ABFM\ American Board of Family Medicine KSA
Behavioral Health Study Guide | Questions and
Correct Answers Graded A+ | 2026\2027 Latest
A 26-year-old female presents for evaluation of sudden episodes of
dizziness, nausea, sweating, and shakiness that have occurred four times
in the last 6 weeks. The episodes have interfered with her daily activities
and she is concerned that they will continue. Her past medical history is
unremarkable. She does not take any routine prescriptions or over-the-
counter medications or supplements. She does not smoke cigarettes or use
recreational or illicit drugs, and typically limits her alcohol consumption to
two glasses of wine on weekends. She states that her relationship with her
long-term boyfriend is very good. Her vital signs are normal and her serum
TSH level is also normal. Which one of the following is true concerning the
most likely diagnosis?
The diagnosis requires that episodes are not the result of substance use
Episodes occur exclusively in patients with the disorder
Short screening questionnaires are les
-Correct Answer-The diagnosis requires that episodes are not the result of
substance use
This patient's symptoms are consistent with panic attacks, and her history
is consistent with panic disorder. Panic attacks are unprovoked, intense,
unexpected, rapidly occurring episodes of intense fear that usually peak
within 10 minutes and last up to an hour. They are a hallmark symptom of
panic disorder but accompany many other psychiatric conditions, including
other anxiety disorders and major depressive disorder. At least 4 of the
following 13 characteristic symptoms must be present to make the
diagnosis of panic attack.
palpitations, or a pounding or racing heart
sweating
tremulousness
,shortness of breath
feelings of choking
chest pain/discomfort
nausea or abdominal distress
dizziness, unsteadiness or lightheadedness
chills or heat sensations
paresthesias
derealization or depersonalization
fear of losing control or going crazy
fear of dying
Panic disorder has a lifetime prevalence of up to 6%, and is more common
than generalized anxiety disorder. The age of onset is typically in the 20s,
and it is more common in women than in men. At least two or more attacks
within 1 month are required to make the diagnosis of panic disorder. The
diagnosis also requires persistent worry or fear that another attack will
occur, or a significant change in behavior. A diagnosis of panic disorder
requires that symptoms are not caused by an underlying medical condition
such as hyperthyroidism or cardiac arrhythmia, or another psychological
problem. The DSM-5 also states that symptoms cannot be caused by
substance use, but careful history taking and assessment is required, as
panic disorder may be present in those with substance use disorders and
some patients may attempt to self-treat their symptoms with alcohol or
drugs. Panic attacks may or may not be associ
During a health maintenance visit, a 32-year-old female asks you about
discontinuing her antidepressant. She has been taking fluoxetine (Prozac),
20 mg daily, for the last year and has been in remission for the last 8
months. Her PHQ-9 score at this visit is 3. Which one of the following is
NOT true regarding maintenance therapy and relapse prevention in
patients with depression?
There is approximately a 30% risk of depression recurrence after a first
episode of major depression
After achievement of remission, ongoing cognitive-behavioral therapy is
effective in preventing long-term relapse of depression
,Candidates for long-term maintenance therapy for depression include
individuals with two or more previous episodes of depression
To reduce the risk of relapse, patients with major depression should
continue medication for at least 4 months after achieving remission
Patients with major depression and prominent an
-Correct Answer-There is approximately a 30% risk of depression
recurrence after a first episode of major depression
Current evidence-based guidelines recommend treatment of major
depression for at least 4-9 months after remission is achieved. Candidates
for longer-term maintenance therapy include individuals with two or more
previous episodes of depression, those with more severe depression, and
those who had difficulty achieving or initially maintaining remission.
Ongoing cognitive-behavioral therapy after remission is effective in
preventing long-term relapse of depression.Evidence from the STAR*D trial
has shown that patients with prominent anxiety symptoms are less likely to
achieve remission and more likely to relapse. After a single episode of
major depression the risk of recurrence is over 50%, but a trial of
antidepressant discontinuation may be warranted after an appropriate
period of treatment and remission. After two episodes the relapse rate is as
high as 80%, and after three or more episodes the relapse rate may be as
high as 90% over the next 15 years, suggesting that ongoing surveillance is
critical. One study has shown that in patients with two or more past
episodes of major depression, 79.5% were symptom-free after 1 year of
treatment (95% CI: 73.2%-85.8%), compared to 56.5% who discontinued
treatment (95% CI: 48.9%-64.2%). In patients with at least three past
episodes or a chronic course, 71.7% were symptom-free at 2 years with
antidepressant treatment (95% CI: 64.6%-78.9%) compared to 14.7% of
those not taking antidepressants (95% CI: 7.10%-22.2%). A shared
decision-making discussion with patients who have had multiple previous
episodes of major depression is useful for determining patient preferences
, regarding long-term continuation of antidepressants versus a trial of
discontinuation.
