BCACP Mental Health and Substance Use Disorders 1 — Questions and Answers
Question 1: Which first-line antidepressant class is preferred for treating major depressive disorder in ambulatory care due to its favorable safety profile?
- Tricyclic antidepressants (TCAs)
- Monoamine oxidase inhibitors (MAOIs)
- Selective serotonin reuptake inhibitors (SSRIs) (Correct answer)
- Benzodiazepines
Correct answer: Selective serotonin reuptake inhibitors (SSRIs)
SSRIs are first-line for MDD due to their tolerability and safety compared to older antidepressant classes.
Question 2: A patient on lithium presents with tremor, polyuria, and a serum level of 1.6 mEq/L. What is the most appropriate action?
- Add a beta-blocker for the tremor
- Increase the lithium dose
- Hold lithium and assess for toxicity (Correct answer)
- Switch to valproate immediately
Correct answer: Hold lithium and assess for toxicity
A lithium level of 1.6 mEq/L exceeds the therapeutic range (0.6–1.2 mEq/L) and symptoms indicate toxicity requiring dose hold and evaluation.
Question 3: Which medication used for opioid use disorder (OUD) requires enrollment in the DEA X-waiver program (prior to 2023 regulations) for office-based prescribing?
- Naltrexone
- Methadone (office-based)
- Buprenorphine/naloxone (Correct answer)
- Clonidine
Correct answer: Buprenorphine/naloxone
Buprenorphine/naloxone previously required a DEA X-waiver for office-based prescribing for OUD, unlike methadone which required an OTP clinic.
Question 4: What is the recommended duration of maintenance antidepressant therapy after a second episode of major depressive disorder?
- 3 months
- 6 months
- At least 1 year (Correct answer)
- Lifetime therapy
Correct answer: At least 1 year
After a second MDD episode, guidelines recommend at least 1 year of maintenance therapy to reduce recurrence risk.
Question 5: Which screening tool is validated for detecting alcohol use disorder in primary care settings?
- PHQ-9
- GAD-7
- AUDIT-C (Correct answer)
- CAGE-AID
Correct answer: AUDIT-C
The AUDIT-C is a validated 3-item alcohol screening tool recommended for use in primary care ambulatory settings.
Question 6: A patient with schizophrenia has poor medication adherence due to lack of insight. What formulation strategy is most appropriate to address this?
- Increase the oral dose
- Switch to a long-acting injectable antipsychotic (Correct answer)
- Add a mood stabilizer
- Use a clozapine taper
Correct answer: Switch to a long-acting injectable antipsychotic
Long-acting injectable (LAI) antipsychotics eliminate the need for daily oral dosing and improve adherence in patients with poor insight.
BCACP Mental Health and Substance Use Disorders 1
Which first-line antidepressant class is preferred for treating major depressive disorder in ambulatory care due to its favorable safety profile?