.' B. 'Depression is an illness, just like diabetes.' C. 'How does your family view this illness?' D. 'Do you need your daughter to translate?'
Correct answer
'How does your family view this illness?'
Why: Culturally competent care includes exploring the patient's explanatory model and the role of family in illness understanding and treatment decisions. In many Latino cultures, family is central to health decisions (familismo). Asking about family views is the most culturally responsive approach before prescribing.
Q5
Which condition is one of the most common comorbidities associated with anorexia nervosa? A. Bipolar disorders B. Depressive disorders C. Personality disorders D. Somatic disorders
Correct answer
Depressive disorders
Why: Depression is the most common comorbidity in anorexia nervosa, present in up to 50–70% of patients. Major depressive disorder frequently co-occurs and can precede or follow the onset of AN. Anxiety disorders are also highly comorbid but among the listed options, depressive disorders are correct.
Q6
An adult patient with multiple prior depressive episodes and obesity presents after jejunoileal bypass surgery. Which statement about pharmacological treatment is most accurate? A. TCAs are recommended first-line after bariatric surgery. B. Medications should always be given in solid form. C. Post-surgical changes do not impact absorption. D. Changing the dose or starting immediate-release medication may be required.
Correct answer
Changing the dose of medication or starting immediate-release medication may be required after bariatric surgery.
Why: Bariatric surgery alters the GI anatomy, affecting drug absorption. Extended-release formulations may pass through too quickly. Immediate-release forms or dose adjustments may be needed. TCAs are not first-line due to cardiac and anticholinergic side effects. Absorption IS affected.
Q7
A 29-year-old woman presents with 4 years of fatigue, sleeping 11 hours and still tired, poor concentration, difficulty making decisions, 10-pound weight gain, overeating, no suicidal ideation, no manic symptoms, no psychosis. What is the most likely diagnosis? A. Major depressive disorder B. Generalized anxiety disorder C. Persistent depressive disorder (Dysthymia) D. Cyclothymic disorder
Correct answer
Persistent depressive disorder (Dysthymia)
Why: Persistent depressive disorder (PDD/Dysthymia) requires depressed mood for at least 2 years (1 year in children) with at least 2 of: poor appetite or overeating, insomnia or hypersomnia, low energy, low self-esteem, poor concentration, hopelessness. 4 years of symptoms without discrete MDE episodes = PDD, not MDD.
Q8
An NP is evaluating a patient assigned male at birth with SSRI-induced sexual dysfunction. The SSRI is working well and the patient doesn't want to switch. Which adjunctive medication improves sexual function in this population? A. Methylphenidate B. Sildenafil (Viagra) C. Yohimbine D. Mirtazapine
Correct answer
Sildenafil (Viagra)
Why: Sildenafil (PDE5 inhibitor) is evidence-based for SSRI-induced erectile dysfunction in males. It does not interfere with the antidepressant effect. Mirtazapine is sometimes used as an augmentation strategy but its primary use here would be switching, not adjunctive. Yohimbine has weak evidence.
Q9
What does the mnemonic SIG-E-CAPS represent? A. Sleep, inhibition, guilt, energy, cognition, appetite, psychomotor, suicide B. Sleep, interest, guilt, energy, cognition, appetite, psychomotor, suicide C. Sex, interest, guilt, energy, cognition, appetite, psychomotor, suicide D. Sleep, interest, guilt, elevated mood, cognition, appetite, psychomotor, suicide
Correct answer
Sleep, interest, guilt, energy, cognition or concentration, appetite, psychomotor, suicide
Why: SIG-E-CAPS is the mnemonic for the 8 neurovegetative symptoms of depression: Sleep (insomnia/hypersomnia), Interest (anhedonia), Guilt (worthlessness), Energy (fatigue), Concentration, Appetite (weight change), Psychomotor (agitation/retardation), Suicidal ideation. Together with depressed mood, 5+ symptoms for 2 weeks = MDD.
Q10
A 21-year-old woman presents with depression. After PHQ-9 administration, the PMHNP considers inpatient hospitalization. What was her likely score? A. 10 B. 15 C. 25 D. 5
Correct answer
25
Why: PHQ-9 scoring: 1–4 minimal, 5–9 mild, 10–14 moderate, 15–19 moderately severe, 20–27 severe. Inpatient hospitalization is typically considered for scores of 20+ (severe depression), especially with active suicidal ideation. A score of 25 = severe depression warranting hospitalization consideration.
