Addiction and Mental Health

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Addictive Screen Use and Suicidal Behaviours

High and increasing addictive screen use trajectories in early adolescence are associated with suicidal behaviours.

  • True
  • False
Volume 41.1 - Question 5

Varenicline & Vaping

Varenicline, combined with behavioral counseling, increases vaping abstinence in youth who vape nicotine and do not regularly smoke tobacco.

  • True
  • False
Volume 40.5 - Question 27

Opioids for Headache

Opioid prescriptions for headache in the emergency department are associated with higher rates of long-term prescription opioid use.

  • True
  • False
Volume 40.5 - Question 11

Emergency Department Opioid Prescriptions

Which one of the following outcomes at one year is associated with emergency department opioid prescriptions?

  • Increased rate of overdoses
  • New opioid agonist therapy
  • Increase in mortality
  • Increases in subsequent opioid prescription use
Volume 40.5 - Question 10

Obsessive-Compulsive Disorder

Which one of the following statements about obsessive-compulsive disorder is false?

  • The Yale-Brown Obsessive-Compulsive Scale measures severity.
  • Exposure and response prevention is the most effective form of psychotherapy.
  • Psychotherapy is less effective than pharmacotherapy.
  • Clomipramine is not a first line treatment.
Volume 40.3 - Question 19

Methylphenidate and Atomoxetine in Pregnancy

Methylphenidate or atomoxetine intake during pregnancy are not associated with higher frequency of congenital anomalies.

  • True
  • False
Volume 40.3 - Question 18

Electronic Cigarettes

Electronic cigarettes are similarly effective to varenicline for smoking cessation in adults.

  • True
  • False
Volume 40.2 - Question 29

Opioid Prescribing in the Emergency Department

Which one of the following statements regarding opioid prescribing in the emergency department is false?

  • Patients experiencing renal colic required more opioids over a 2 week period than patients with fractures.
  • About 20% of patients with opioid use disorder report that their initial exposure was in the ED.
  • The majority of patients who misuse prescription opioids have a previous substance use disorder.
  • Most opioid tablets prescribed for acute pain in adults are unused.
Volume 40.2 - Question 20

Alcohol Use Disorder

Which one of the following statements about alcohol use disorder (AUD) is false?

  • Less than 50% of people in Canada aged 15 years or older currently drink more than the amount recommended in Canada’s Guidance on Alcohol and Health.
  • A recommended first screening question is ‘How many times in the past year have you had 5 or more drinks on one occasion (for males) or 4 or more drinks on one occasion (for females).
  • Acamprosate is recommended as a first line pharmacotherapy in moderate to severe AUD.
  • Naltrexone is contraindicated when the patient has acute hepatitis.
Volume 40.1 - Question 6

Treatment of Chronic Insomnia in Adults

Which one of the following statements about the treatment of chronic insomnia is false?

  • Successful sleep management can occur only with optimization of comorbid conditions that contribute to insomnia.
  • All patients should be offered Cognitive Behavioral Therapy – Insomnia as first-line treatment for chronic insomnia.
  • A small group of patients may require adjunct sedative use in addition to non-pharmacologic therapy following the adage “start low and taper fast”.
  • Physicians should refrain from deprescribing sedatives for patients who have been taking them on a long-term basis.
Volume 39.6 - Question 30

Cannabis Use Disorder in Adolescents

Important postoperative complications occurred more frequently among adolescents with Cannabis Use Disorder (CUD) compared with those without CUD.

  • True
  • False
Volume 39.6 - Question 10

Pharmacotherapy and Mortality in ADHD

Among individuals diagnosed with ADHD, medication initiation is associated with significantly lower all-cause mortality.  

  • True
  • False
Volume 39.5 - Question 21

Dementia

Three years of daily use of a single strong anticholinergic medication at the minimum effective dose recommended for older people is associated with 50% increased odds of dementia.

  • True
  • False
Volume 35.61 - Question 28

E-cigarettes and Smoking Cessation

The success rate of attempts to quit smoking cigarettes is positively associated with increasing prevalence of e-cigarette use.

