PHQ-9 & BDI Scoring
HAM-D & GDS
Zung & EPDS
SSRI Side Effects
Antidepressant Pharmacology
Dysthymia vs MDD
PMDD Criteria
Cognitive Distortions
Suicide Risk — Gender
SIG-E-CAPS
0 / 38 answered
Q1
Which statement regarding the risk of death from suicide is most accurate? A. People with insomnia have an equivalent risk compared with the general population. B. People with ADHD have a lower risk than the general population. C. The rate of death by suicide in bipolar disorder is the highest for any disorder. D. The rate of death by suicide in bipolar disorder is higher than that of people with 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 one of the highest suicide mortality rates of any psychiatric diagnosis — approximately 20-30 times that of the general population. While bipolar disorder has very high risk, schizophrenia and anorexia nervosa also carry extremely high mortality. The rate in bipolar disorder exceeds unipolar depression due to the impulsivity and high-energy states of mixed episodes.
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: The GDS-15 scoring: 0-4 = normal, 5-8 = mild depression, 9-11 = moderate depression, 12-15 = severe depression. A score of 6 falls in the mild depression range. The GDS is the validated screening tool for depression in older adults.
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? B. Have you lost interest or pleasure in things you used to enjoy? C. Is it hard for you to control 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 one of the two cardinal symptoms of depression (along with depressed mood). It specifically maps to the 'mood' domain of the psychiatric ROS. Sleep belongs to the sleep/neurovegetative domain; worrying maps to anxiety; frequent illness maps to somatic domain.
Q4
A 33-year-old Mexican-American woman is diagnosed with depression. Considering her cultural identity, which is the most appropriate clinical communication prior to beginning treatment? A. 'I have worked with many Hispanic patients who have been depressed.' B. 'Depression is an illness, just like diabetes, and you have to take medicine.' C. 'How does your family view this illness?' D. 'Do you need your daughter to translate anything for you?'
Correct answer
'How does your family view this illness?'
Why: Culturally competent care requires exploring the patient's explanatory model and the role of family in health decisions, particularly in collectivist cultures. Asking about the family's view opens a culturally appropriate conversation. Comparing to diabetes without eliciting beliefs is prescriptive. Assuming she needs a translator is presumptuous and potentially offensive.
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: Depressive disorders are the most common psychiatric comorbidity in anorexia nervosa, occurring in 50-70% of cases. The relationship is bidirectional — depression worsens restrictive behaviors and nutritional deficits worsen depressive symptoms. This comorbidity significantly impacts treatment planning.
Q6
An adult with a history of multiple depressive episodes and obesity presents after jejunoileal bypass surgery. Which statement about pharmacological treatment of depression 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 after bariatric surgery.
Correct answer
Changing the dose of medication or starting immediate-release medication may be required after bariatric surgery.
Why: Bariatric surgery significantly alters GI anatomy, gastric acid production, and transit time — all affecting drug absorption. Extended-release formulations may pass through intact without adequate absorption. Immediate-release forms may be needed. Dose adjustments are common. TCAs are not preferred due to cardiac and anticholinergic effects.
Q7
A 29-year-old woman presents with 4 years of fatigue, feeling 'tired' and 'empty,' sleeping 11 hours daily still tired, trouble concentrating, 10-pound weight gain from 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) requires depressed mood for at least 2 years in adults with two or more associated symptoms. This patient has 4 years of symptoms — hypersomnia, fatigue, poor concentration, overeating, low energy — below the threshold for MDD severity. Atypical features (hypersomnia, increased appetite) are common in PDD.
Q8
A patient on an SSRI with significantly improved depression prefers not to switch medications but is experiencing persistent sexual dysfunction. Which adjunctive medication improves sexual function in patients assigned male at birth? A. Methylphenidate. B. Sildenafil (Viagra). C. Yohimbine. D. Mirtazapine.
Correct answer
Sildenafil (Viagra).