Q11
During a psychiatric ROS, which question is most likely designed to elicit a response for the system 'mood'? A. What do you think of your appearance? B. Do you worry about your physical health more than others? C. Is it hard for you to control or stop your worrying? D. Have there ever been periods when you needed much less sleep but felt very energized, happy, or outgoing?
Correct answer
'Have there ever been periods of time when you needed much less sleep but still felt very energized, happy, or outgoing?'
Why: This question screens for hypomanic/manic episodes — elevated, expansive, or irritable mood — which is a core mood system inquiry. Decreased need for sleep with elevated energy is a hallmark of (hypo)mania. Questions A and B screen for body dysmorphia and somatic anxiety; C screens for GAD.
Q12
A 23-year-old female is being evaluated for depression. The PMHNP will administer which tool to determine depression level at baseline, during, and at end of treatment? A. Beck Depression Inventory (BDI) B. Hamilton Depression Rating Scale (HAM-D) C. Beck Hopelessness Scale D. PHQ-9
Correct answer
Hamilton Depression Rating Scale (HAM-D)
Why: The HAM-D (Hamilton Depression Rating Scale) is a clinician-administered instrument used to measure depression severity at baseline, during treatment, and at endpoint in research and clinical settings. It tracks treatment response over time. The PHQ-9 is self-administered; BDI is also self-administered.
Q13
A 22-year-old woman reports feeling unable to handle responsibilities and increased emotional sensitivity 4 days before menses onset. Which symptom must be present for PMDD diagnosis? A. Physical symptoms such as breast tenderness B. Decreased interest in usual activities C. Marked change in appetite D. Marked affective lability
Correct answer
Marked affective lability
Why: DSM-5-TR requires at least 1 of 4 core affective symptoms for PMDD: marked affective lability, marked irritability/anger, marked depressed mood, or marked anxiety/tension. Affective lability is the hallmark core symptom. Physical symptoms (breast tenderness, bloating) are associated but not required for diagnosis.
Q14
Which statement is correct regarding antidepressant discontinuation syndrome? A. Management includes starting an antidepressant with a different pharmacodynamic profile. B. This syndrome can occur from tapering too quickly or missing several doses. C. Most common signs include diarrhea, hypertension, and tinnitus. D. Patients on antidepressants with longer half-life are at greater risk.
Correct answer
This syndrome can occur from tapering antidepressants too quickly or missing several doses.
Why: Antidepressant discontinuation syndrome (FINISH mnemonic: Flu-like, Insomnia, Nausea, Imbalance, Sensory disturbances, Hyperarousal) occurs when SSRIs/SNRIs are stopped abruptly or tapered too fast. Shorter half-life drugs (paroxetine, venlafaxine) carry higher risk — NOT longer half-life. Fluoxetine's long half-life is protective.
Q15
An NP is educating a patient about risks of abruptly stopping a medication. Which medication is associated with the most significant discontinuation syndrome if stopped abruptly? A. Levothyroxine B. Metformin C. Lisinopril D. Sertraline (Zoloft)
Correct answer
Sertraline (Zoloft)
Why: Among the options, sertraline (SSRI) carries significant discontinuation syndrome risk including dizziness, paresthesias, nausea, irritability, and flu-like symptoms. Non-psychiatric medications (levothyroxine, metformin, lisinopril) do not cause comparable psychiatric discontinuation syndromes.
Q16
An adolescent patient with a history of MDD exercises after each meal until they've expended the calories eaten, suggesting bulimia nervosa. They want to augment sertraline with bupropion. What is the relative contraindication? A. Bupropion is not recommended in bulimia nervosa due to seizure risk. B. Not recommended in patients who haven't responded to sertraline. C. Not recommended in pediatric patients due to limited safety data. D. Not recommended with sertraline due to tyramine crisis risk.
Correct answer
Bupropion (Wellbutrin) is not recommended in patients who have bulimia nervosa due to risk of seizures.
Why: Bupropion has an FDA black box warning for seizures in patients with eating disorders (bulimia nervosa and anorexia nervosa). Purging behaviors cause electrolyte abnormalities (especially hypokalemia) that lower the seizure threshold. This is a hard contraindication, not just a relative one.
Q17
A 28-year-old woman started escitalopram 20 mg 3 days ago. She reports upset stomach, headache, and difficulty sleeping. What is the PMHNP's next step? A. Discontinue escitalopram. B. Decrease dose to 10 mg. C. Switch to citalopram. D. Switch to a different antidepressant.
