Diagnostic Criteria and Screening
A 35-year-old woman presents with low mood, poor appetite, and sleep disturbance for three weeks. What screening tool would you use to assess for major depression in primary care?
PHQ-9
A 27-year-old patient starts sertraline and returns two weeks later reporting mild nausea and restlessness. What’s your next step?
Reassure; side effects are common early and usually self-limit within 1–2 weeks.
You’re using reflective listening and open-ended questions to help a patient explore readiness to quit smoking. What counseling style are you using?
Motivational Interviewing.
A 23-year-old female has episodes of binge eating followed by self-induced vomiting. BMI is normal. What’s the most likely diagnosis?
Bulimia Nervosa.
A 19-year-old reports thoughts of “not wanting to wake up” but no plan. What is the first step?
Assess suicidal ideation, intent, and plan.
A 52-year-old man reports excessive worry about his children’s safety, difficulty concentrating, and muscle tension for the past eight months. Which DSM-5 diagnosis best fits?
Generalized Anxiety Disorder
A 26-year-old woman with depression is starting her first antidepressant. What medication class is most commonly used as first-line in primary care?
Selective Serotonin Reuptake Inhibitors (SSRIs).
A patient identifies negative automatic thoughts like “I’ll always fail.” You work together to test these beliefs and generate alternatives. What therapy is this?
Cognitive Behavioral Therapy (CBT).
A 30-year-old postpartum woman feels detached from her baby, has intrusive thoughts of harm, and feels intense guilt. What’s the diagnosis?
Postpartum Depression (rule out postpartum psychosis).
A 50-year-old patient with major depression reports active suicidal thoughts and has firearms at home. What is the immediate next step?
Ensure safety (remove means) and arrange urgent psychiatric evaluation.
A 16-year-old student reports poor concentration and restlessness in class. His teacher describes frequent fidgeting and blurting out answers. What screening tool can help confirm your suspicion?
Vanderbilt ADHD Rating Scale
A 40-year-old man with depression complains of sexual side effects from his SSRI. What antidepressant could you consider switching to?
Bupropion (Wellbutrin).
You encourage a patient with depression to schedule pleasurable activities such as walks with friends and journaling. Which CBT technique is that?
Behavioral Activation
A 25-year-old female presents after a breakup, reporting emptiness, impulsive spending, and self-harming behavior when he feels rejected. What is the most likely diagnosis?
Borderline Personality Disorder.
A patient with moderate suicidal thoughts has strong family support and no plan. How would you manage this in primary care?
Outpatient management with safety planning and close follow-up.
A patient describes recurrent, unexpected panic attacks followed by persistent fear of having another. No substance use or medical cause identified. What’s the diagnosis?
Panic Disorder
A patient on citalopram reports feeling better but is having trouble sleeping. What adjustment might help?
Take the medication in the morning, since SSRIs can cause insomnia in some patients.
A patient with mild insomnia is asked to track sleep habits and try setting a consistent bedtime. What therapy approach is this?
Behavioral therapy / CBT for insomnia (CBT-I).
A 40-year-old veteran has flashbacks, insomnia, and hypervigilance after witnessing combat trauma. What are the first-line evidence-based therapies?
Trauma-focused CBT, EMDR, or Prolonged Exposure Therapy.
A patient is discharged from inpatient care after a suicide attempt. What follow-up step reduces post-discharge risk?
Contact within 1 week (phone call, check-in, or visit).
A 30-year-old woman reports 2 years of depressed mood and low self-esteem but denies suicidal ideation. She functions but says, “I’ve felt down for as long as I can remember.” What’s the most likely diagnosis?
Persistent Depressive Disorder (Dysthymia)
Severity: MDD is characterized by severe depressive episodes, while dysthymia involves chronic, low-grade depression.
A 55-year-old woman taking paroxetine for depression has gained weight and feels sedated. What SSRI might be a better option with fewer of these side effects?
Sertraline or Escitalopram.
You teach a patient simple breathing exercises, mindfulness, and grounding techniques to manage stress in clinic. What kind of skills are you teaching?
Mindfulness-based coping / self-management skills.
A 40-year-old patient with chronic back pain reports low mood, fatigue, and poor concentration. What co-management strategy can improve both pain and depression outcomes?
Behavioral activation, exercise, or CBT for chronic pain.
A patient expresses hopelessness, stating “Nothing will ever get better.” What is the significance in suicide risk assessment?
Hopelessness is a strong predictor of suicidal behavior and indicates higher risk.