Why: PDE-5 inhibitors (sildenafil, tadalafil) are evidence-based treatments for SSRI-induced erectile dysfunction and delayed ejaculation in males. They do not affect the antidepressant efficacy of SSRIs. Mirtazapine can actually worsen sexual dysfunction in some cases due to sedation. Yohimbine has very limited 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 used in DSM-5 criteria: Sleep disturbance, Interest loss (anhedonia), Guilt/worthlessness, Energy loss, Concentration difficulty, Appetite change, Psychomotor changes, Suicidal ideation. Five or more (including depressed mood or anhedonia) for 2 weeks = MDD.
Q10
A 21-year-old woman presents with depression. After a PHQ-9, 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: 0-4 minimal, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. Inpatient hospitalization is considered for scores in the severe range (20-27), particularly when combined with active suicidal ideation. A score of 25 indicates severe depression warranting the highest level of care.
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 other people? C. Is it hard for you to control or stop your worrying? D. Have there ever been periods of time when you needed much less sleep but still 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 hypomania or mania — decreased need for sleep with increased energy and elevated mood — which belongs to the mood/bipolar domain of the psychiatric ROS. Appearance questions map to body image/eating. Worry questions map to anxiety. Physical health worry maps to somatic/health anxiety.
Q12
A 23-year-old female is being evaluated for depression. The PMHNP will administer which tool to determine the client's level of depression at baseline, during, and at the 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 the gold-standard clinician-administered scale for measuring depression severity in clinical trials and treatment monitoring. It is used at baseline, during treatment, and at endpoint to track response. The PHQ-9 and BDI are patient self-report tools, not clinician-rated.
Q13
A 22-year-old woman experiences emotional sensitivity and inability to handle responsibilities 4 days before menses. Which symptom must be present for PMDD? 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 PMDD criteria require at least one of four affective symptoms: marked affective lability (mood swings), marked irritability or anger, marked depressed mood, or marked anxiety/tension. Affective lability is the most prominent and is required. Physical symptoms alone are insufficient. At least 5 total symptoms must be present.
Q14
Which statement is correct regarding antidepressant discontinuation syndrome? A. Treat by starting an antidepressant with a different pharmacodynamic profile. B. Can occur from tapering too quickly or missing several doses. C. Most common signs include diarrhea, hypertension, and tinnitus. D. Patients taking antidepressants with a longer elimination 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: Flu-like symptoms, Insomnia, Nausea, Imbalance/dizziness, Sensory disturbances, Hyperarousal) results from abrupt stopping or rapid taper. Longer half-life medications (like fluoxetine) are protective — shorter half-life SSRIs/SNRIs (paroxetine, venlafaxine) carry highest risk. Management is restarting and tapering more slowly.
Q15
Which medication is associated with the most significant discontinuation/withdrawal syndrome if stopped abruptly? A. Levothyroxine. B. Metformin. C. Lisinopril. D. Sertraline (Zoloft).
Correct answer
Sertraline (Zoloft).
Why: Among the choices, sertraline is the only psychotropic and the only one associated with antidepressant discontinuation syndrome. SSRIs produce physical dependence, and abrupt cessation causes FINISH symptoms. Levothyroxine, metformin, and lisinopril do not cause withdrawal syndromes when stopped (though levothyroxine should be tapered for clinical reasons).
Q16
An adolescent patient with restrictive eating behaviors (running to expend calories after meals), thin appearance, and MDD unresponsive to sertraline presents for augmentation. Which aspect is a relative contraindication to adding bupropion (Wellbutrin)? A. Bupropion is not recommended in bulimia nervosa due to risk of seizures. B. Not recommended in patients not responding to sertraline. C. Not recommended in pediatric patients due to limited safety data. D. Not recommended with sertraline due to risk of tyramine crisis.
Correct answer
Bupropion (Wellbutrin) is not recommended in patients who have bulimia nervosa due to risk of seizures.