Correct answer
Decrease the dose of escitalopram (Lexapro) to 10 mg
Why: Side effects in the first few days of an SSRI (GI upset, insomnia, headache) are common and dose-related, often resolving within 1–2 weeks. The appropriate step is to decrease to 10 mg (starting dose) and titrate more slowly — not to discontinue or switch after only 3 days. Citalopram is essentially the same drug.
Q18
Where is the neurotransmitter dopamine produced? A. Thalamus B. Amygdala C. Substantia nigra and ventral tegmental area D. Hippocampus
Correct answer
Substantia nigra and ventral tegmental area
Why: Dopamine is synthesized in two main brain regions: the substantia nigra (nigrostriatal pathway — movement) and the ventral tegmental area (mesolimbic/mesocortical pathways — reward, motivation, psychosis). Degeneration of the substantia nigra causes Parkinson's disease. VTA dysfunction underlies addiction and psychosis.
Q19
A 32-year-old male on a new antidepressant reports painful erections lasting more than 1 hour. The PMHNP should instruct him to discontinue: A. Alprazolam B. Desvenlafaxine C. Trazodone D. Lamotrigine
Correct answer
trazodone (Desyrel)
Why: Priapism (painful, prolonged erection) is a well-known and serious adverse effect of trazodone due to its alpha-1 adrenergic blocking properties. It requires immediate medical attention and discontinuation of trazodone. This is a medical emergency if erection lasts >4 hours.
Q20
A 22-year-old female scored 18 on the Beck Depression Inventory (BDI). What does this score represent? A. Normal ups and downs B. Mild mood disturbance C. Moderate depression D. Borderline clinical depression
Correct answer
Borderline clinical depression
Why: BDI-II scoring: 0–13 minimal, 14–19 mild (borderline clinical depression), 20–28 moderate, 29–63 severe. A score of 18 = borderline clinical depression (mild category). Some sources classify 17–20 as borderline.
Q21
A 27-year-old pregnant patient in her third trimester answered 'yes, quite often' to question 10 of the EPDS. How should the PMHNP advise? A. Hospitalize immediately. B. Keep a close eye if no mental health history. C. A 'yes' to question 10 is not cause for concern. D. This requires close monitoring, full psychiatric evaluation, and mental health needs assessment.
Correct answer
Because question 10 asks about thoughts of self-harm, this client requires particularly close monitoring, a full psychiatric evaluation, and assessment to determine her mental health needs.
Why: EPDS question 10 asks about thoughts of self-harm. Any positive response requires full psychiatric evaluation and close monitoring — it is never dismissed. Immediate hospitalization is not automatically required; the response must be clinically evaluated. A 'yes' to question 10 is always clinically significant.
Q22
A 64-year-old widow with 3-month history of depression, anxiety, insomnia, heart palpitations, weight loss, and occasional suicidal thoughts since her husband's death. She cannot manage finances alone. Which therapeutic modality is most appropriate? A. EMDR B. Interpersonal therapy C. Group therapy D. Reminiscence therapy
Correct answer
Group therapy
Why: Group therapy addresses grief, social isolation, and lack of social support in bereaved elderly patients. The patient lacks a support network, cannot pay bills alone, and is isolated — group therapy addresses the interpersonal and social dimensions. Interpersonal therapy (IPT) is also evidence-based for grief but is individual-focused; group addresses isolation directly.
Q23
A 27-year-old pregnant patient screened positive for perinatal depression. Which screening tool was used by the OB/GYN? A. Postpartum depression rating scale B. PHQ-9 C. Center for Epidemiologic Studies Depression Scale D. Edinburgh Postnatal Depression Scale (EPDS)
Correct answer
Edinburgh Postnatal Depression Scale (EPDS)
Why: The EPDS is the standard, validated screening tool for perinatal depression — used both antenatally and postnatally. It is specifically designed for the perinatal period and includes a self-harm question (Q10). The PHQ-9 is a general depression screen not specific to the perinatal context.
Q24
Clomipramine (TCA) is taken concurrently with buspirone. Which symptom may occur? A. Hyperthermia B. Tardive dyskinesia C. Hypotonia D. Bradycardia
Correct answer
Hyperthermia
Why: Clomipramine has serotonergic properties (strongest of the TCAs). Combined with buspirone (partial 5-HT1A agonist with serotonergic activity), the combination can precipitate serotonin syndrome. Hyperthermia is a hallmark feature of serotonin syndrome along with agitation, hyperreflexia, and diaphoresis.