  • True
  • False
Volume 35.61 - Question 13

Pharmacotherapy for Alcohol Use Disorder

Which one of the following statements about pharmacotherapy for alcohol use disorder is false? 

  • Acamprosate is associated with higher incidence of diarrhea compared with placebo.   
  • Evidence regarding the effectiveness of gabapentin is stronger than other pharmacotherapy options.   
  • Oral naltrexone dosing is more convenient than acamprosate dosing.   
  • Acamprosate requires dose adjustment for patients with moderate kidney impairment. 
Volume 39.4 - Question 16

Cannabis Use in Adolescents

An adolescent is more likely to use cannabis when a sibling uses 

  • True
  • False
Volume 39.4 - Question 9

Alcohol Use Disorder and SSRI Therapy

Which one of the following statements regarding patients with alcohol use disorder is false? 

  • Substance-induced symptoms of depression, anxiety and insomnia typically resolve with cessation of alcohol.   
  • Some patients demonstrate a worsening of alcohol-related outcomes when prescribed SSRIs.   
  • Adrenergic symptoms of alcohol withdrawal may be experienced as anxiety.   
  • For patients with active alcohol use disorder, SSRI’s have been shown to be effective in treating concurrent major depressive disorder.
Volume 39.4 - Question 1

Alcohol Policies During the COVID-19 Pandemic

During the COVID-19 pandemic, many national governments have, explicitly or implicitly, deemed the supply of alcohol to be essential and some have even argued that doing so prevents cases of alcohol withdrawal swamping hospitals. Which one of the following statements about the impact of alcohol on health systems or patients is false?

  • Alcohol withdrawal admissions pre-pandemic likely accounted for about 5% of alcohol attributable hospitalizations in Canada.
  • Estimates of alcohol-attributable emergency room visits in Canada exceeds by a factor of about seven all the known cases of COVID-19 in the first wave of the pandemic in Canada.
  • Heavy drinking increases risk for severe lung infections (including both viral and bacterial pneumonia).
  • In South Africa during the COVID-19 pandemic, public policies that resulted in reduced alcohol availability resulted in increased acute-care utilization.
Volume 36.63 - Question 6

Combining Antidepressants for Treatment of Patients with Acute Depression

Concerning combination treatment as compared to monotherapy for patients with acute depression, which one of the following is false? 

  • Combination treatment with presynaptic alpha2-autoreceptor antagonists provides superior treatment outcomes in first-line treatment.   
  • Combination treatment with presynaptic alpha2-autoreceptor antagonists provides superior treatment outcomes in nonresponders.   
  • Combination treatment results in a higher rate of dropouts due to adverse events.   
  • Bupropion combinations are not superior to monotherapy. 
Volume 38.21 - Question 8

Cannabis Use Among Injured Drivers

After cannabis legalization, the percentage of moderately injured drivers with a THC level above the legal limit, measured at participating trauma centers, more than doubled.

  • True
  • False
Volume 37.3 - Question 30

Naltrexone

Which one of the following statements about naltrexone is false?

  • It is approved for treatment of alcohol dependence.
  • It is used for treatment of opioid use disorder.
  • Severe hepatotoxicity has occurred with high doses.
  • It can decrease the effects of cannabinoids.
Volume 37.3 - Question 29

Maintenance or Discontinuation of Antidepressants

Among patients with a history of at least 2 depressive episodes or who had been taking antidepressants for two years or longer who feel well enough to discontinue antidepressant therapy, those who stop their medication have a higher risk of relapse than those who maintain their current therapy.

  • True
  • False
Volume 37.3 - Question 26

Smoking Cessation

Combined treatment with varenicline and nicotine patch is more effective than placebo and nicotine patch for smoking cessation among smokers who drink heavily.

  • True
  • False
Volume 37.6 - Question 33

Gabapentin for Alcohol Use Disorder

Which one of the following statements regarding gabapentin for alcohol use disorder is false? 