Why: Bupropion lowers the seizure threshold and is specifically contraindicated in eating disorders characterized by purging or restrictive behaviors (anorexia and bulimia nervosa) due to the electrolyte disturbances and malnutrition that dramatically increase seizure risk. This patient's behavior of running to expend calories suggests a compensatory/restrictive eating pattern.
Q17
A 28-year-old woman started escitalopram 20 mg 3 days ago for MDD and GAD. She calls reporting upset stomach, headache, and difficulty sleeping. What is the PMHNP's next step? A. Discontinue escitalopram. B. Decrease the 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: GI upset, headache, and insomnia in the first 1-2 weeks are common, expected SSRI side effects that typically resolve with time. The dose of 20 mg is high to start for escitalopram — the recommended starting dose is 10 mg. Reducing to 10 mg allows the patient to continue treatment with the effective medication while minimizing side effects. Discontinuing entirely would be premature.
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 (projects to the striatum via the nigrostriatal pathway — involved in movement; loss causes Parkinson's disease) and the ventral tegmental area (VTA) (projects to the limbic system and prefrontal cortex — involved in reward, motivation, and mood).
Q19
A 32-year-old male on a new antidepressant reports painful erections, the most recent lasting more than 1 hour. The PMHNP should instruct him to discontinue which medication? A. Alprazolam. B. Desvenlafaxine. C. Trazodone. D. Lamotrigine.
Correct answer
Trazodone (Desyrel).
Why: Priapism — prolonged, painful erection — is a well-known and serious side effect of trazodone, occurring in approximately 1 in 6,000-8,000 male patients. It is a urological emergency requiring immediate discontinuation of trazodone and urgent urological evaluation if erection lasts more than 4 hours. The mechanism involves alpha-1 adrenergic blockade.
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 depression, 14-19 mild depression (some sources call this 'borderline clinical depression'), 20-28 moderate depression, 29-63 severe depression. A score of 18 falls in the mild/borderline clinical depression range. Note: original BDI scoring designated 14-19 as 'borderline clinically depressed.'
Q21
A 27-year-old pregnant woman in her third trimester responded 'yes, quite often' to question 10 on the Edinburgh Postnatal Depression Scale (EPDS). How should the PMHNP advise? A. Hospitalize immediately. B. If no mental health history, keep a close eye on her. C. A 'yes' to question 10 is not cause for concern. D. Requires particularly close monitoring, full psychiatric evaluation, and assessment of mental health needs.
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: Question 10 of the EPDS specifically screens for thoughts of self-harm or suicide. Any positive response to question 10 requires immediate clinical action — not automatic hospitalization, but a thorough safety assessment and psychiatric evaluation. The EPDS guidelines mandate that any positive response to question 10 triggers a full assessment.
Q22
A 64-year-old woman whose husband died 3 months ago has uncontrollable crying, depression, anxiety, inability to leave bed, social withdrawal, insomnia, palpitations, 10-pound weight loss, and occasional suicidal thoughts. Which therapeutic modality would be most appropriate? A. EMDR. B. Interpersonal therapy. C. Group therapy. D. Reminiscence therapy.
Correct answer
Group therapy.
Why: This presentation suggests complicated grief or adjustment disorder with depressive features after bereavement. Group therapy provides peer support, normalization of grief, and shared coping strategies — particularly appropriate for recent widowhood. Interpersonal therapy is also evidence-based for grief but individual. Reminiscence therapy is used primarily for dementia. EMDR is for trauma.
Q23
A local OB/GYN refers a 27-year-old pregnant patient in her third trimester who screened positive for perinatal depression. Which screening tool was used? 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 Edinburgh Postnatal Depression Scale (EPDS) is the standard validated screening tool for perinatal and postpartum depression. It is used during pregnancy and the postpartum period and is recommended by ACOG. The PHQ-9 is not validated specifically for perinatal depression. The EPDS is a 10-item self-report questionnaire with a cutoff of ≥13 for probable depression.
