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A 32 year-old graduate student accompanied by her husband is seen in the clinic with concerns about having ADHD. She reports feeling “hyper” the past four or five days. She has been staying up studying until 3 or 4 a.m. and gets up by 7 a.m. to get ready for class. She reports being easily distracted, and finds it is difficult to maintain focus. She is afraid she will not be able to keep up with the semester expectations. Discussing this with her husband, this is a pattern over the past several years that he has noticed three or four times a year, and after several weeks of the frenetic pace, she sleeps 10 to 12 hours a night, complains of no energy, lacks motivation, stops engaging with him and tends not to eat. Her presentation is most consistent with

A 78-year-old woman presents for an initial psychiatric interview 7 months after the death of her husband. She is accompanied by her daughter. The patient has lost 8 pounds over the past year, reports daily crying episodes, low energy, insomnia, poor concentration, and no longer socializes with friends. Vitals and BMI are normal. She has a history of Type 2 diabetes (HgbA1C = 4.8). Which comorbidity is of primary importance to consider when making treatment recommendations?

Which of the following symptoms are consistent with significant trauma history and cause for significant concern in a 4 year old child?

A 37-year-old firefighter presents with flashbacks, avoidance of reminders, hypervigilance, and nightmares 6 months after surviving a warehouse explosion. He reports feeling detached from family and has difficulty concentrating at work. He asks about both therapy and medication options. Which of the following represents the most evidence-based treatment for this patient?

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mood with increased energy, talkativeness, and decreased need for sleep, and periods of feeling sad, fatigued, and withdrawn.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?