NURS 660 / NURS660 Exam 2: Psychopharmacology and Advanced Mental Health | Complete Questions and Verified Answers (Latest 2026 / 2027)100% Correct - Maryville

NURS 660 / NURS660 Exam 2: Psychopharmacology and Advanced Mental Health | Complete Questions and Verified Answers (Latest 2026 / 2027)100% Correct - Maryville Q: What occurs with mania associated with bipolar disorder a. Varying degrees of sadness b. Distinct episodes of elation c. Suicide d. Psychomotor retardation B Q: Which postoperative narcotic analgesic will most likely be prescribed to a patient whose current medications include a monoamine oxidase inhibitor (MAOI), a thyroid hormone, and a multivitamin? a. Meperidine (Demerol) b. Morphine c. Ibuprofen (Advil) d. Acetaminophen (Tylenol) B Q: What is the major advantage of selective serotonin reuptake inhibitors (SSRIs) over other types of antidepressant therapy? a. They are less expensive than the other classes of antidepressants b. They cure major depressive illnesses c. They do not cause the anticholinergic and cardiovascular adverse effects d. Therapeutic relief is immediate C Q: Lithium (Eskalith) is the drug of choice for which of the following disorders? a. Psychotic episodes b. Obsessive compulsive disorders (OCDs) c. Bipolar disorders d. Depressive disorders C Q: Which psychological manifestations of depression will improve in response to antidepressant therapy? a. Loss of energy b. Palpitations c. Sleep disturbances d. Social withdrawal D Q: On what is the choice of tricyclic antidepressants based? a. The need to decrease the action of norepinephrine, dopamine, or serotonin b. Patient age and gender c. An absence of adverse effects, such as orthostatic hypotension d. The need for stimulation and increased mental alertness B Q: The nurse is teaching a patient about medication treatment for depression. The patient asks how long it will take before sleep and appetite will begin to improve. Which response by the nurse is most accurate? a. 3 days b. 1 week c. 4 weeks d. 2 months B Q: What is the action of MAOIs on neurotransmitters? a. Blocking their reuptake b. Increasing their production c. Blocking their destruction d. Increasing their reuptake C Q: A patient who is taking an MAOI to treat depression admits to eating pickled herring and cheese and drinking red wine. Which assessment finding alerts the nurse to a potential complication? a. Constipation b. Hypotension c. Neck stiffness d. Urinary retention C Q: Which assessment would the nurse expect to observe in a patient who has been prescribed trazodone for treatment of anxiety? a. Excessive thirst b. Hand tremor c. Drowsiness d. Diarrhea C Q: The nurse is caring for a patient who is taking a newly prescribed drug nefazodone, for treatment of depression. Which physical assessment finding is important for the nurse to report to the health care provider immediately? a. Bradycardia b. Dizziness c. Drowsiness d. Urinary retention A Q: The nurse is providing education to a patient who has been prescribed bupropion (Wellbutrin) for smoking cessation. Which statement by the patient would indicate the need for further teaching? a. My dose will increase after 3 days b. I should swallow the medication whole c. If I have the urge to smoke, I will take more medication d. I do not need to taper my dose when the drug is discontinued C Q: Which nursing action is most important when providing care to a patient diagnosed with a mood disorder? a. Assess the patient for thoughts of suicide b. Provide supplemental feedings as needed c. Assist with activities of daily living d. Offer opportunities for interaction with other patients A Q: A patient is admitted to a long term psychiatric setting. The MAOI medication previously prescribed is discontinued by the physician. New orders are obtained to initiate imipramine therapy. The nurse will provide the first dose of imipramine to the patient _____ the MAOI drug. a. Immediately following the last dose of b. In 1 week following the last dose of c. In 14 days following the last dose of d. Before discontinuing C Q: A patient taking vilazodone has been vomiting persistently for 12 hours. The priority nursing diagnosis for this patient is a. Nausea b. Imbalanced nutrition (less than body requirements) c. Fluid volume deficit d. Altered peripheral tissue perfusion C Q: 1. You are admitting a new patient who is depressed. Your initial contact should do what? a. Address why he is depressed b. Keep communication open c. Lift his spirits d. Establish trust D Q: 1. In caring for a patient with major depression, the nurse knows that the patient needs a. Frequent changes in activities b. Introduction to multiple new staff members c. Behavior modification that restructures feelings d. Well-defined, structured interactions at the beginning of treatment D Q: 1. Patients with major depression commonly display signs of a. Energy b. Repetitive, compulsive behaviors c. Worthlessness d. Visual hallucinations C Q: 1. When your patient says I am depressed, what is the best response? a. We all feel that way now and then b. Why do you feel that way? c. Everything will be OK once you snap out of it d. Tell me more about what is going on with you D Q: 1. Your patient takes tranylcypromine for depression. Which of the following is most likely to indicate dietary restrictions have not been followed? a. Hypertensive crisis b. Syncope c. Muscle spasms d. Increased depression A Q: 1. Your depressed patient who is taking a tricyclic antidepressant is advised of possible anticholinergic side effects. Which of the following is not an anticholinergic side effect? a. Blurred vision b. Difficulty starting urine stream c. Dry mouth d. Muscle rigidity D Q: 1. Helen, a 47-year-old client with a long history of severe depression, has not responded to antidepressant medications or psychotherapy. The nurse caring for the patient knows that the treatment of choice for depression unresponsive to conventional treatment would be a. Lithium b. Electroconvulsive therapy (ECT) c. Light therapy d. Neurolinguistic programming B Q: 1. Your depressed patient is just started on duloxetine (Cymbalta). Which statement by the spouse tells you that family teaching has been effective? a. I can't wait for him to be back to his old self in the next day or so b. I realize we can't expect big changes right away c. I have to take him for weekly blood tests to monitor the drug dosage d. I will make sure he doesn't eat any aged cheese for the next 2 months until the dose is stabilized B Q: 1. Biological theories of depressive disorder include all of the following except a. Chemical imbalances are responsible b. The patient experiences maladaptive thought processes c. There are genetic tendencies that run in families d. Hormonal factors make women more susceptible than men B Q: 1. Light therapy has been shown to be effective in treating patients with a. Bipolar disorder b. Dysthymia c. Major depression with seasonal pattern d. Schizophrenia C Q: 1. You are doing patient teaching for Margaret, who has been prescribed amitriptyline (Elavil) for treatment of depression. Which of the following statements suggest that Margaret needs further instruction? a. I know I might not start feeling better for a few weeks, but I'll keep taking my medication just as the doctor prescribed b. I'll keep some hard candies in my purse in case my mouth gets dry from the medicine c. Once I start feeling better, I am looking forward to cutting down on this medication d. I'm worried I may gain some weight, but that is the small price to pay to feeling better C Q: 1. What is the main difference between depression and dysthymic depression? a. Dysthymia is a short-term depression and major depression lasts for years b. Dysthymia is a chronic, low-level depression that lasts for years, while major depression is more severe c. Dysthymia is more likely to be caused by psychological factors and major depression is caused by neurological dysfunction d. Dysthymia is normally treated with psychotherapy only, while major depression is treated with antidepressants and psychotherapy B 1. Your depressed patient is starting a new medication called phenelzine (Nardil). Which teaching would be most important to emphasize? a. Educate the patient to take this medication ongoing, even as symptoms improve b. Instruct the patient and family about the many food-drug interactions c. Instruct the patient about interventions to relieve dry mouth d. Inform the patient that this medication takes 4 to 6 weeks to take full effect B 1. Which of the following antidepressants is a tricyclic? a. Bupropion (Wellbutrin) b. Sertraline (Zoloft) c. Nortriptyline (Pamelor) d. Venlafaxine (Effexor) C 1. Which statement is most true about depression? a. It is more common in women than men b. It is rare to have more than one episode of major depression in one's lifetime c. Young children do not suffer from depression d. As one ages, there is reduced risk of depression A 1. A newly admitted client has been diagnosed with major depressive disorder. Which nursing diagnosis takes priority? a. Impaired social interaction b. Self-esteem deficit c. Hopelessness d. Self-care deficit C 1. The nurse knows that the two factors that often differentiate major depression from dysthymia depression are a. Amounts of mania and sadness b. Presence or absence of anger and guilt c. Severity and duration of symptoms d. Patient's gender and age C 1. You are caring for an older adult who is recently widowed. She says "No one cares if I die. Everyone I ever loved is dead." What is the best response? a. I am sure that you still have people who care about you b. You sound like you are feeling alone c. Boy, that is depressing d. I don't believe that B 1. Your patient with major depression tells you he suffers from urinary retention. Which medication would most likely to cause this? a. Amitriptyline b. Duloxetine c. Carbamazepine d. Ritalin A 1. Which activity would be best for a depressed patient? a. A puzzle b. Drawing c. Crossword puzzles d. Television B 1. Which of the following meal choices indicates the patient understands the diet restrictions when taking an MAOI? a. Pepperoni pizza and beer b. Roast chicken, baked potato, and beer c. Fried fish, rice, and cola d. Pickled herring, eggs, and coffee C 1. Your patient with major depression sits in her room for hours staring out the window. Which of the following would be the most appropriate intervention? a. Sit with the patient and gently offer your availability to help b. Keep encouraging the patient to go to exercise class c. Offer the class once and then let the patient decide d. Sit with the patient and ask her to list reasons for her depression A 1. Which of the following drugs is a tricyclic antidepressant? a. Bupropion (Wellbutrin) b. Amitriptyline (Elavil) c. Fluoxetine (Prozac) d. Citalopram (Celexa) B 1. Some medications such as tricyclics cause blurred vision. What is the cause of this effect? a. Hyperglycemia b. Anticholinergic effect c. Hypoxia d. Hypertension B 1. Your patient has been taking an SSRI for 6 weeks. On arrival at the clinic, which observation would indicate a positive outcome from the medication? a. Patient reports sleeping 12 hours a night b. Patient reports sleeping 3 hours a night c. Patient reports a weight loss of 10 pounds d. Patient arrives neatly dressed D 1. Which response best describes how dysthymic disorder is different from major depression? a. More severe depression with psychotic features b. Chronic low-level depression c. Mild depression with episodes of hypomania d. Depression with more anxiety symptoms B 1. Which of the following would be the most effective intervention for a depressed patient? a. Establish one small goal to accomplish today b. Help the patient develop a goal to complete in the next month c. Encourage the patient to talk about recent failures in his or her life d. Let the patient guide what is the next best action A 1. Which of the following is an important intervention for a patient taking nortriptyline? a. Make sure that CBC is ordered to monitor blood counts b. Monitor for anticholinergic side effects c. Ensure that the patient's diet is gluten free d. Push fluids to prevent dehydration B 1. A patient admitted to the mental unit has shown a deficit in providing self-care and has a medical diagnosis of major depression. The nursing diagnosis for this would be: a. Knowledge deficit related to personal choices b. Self-care deficit related to impaired ability to provide personal hygiene c. Risk for violence related to poor hygiene d. Impaired social interaction related to poor hygiene B 1. The nurse learns at report that a newly admitted manic patient is demonstrating grandiosity. Which statement would be most consistent with this symptom? a. I can't do anything anymore b. I am the world's most astute financier c. I can understand why my wife is upset that I overspend d. I can't understand where all the money in our family goes B 1. The nurse will base a discussion of dysthymia on the fact that the condition a. Typically has an acute onset b. Involves delusional thinking c. Is chronic low-level depression d. Does not include suicide ideation C 1. What is the priority nursing diagnosis for a patient exhibiting signs of acute mania that include exaggerated physical activity, agitation, insomnia, and anorexia? a. Risk for injury b. Chronic low self-esteem c. Noncompliance d. Insomnia A 1. A patient has been admitted with a diagnosis of atypical depression. In planning interventions, the nurse would expect to consider the characteristic symptoms of a. Seasonal episodes b. Leaden paralysis c. Psychomotor agitation d. Increased depression in the morning B 1. An inappropriately dressed patient has not slept for 3 days while making excessive expensive long-distance phone calls. When the patient can be heard singing loudly in the examining room, the nurse makes initial plans to focus on a. Assessing needs for food, liquids, and rest b. Setting strict limits on dress and behavior c. Conducting an in-depth suicide assessment d. Obtaining a complete psychosocial assessment A 1. Which statement by the patient would indicate the need for additional education regarding the prescribed lithium treatment regimen? a. I will restrict my daily salt intake b. I will take my medication with food c. I will have my blood drawn on schedule d. I will drink 8 to 12 glasses of water daily A 1. The nurse would evaluate that patient education regarding lithium therapy for an individual with bipolar disorder as effective if the patient states: a. I can stop my lithium when I feel better b. I can continue with my diuretic and cardiac medications c. I will probably need to take the lithium for the rest of my life d. I will taper my Lithium when a therapeutic serum is achieved. C 1. A patient who has been taking lithium carbonate 300 mg tid comes to the Outpatient Department with a list of medications he is taking. Which of the medications on the list would require re-evaluation of lithium dosage a. Hydrodiuril daily b. Navane bid c. Ativan at bedtime d. Cefobid daily A 1. Which outcomes would be appropriate to determine early favorable response to antidepressant medication? a. The patient will complete own self-care activities