  • It decreased the percentage of heavy drinking days.    
  • It increased total abstinence.   
  • Patients experienced 10% more adverse effects than placebo.   
  • Patients prescribed gabapentin for any reason had double the death rate of the general population.  
Volume 36.6 - Question 10

Acute Alcohol and Drug Intoxication

Which one of the following statements about the medical needs of emergency department (ED) patients presenting with acute altered mental status due to presumed alcohol or illicit substance intoxication is false? 

  • The majority of patients require a medical intervention during their ED stay.   
  • A minority of patients receive a medical intervention that is not usually available at a detoxification centre.   
  • Patients require repositioning to open their airway in 10% of encounters.    
  • 1% of patients require admission to the intensive care unit. 
Volume 36.5 - Question 18

Treatment of Bipolar Depression 

Which one of the following statements about treatment of bipolar depression is false? 

  • Antidepressants should be avoided in bipolar depression with mixed features.   
  • Quetiapine is effective in both bipolar I and bipolar II depression.   
  • Divalproex has been shown to be superior to lithium in preventing the recurrence of depressive episodes.   
  • Lurasidone has a negligible liability to cause weight gain. 
Volume 36.4 - Question 12

Physical Exercise and Schizophrenia

Which one of the following statements about physical exercise in those with schizophrenia is false? 

  • Guidelines recommend achieving 90–150 minutes of moderate-to-vigorous activity per week.   
  • Supervision by exercise professionals has no effect on dropout rates.   
  • Improvements in aerobic capacity correlate with a better total score on the Positive and Negative Syndrome Scale.    
  • Video games that require physical movement can motivate patients. 
Volume 36.4 - Question 11

Seasonal Affective Disorder

Which one of the following statements about seasonal affective disorder (SAD) is false? 

  • The spring/summer type of SAD may have atypical symptoms.    
  • Fluoxetine and light therapy have similar effectiveness.    
  • Cognitive behavioural therapy is superior to light therapy for recurrent SAD.   
  • Vitamin D supplementation has been shown to be an effective treatment.
Volume 36.4 - Question 10

Postpartum Depression

Which one of the following alternative therapies has the best evidence to support its use in treatment of postpartum depression? 

  • Physical activity   
  • Cognitive behavioural therapy    
  • Telecommunications therapies    
  • Hormonal treatments  
Volume 36.4 - Question 7

AF and Alcohol

In patients with atrial fibrillation, abstaining from moderate alcohol use reduces the incidence of stroke or other cardiovascular events.

  • True
  • False
Volume 37.1 - Question 29

Depression in Adolescents

Which one of the following statements about depression in adolescents is false?

  • Insomnia is a common symptom.
  • Adolescents who do not have a response to an initial trial of an SSRI are more likely to have a reduction in depressive symptoms with venlafaxine than a different SSRI.
  • Patients receiving both antidepressant medication and cognitive behavioral therapy. (CBT) have significantly greater improvement than those receiving medication without CBT.
  • Recent trials of antidepressant treatment in the pediatric population show no significant difference in suicide risk between adolescents receiving placebo and those receiving antidepressant medication.
Volume 37.1 - Question 27

Pharmacotherapy for Smoking Cessation

Among smokers not yet ready to abstain from tobacco, beginning therapy with varenicline is unlikely to be of benefit. 

  • True
  • False
Volume 36.3 - Question 13

Bipolar Disorder

Which one of the following statements about bipolar disorder is false? 

  • Adults with bipolar disorders are approximately 20–30 times more likely to die by suicide compared with the general population.   
  • Bipolar II disorder is associated with a higher suicide rate than bipolar I disorder.   
  • Suicide is the most common cause of premature mortality.   
  • Maintenance treatment with lithium reduces suicide risk. 
Volume 36.3 - Question 12

Alcohol Policies During the COVID-19 Pandemic

During the COVID-19 pandemic, many national governments have, explicitly or implicitly, deemed the supply of alcohol to be essential and some have even argued that doing so prevents cases of alcohol withdrawal swamping hospitals. Which one of the following statements about the impact of alcohol on health systems or patients is false? 