Q24
Clomipramine (TCA) is taken concurrently with buspirone (Buspar). Which symptom may occur? A. Hyperthermia. B. Tardive dyskinesia. C. Hypotonia. D. Bradycardia.
Correct answer
Hyperthermia.
Why: Clomipramine combined with buspirone can cause serotonin syndrome due to their combined serotonergic effects. Serotonin syndrome presents with hyperthermia (elevated body temperature), autonomic instability, and neuromuscular abnormalities (hyperreflexia, clonus). Clomipramine has significant serotonin reuptake inhibition among TCAs.
Q25
A 42-year-old male patient says 'You must think I'm a complete loser.' Which cognitive distortion does this represent? 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 in a negative direction, without objective evidence. The patient is attributing a specific negative thought to the therapist ('you must think I'm a loser') without any evidence. This is a common cognitive distortion in depression and social anxiety.
Q26
Mr. Jones, 52 years old, is stable on acetaminophen prn, omeprazole 20 mg BID, escitalopram 20 mg daily, and brexpiprazole 1 mg daily, with no 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
Complete blood count (CBC), comprehensive metabolic panel (CMP), lipid profile, thyroid profile, and vitamins B12 and D levels.
Why: Brexpiprazole (atypical antipsychotic) requires metabolic monitoring: CBC, CMP, lipid profile. Escitalopram warrants thyroid monitoring (depression can be thyroid-related). B12 deficiency causes depression and cognitive symptoms; Vitamin D deficiency is highly prevalent and associated with depression. The CMP (not just BMP) is needed to monitor hepatic function.
Q27
In which scenario would a patient with adjustment disorder most likely benefit from pharmacotherapy? A. Not responding to psychotherapy and sufficiently distressed. B. Symptoms last longer than 6 months after the stressor has stopped. C. Symptoms start 6 months after the initial 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 treated primarily with psychotherapy (CBT, supportive therapy). Pharmacotherapy is a second-line adjunct when the patient is not responding adequately to therapy and is experiencing significant distress. Symptoms lasting more than 6 months after stressor cessation would change the diagnosis away from adjustment disorder (which requires resolution within 6 months of stressor end).
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 Self-Rating Depression Scale scoring: 25-49 normal range, 50-59 mild depression, 60-69 moderate to marked depression, 70+ severe depression. A score of 51 falls in the mild depression range. Note: some sources place 50-59 as the 'mildly depressed' range.
Q29
Which statement is accurate about gender differences in suicide risk in MDD? A. Risk of attempts and completions is equal in men and women. B. Risk of attempts is higher in women, but completions 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 approximately 2-3 times more often than men, but men complete suicide approximately 3-4 times more often than women. Men use more lethal means (firearms, hanging) while women more commonly use overdose, which has lower lethality.
Q30
A 22-year-old diagnosed with MDD is referred to the PMHNP for treatment. Which tool helps gauge the intensity of depression in patients who have been diagnosed 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 specifically to measure the severity/intensity of depression in patients already diagnosed with a depressive syndrome — not as a screening tool. The PHQ-9 is both a screening and severity measurement tool. The Beck Hopelessness Scale assesses pessimism and hopelessness specifically, not overall depression severity.
Q31
An adult patient treated with amitriptyline and bupropion reports blurred vision and urinary retention shortly after starting. What is the most likely explanation? A. Benign prostatic hyperplasia. B. Adverse effects from a medication interaction. C. Ongoing clinical manifestations of depression. D. Urinary tract infection.
Correct answer
The patient is experiencing adverse effects from a medication interaction.
Why: Amitriptyline (TCA) has significant anticholinergic effects. Bupropion inhibits CYP2D6, which metabolizes amitriptyline — raising amitriptyline levels. The combination produces excessive anticholinergic toxicity: blurred vision (mydriasis, loss of accommodation), urinary retention, dry mouth, constipation, and cognitive effects. The interaction is pharmacokinetic (bupropion increases amitriptyline exposure).
