Case Studies in Addressing Mental Health and Improving Outcomes for People with HIV (Web)

A. ParoxetineB. DuloxetineC. Bupropion XRD. Sertraline

Congratulations. The best choice is B. Duloxetine is a first-line option for the treatment of major depressive disorder, with evidence of responsiveness for symptoms in a first degree relative. A is incorrect because the patient endorses difficulty with medication adherence; because of paroxetine’s short half-life, the patient may frequently experience symptoms of withdrawal if they are not compliant. C is incorrect because bupropion XR is an activating medication and can exacerbate generalized anxiety symptoms at initiation. D is incorrect because, although the patient did not have an adequate trial of sertraline due to non-compliance, they also have a diagnosis of irritable bowel syndrome, which could be exacerbated by sertraline.

References: Lam RW, Kennedy SH, Adams C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 update on clinical guidelines for management of major depressive disorder in adults. Can J Psychiatry. 2024;69(9): 641-87. Doi: 10.1177_07067437241245384.

Sorry, the correct answer is B. Duloxetine is a first-line option for the treatment of major depressive disorder, with evidence of responsiveness for symptoms in a first degree relative. A is incorrect because the patient endorses difficulty with medication adherence; because of paroxetine’s short half-life, the patient may frequently experience symptoms of withdrawal if they are not compliant. C is incorrect because bupropion XR is an activating medication and can exacerbate generalized anxiety symptoms at initiation. D is incorrect because, although the patient did not have an adequate trial of sertraline due to non-compliance, they also have a diagnosis of irritable bowel syndrome, which could be exacerbated by sertraline.

A. Cognitive behavioral therapy (CBT)B. Antidepressant medicationC. Interpersonal therapy + antidepressant medicationD. Antipsychotic medication

Congratulations. The best answer is C. A PHQ-9 score of 21 indicates severe depressive symptoms, thus both psychotherapy (i.e., CBT, interpersonal therapy, or behavioral activation) and pharmacotherapy are recommended in combinations A is incorrect because, although CBT is a recommended therapeutic intervention, the severity of depressive symptoms would be best treated in combination with medication. B is incorrect with similar rationale to why A is incorrect (i.e., combination of both psychotherapy and medication). D is incorrect because antipsychotics are best utilized as augmentation agents to antidepressants when partially responsive to monotherapy.

Reference: Lam RW, Kennedy SH, Adams C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 update on clinical guidelines for management of major depressive disorder in adults. Can J Psychiatry. 2024;69(9): 641-87. Doi: 10.1177_07067437241245384.

Sorry, the best answer is C. A PHQ-9 score of 21 indicates severe depressive symptoms, thus both psychotherapy (i.e., CBT, interpersonal therapy, or behavioral activation) and pharmacotherapy are recommended in combinations A is incorrect because, although CBT is a recommended therapeutic intervention, the severity of depressive symptoms would be best treated in combination with medication. B is incorrect with similar rationale to why A is incorrect (i.e., combination of both psychotherapy and medication). D is incorrect because antipsychotics are best utilized as augmentation agents to antidepressants when partially responsive to monotherapy.

A. Significant improvement in depressive symptoms, antiretroviral therapy (ART) adherence and odds of undetectable viral load.B. Reduction in depressive symptom severity, but no significant improvement in ART adherence nor viral suppression.C. No improvement in depressive symptom severity, and increased risk of HIV disease progression.D. No measurable improvement in mental health nor HIV outcomes.

Congratulations. The best answer is A. Both mental health and HIV outcomes improve when patients receive mental health treatment since untreated depression in HIV makes all outcomes worse.

Reference: Safren SA, O’Cleirigh C, Andersen LS, et al. Treating depression and improving adherence in HIV care with task-shared cognitive behavioural therapy in Khayelitsha, South Africa: a randomized controlled trial. J Int AIDS Soc. 2021;24(10): e25823. Doi: 10.1002/jia2.25823.

Sorry, the best answer is A. Both mental health and HIV outcomes improve when patients receive mental health treatment since untreated depression in HIV makes all outcomes worse.

YesNoRemained the same

	Strongly Agree (5)	Agree (4)	Neutral (3)	Disagree (2)	Strongly Disagree (1)
The content covered was useful and relevant to my current or future scope of practice.
The activity was fair, balanced, and free of bias.
The activity improved my knowledge of this clinical issue.
The learning objectives for this activity were achieved.
I am better able to: Communicate/collaborate with other members of the care team on this issue.
I am better able to: Improve access to care and treatment for underrepresented patient groups or geographies because of what I learned.
The information learned during this activity will help improve my skills or judgment within the next six months.
The content was presented clearly.
The educational activity was well planned and presented.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
I intend to: Modify/change my practice or the practice of my team based on this educational activity.
I intend to: Work with my team to create/revise protocols, policies, and/or procedures with my care team.
I intended to: Share what I learned with other members of my care team.
I intend to: Make changes in how I communicate with/educate my patients.
I intend to: Seek additional information on topics discussed during the activity.
On average, I utilized the patient treatment strategies described in this educational activity prior to my participation.

	Strongly Agree	Agree	Neutral	Disagree	Strongly Disagree
My office and practice systems can accommodate the above changes.
My patients can accommodate the above changes.
Patient access to the treatments provided will be a barrier to implementing the above changes.

	Excellent (5)	Good (4)	Acceptable (3)	Poor (2)	Very Poor (1)
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Case Studies in Addressing Mental Health and Improving Outcomes for People with HIV (Web)

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