b. The patient will demonstrate assertive communication skills c. The patient will describe signs and symptoms of major depression d. The patient will make plans to attend one community social activity a week A 1. Prior to initiating medication therapy with phenelzine (Nardil), the nurse should plan to determine the patients a. Mood and affect b. Activity level c. Cognitive ability to understand information about the medication d. Support network and its members willingness to participate in treatment C 1. A patient who has a history of bipolar disorder recently underwent orthopedic surgery and was discharged to return home. When visited by the home care nurse, the nurse documented the following: Slow and soft speech; sad facial expressions; and patient crying when describing extreme fatigue, low mood, and the feeling that he will never get well. He has refused to bathe and perform ADLs for several days. Which nursing diagnosis would be appropriate? a. Self-care deficit secondary to possible depression b. Situational low self-esteem related to immobility c. Deficient knowledge related to depression and surgery d. Disturbed thought processes related to bipolar disorder A 1. The nurse caring for an extremely withdrawn patient with depression wants to assist her to become more interactive. The best approach would be to say a. I know you will feel better if you leave your room b. You look so gloomy sitting here all by yourself c. Let's explore how it feels to sit alone here all day and feel sad d. I need another person for a card game and I would like you to be my partner D 1. Which nursing diagnosis would relate to the primary nursing concern related to a recently written prescription for amitriptyline (Elavil) 50 mg tid? a. Anxiety b. Ineffective coping c. Risk for self-injury d. Chronic low self-esteem C 1. What information concerning amitriptyline (Elavil) 50 mg tid would the nurse give the patient regarding the expected outcome of this medication therapy? a. Complying with this therapy will cure your depression b. This medication is expected to improve brain chemical imbalance c. d. Amitriptyline will help re-establish your ability to think clearly again e. Elavil will be particularly effective at assisting you in regaining your independence B 1. Which principle should the nurse apply when planning nursing care for a patient who was voluntarily admitted after a suicide attempt? a. Patients who attempt suicide and fail will not try again b. The more specific the plan, the greater the risk for suicide c. Patients who talk about suicide are less likely to attempt it d. Patients who attempt suicide and fail do not really want to die B 1. An appropriate nursing strategy to assist a patient who was involuntarily admitted after suicide attempt is a. Avoiding any focus on the topic of suicide b. Encouraging patient to verbalize personal feelings c. Supporting patient focus on others rather than self d. Discussing the impact of suicidal thoughts on the family B 1. Which principle should the nurse apply when planning care for a patient who is diagnosed with bipolar disorder and currently in the manic phase? a. Manic patients respond well to peer pressure b. Decreasing stimulation tends to diminish symptoms c. Increasing stimulation tends to encourage the patient to focus d. Detailed activities will facilitate the patient's ability to self-control behavior D 1. Which nursing intervention is most therapeutic when the nurse is managing the aggressive, disruptive behaviors of a manic patient whose attempts to control the milieu has been rejected by the other patients? a. Advising that the patient to accept the wishes of the group b. Suggesting that the patient either quiet down or leave the room c. Accompanying the patient to a quieter part of the unit d. Ignoring the patient's outbursts because they are surly related to the mania C 1. What information would serve as the basis for the nurses reply when asked whether the cycling of moods from depressed to manic is a constant pattern seen in bipolar disorders? a. Clinical observation tells us that mood disorders tend to remint and recur b. Most cyclic behavior can be managed with appropriate forms of therapy c. Mood disorders generally see a decrease in cyclic affecting within 5 years of onset d. Persons with higher cognitive abilities will generally exhibit fewer cyclic episodes A 1. The individual who displays the history and symptoms most consistent with a medical diagnosis of seasonal affective disorder (SAD) is: a. 26 years of age and complains of 3 consecutive years of depressed mood beginning in November and remitting in April b. 64 years of age and complains of anhedonia, early morning awakening, psychomotor retardation, weight loss, and excessive feelings of guild c. 46 years of age and complains of dysphoric mood for 3 years, poor concentration, loss of interest in social activities, indecision, low energy, and low self-esteem d. 38 years of age and complains of sadness, loss of ability to react to positive stimuli, weight gain, hypersomnia, leaden paralysis of limbs, and sensitivity to interpersonal rejection A 1. A patient with suspected seasonal affective disorder asks the nurse, "I've been feeling down for 3 months, will I ever feel like myself again?" the response that builds on an understanding of this disorder is: a. Spontaneous improvement usually comes in 6 months to a year b. Can you tell me what you mean when you say you feel like myself? c. People who have seasonal mood changes often feel better when spring comes Usually patients with this C 1. A Chinese-American patient comes to the mental health clinic after referral by her primary care physician. She complains of nervousness, headaches, fatigue, and vague GI symptoms for which no organic basis has been established. The symptoms began about 9 months ago when her favorite aunt died. The most appropriate independent nursing action would be to: a. Prescribe a trial course of antianxiety medication b. Plan strategies for cognitive behavioral therapy c. Arrange admission to the inpatient unit for a complete workup and psychologic testing d. Confer with the psychiatrist about the cultural association between depression and somatic symptoms D 1. A patient with melancholic depression paces and wrings her hands for hours at a time while repeating, "I am a bad person". Staff members have been unsuccessful in their attempts to promote rest. Which intervention is most appropriate in promoting rest? a. Instructing the patient to lie down for 15 minutes of every hour b. Asking the patient to fold and stack bath towels and washcloths c. Making the patient aware of the negative effects of fatigue on mood d. Reassuring the patient that she is accepted and not considered a bad person B 1. What measure will facilitate communication with a patient who is depressed and evidencing psychomotor retardation and withdrawal? a. Ask the patient to indicate yes or no with finger signals b. Arrange to spend time with the patient at prearranged intervals c. Give concrete and concise directions rather than asking questions d. Speak loudly and rapidly to the patient to focus his or her attention B 1. Which measure consistent with the use of cognitive therapy could the nurse incorporate into the treatment plan of a chronically depressed patient? a. Approach the patient with cheerful affect and optimistic remarks b. Ignore the patient's pessimistic statements; give attention for positive thinking c. Identify negative evaluations and challenge pessimistic beliefs d. Seek to uncover unconscious conflicts about significant relationships C 1. Which