Bipolar Fatigue Assessment

The PMHNP is evaluating a 27-year-old patient referred from the primary care provider for evaluation and treatment of a failure to respond to first line antidepressant pharmacotherapy. According to the referral the patient was diagnosed with major depressive disorder, recurrent, and started on a trial of escitalopram titrated up to 20 mg daily with no improvement. In fact, the patient tells you that he actually felt worse, with increasing irritability and agitation. Today the patient admits to depressed mood, anhedonia, hopelessness, irritability, chronic difficulty sleeping with nocturnal awakening, and occasional passive suicidal ideation. The patient reports that he has been struggling with depressed mood off and on since high school, and that he drinks at least a 6-pack of beer most days because it makes him feel better. The NP recognizes that the priority of care today is which of the following? A. Changing his antidepressant B. Ruling out bipolar disorder C. Managing the alcohol use disorderD. Involving a therapist in the plan of care ---YouTube: https://www.youtube.com/watch?v=yVyuYemV8E0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=146

A 29-year-patient with bipolar disorder is being seen today in follow-up. She has a history of not being well managed, but for the last several months she has been maintained on aripiprazole 15 mg daily and citalopram 20 mg daily with much improvement for the last two months. Today she reports that her mood remains stable, but she feels fatigued all the time. She is sleeping 9-10 hours a night but still feels physically fatigued all day. A review of psychiatric symptoms does not reveal any other findings consistent with a depressive episode; she specifically denies depressed mood, anhedonia, hopelessness, worthlessness, self-harm, suicidal ideation or appetite change. Irritability, which was a dominant symptom prior to treatment, has completely resolved.The next step in this patient’s assessment should include:A. A validated depression questionnaire B. Laboratory assessment including a CMP, CBC and TSHC. Decreasing the aripiprazole to 10 mg daily D. Increasing the dose of the citalopram ---YouTube: https://www.youtube.com/watch?v=9lnB3bKD_sY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=145

The PMHNP is performing a follow-up visit on a 41-year-old female who is being treated for obsessive-compulsive disorder. She has been seeing an exposure-response therapist for over six months, and approximately two months ago both patient and the therapist felt that pharmacotherapy should be considered. The patient was started on fluoxetine and was rapidly titrated up to 40 mg day two months ago. Today in follow-up the patient’s Y-BOCS score is 23, as compared to a 24 when she started her medication 2 months ago. Subjectively she feels distinct improvement. She still loses time to both her obsessive thoughts and occasionally her husband has to pick her up and carry her from bed to living room because of her obsession about touching the floor.  But, she feels encouraged and genuinely feels as though things are better. The appropriate course of action today would be to do which of the following? A. Increase her fluoxetine to 60 mg day B. Change her SSRI to fluvoxamine rapidly tapering to 300 mg/day C. Continue the current plan of care and follow-up in one month D. Discuss with her a change of therapeutic modality to EMDR. ---YouTube: https://www.youtube.com/watch?v=UIuwwA5N63I&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=144

The PMHNP is reviewing the results of a comprehensive new patient assessment and notes that the result of the patient health questionnaire (PHQ)-9 is a 7. Knowing that the sensitivity of this screening tool is 90% for a score of 8 or more, the PMHNP recognizes that the likelihood that the patient is having a major depressive episode is: A. 10%B. 15%C. 85%D. 90%---YouTube: https://www.youtube.com/watch?v=iK87yMniCNY&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=143

J.T. is a 38-year-old male patient who presents for assessment and treatment of substance use disorder. He has a long history of chronic alcohol use, typically drinking a 6-pack of beer every evening.  According to his primary care provider his physical examination and laboratory studies are all within normal limits and there are no documented medical conditions. He admits that he personally does not truly believe he has substance use problem, but his wife does like the fact that he drinks, and they argue about it often. He loves his wife and does not want to argue, but he enjoys his beer and feels strongly that it is not hurting anything when he drinks. He thinks she is being unreasonable. The PMHNP recognizes that he is at what point in the change process? A. Precontemplative B. Focusing C. UnfreezingD. Planning ---YouTube: https://www.youtube.com/watch?v=vY9f7ZTdt4M&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=142

The PMHNP is seeing a 11-year-old patient who is being managed for obsessive-compulsive disorder. The patient has been in exposure response therapy for almost one year and has been taking fluoxetine 40 mg daily. For the last six months the patient was in an acceptable remission, but today he reports that his obsessive thought processes and compulsive hygiene behaviors have started to become intrusive and are making it difficult for him to manage his day appropriately. Additional assessment today must include which of the following? Select all that apply A. Subjective information from the patientB. Subjective information from the parentC. Subjective information from the teacher D. Subjective information from the therapist ---YouTube: https://www.youtube.com/watch?v=q2r-w3LoANQ&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=141

An initial psychiatric evaluation should include a comprehensive risk assessment across the lifespan. Which of the following should be part of the initial intake for all patients aged 8 to 24 as part of that risk evaluation?A. The CAGE questionnaire B. The ASQ toolC. The SCARED tool D. The MCHAT-R questionnaire ---YouTube: https://www.youtube.com/watch?v=jB53p074Ze0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=140

The PMHNP is performing a follow-up visit on a 32-year-old male. He is being treated with sertraline 100 mg daily for a major depressive episode that began when he started having serious marital problems. His depressive symptoms have much improved, and he currently denies depressed mood, anhedonia, hopelessness, worthlessness, guilt or irritability. Even sleep has improved, and he is currently satisfied with his response to pharmacotherapy. During the visit, the PMHNP notes that the patient repeatedly voices his opinion that his wife will not consider reconciliation, that she does not understand he has improved and wants to work on the marriage. Despite several attempts to redirect the conversation, the patient repeatedly returns to the topic of his wife not doing her part. The NP documents which finding with respect to mental status examination? A. RuminationB. EcholaliaC. Tangential thought D. Perseveration---YouTube: https://www.youtube.com/watch?v=p_3AhDQt5og&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=139

A 5-year-old child presents for evaluation with her mother. The mother is concerned that the child might have autism spectrum disorder and asks for a comprehensive evaluation. As part of a developmentally appropriate assessment, the PMHNP recognizes that which of the following is the appropriate approach to assessing the child’s affect, coordination and motor skills, speech, attention span, capacity for complex thinking and interaction? A. Playing with the child on the floorB. Administering the Sally/Anne test C. A complete neuropsychiatric assessment D. Evaluate responses to a CRAFFT questionnaire ---YouTube: https://www.youtube.com/watch?v=QpiaTE0r7bo&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=138

The PMHNP is seeing a 22-year-old male patient for his initial evaluation.  The appointment is court ordered and the patient seems very uncomfortable being there and answers direct questions with one-word responses. According to information provided by the court, the patient comes from a very dysfunctional upbringing, has been homeless for an indeterminate time period, and did not adapt well during his brief period of incarceration. The PMHNP is very open about all information that she has from the referral, is clear about her role, what has to be reported to the court, and what remains confidential, and offers to answer any questions the patient has before they begin their discussion. The PMHNP is employing which key component of developing a therapeutic alliance? A. Empathy and active listening B. Trust and safety C. Goal alignment D. Collaborative tasks ---YouTube: https://www.youtube.com/watch?v=BOxvSEiUqe0&list=PLf0PFEPBXfq5HGfNV-GbOlYHtDwd35OeG&index=137