A 16-year-old boy with a history of substance use disorder reports fatigue, apathy, and anhedonia almost every day and his mother reports increasing irritability and raging behavior.  The boy says he smokes marijuana daily just to feel good and is unwilling to give it up.  The mother wants some sort of medication to help him feel better so that he stops smoking marijuana.  The PMHNP agrees to prescribe fluoxetine 20 mg daily.  What is the most common side effect associated with this medication?

A 34-year-old female comes to an appointment because she is bothered by disturbing and recurrent thoughts of harming her 7-month-old infant, along with hearing voices telling her to do so.  She reports that her thoughts are distressing enough that she has removed all sharp objects from the kitchen so that she cannot stab her baby with a knife.  She has not shared these thoughts with her husband for fear of how he may react to her.  What is the most appropriate treatment for this diagnosis? 

A ten-year-old patient was just diagnosed with pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections (PANDAS). Which of the following symptoms (in addition to obsessive compulsive disorder symptoms) is not commonly associated with PANDAS?

A 10-year-old boy is referred by the school nurse because of persistent stomachaches every morning in school.  In evaluating the boy, the PMHNP learned that he does not like to go to school and insists on coming home immediately, and that he sleeps in his parent’s bed at night.  His clinical description is most characteristic of which of the following conditions?

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 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?

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?

An 8-year-old girl is referred to you for evaluation for disruptive behavior in school.  The teachers report that she will make disruptive sounds or shout out in class.  Other than these instances she is described as polite and well kempt, but restless.  This clinical presentation is most consistent with which of the following disorders?

A 25-year-old female presents to the emergency department, having just witnessed an accident.  Her speech is pressured.  She states, “There were a lot of people in need of care at the scene, and I should know because I have traveled to many Third World countries.  I know how bad needs can get.  The people were injured, and I was hit by a car before but I did not suffer any injuries.  There were a lot of police cars and ambulances.”  The patient was triaged to psychiatry.  The PMHNP describes her thought process as:

A 7-week old infant presents in the primary care clinic with her mother for a well child checkup.  Mother expresses some concern with the infant’s feeding pattern.  She is slow at sucking and is difficult to position during feeding.  What findings on the neurologic exam would cause concern about this infant?