Q25
A patient tells his PMHNP, 'You must think I'm a complete loser.' Which cognitive distortion fits his statement? A. All or nothing B. Mind reading C. Personalization D. Catastrophizing
Correct answer
Mind reading
Why: Mind reading is the cognitive distortion of assuming you know what others are thinking — typically that they are thinking negatively about you. The patient is assuming the PMHNP thinks he is a loser, without any evidence. All-or-nothing thinking involves extremes ('complete loser' could also suggest this, but the key feature is the assumption about the clinician's thoughts).
Q26
Mr. Jones, 52 years old, stable on escitalopram 20 mg and brexpiprazole 1 mg, hasn't had labs in 2 years. What screening labs are appropriate? A. CBC and CMP B. CBC, CMP, lipid profile, and thyroid panel C. CBC, CMP, lipid profile, thyroid profile, and vitamins B12 and D D. CBC, BMP, thyroid panel, lipid profile, and vitamin D
Correct answer
CBC, CMP, lipid profile, thyroid profile, and vitamins B12 and D levels
Why: Brexpiprazole (atypical antipsychotic) requires metabolic monitoring: lipid profile, fasting glucose/CMP. Escitalopram requires baseline and periodic thyroid (affects metabolism) and QTc monitoring. For any patient on antidepressants without recent labs, B12 and D deficiencies are common causes of refractory depression. CMP (not just BMP) is more comprehensive.
Q27
In which scenario would a patient with adjustment disorder most benefit from pharmacotherapy? A. Not responding to psychotherapy and is sufficiently distressed. B. Symptoms last longer than 6 months after stressor stops. C. Symptoms start 6 months after the stressor. D. Patient meets criteria for disturbance of conduct.
Correct answer
The patient is not responding to psychotherapy and is sufficiently distressed.
Why: Adjustment disorder is primarily treated with psychotherapy. Pharmacotherapy is considered when psychotherapy is insufficient and the patient remains significantly distressed. If symptoms persist >6 months after the stressor has resolved, the diagnosis changes to another disorder (not adjustment disorder). Symptoms starting 6 months after stressor = doesn't meet criteria.
Q28
A 31-year-old woman's Zung Depression Scale score is 51. What does this represent? A. Normal mental state B. Mild depression C. Moderate depression D. Severe depression
Correct answer
Mild depression
Why: Zung Depression Scale scoring: 20–44 normal range, 45–59 mild depression, 60–69 moderate depression, 70+ severe depression. A score of 51 falls in the mild depression range (45–59).
Q29
Which statement is accurate about gender differences in suicide risk in MDD? A. Risk of attempts and completions is equal. B. Risk of attempts is higher in women, but completions are higher in men. C. Risk of attempts and completions is higher in women. D. Risk of attempts and completions is higher in men.
Correct answer
The risk of suicide attempts is higher in women, but risk of suicide completions is higher in men.
Why: This is a well-established epidemiological finding. Women attempt suicide 2–3x more often than men; men complete suicide 3–4x more often than women. Men use more lethal means (firearms) which accounts for the higher completion rate despite fewer attempts — called the 'gender paradox of suicide.'
Q30
A 22-year-old female was diagnosed with MDD by her PCP and referred for further evaluation. Which tool helps gauge intensity of depression in patients with a depressive syndrome? A. PHQ-9 B. Beck Depression Inventory (BDI) C. Beck Hopelessness Scale D. SLUMS
Correct answer
Beck Depression Inventory (BDI)
Why: The BDI is designed to measure the severity of depression in patients already diagnosed with a depressive syndrome. The PHQ-9 is a screening tool used in primary care for initial detection. The Beck Hopelessness Scale measures hopelessness specifically. SLUMS assesses cognitive function, not depression severity.
Q31
An adult patient on amitriptyline and bupropion develops blurred vision and urinary retention shortly after starting. What is the most likely explanation? A. BPH B. Medication interaction adverse effects C. Clinical manifestations of depression D. UTI
Correct answer
The patient is experiencing adverse effects from a medication interaction.
Why: Amitriptyline has strong anticholinergic effects. Bupropion inhibits CYP2D6, which metabolizes amitriptyline — raising amitriptyline levels and amplifying its anticholinergic effects. The result: blurred vision (cycloplegia), urinary retention, dry mouth, constipation. This is a pharmacokinetic drug interaction, not a disease process.
Q32
How does persistent depressive disorder differ from major depressive disorder? A. Onset is usually late in life. B. Hypomanic episodes are present. C. Persistent depressive disorder has high-grade chronicity. D. Persistent depressive disorder is subjective in nature.