symptom related to thought-flow disturbance is the nurse most likely to assess in a newly admitted patient who is diagnosed with bipolar disorder, manic episode? a. Slow, halting speech b. Flight of ideas c. Schemata d. Anhedonia B 1. Therapeutic interactions between the nurse and a manic patient will be facilitated when the nurse: a. Uses a calm, matter-of-fact approach to structuring b. Focuses primarily on enforcing rigid limits on behavior c. Implements a laissez-faire approach to the patient's symptoms d. Encourages the patient to use humor and wit to redirect energy A 1. A patient who is experiencing a manic episode approaches the nurse with pressured speech states "I hate oatmeal. Lets get everybody together to do exercises. I'm thirsty and I'm burning up. Get out of my way; I have to see that guy." The priority nursing action is to: a. Measure the patient's temperature and pulse b. Offer to have the dietitian visit to discuss his diet c. Tell the patient he can lead exercises at the community meeting d. Show relief when the patient ends the interaction and walks away A 1. A patient with bipolar disorder reveals to the clinic nurse that she may be 4 weeks pregnant. Which action will the nurse take? a. Confer with the physician about ordering a pregnancy test and discontinuing lithium b. Educate the patient to the risk to the fetus as a result of exposure to the lithium in her blood c. Suggest to the physician that the lithium dose should be increased for better symptom control Remint the patient that barrier birth control A 1. Which nursing measure would be relevant to protecting the physiologic integrity of a patient during a manic episode when marked hyperactivity is present? a. Provide appropriate attire for patient to wear b. Set firm limits on behavior injurious to others c. Monitor the patient's weight at the same time daily d. Use genuineness to develop a therapeutic alliance with the patient C 1. Care planned for a patient with adjustment disorder will be most effective if the nurse knows adjustment disorders are a group of disorder that: a. Involve psychotic thinking in adolescents b. Address issues of anxiety and depression c. Include behaviors that are seen primarily in the child and adolescent population d. Manifest as transient episodes of dysfunction in response to specific stressors D 1. The nurse manager, teaching a class to new staff members about working with patients with adjustment disorders, will specify that the intervention most helpful in working with patients with this diagnosis is: a. Entering pertinent data in the patient's medical record b. Including family members in the interdisciplinary treatment plan c. Identifying the precipitating stressful event and current problems d. Reducing the patient's level of anxiety to prevent behavioral escalation C 1. When a father states "I don't understand what the doctor means by saying my daughter has an adjustment disorder." The nurse explains that this disorder often results from: a. Failure of existing coping skills b. Lack of stable emotional support c. Denial that a problem truly exists d. Overcompensation to present a controlled appearance A 1. Which question would be most effective in helping a patient with an adjustment disorder identify the event that triggered the maladaptive response? a. Can you tell me about your support system? b. Have you ever been in psychotherapy before? c. Did you experience any stressful events lately? d. How do you usually handle problems in your life? C 1. A teenager is admitted to the adolescent unit with a diagnosis of adjustment disorder with depression. Which information collected from the assessment interview will be given highest priority when planning the patient's care? a. Patient frequently disregards curfew b. Patient's parents were divorced 8 years ago c. Patient states she finds no pleasure in living d. Patient is failing most of her high school classes c 1. The nurse has been working with a patient who has adjustment disorder with depressed mood. Which finding would permit the nurse to accurately evaluate that the crisis has been resolved? a. Absence of presenting symptoms b. Decreased need for medications c. Increased socialization with peers d. Significant increase in the patient's appetite a 1. Which of the following statements would correctly serve as a basis for teaching a family the usual outcome of an adjustment disorder? a. The symptoms will likely resolve completely b. The patient may continue to be in danger of self-harm c. Medications are frequently used to mask the symptoms d. Relaxation is an effective tool to decrease and manage stress a 1. Which activity would be a constructive outlet for tension and anxiety while enhancing self esteem for a patient with adjustment disorder with anxious mood? a. Knitting scarves for a homeless shelter b. Painting a paint-by-number scenic picture c. Working on a large, colorful puzzle d. Engaging in regular, age-appropriate physical activity d 1. The major rationale for careful ongoing assessment of a patient with adjustment disorder is a. Characteristic symptoms abate but take at least 6 months to do so b. The disorder may be a precursor to a more serious mental health disorder c. Practitioners become less discerning as they become more familiar with the patient d. Patients with adjustment disorders have a high risk for self-harm, especially suicide b 1. The syndrome of bipolar disorder: a) Is defined by occurrence of at least one manic episode b) Is approximately as prevalent as major depressive disorder c) Has many varied presentations d) A and C e) B and C c 1. A patient presents to a new clinician with a major depressive episode. In addition to taking a patient's history, the two factors most useful for helping to determine if a presenting depressive episode is part of a unipolar or bipolar illness include: a) Family history and input from someone close to the patient b) Input from someone close to the patient and specific symptoms of the current episode c) Specific symptoms of the current episode and patient insight d) Patient insight and family history a 1. A mother whose daughter has just been diagnosed with major depressive disorder wants to know more about the underlying cause. Recent research largely supports the hypothesis that depression is due to a measurable deficiency of monoamines in the brain. A. True B. False b 1. A 24-year-old man with moderate depression achieves remission after 16 weeks on a therapeutic dose of an antidepressant. According to the neurotrophic hypothesis of depression, which of the following is most likely true of his BDNF expression before and after his successful treatment? a) BDNF expression was abnormally low while he was depressed, and increased during antidepressant treatment b) BDNF expression was abnormally high while he was depressed, and decreased during antidepressant treatment c) BDNF expression was normal while he was depressed, and was unaffected during antidepressant treatment a 1. A 19-year-old female requires a hospital consultation, after she was admitted following an attempted suicide. Her family reports that she has been suffering from severe depression for the last 3 years. What area of the brain may best be described as hypothetically involved in her feelings of worthlessness and suicidality? a) Amygdala b) Basal forebrain c) Hypothalamus d) Nucleus accumbens a 6. Which of the following statements regarding mood symptoms is true? a) Symptoms related to reduced positive affect are hypothetically linked to serotonergic (and noradrenergic) dysfunction b) Symptoms related to increased negative affect are