You are considering systematic efforts in your practice to better identify and
treat depression and anxiety in patients with chronic disease. Which one of
the following statements about these conditions is true?
Antidepressants are more effective than placebo for treating depression in
cancer patients
There is a bidirectional relationship between depression and diabetes
mellitus
Collaborative care models for depression in adults with coronary artery
disease are associated with long-term reductions in major cardiac events
Anxiety is more common than depression in patients with heart failure
-Correct Answer-There is a bidirectional relationship between depression
and diabetes mellitus
Depression and anxiety are common in patients with chronic diseases.
Identification and treatment of these patients could potentially improve
patient outcomes and quality of life, but available evidence varies by
condition.A 2018 Cochrane review found only a few low-quality studies
regarding the treatment of depression in cancer patients, with no difference
in effectiveness between antidepressants and placebo.There appears to be
a bidirectional relationship between depression and diabetes mellitus.
Patients with major depressive disorder have a greater risk of developing
type 2 diabetes than the general population (relative risk = 1.49). The
prevalence of depressive disorders in patients with diabetes is twice that of
patients without diabetes.A 2016 meta-analysis concluded that patients
with depression are at increased risk for myocardial infarction and coronary
death. This meta-analysis did not examine the effect of treatment on these
outcomes. A 2015 systematic review and meta-analysis showed that
collaborative care for comorbid depression and coronary heart disease
improved quality of life, reduced depression and anxiety symptoms, and
was associated with reductions in major cardiac events for up to 12
months, but the reduction of major cardiac events was not sustained over
Behavioral Health Study Guide | Questions and
Correct Answers Graded A+ | 2026\2027 Latest
A 26-year-old female presents for evaluation of sudden episodes of
dizziness, nausea, sweating, and shakiness that have occurred four times
in the last 6 weeks. The episodes have interfered with her daily activities
and she is concerned that they will continue. Her past medical history is
unremarkable. She does not take any routine prescriptions or over-the-
counter medications or supplements. She does not smoke cigarettes or use
recreational or illicit drugs, and typically limits her alcohol consumption to
two glasses of wine on weekends. She states that her relationship with her
long-term boyfriend is very good. Her vital signs are normal and her serum
TSH level is also normal. Which one of the following is true concerning the
most likely diagnosis?
The diagnosis requires that episodes are not the result of substance use
Episodes occur exclusively in patients with the disorder
Short screening questionnaires are les
-Correct Answer-The diagnosis requires that episodes are not the result of
substance use
This patient's symptoms are consistent with panic attacks, and her history
is consistent with panic disorder. Panic attacks are unprovoked, intense,
unexpected, rapidly occurring episodes of intense fear that usually peak
within 10 minutes and last up to an hour. They are a hallmark symptom of
panic disorder but accompany many other psychiatric conditions, including
other anxiety disorders and major depressive disorder. At least 4 of the
following 13 characteristic symptoms must be present to make the
diagnosis of panic attack.