Q32
How does the diagnosis of persistent depressive disorder differ from major depressive disorder? A. Onset is usually late in life. B. Hypomanic episodes are present. C. PDD has high-grade chronicity. D. PDD is subjective in nature.
Correct answer
Persistent depressive disorder is subjective in nature.
Why: PDD is characterized by chronicity (2+ years) and by the subjective quality of the depression — patients describe feeling 'down,' 'empty,' or 'not myself' rather than the clearly articulated severity of MDD. PDD does not include hypomanic episodes (that would be cyclothymia). The chronicity distinguishes it from MDD, not the severity.
Q33
Mirtazapine (Remeron) is a NaSSA. Which 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) classified as a noradrenergic and specific serotonergic antidepressant (NaSSA). It works by blocking alpha-2 autoreceptors (increasing NE and 5-HT release) and blocking 5-HT2 and 5-HT3 receptors. It is not a TCA (3-ring) despite structural similarity. Notable for sedation and appetite stimulation via H1 blockade.
Q34
A patient with OCD receiving CBT but no medication lost their job 2 months ago and now has depressed mood, anhedonia, hopelessness, and difficulty getting up in the morning. No sleep/eating problems, no fatigue, no suicidality, no concentration difficulty. What is the most likely differential diagnosis? 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 a stressor (job loss), emotional/behavioral symptoms within 3 months, and marked distress or functional impairment. The patient has fewer than 5 depressive symptoms and a clear identifiable stressor within 2 months. This does not meet full MDD criteria. Adjustment disorder with depressed mood is the correct diagnosis for subthreshold depression following an identifiable stressor.
Q35
Which neurotransmitter is matched correctly with its function? A. Serotonin: thinking, fine muscle action, and reward-seeking behavior. B. GABA: reduces arousal, aggression, and anxiety. C. Norepinephrine: regulates sleep, pain, mood states, 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 CNS excitability, including arousal, aggression, and anxiety. Dopamine is primarily associated with reward, motivation, movement, and psychosis (not memory — that's more acetylcholine). Norepinephrine is involved in alertness, fight-or-flight, attention. Serotonin regulates mood, sleep, appetite, and pain.
Q36
Which tool would the PMHNP use to aid in diagnosis of 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 the validated depression screening tool specifically designed for older adults. It avoids somatic questions that overlap with normal aging. SLUMS, MMSE, and MoCA are cognitive assessment tools for dementia/cognitive impairment, not depression screening. The GDS exists in 15-item and 30-item versions.
Q37
A 28-year-old woman who moved across the country 2 months ago cries daily after work. The move was for a good job opportunity and she has no regrets, but misses her family and friends. What is the most likely diagnosis? A. Acute stress disorder. B. Adjustment disorder. C. Conversion disorder. D. PTSD.
Correct answer
Adjustment disorder.
Why: Adjustment disorder occurs when emotional symptoms (crying, sadness) develop within 3 months of an identifiable stressor (the move) and cause distress or impairment, but don't meet criteria for another specific disorder. ASD and PTSD require a traumatic stressor. The move was a positive life change, not a trauma. Conversion disorder involves neurological symptoms without medical explanation.
Q38
A 28-year-old woman asks about genetic testing to determine which antidepressant would work best, given her mother and sister have been on antidepressants for years. What is the PMHNP's most appropriate response? A. 'You don't need a genetic test until you've failed a few medications.' B. 'We can certainly conduct a genetic screening test if you would 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 that is 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 (e.g., GeneSight) is increasingly available and valid to guide antidepressant selection, particularly in treatment-resistant cases or for patients with concerns. The pragmatic approach is to order the test AND start treatment — because results take 1-2 weeks and treatment shouldn't be delayed. Starting with a medication effective in first-degree relatives has reasonable empirical support given genetic similarities in drug metabolism.
More Board Prep