hypothetically linked to dopaminergic (and noradrenergic) dysfunction c) Symptoms related to reduced positive affect are hypothetically linked to dopaminergic (and serotonergic) dysfunction d) Symptoms related to increased negative affect are hypothetically linked to serotonergic (and noradrenergic) dysfunction d 6. A 23-year-old female college student has gotten in significant trouble for her risky and impulsive behavior, stealing a fire extinguisher, driving on the common area lawn, and hostilely addressing a professor. Which of the following monoamine projections may account for her recent behavior? Projections to the: a) Amygdala b) Hypothalamus c) Prefrontal cortex d) Striatum c 6. Neuroimaging data show that neuronal activity in the amygdala of depressed patients is: a) Overreactive to induced sadness b) Under-reactive to induced happiness c) A and B d) Neither A nor B c 1. A 34-year-old man presents with a major depressive episode characterized by depressed mood, insomnia, problems concentrating, weight loss, and suicidal ideation. Which of the following symptoms is the most likely to be residual following otherwise successful treatment? a) Depressed mood b) Insomnia c) Suicidal ideation b 1. The age class with the worst risk/benefit ratio for suicidality with use of antidepressants is: a) Adults over age 65 b) Adults ages 19-64 c) Adolescents ages 13-18 d) Children under age 12 d 1. A 25-year-old patient with first-episode major depressive disorder is being prescribed an antidepressant. The time course for therapeutic effects of antidepressants correlates with: a) Increase in presynaptic neurotransmission b) Increase in postsynaptic neurotransmission c) Changes in receptor sensitivity c 1. A 48-year-old patient with depression was recently started on 20 mg/day fluoxetine to combat his presenting symptoms of apathy, fatigue, problems concentrating, and hypersomnia. The patient reports that he is feeling much more energized and can see improvements in his cognition and attention within a day or two of starting fluoxetine. Which of the following properties of fluoxetine is theoretically most likely responsible for this patient's positive response? a) 5HT2C antagonism b) Norepinephrine reuptake inhibition c) Serotonin reuptake inhibition a 1. A 40-year-old woman presents with a major depressive episode. Her clinician is considering prescribing the antidepressant vilazodone, which has what two major mechanisms of action? a) Serotonin and norepinephrine reuptake inhibition b) Serotonin reuptake inhibition and serotonin 2A antagonism c) Serotonin reuptake inhibition and serotonin 1A partial agonism d) Serotonin and dopamine reuptake inhibition c 6. Agents that block reuptake of norepinephrine have what effect on dopamine in the prefrontal cortex? a) Increase its synaptic availability b) Decrease its synaptic availability c) No notable effect on dopamine a 6. A 58-year-old patient with a history of depression is currently taking agomelatine, which has what mechanism of action? a) Binding to melatonin receptors in the suprachiasmatic nucleus b) Binding to 5HT2C receptors c) Both of the above d) Neither of the above c 6. A clinician has decided to administer an alpha 2 antagonist to his patient. Alpha 2 antagonists have what effect on neurotransmission? a) Decrease norepinephrine and increase serotonin b) Decrease norepinephrine and decrease serotonin c) Increase norepinephrine and decrease serotonin d) Increase norepinephrine and increase serotonin d 6. Which of the following is the most potent property of trazodone? a) Serotonin reuptake inhibition b) Serotonin 2C antagonism c) Serotonin 2A antagonism d) Histamine 1 antagonism c 6. A clinician is considering options for a 45-year-old man with severe treatment-resistant depression who has exhibited only partial response to first-line and older generation antidepressants and who is unwilling to attempt electroconvulsive therapy or other stimulation therapy. One option, with extreme caution and under expert guidance, is to combine a monoamine oxidase inhibitor (MAOI) with a tricyclic antidepressant; however, which of the following should absolutely NOT be used in combination with an MAOI, even by an expert? A. Amitriptyline B. Clomipramine C. Nortriptyline D. Protriptyline b 11. A 36-year-old man with depression has had 3 therapeutic trials of serotonin reuptake inhibitors (SRIs) without notable improvement. His clinician is now considering switching the patient's SRI to a monoamine oxidase inhibitor (MAOI). Which of the following is an appropriate switching strategy in this situation? a) Cross-titrate SRI with MAOI b) Discontinue SRI, then initiate MAOI c) Discontinue SRI, then wait 5 half-lives before initiating MAOI d) Discontinue SRI, then wait 14 days before initiating MAOI c 11. Tricyclic antidepressants, compared to newer antidepressants such as serotonin selective reuptake inhibitors or serotonin norepinephrine reuptake inhibitors, have: a) Less favorable efficacy profiles b) Less favorable tolerability profiles c) A and B d) Neither A nor B b 11. A 39-year-old patient with major depressive disorder presents to your office after several months of trying various antidepressant drugs. It is suggested that he try augmenting his current regimen with L-methylfolate. Why might L-methylfolate hypothetically boost the therapeutic efficacy of antidepressants? a) It increases synthesis of monoamines b) It increases the release of monoamines It both increases synthesis and inhibits metabolism of monoamines a 11. Which of the following is true about depression and reproductive hormones? a) Depression is linked to estrogen levels in women across their life cycles b) Depression is linked to testosterone levels in men across their life cycles c) AandB d) Neither A nor B a 1. A 24-year-old woman has been taking lithium to treat her bipolar disorder for 6 years. Lithium's hypothesized mechanism of action is: a) Inhibition of second messenger enzymes b) Interaction with downstream signal transduction cascades c) Inhibition of voltage-sensitive sodium channels d) AandB e) BandC d 1. A 35-year-old patient with bipolar disorder is currently experiencing a depressive episode that involves suicidal ideation. Which of the following mood stabilizers has shown efficacy for the prevention of suicide? a) Lithium b) Carbamazepine c) Divalproex d) Lamotrigine a 1. A patient with bipolar disorder responds to treatment with a mood stabilizing anticonvulsant agent. Which of the following has the strongest evidence of direct involvement in the mechanism of action of these agents? a) Voltage-sensitive calcium channels b) Voltage-sensitive potassium channels c) Voltage-sensitive sodium channels c 1. A patient with bipolar II disorder responds well to monotherapy with lamotrigine. Lamotrigine's unique therapeutic profile in bipolar depression compared to other anticonvulsants appears to be hypothetically linked to its: a) Activation of GABA release b) Inhibition of glutamate release b 1. A 32-year-old man with bipolar disorder has had a partial response to divalproex and is now being augmented with an atypical antipsychotic. The effects of atypical antipsychotics in nonpsychotic mania may be due to: a) Indirect effects on GABA release via D2 receptor antagonism b) Indirect effects on glutamate release via serotonin 2A antagonism c) Direct effects on voltage-sensitive sodium channels d) Direct effects on voltage-sensitive calcium channels b 6. A 28-year-old woman presents with a depressive episode. She has previously been hospitalized and treated for a manic episode, but is not currently taking any