palpitations, or a pounding or racing heart
sweating
tremulousness
,shortness of breath
feelings of choking
chest pain/discomfort
nausea or abdominal distress
dizziness, unsteadiness or lightheadedness
chills or heat sensations
paresthesias
derealization or depersonalization
fear of losing control or going crazy
fear of dying
Panic disorder has a lifetime prevalence of up to 6%, and is more common
than generalized anxiety disorder. The age of onset is typically in the 20s,
and it is more common in women than in men. At least two or more attacks
within 1 month are required to make the diagnosis of panic disorder. The
diagnosis also requires persistent worry or fear that another attack will
occur, or a significant change in behavior. A diagnosis of panic disorder
requires that symptoms are not caused by an underlying medical condition
such as hyperthyroidism or cardiac arrhythmia, or another psychological
problem. The DSM-5 also states that symptoms cannot be caused by
substance use, but careful history taking and assessment is required, as
panic disorder may be present in those with substance use disorders and
some patients may attempt to self-treat their symptoms with alcohol or
drugs. Panic attacks may or may not be associ
During a health maintenance visit, a 32-year-old female asks you about
discontinuing her antidepressant. She has been taking fluoxetine (Prozac),
20 mg daily, for the last year and has been in remission for the last 8
months. Her PHQ-9 score at this visit is 3. Which one of the following is
NOT true regarding maintenance therapy and relapse prevention in
patients with depression?
There is approximately a 30% risk of depression recurrence after a first
episode of major depression
After achievement of remission, ongoing cognitive-behavioral therapy is
effective in preventing long-term relapse of depression
,Candidates for long-term maintenance therapy for depression include
individuals with two or more previous episodes of depression
To reduce the risk of relapse, patients with major depression should
continue medication for at least 4 months after achieving remission
Patients with major depression and prominent an
-Correct Answer-There is approximately a 30% risk of depression
recurrence after a first episode of major depression
Current evidence-based guidelines recommend treatment of major
depression for at least 4-9 months after remission is achieved. Candidates
for longer-term maintenance therapy include individuals with two or more
previous episodes of depression, those with more severe depression, and
those who had difficulty achieving or initially maintaining remission.
Ongoing cognitive-behavioral therapy after remission is effective in
preventing long-term relapse of depression.Evidence from the STAR*D trial
has shown that patients with prominent anxiety symptoms are less likely to
achieve remission and more likely to relapse. After a single episode of
major depression the risk of recurrence is over 50%, but a trial of
antidepressant discontinuation may be warranted after an appropriate
period of treatment and remission. After two episodes the relapse rate is as
high as 80%, and after three or more episodes the relapse rate may be as
high as 90% over the next 15 years, suggesting that ongoing surveillance is
critical. One study has shown that in patients with two or more past
episodes of major depression, 79.5% were symptom-free after 1 year of
treatment (95% CI: 73.2%-85.8%), compared to 56.5% who discontinued
treatment (95% CI: 48.9%-64.2%). In patients with at least three past
episodes or a chronic course, 71.7% were symptom-free at 2 years with
antidepressant treatment (95% CI: 64.6%-78.9%) compared to 14.7% of
those not taking antidepressants (95% CI: 7.10%-22.2%). A shared
decision-making discussion with patients who have had multiple previous
episodes of major depression is useful for determining patient preferences
, regarding long-term continuation of antidepressants versus a trial of
discontinuation.
You are considering systematic efforts in your practice to better identify and
treat depression and anxiety in patients with chronic disease. Which one of
the following statements about these conditions is true?
Antidepressants are more effective than placebo for treating depression in
cancer patients
There is a bidirectional relationship between depression and diabetes
mellitus
Collaborative care models for depression in adults with coronary artery
disease are associated with long-term reductions in major cardiac events
Anxiety is more common than depression in patients with heart failure
-Correct Answer-There is a bidirectional relationship between depression
and diabetes mellitus
Depression and anxiety are common in patients with chronic diseases.
Identification and treatment of these patients could potentially improve
patient outcomes and quality of life, but available evidence varies by
condition.A 2018 Cochrane review found only a few low-quality studies
regarding the treatment of depression in cancer patients, with no difference
in effectiveness between antidepressants and placebo.There appears to be
a bidirectional relationship between depression and diabetes mellitus.
Patients with major depressive disorder have a greater risk of developing
type 2 diabetes than the general population (relative risk = 1.49). The
prevalence of depressive disorders in patients with diabetes is twice that of
patients without diabetes.A 2016 meta-analysis concluded that patients
with depression are at increased risk for myocardial infarction and coronary
death. This meta-analysis did not examine the effect of treatment on these
outcomes. A 2015 systematic review and meta-analysis showed that
collaborative care for comorbid depression and coronary heart disease
improved quality of life, reduced depression and anxiety symptoms, and
was associated with reductions in major cardiac events for up to 12
months, but the reduction of major cardiac events was not sustained over