Correct answer
Persistent depressive disorder is subjective in nature.
Why: PDD (Dysthymia) is characterized by a chronically low-grade depressed mood (not necessarily meeting full MDD criteria) that the patient may experience as their normal baseline rather than a distinct illness episode. It tends to be subjective and ego-syntonic compared to MDD, which involves more discrete episodic changes.
Q33
Mirtazapine (Remeron) is a noradrenergic and specific serotonergic antidepressant (NaSSA). Which antidepressant class does it belong to? A. Tetracyclic antidepressants B. Tricyclic antidepressants C. MAOIs D. Benzodiazepines
Correct answer
Tetracyclic antidepressants
Why: Mirtazapine is a tetracyclic antidepressant (4-ring structure vs. TCA's 3 rings). Its mechanism is unique: alpha-2 adrenergic antagonism (increases norepinephrine and serotonin release) plus 5-HT2 and 5-HT3 receptor blockade. This causes fewer sexual side effects than SSRIs and promotes sleep and appetite.
Q34
An adult patient with OCD on CBT (no pharmacotherapy) reports 2 months of depressed mood, anhedonia, and hopelessness after job loss. No sleep, appetite, fatigue, substance use, or concentration problems. Most likely differential? A. OCD with depressive features B. OCD and bipolar disorder C. OCD and major depressive episode D. OCD and adjustment disorder with depressed mood
Correct answer
OCD and adjustment disorder with depressed mood
Why: Adjustment disorder requires: emotional or behavioral symptoms in response to an identifiable stressor (job loss), within 3 months of stressor onset, causing significant distress or impairment. The symptom count and duration (2 months) do not meet MDD criteria (5+ symptoms for 2+ weeks). The clear stressor and limited symptom count support adjustment disorder.
Q35
Which neurotransmitter is matched correctly with its function? A. Serotonin: thinking, fine muscle action, reward-seeking. B. GABA: reduces arousal, aggression, and anxiety. C. Norepinephrine: regulates sleep, pain, mood, and temperature. D. Dopamine: alertness, focused attention, learning, and memory.
Correct answer
Gamma aminobutyric acid (GABA): reduces arousal, aggression, and anxiety
Why: GABA is the primary inhibitory neurotransmitter — it reduces neuronal excitability, decreasing arousal, aggression, and anxiety. Benzodiazepines and alcohol enhance GABA activity. Dopamine mediates reward/motivation; norepinephrine mediates alertness and fight-or-flight; serotonin regulates mood, sleep, and appetite.
Q36
Which tool would the PMHNP use to aid in diagnosing a 69-year-old woman with depressive symptoms? A. SLUMS B. MMSE C. Geriatric Depression Scale (GDS) D. MoCA
Correct answer
Geriatric Depression Scale (GDS)
Why: The GDS is specifically designed and validated for detecting depression in older adults. SLUMS, MMSE, and MoCA are cognitive assessment tools, not depression screening tools. For a 69-year-old presenting with depressive symptoms (not cognitive concerns), GDS is the appropriate instrument.
Q37
A 28-year-old woman presents with daily crying spells after moving across the country 2 months ago for a new job. She misses family and friends but does not regret the move. Most likely diagnosis? A. Acute stress disorder B. Adjustment disorder C. Conversion disorder D. PTSD
Correct answer
Adjustment disorder
Why: Adjustment disorder is characterized by emotional symptoms (crying, distress) in response to an identifiable stressor (moving, new job) within 3 months of onset, causing significant distress disproportionate to the stressor's severity. She does not have trauma exposure (ruling out ASD/PTSD) or neurological symptoms (ruling out conversion disorder).
Q38
A 28-year-old woman with family members on antidepressants asks about pharmacogenomic testing. What is the PMHNP's most appropriate response? A. 'You don't need testing until you've failed a few medications.' B. 'We can conduct genetic screening if you'd like.' C. 'Which medications are your mother and sister taking?' D. 'We can obtain a genetic test; while we wait for results, let's start with a medication working for your mother or sister.'
Correct answer
'We can certainly obtain a genetic test; while we wait for results, let's start with a medication that is working for your mother or sister.'
Why: Pharmacogenomic testing (PGx) is a valid clinical tool that can guide antidepressant selection. The most practical approach is to order it AND start treatment simultaneously — using family history of medication response as a starting point. Waiting for results delays care. Family medication response has some genetic basis (CYP enzyme polymorphisms).