medication. Which of the following have the best evidence of efficacy to treat bipolar depression? a) Lamotrigine, quetiapine b) Quetiapine, olanzapine monotherapy c) Olanzapine monotherapy, lithium d) Lithium, valproate e) Valproate, lamotrigine a 6. A 32-year-old woman with bipolar I disorder has just found out that she is 6 weeks pregnant. Her mania has been stable on a combination of lithium, valproate, and olanzapine, but she is unsure about the safety of maintaining her medications during her pregnancy. Which of the following is true regarding medication use for bipolar disorder during pregnancy? a) Lithium is associated with known risk for various fetal toxicities b) Lithium and valproate are associated with known risk for various fetal toxicities c) Lithium, valproate, and olanzapine are associated with known risk for various fetal toxicities b Janet is a 22-year old patient with major depressive disorder who is pregnant with her first child. She is deeply concerned about the effects of psychotropic agents on her developing baby. Which non-pharmacological treatment(s) have the best evidence for efficacy in the treatment of antenatal major depressive disorder? A. Cognitive behavioral therapy B. Interpersonal behavioral therapy C. Bright light therapy D. A and B E. All of the above d Susanna is a 28-year-old woman who gave birth to her second child approximately 3 weeks ago. Screening for postpartum depression reveals a score of 14 on the Edinburgh Postnatal Depression Scale (EPDS). An EPDS score of 14 indicates that this patient has: A. Possible depression B. Probable depression C. Severe depression b Patricia is a 31-year-old patient with major depressive disorder who is currently 2 months pregnant. She has been taking an antidepressant for the past 2 years with good response and would like to continue her current treatment regimen for the duration of her pregnancy. However, the patient expresses concerns over continuing antidepressant treatment during the postpartum period because she is planning to breastfeed. Which of the following statements is true regarding antidepressants and breastfeeding? A. Breastfeeding exposure to most antidepressants is 10-fold higher than in utero exposure B. First generation MAOIs should not be used during breastfeeding C. Among selective serotonin reuptake inhibitors (SSRIs), fluoxetine has the lowest relative infant dose b Andrea is a 27-year-old patient with bipolar disorder I whose symptoms have been successfully managed for the past 5 years with lamotrigine. Andrea and her husband are now planning to start a family and are considering stopping lamotrigine when Andrea gets pregnant. What is the relapse rate for women with bipolar disorder I or II who discontinue prophylactic mood stabilizer treatment during pregnancy? A. 23% B. 37% C. 65% c Amelia is a 24-year-old patient with treatment resistant depression currently enrolled in a clinical trial involving esketamine. Esketamine is an antagonist at which of the following receptors? A. AMPA B. NMDA C. mGluR b Marsha is a 31-year-old patient with postpratum depression who is intrested in enrolling in a clinical trial testing the novel antidepressant brexanolone. Brexanolone is hypothesized to work due to its actions with which of the following neurotransmitter systems? A. GABA B. Glutamate C. Opioid a Clark is a 43-year-old patient with treatment resistant depression currently enrolled in a clinical trial testing the novel antidepressant SAGE-217. Compared to brexanolone, SAGE-217 differs in that it: A. Is a positive allostric modulator of GABA-B receptors B. Requires intravenous administration C. Has higher oral availability c Patrick is a 34-year-old patient with MDD. Lab results indicate that this patient has increased levels of pro-inflammatory cytokines. Which of the following agents is hypothesized to ameliorate symptoms of depression primarily via its anti-inflammatory properties? A. SAGE-217 B. Minocycline C. Rapastinel D. Buprenorphine/samidorphin combination b Studies have shown that 0.4-0.6 mg/kg of ketamine, typically infused over approximately _______minutes, can exert a dramatic antidepressant effect in 40%-60% of depressed patients. A. 5-20 B. 30-60 C. 60-120 D. 120-180 b Which of the follow novel compounds is thought to be a partial agonist of an allosteric glycine site of the NMDA receptor: A. Ketamine B. Esketamine C. Rapastinel D. Riluzole E. Lanicemine c A novel compound being investigated, ALKS-5461, is administered as a sublingual formulation containing equal amounts of two components: Buprenorphine, a mu- and kappa-opioid partial agonist, and samidorphan, an investigational _______. A. kappa-opioid partial agonist B. delta-opioid antagonist C. mu-opioid agonist D. mu-opioid antagonist E. kappa-opioid partial antagonist d A patient with major depressive disorder has not responded to two adequate trials of antidepressant monotherapy. Which of the following has the best evidence of efficacy for augmenting antidepressants in patients with inadequate response? Elevated cytokine levels may indirectly lead to: A. Atypical antipsychotic B. Buspirone C. Stimulant a A 31-year-old married man has been taking an SSRI for his depression. He discloses that although his mood has improved, he is experiencing sexual dysfunction that is affecting his relationship with his wife. What pharmacological treatment option might be appropriate to address his sexual dysfunction? A. 5HT2 antagonist B. 5HT3 antagonist C. 5HT6 antagonist a Symptoms of reduced positive affect (depressed mood, anhedonia, loss of energy) are hypothetically more likely to respond to agents that enhance: A. Dopamine and possibly norepinephrine B. Norepinephrine and possibly serotonin C. Serotonin and possibly dopamine a Which of the following foods must be avoided by patients taking MAOIs? A. Aged cheeses B. Bottled beer C. Fresh fish D. All of the above E. None of the above a Sam is a 31-year-old patient who presents with a major depressive episode. He has previously been hospitalized and treated for a manic episode but is not currently taking any medication. The agents with the strongest evidence of efficacy in bipolar depression are: A. Lamotrigine, lithium, quetiapine B. Olanzapine-fluoxetine, lurasidone, lamotrigine C. Quetiapine, olanzapine-fluoxetine, lurasidone D. Lurasidone, lamotrigine, lithium c Patricia is a 39-year-old patient with bipolar I disorder. He has been maintained on 1200 mg/day of lithium. He was doing well for a long time and had even been able to lose the weight he had initially gained with lithium. He lost his job as a postal service worker 6 months ago and has been feeling depressed ever since. You augment him with 300 mg/day of quetiapine, but after several weeks he complains of weight gain and wants to change medications. Blockade of which two receptors was most likely responsible for this weight gain induced by quetiapine? A. Serotonin 2C and histamine 1 B. Serotonin 2A and muscarinic 3 C. Muscarinic 1 and serotonin 6 D. Dopamine 2 and alpha 1 adrenergic a Diane is a 31-year-old patient with bipolar I disorder who frequently exhibits impulsive symptoms of mania including risk taking and pressured speech during her manic episodes. Compared to a healthy brain, neuroimaging of this patient's brain during a no-go task (designed to test response inhibition) would likely show: A. Increased activity in the dorsolateral prefrontal cortex B. Increased activity in the orbitofrontal cortex C. Decreased activity in the orbitofrontal cortex c Steven is a 29-year-old patient with bipolar II disorder who tends to endorse some manic symptoms during depressive