  • Alcohol withdrawal admissions pre-pandemic likely accounted for about 5% of alcohol attributable hospitalizations in Canada.   
  • Estimates of alcohol-attributable emergency room visits in Canada exceeds by a factor of about seven all the known cases of COVID-19 in the first wave of the pandemic in Canada.    
  • Heavy drinking increases risk for severe lung infections (including both viral and bacterial pneumonia).   
  • In South Africa during the COVID-19 pandemic, public policies that resulted in reduced alcohol availability resulted in increased acute-care utilization.  
Volume 36.3 - Question 11

Maintaining Abstinence from Alcohol

In primary care treatment of recently detoxified, alcohol dependent patients, the only intervention associated with increased probability of abstinence and moderate certainty of evidence is acamprosate. 

  • True
  • False
Volume 36.3 - Question 10

Prevention of Depression with Vitamin D 

In adults aged 50 years and older vitamin D supplementation (2000 IU/d) reduces the incidence of depression. 

  • True
  • False
Volume 36.2 - Question 15

Neurodevelopmental Effects of Cannabis in Pregnancy

Which one of the following neurodevelopmental disorders is associated with a statistically significant increase when cannabis is used during pregnancy?  

  • Attention deficit hyperactivity disorder   
  • Autism   
  • Learning disorder   
  • Intellectual disability  
Volume 36.2 - Question 14

Off-Label Treatment for Alcohol Use Disorder

Which one of the following off-label treatments should not be recommended in the management of alcohol use disorder?

  • Topiramate
  • Gabapentin
  • Baclofen
  • Selective serotonin reuptake inhibitors
Volume 37.4 - Question 41

Acamprosate

Which one of the following statements about acamprosate is false?

  • It must be taken three times daily because of its low bioavailability.
  • It is used to maintain abstinence from alcohol.
  • Abdominal pain is the most common adverse effect.
  • It has no clinically significant drug interactions.
Volume 37.4 - Question 33

Cannabis

Which one of the following statements about conditions related to cannabis use is false?

  • Cannabis withdrawal syndrome occurs within 7 days of reducing cannabis use.
  • Cannabis hyperemesis occurs during recurrent cannabis intoxication.
  • Cannabis withdrawal symptoms can last for months.
  • There is no role for selective serotonin reuptake inhibitors in the management of withdrawal symptoms.
Volume 37.4 - Question 19

Smoking Cessation in Adolescents

In adolescent smokers, no pharmacologic interventions have been shown to be efficacious in increasing smoking abstinence rates at 6 months’ follow-up.

  • True
  • False
Volume 37.4 - Question 5

Addiction Medicine

Which one of the following statements about addiction treatment is false? 

  • Abstinence is the sole useful endpoint.    
  • Targeting depression has value in treating opioid use disorder. 
  •  Addressing social isolation is an important intervention. 
  • Cognitive behavioral treatments are effective in addressing specific dimensions of the addiction process. 
Volume 36.1 - Question 12

Combining Antidepressants for Treatment of Patients with Acute Depression

Concerning combination treatment as compared to monotherapy for patients with acute depression, which one of the following is false?

  • Combination treatment with presynaptic alpha2-autoreceptor antagonists provides superior treatment outcomes in first-line treatment.
  • Combination treatment with presynaptic alpha2-autoreceptor antagonists provides superior treatment outcomes in nonresponders.
  • Combination treatment results in a higher rate of dropouts due to adverse events.
  • Bupropion combinations are not superior to monotherapy.
Volume 37.5 - Question 2

Personality Disorders

Which one of the following statements about personality disorders is false? 

  • Borderline personality is the most frequently diagnosed personality disorder in clinical settings. 
  • Prevalence studies have suggested the rate among men is significantly lower than among woman in the general population.  
  • They commonly co-exist with other mental disorders. 
  • Few randomized control trials have focused on adolescents. 
Volume 38.1 - Question 8

Alcohol-Associated Hepatitis

Which one of the following statements about alcohol-associated hepatitis is false?

  • Glucocorticoids can improve long-term survival.
  • Women are more susceptible to alcohol injury.
  • Mortality from moderate disease is up to 20% at one year.
  • The use of alcohol anticraving drugs has not been rigorously tested in the context of alcohol-associated hepatitis.
Volume 38.3 - Question 23

Buprenorphine Use Myths

Which one of the following statements regarding buprenorphine use and opioid use disorder is false?

