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A 42-year-old man presents with recurrent episodes of major depressive disorder. He generally experiences remissions at therapeutic doses of serotonin reuptake inhibitors but has subsequently required dosage escalations to control symptoms. He was eventually changed to a new medication due to resistance to adequate trials at maximum dosages. His only current medication is sertraline 200 mg per day. His adult children brought him to the emergency department due to concerns that he is behaving differently than during past episodes of depression. They report he has withdrawn from them and refuses to speak to anyone. He sits in his recliner all day and stares straight ahead. They have been unable to get him to eat for two days. They even tried to put a glass of juice in his hand and lift it to his mouth, at which time he kept his hand up by his mouth but did not take a drink. They ended up removing the glass from his hand so that he did not accidentally break it. His mental status exam is significant for lack of speech and lack of movement except for purposelessly keeping his right arm up in the air. When the examiner attempts to lower the patient’s arm, he demonstrates slight, even resistance. Which of the following is the best initial step?

A 24-year-old woman is being seen by her primary care practitioner for a routine check-up. Although her body mass index is normal, she indicates on a screening form that she is unhappy about her weight. Upon further exploration during intake with the nurse, she reports feeling that she has lost control over episodes of excessive eating that occur over a period of about an hour happening several times a week. As a result, she engages in rigorous exercise for up to several hours at a time daily. This has resulted in being too tired for work the next day, as well as minor muscular injuries. She denies the following compensatory behaviors: self-induced vomiting; misuse of laxatives, diuretics or other medications; and fasting. Which one of the following is the most likely diagnosis?

A 30-year-old female presents for follow-up and is currently experiencing mania symptoms for the past week.  She has been diagnosed with Bipolar I Disorder and decided to stop taking medication 6 months ago.  The PMHNP knows to avoid this medication for the treatment of bipolar disorder with this patient:

The graph shows the progress of a chemical reaction with and without the aid of an enzyme. Which letter represents the total activation energy required for this reaction when an enzyme is present?

A patient started haloperidol yesterday and presents to the emergency department with a dystonic reaction to the medication.  The PMHNP discontinues the haloperidol and orders the following medication to treat this adverse reaction:

A PMHNP is seeing a patient diagnosed with schizophrenia in the outpatient clinic. The patient is experiencing an inadequate response to the first prescribed antipsychotic medication or dopamine reuptake blocking agent (DRBA). Which of the following interventions is not an appropriate next step in this patient’s treatment plan?

A 10-year-old female presents with history of major depressive disorder, single episode that was diagnosed approximately 2 year ago. She originally presented with feeling sad and down most days of the week, some irritability, withdrawing to her room often, low self-esteem, and a decrease in interest for activities she typically enjoyed last year. Patient reports she still has some depressed periods but overall her depression has improved over the last year with her current medication regimen. However mother is concerned that within the last 12 months the patient has become increasingly irritable. The patient reports feeling annoyed or irritated almost daily and for most of the day. She has more frequent outbursts of anger in the last couple months and her anger seems to be triggered by minor incidents or being denied something she has requested. Mother also reports when she has her anger outbursts she will destroy property, scream, and slam doors. Majority of outbursts occur at home, but teachers have noted the change in mood and increase in “snapping” or getting angry with peers at school. Would you consider revising her diagnosis? If so, what would you update her working diagnosis list to?

Which DSM-5-TR category includes attention-deficit/hyperactivity disorder?

If an initial trial of a psychostimulant is ineffective for symptoms of attention-deficit/hyperactivity disorder at optimal dosing, which of the following is generally the best next step?

A 19-year-old male presents to the emergency department with symptoms of psychosis including hearing voices and delusions that he is being followed by the FBI.  The PMHNP knows that substance use needs to be ruled out.  All of the following substances are associated with symptoms of psychosis except: