Rosh Psychiatry Board Practice Exam

What should be the next best step in treating a patient with unexplained symptoms who has a high PHQ-15 score?

1. Empirically prescribe antibiotics for Helicobacter pylori

2. Repeat endoscopy

3. Refer for psychological evaluation

4. Schedule regular outpatient visits regardless of symptom

The correct answer is: Schedule regular outpatient visits regardless of symptom

In treating a patient with unexplained symptoms and a high PHQ-15 score, the most appropriate next step is to schedule regular outpatient visits regardless of the symptoms. This approach is based on the understanding that patients presenting with high scores on the Patient Health Questionnaire-15 (PHQ-15) may be experiencing somatic symptom disorder or other psychosomatic issues. Regular follow-up visits facilitate ongoing assessment, reassurance, and the establishment of a therapeutic alliance, which can enhance the patient’s engagement in their care. By scheduling outpatient visits, the clinician can monitor the patient's condition over time, provide education about the nature of their symptoms, and encourage open communication. This strategy helps in identifying any changes in the patient's symptoms, allowing for adjustments in treatment as necessary. It also allows for further evaluations if new symptoms arise or if there is a lack of improvement, ensuring a comprehensive approach to the patient’s health without prematurely focusing on invasive procedures or referrals that may not address the underlying issue. This proactive management style is particularly beneficial in cases where symptoms are unexplained, as it acknowledges the patient's concerns while promoting a more holistic understanding of their health. The focus remains on building rapport and providing ongoing support, rather than jumping to conclusions or immediate interventions that may not be warranted