Blog

A 24-year-old college student presents for evaluation due to ongoing mood instability. For the past three years, she has experienced frequent shifts between periods of elevated mood with increased energy, talkativeness, and decreased need for sleep, and periods of feeling sad, fatigued, and withdrawn. None of the mood changes have lasted long enough or been severe enough to meet full criteria for hypomanic or major depressive episodes. She denies hallucinations, delusions, suicidal ideation, or prior psychiatric hospitalization. Her symptoms cause distress and interfere with her academic functioning. What is the most appropriate diagnosis?

A 38-year-old man is brought to the clinic by his wife for unusual behavior. He is disoriented, provides only approximate answers to questions, and reports hallucinations, blackouts, and memory lapses without coherent explanations. For example, when asked his age, he replies, “I’m not 10.” There is no evidence of neurological disease or substance use. What is the most likely diagnosis?

A 27-year-old woman describes experiencing periods lasting 5 to 6 days during which she feels unusually energetic and productive. During these times, she needs less sleep, talks more than usual, feels restless and unable to sit still, and often takes on multiple new projects. These episodes are followed by periods lasting 2 to 3 weeks of low mood, fatigue, hypersomnia, poor concentration, and feelings of guilt about overpromising things during her elevated mood states that she cannot fulfill while feeling depressed. She has never been hospitalized or experienced psychosis. What is the most appropriate diagnosis?

A 40-year-old military veteran reports nightmares and flashbacks of combat, avoids reminders of deployment, feels detached from family, and experiences irritability and difficulty concentrating. Which DSM-5-TR criterion for PTSD is not demonstrated in this case?

A 29-year-old patient is being evaluated for persistent symptoms of hypervigilance, intrusive memories, and intense distress when recalling a traumatic event. The PMHNP explains that these clinical manifestations are linked to specific neurobiological changes. Which of the following findings best reflects the pathophysiology of this condition?

A 21-year old female diagnosed with bipolar disorder stopped taking all her medications 6 months ago and is being evaluated because she decompensated and is very depressed. She is actively taking college courses, is involved in a sorority and sexually active insisting that partners use a condom. Vital signs are WNL and BMI is 23.8. Which combination of medication is it most important to avoid in this patient?

The nurse is caring for a patient who is slightly confused and impulsive, placing them at high risk for falls. The patient also shows subtle signs of low cardiac output: BP 92/60, HR 108, capillary refill >3 seconds, slightly cool extremities, and reports mild dizziness. Which intervention should the nurse prioritize?

Based upon Katie’s case above, write one related goal to the client factor and occupation identified using all COAST format components (.5 points per component; .5 for appropriateness = 3 pt). 

You as a therapist recently attended a continuing education conference about a content specific area of your practice. You go back to work and share the information at an evidenced based roundtable discussion with your colleagues. What step of implementation science are you using? 

A 12-year-old boy presents with a history of severe mood swings, including episodes of extreme irritability and violent outbursts described by his parents as “affective storms.” Teachers report rapid shifts from laughing to yelling, pressured speech, and grandiose statements such as “I’m the smartest kid in the world.” He has a decreased need for sleep and has engaged in risky behaviors, including attempting to jump off the roof “just to prove he could fly.” Which of the following is the most appropriate diagnosis based on DSM-5 criteria?