episodes. Of the following symptoms, which is the most common subsyndromal mania symptom in patients during a major depressive episode with mixed features? A. Psychomotor agitation B. Decreased need for sleep C. Inflated self-esteem D. Elevated mood E. High-risk behavior a A 34-year-old man has recently been diagnosed with bipolar disorder, six years after his symptoms began. He has had no mood stabilizing treatment in that time. According to the kindling model and allostatic load hypothesis, what progressive pattern of illness would you expect this patient to have exhibited over the course of the last six years? A. Longer interval between episodes, worsened emotionality, minimal change in cognitive impairment B. Shorter interval between episodes, worsened emotionality, minimal change in cognitive impairment C. Longer interval between episodes, worsened emotionality, worsened cognitive impairment D. Shorter interval between episodes, worsened emotionality, worsened cognitive impairment d A 28-year-old woman with bipolar disorder recently began taking a mood stabilizer and has experienced improvement in her symptoms. Which of the following are mechanisms by which different mood stabilizers may prevent mitochondrial dysfunction in bipolar disorder? A. Increasing levels of anti-apoptotic proteins B. Decreasing levels of pro-apoptotic proteins C. Increasing levels of key antioxidants D. A and B E. A, B, and C e A 32-year-old woman with bipolar I disorder has just found out that she is 6 weeks pregnant. Her mania has been stable on a combination of lithium, valproate, and quetiapine, but she is unsure about the safety of maintaining her medications during her pregnancy. Which of the following is true regarding the use of these medications for bipolar disorder during pregnancy? A. Lithium has known teratogenic effects and is not a preferred treatment B. Lithium and valproate have known teratogenic effects and are not preferred treatments C. Lithium, valproate, and quetiapine have known teratogenic effects and are not preferred treatments b A 28-year-old woman presents with a depressive episode. She has previously been hospitalized and treated for a manic episode but is not currently taking any medication. The agents with the strongest evidence of efficacy in bipolar depression are: A. Lamotrigine, lithium, quetiapine B. Quetiapine, olanzapine-fluoxetine, lurasidone C. Olanzapine-fluoxetine, lurasidone, lamotrigine D. Lurasidone, lamotrigine, lithium b A 24-year-old female patient, who recently moved from Germany, presents to your office during a manic episode that initiated following abrupt discontinuation of her medication as she ran out of her prescription. She informs you that she had been diagnosed with rapid-cycling bipolar disorder, and wants to be prescribed the same medication she used to take in Germany but does not remember the generic name of the medication. She gives you the following information: she was on 1250 mg/day; she gained weight when she started it, which she did not like, but she liked the sedating effects of the drug, which helped calm her down and sleep at night. Her German doctor had told her she could experience the following side effects: hair loss, hepatotoxicity and seizure upon abrupt withdrawal. Also she knows that she should consider switching medications when she intends to become pregnant, as the medication can lead to birth defects. Which medication was she most probably taking? A. Lamotrigine B. Gabapentin C. Aripiprazole D. Valproate d A 17-year-old girl presents with symptoms of depression. She has always been a good student and a caring and responsible sister to her two younger siblings. Recently, she has suddenly become somewhat withdrawn and reports feeling sad much of the time. Her MADRS score is 35, indicating severe depression. This patient also endorses feelings of hostility and aggression and has recently started getting into physical altercations with her peers. There is no information regarding family history, as the patient is adopted. Although not definitive, this particular symptom profile may be more suggestive of: A. Unipolar depression B. Bipolar depression b The "bipolar storm" refers to the concept that unstable, unregulated and excessive neurotransmission occurs at synapses in specific brain regions, and both voltage-sensitive sodium channels and voltage-sensitive calcium channels are involved in this excessive stimulation of glutamate release. Which drugs would theoretically reduce glutamate release by blocking voltage-sensitive sodium channels? A. Valproate and lamotrigine B. Pregabalin and gabapentin C. Levetiracetam and amantadine a A 24-year-old man has been taking lithium for 3 years to treat his bipolar disorder. What are two primary candidates for the direct mechanisms of lithium? A. Inhibition of glycogen synthase kinase 3ß (GSK-3ß) and inositol monophosphatase (IMPase) B. Activation of GSK-3ß and IMPase C. Inhibition of GSK-3ß and activation of IMPase D. Activation of GSK-3ß and inhibition of IMPase a A 24-year-old man with bipolar disorder is being initiated on lithium, with monitoring of his levels until a therapeutic serum concentration is achieved. Once the patient is stabilized, how often should his serum lithium levels be monitored (excluding one-off situations such as dose or illness change)? A. Every 2 to 3 months B. Every 6 to 12 months C. Every 1 to 2 years D. Routine monitoring is not necessary b A 49-year-old clerk with bipolar disorder has been maintained on 900 mg/day of lithium. She was doing well for a long time and had even been able to lose the weight she had initially gained with lithium. She broke up with her boyfriend 5 months ago and has been feeling depressed ever since. You augment her with 300 mg/day of quetiapine, but after several weeks she complains of weight gain and wants to change medications. Blockade of which two receptors was most likely responsible for this weight gain induced by quetiapine? A. Serotonin 2A and muscarinic 3 B. Dopamine 2 and alpha 1 adrenergic C. Muscarinic 1 and serotonin 6 D. Serotonin 2C and histamine 1 d Maria is a 31-year-old patient with bipolar II disorder. During major depressive episodes, this patient often experiences several symptoms of hypomania, including flight of ideas, increased risk-taking behavior, and increased talkativeness. According to data from the Stanley Foundation Bipolar Network, how many patients with bipolar disorder exhibit subsyndromal hypomanic symptoms during a major depressive episode? A. 5% B. 25% C. 45% D. 65% E. 85% d A 43-year-old obese patient with bipolar II disorder has agreed to a trial of an atypical antipsychotic. Considering this patient's current weight and the wish to avoid any treatment induced weight gain, which of the following treatments would be the least optimal treatment for this patient? A. Lurasidone B. Olanzapine C. Aripiprazole b Thomas, a 28-year-old patient with major depressive disorder with mixed features, complains of significant irritability and agitation that are affecting his family and work. Which psychotropic treatment(s) can be considered as ALTERNATIVE maintenance treatments to antidepressants? A. An atypical antipsychotic such as quetiapine B. A mood stabilizer such as lamotrigine C. A benzodiazepine such as lorazepam D. A and B only E. B and C only d Ten-year-old Rebecca experienced seizures as a toddler. Her mother took her to a psychiatrist at age 8, because she had violent outbursts of anger, was attacking her older brother, and was severely irritable. That behavior had been going on for the last 6 months. After screening her for ADHD, and