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

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

  • Assessment

    Please answer the following questions based on what you learned in this activity.
  • 1. JC is a 19-year-old patient who is diagnosed with major depressive disorder and generalized anxiety disorder and would like to start a new medication. He was most recently prescribed sertraline 100mg daily but had difficulty remembering to take it every day. His sister is also diagnosed with major depressive disorder but has responded well to her current treatment of duloxetine 60mg daily. His pertinent medical history includes irritable bowel syndrome, HIV, and tobacco use disorder. Which first-line option is MOST appropriate to initiate?*

  • 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.

    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.

     

  • 2. Which treatment(s) should be offered to a patient who scores 21 on the PHQ-9 assessment?*

  • 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.

    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.



  • 3.Which of the following outcomes has been demonstrated in people living with HIV and major depressive disorder?*

  • 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.

    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.

  • Evaluation

    To receive your CME/CE credit for participating in this activity, please complete the following evaluation.
  • After participating in the webinar, please rate your current confidence addressing the mental health needs of PWH.*
  • Did your confidence improve?
  • Rows
  • Rows
  • What barrier(s) impact your ability to make the change(s) you indicated above in your practice or with your care team? (check all that apply)*
  • Rows
  • Rows

  • Please provide the following informaiton to receive your CME/CE Certificate.


  •

  • The certificate emails auto-generated by this form are blocked by comcast.net email addresses. Please use an alternate email address if possible, or contact CEServices@academycme.org after submitting your form. **

  • Profession*
  • Please indicate your practice setting:*
  • Please select your area of practice:*
  • Number of years caring for people with HIV:*
  • On average, how many PWH do you see/impact per week?*
  • Amount of Time Spent in Activity/Number of Credits Claimed*

  • This educational activity was certified for a maximum of 1.0 AMA PRA Category 1 Credits(TM), 1.0 ANCC Contact Hours, 1.0 AAPA Category 1 CME credits, and 1.0 ACPE Contact Hours.

  • 1.25

  • 1.0

  • 0.75

  • 0.5

  • 0.0

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