  • It can effectively treat pain.
  • It replaces one addiction for another.
  • It reduces cravings for other opioids.
  • It provides stability from craving-withdrawal cycle.
Volume 38.3 - Question 11

Ketamine and Depression

In treatment resistant depression, the antidepresskant effect of intravenous ketamine is prolonged when combined with a computerized training that targets self-esteem.

  • True
  • False
Volume 38.3 - Question 10

Opioid Use Disorder in Pregnancy

In the treatment of opioid use disorder in pregnancy, comparing exposure to methadone or buprenorphine, buprenorphine treatment is associated with each of the following except:

  • A lower risk of fetal abstinence syndrome in infants exposed in the 30 days before delivery.
  • Fewer preterm births among infants exposed in early pregnancy.
  • A lower risk of low birth weight in infants exposed during early pregnancy.
  • Fewer severe maternal complications in mothers exposed in early pregnancy.
Volume 38.3 - Question 6

Psilocybin in Life-Threatening Cancer

One time administration of psilocybin significantly reduces anxiety and depression associated with a life-threatening cancer when utilized under the direct supervision of a trained therapist and followed up with a few psychotherapy sessions.

  • True
  • False
Volume 39.2 - Question 15

Anorexia

Volume 39.2 - Question 42

Group Based Interventions for Opioid Reduction

A group based educational intervention supplemented by 1-on-1 support delivered for 12 months can reduce opioid use among patients using opioids for chronic non-malignant pain.

  • True
  • False
Volume 39.2 - Question 41

Wilson’s Disease

Which one of the following statements about Wilson’s disease is false?

  • Dysarthria is often the first prominent neurological symptom.
  • Serum ceruloplasmin level alone is adequate for diagnosis.
  • Acute liver failure may be the first manifestation.
  • Screening of all first-degree relatives is mandatory.
Volume 39.2 - Question 18

Treatment of Anxiety

Which one of the following statements about drug treatment of anxiety is false?

  • Pregabalin is as effective as an SSRI in relieving symptoms.
  • The onset of action of pregabalin is more rapid than SSRIs.
  • Buspirone is similar in efficacy to benzodiazepines for generalized anxiety disorder.
  • There is good evidence to support the efficacy of cannabinoids.
Volume 39.2 - Question 17

Deprescribing Benzodiazepines

Which one of the following statements about deprescribing of benzodiazepines is false?

  • High maintenance doses can be decreased up to 25% initially.
  • Adjustments often need two to four weeks before the next taper.
  • Doses may need to be modified if withdrawal symptoms become problematic.
  • Cognitive behaviour therapy has not been shown to improve outcomes.
Volume 39.2 - Question 16

Menstrual Suppression in Transgender and Gender-Diverse Adolescents

Which one of the statements regarding menstrual suppression in transgender and gender-diverse adolescents is false?

  • It should be considered for those experiencing gender dysphoria whose menstruation is not already suppressed (e.g., by using testosterone).
  • There is an association with improved rates of depression.
  • No particular agent demonstrates greater efficacy over another.
  • Users of intramuscular medroxyprogesterone report lower rates of satisfaction compared with those using the combined oral contraceptives.
Volume 39.2 - Question 14

Major Depression Treatment

For treatment-resistant major depression without psychosis, ketamine is inferior to electroconvulsive therapy.

  • True
  • False
Volume 39.2 - Question 13

Recreational Use of Nitrous Oxide

Which one of the following statements about toxicity associated with the recreational use of nitrous oxide is false?

  • Isolated, short-term use rarely leads to serious complications.
  • Encephalopathy is a complication, often presenting with new-onset psychiatric symptoms.
  • The most commonly reported presentation is a peripheral sensorimotor neuropathy.
  • The pathophysiology results from functional vitamin B12 deficiency.
Volume 39.2 - Question 7

Cannabis and Alcohol Use Among Smokers

Among current cigarette smokers in Canada, cannabis use is associated with high-risk alcohol consumption. 

  • True
  • False
Volume 39.1 - Question 4

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