other conduct disorders, Dr. Jones had diagnosed her with bipolar I disorder and put her on 800 mg/day of carbamazepine. Over the last few years she has only had a couple of manic episodes but has recently started having frequent debilitating migraines. She has gained weight as well, and now weighs 30 kg (height of 100 cm, BMI=30) and her mother does not want her to start a medication that could lead to more weight gain. Which medication, and at which dose, could be added to her current treatment? A. 150 mg/day of topiramate (=5 mg/kg/day) B. 400 mg/day of topiramate (=13 mg/kg/day) C. 900 mg/day of lithium D. 1800 mg/day of lithium E. 10 mg/day of olanzapine F. 30 mg/day of olanzapine a A 23-year-old patient with major depressive disorder presents with several symptoms that may indicate the presence of mixed features. Which of the following symptoms was NOT excluded from the DSM-5 mixed features specifier diagnostic criteria? A. Agitation B. Irritability C. Increased goal-directed activity D. Distractibility c A patient with bipolar depression has been treated for 6 months with lamotrigine plus an atypical antipsychotic with partial response. The decision is made to stop the atypical antipsychotic; however, during down-titration, the patient develops withdrawal dyskinesias. No treatment for the dyskinesias is initiated, and after 2 weeks, they still remain. Which of the following is true? A. If the withdrawal dyskinesias still remain after 2 weeks, they are likely to be permanent B. The patient's withdrawal dyskinesias may take several weeks to months to resolve b A patient with bipolar disorder has been taking valproate with only partial control of depressive symptoms, and his clinician elects to add lamotrigine. Compared to lamotrigine monotherapy, what adjustment should be made to the lamotrigine titration schedule in the presence of valproate? A. Slower titration schedule, same target dose B. Same titration schedule, half the target dose C. Slower titration schedule, half the target dose D. Same titration schedule, same dose c A 28-year-old obese woman presents with a depressive episode. She has previously been hospitalized and treated for a manic episode but is not currently taking any medication. The agent with the lowest risk of cardiometabolic side effects is: A. Lithium B. Lurasidone C. Valproate b Michael is a 42-year-old patient with bipolar I disorder who frequently exhibits impulsive symptoms of mania including risk taking and pressured speech during his manic episodes. Compared to a healthy brain, neuroimaging of this patient's brain during a no-go task (designed to test response inhibition) would likely show: A. Increased activity in the orbitofrontal cortex B. Decreased activity in the orbitofrontal cortex C. Increased activity in the dorsolateral prefrontal cortex b Sarah is a 20-year-old patient who presents with symptoms of depression (including sadness, feelings of worthlessness, and suicidal ideation) occurring every day for the past month. Clinical interview with Sarah reveals that she has a maternal aunt with bipolar disorder I. Further assessment reveals that this patient also feels distracted and as though her thoughts are racing. Upon speaking with the patient’s mother, it is discovered that Sarah has been, at times, more talkative than usual and irritable with her friends and family. Which class of medication would NOT be recommended as monotherapy for this patient? A. An antidepressant B. A mood stabilizer C. An antipsychotic a Stacey is a 25-year-old patient with bipolar depression who tends to endorse some manic symptoms during depressive episodes. Of the following symptoms, which is the most common subsyndromal mania symptom in patients during a major depressive episode with mixed features? A. Decreased need for sleep B. Inflated self-esteem C. Psychomotor agitation D. Elevated mood E. High-risk behavior c A 26-year-old woman began treatment for a major depressive episode 8 months ago. Two months into her treatment she began to experience noticeable symptom improvement, and for the last 5 months she has been nearly symptom free. According to the general consensus, her current state could be classified as a: A. Response B. Remission C. Recovery D. Relapse E. Recurrence b A 38-year-old patient with depression presents with depressed mood, anhedonia, and loss of energy. These symptoms can be conceptualized as reflecting reduced positive affect; such a categorization is theoretically useful because it may direct treatment choice. Specifically, symptoms of reduced positive affect are hypothetically more likely to respond to agents that enhance: A. Serotonin and possibly dopamine function B. Dopamine and possibly norepinephrine function C. Norepinephrine and possibly serotonin function b A 36-year-old man with major depressive disorder is having lab work done to assess his levels of inflammatory markers. Based on the current evidence regarding inflammation in depression, which of the following results would you most likely suspect for this patient? A. Elevated levels of tumor necrosis factor-alpha (TNF-alpha) B. Reduced levels of interleukin 6 (IL-6) C. Both A and B D. Neither A nor B a Denise is a 56-year-old perimenopausal patient with a history of depression. Her depressed mood seems to be responding to her current treatment with the selective serotonin reuptake inhibitor (SSRI) fluoxetine (40 mg/day); however, she is troubled by hot flashes and night sweats, and she reports some residual depressed mood. Which treatment strategy is likely to optimize this patient's chance for remission? A. Maintain current fluoxetine dose B. Decrease fluoxetine dose C. Switch to a different selective serotonin reuptake inhibitor (SSRI) D. Switch to a serotonin and norepinephrine reuptake inhibitor (SNRI) d Margaret is a 42-year-old patient with untreated depression. She is reluctant to begin antidepressant treatment due to concerns about treatment-induced weight gain. Which of the following antidepressant treatments is associated with the greatest risk of weight gain? A. Escitalopram B. Fluoxetine C. Mirtazapine D. Vilazodone c A 52-year-old man presents to the emergency room with symptoms of hypertensive crisis after an evening dining out with friends. He is currently taking a monoamine oxidase inhibitor (MAOI). Which of the following foods must be avoided by patients taking MAOIs? A. Fresh fish B. Aged cheese C. Bananas D. Bottled beer E. All of these must be avoided F. None of these must be avoided b A 48-year-old woman with a history of treatment-resistant depression is currently taking duloxetine 60 mg/day with partial response as well as trazodone 50 mg/day for insomnia. She states that she feels empty and useless, and she admits to having thoughts of death. She states that she does not have plans to kill herself because it would harm her family and pets. Her clinician decides to try tranylcypromine, a monoamine oxidase inhibitor (MAOI) and one of the few agents that she has not yet tried. Which of the patient's current medications would you discontinue BEFORE initiating tranylcypromine? A. Duloxetine B. Trazodone C. Both duloxetine and trazodone D. Neither duloxetine nor trazodone a A 56-year-old male patient with major depression is brought to the ER with cardiac arrhythmia and possible cardiac arrest. While at the hospital, he suffers a seizure. His wife states that he may have ingested an increased dose of his medication. Which of the following is most likely responsible for this apparent overdose reaction? A. Clomipramine B. Atomoxetine C. Fluvoxamine D. Venlafaxine a A 65-year-old patient on theophy